Bethany Christian Services

1. Bethany Christian Services 75 Offices * 30 States * 16 Countries

2. Primary Services Adoptions • Birth Parent Counseling • Infant • Older Special Needs • International

3. Large Offices • Foster Care • Out Patient Counseling • In Home Services • Refugee Services

4. Post Adoption Services • Wellness programs • Support Groups • Specific Outpatient Counseling • Search & Reunion

5. Approaches • Attachment Therapies • Holding Therapy • Play Therapy • Grief/Loss

6. Diagnosis • Reactive Attachment D.O. (R.A.D.) • Dissociative Identity D.O. (D.I.D.) • Adjustment Disorders • ADHD

7. Issues & Diagnosis/Approaches • Poor prognosis/little hope • Long Term with slow progress • Problem/Crisis Focus • Behavioral Focused

8. Trauma Alters Brain Pathways • Low Road • High Road

9. Trauma & Memory • The stress hormones and neurotransmitters that permeate the brain’s ability to encode new memories and simultaneously interfere with its ability to sequence and contextualize those memories.

10. Traumatic Memories • Have tunnel vision • Have lost peripheral detail • Are fragmented and sensory • Are encoded as disconnected fragments • And are triggered by unforeseen cues

11. Traumatic Memories • Are not the consequence of conscious choice or resistance. They are the consequence of the radically altered neuro chemical environment in which the memories were encoded.

12. Trauma Leaves • Brain permanently altered • Legacy of fear networks that are etched in brain (Amygdala) that can be triggered by a multitude of cues that would not ordinarily evoke fear. • Fragmented and discontinuous memories of what happened.

13. Trauma Is: • A traumatic or life-threatening event that is outside the normal range of daily human experience. • It arises when adult/children experience or witness such an event • These events confront people with such horror and threat that it may temporarily or permanently alter their capacity to cope, their perception of biological threat and their self-concepts.

14. Sexual Abuse Life-threatening injury/illness Violence (family, social, predatory) Terrorism Natural or other disasters (hurricane, earthquake, fire) Parental Substance Abuse Rape/Assaults Murder Threaten with a weapon War Early loss of parent Neglect Physical Abuse Emotional Abuse Vicarious/Secondary Trauma Traumatic Events

15. Acute Normal response to a single or single episode of trauma response involves intense fear, helplessness or horror. Symptoms include: • Numbing / detachment / lack of emotional responsiveness • “Being in a daze” • Depersonalization • Dissociative amnesia • Traumatic event re-experienced through recurrent images, dreams, illusions and flashbacks • Avoidance of stimuli that arouse recall of traumatic thoughts, feelings, etc… • Medical symptoms of anxiety & increased arousal (difficulty sleeping, irritability, poor concentration, hyper vigilance, exaggerated startle response and motor restlessness

16. Post Traumatic Stress Disorder Can occur in childhood, adolescence, or adulthood. • May become apparent immediately or be delayed until adulthood • May involve both psychological and physical symptoms • Often occurs along with other conditions like depression, substance abuse, memory and thinking problems

17. 3 Major Characteristics of PTSD • Repeated reliving of memories of the traumatic experience • Avoidance of reminders of the trauma, and the numbing, detachment and emotional blunting that often coexist with intrusive recollections • Patterns of increased arousal (hyper arousal) expressed by hyper vigilance, irritability, memory & concentration problems, sleep disturbances and an exaggerated startle response

18. Confusion Agitation Fear/Anxiety Anger/Irritability Feeling of helplessness Fear of imminent death Inability to concentrate Shock / apathy/ numbness Disassociation Withdrawal/ detachment Flashbacks Sleep disturbances Physical symptoms Decrease interest in life’s activities Symptoms

19. Why Do Some Develop PTSD While Other Don’t? • Nature & extent of trauma • Coping skills • Previous experiences • Current stress levels • Support system • Family & social environment • Biology / brain

20. Complex Trauma / PTSD(Disorders of Extreme Stress) • Majority of children/adults who seek treatment for trauma related issues have histories of multiple traumas • They seek treatment not because of PTSD symptoms but related to their depression, anger outbursts, self destructive behaviors, feelings of shame, self blame and distrust

21. Symptoms Associated with Early Complex Interpersonal Trauma:(B. Vanderkolk) • Alterations in the regulation of affective impulses, including difficulty with modulation of anger and being self destructive • Alterations in attention and consciousness, leading to amnesias, dissociation and depersonalization episodes • Alterations in self perception, such as a chronic sense of guilt and responsibility, and chronically feeling ashamed

22. Symptoms Associated with Early Complex Interpersonal Trauma: (B. Vanderkolk) cont… 4. Alterations in relationships with others, such as not being able to trust and not being able to feel intimate with people, • Somatization of the problem: feeling symptoms on a somatic level, when medical explanations cannot be found, • Alterations in systems of meaning.

23. Impact of Trauma on Child Development To understand how trauma affects children, it is important to understand children from a developmental context. When a child experiences a traumatic event or a series of traumas, a great amount of emotional and mental energy is expended to process the event and what it means in their world. This may reduce the child’s capacity to explore and gain mastery over age appropriate developmental tasks. NCTSN The National Child Traumatic Stress Network

24. Impact of Trauma on Child Development As trauma goes untreated, children tend to stray further and further away from appropriate developmental paths. The consequences of chronic exposure to maltreatment can include social inadequacy and increasingly disruptive behavior, resulting in interventions becoming more punitive in nature. *Following is information about how children respond to trauma at different developmental stages. (adapted from Pynoos & Nader; Marans) NCTSN The national Child Traumatic Stress Network

25. Complex TraumaArea #1: Attachment • Uncertainty about the reliability and predictability of the world • Problems with boundaries • Distrust and suspiciousness • Social isolation • Difficulty relating to others • Difficulty empathizing *Source: Complex Trauma White Paper published by the NCTSN NCTSN The National Child Traumatic Stress Network

26. Complex Trauma Area #2: Biology • Hypersensitivity to physical contact • Problems with coordination, balance, body tone • Delayed sensory and motor development • Somatic complaints and increased medical problems (e.g. asthma, skin problems, autoimmune disorders) NCTSN The National Child Traumatic Stress Network

27. Complex TraumaArea #3: Affect Regulation • Difficulty with emotional self-regulation • Difficulty describing feelings and internal experience • Problems knowing and describing internal states • Difficulty communicating wishes and desires NCTSN The National Child Traumatic Stress Network

28. Complex TraumaArea #4: Dissociation • Withdrawing attention from the outside world • A detached feeling as if one is “observing” something happen or as if it is unreal. • When “fleeing or fighting” is not physically possible, a child may “psychologically flee” • Amnesia NCTSN The National Child Traumatic Stress Network

29. Complex Trauma Area #5: Behavioral Control • Poor impulse control • Aggression against self or others • Pathological self-soothing behaviors • Disturbances in sleeping or eating • Substance abuse • Excessive compliance or oppositional behavior • Difficulty understanding and complying with rules • Communicating past trauma by reenactment in behavior or play (sexual, aggressive, etc.) • NCTSN The National Child Traumatic Stress Network

30. Complex TraumaArea #6: Cognition • Lack of sustained curiosity • Problems focusing on and completing tasks • Difficulty planning and anticipating • Problems understanding own contribution to what happens to them • Learning difficulties • Problems with language development • NCTSN The National Child Traumatic Stress Network

31. Complex TraumaArea #7: Self-Concept • Lack of continuous, predictable sense of self • Poor sense of separateness • Disturbances of body image • Low self-esteem • Shame and guilt NCTSN The National Child Traumatic Stress Network

32. The Brain Amygdala – smoke detector /signals release of hormones Cortex – thinking processing reasoning Limbic system – doing responding action Hippocampus – assists in transfer of information Stress hormones suppress the hippo activity – thus information doesn’t make it to the cortex to rationally process cortex Limbic system amygdala

33. Patterns of Reacting & Responding • Fight • Hyperarousal • Aggression • Trouble concentrating • Irritability • Anger • Hyperactive • Flight • Withdrawal • Avoidance • Isolation • Running away • Freeze • Constriction/shutting down • Numbing • Spacey, zoning out • Daydreaming • overcompliance

34. Triggers • Any stimulus which acts as a reminder of a traumatic experience, and leads to a set of behaviors/actions designed to cope with the original experience • A trigger may be • Internal (emotion, physical sensation) • External (facial expressions, crowds, smells, sounds) • A combination Blaustein and Kinniburgh 2004

35. Triggers • Key Triggers • Lack of power or control • Unexpected change • Feeling threatened or attacked • Feeling vulnerable or frightened Responses to triggers To seek safety & avoid danger Blaustein & Kinniburgh 2004

36. Neuroscience of Cognitive Behavioral Therapy • Neural growth and integration are enhanced by: • Activation of neural networks that are inadequately integrated • Moderate levels of stress alternating with periods of calm and safety • Integration of conceptual knowledge with emotional and body experience through narratives that are co-constructed with the therapist

37. Top-Down Integration • Circuits form loops that go from the top of our brain to the bottom and back again • Includes the ability of the cortex to process, inhibit, and organize reflexes, impulses and emotions generated by the brain stem and limbic system • Frontal lobe disorders like ADHD and OCD • Disinhibition of impulse and movements normally under control

38. Left-Right Integration • Allows us to put feelings into words • Bring feelings into conscious awareness • Balance left and right hemisphere biases • Left-more closely identified with cortical (intellectual) functions • Right-more connected to the body via brainstem and limbic functions

39. Cortical Integration • Frontal Cortex (Executive Function) • Mediates the integration of top-down and left-right interaction • Integration is accomplished by: Simultaneous or alternating activation of conscious language production (top and left) with the more primitive, emotional and unconscious processes (down and right) that have been dissociated due to undue stress during childhood or trauma later in life (Siegal, 1999)

40. “Research across most forms of therapy supports the hypothesis that positive outcomes in psychotherapy are related to the combined engagement of thought and affect, utilizing both support and challenge.” (Orlinsky & Howard, 1986) Cortical Integration

41. Telling YOUR Story • Autobiographical memories are at the core of our sense of self • Storytelling weaves together body sensations, feelings, thoughts and behaviors • Stories provide an opportunity for self-reflection

42. Telling YOUR Story • Stories provide an opportunity to learn things about yourself you did not know • Understanding YOUR story can help make you a better person and break multigenerational patterns of disorganized attachment

43. Results of Being Able to Tell YOUR Story • No longer have to relive it • “It happened when I was….”

44. The impacts • The traumatized child develops alterations in one’s system of meaning *all touch is bad, people let you down, nighttime is scary…

45. The ADOPTS ProgramTrauma-informed therapy for pre and post adoptive children Jeremy C. Moore, MPA ADOPTS Coordinator

46. ADOPTS Program • October 2004: 4 year ACF grant • 600 Children to be served (230 served to date) • Currently operating in 5 offices in Michigan • Expanding to Georgia, Iowa, Tennessee, Pennsylvania and Washington in 2007

47. ADOPTS Goals • Reduce adoption disruption rates among children compared to other forms of post-adoption services • 75% of children completing program will reduce PTSD symptoms directly after completion of ADOPTS, and 50% will sustain these gains for 1 year. • Disseminate family education resources to adoptive families • Develop specialty-response adaptations of ADOPTS model

48. Who does ADOPTS serve? • Children in pre or post adoptive situations such as pre-adoptive home, adoptive home, kinship placement, permanent or temporary foster care, residential • 75% of children served between 8 – 16 years of age • 80% of children have been in 1-4 total placements

49. ADOPTS Client Demographics: Chart

50. ADOPTS Client Demographics: Numerical • Race Demographics • 50% Caucasian • 16% African American • 13% Eastern European adoptions • 8% Biracial • 5% Asian or South/Central American adoptions • 4% Hispanic