Trauma Past, Trauma Present: Looking at Addiction through a Trauma Informed Lens

1. Trauma Past, Trauma Present:Looking at Addiction through a Trauma Informed Lens Allison Sampson Jackson, PhD, LCSW, LICSW, CSTOP Family Preservation Services of VA Providence Service Corporation

3. Defining Trauma: • a traumatic event, either witnessed or experienced, representing a fundamental threat to one’s physical integrity or survival • responses involve intense fear, helplessness or horror • the meaning of the event may be as important as the actual physical act/experience • what we want to emphasize is that it is an individual's subjective experience that determines whether an event is or is not traumatic http://www.lisaferentz.com/

4. Key Component of Trauma Is the experience of loss! Loss of: • boundaries • safety • trust • power and control • innocence • protection • attachment • possessions • consistency/predictability • sense of self/body image http://www.lisaferentz.com/

6. Exposure to Violence in Childhood 46 million of 76 million children are exposed to violence, crime and abuse each year • Finkelhor, D., et al. (2010). Trends in childhood violence and abuse exposure: evidence from 2 national surveys. Archives of Pediatric and Adolescent Medicine, 164(3), 238–242. Information and slide part of Dr. Allison Sampson's Trauma Presentation

7. Trauma impacts learning and academic outcomes • Decreased IQ and reading ability (Delaney-Black et al., 2003) • Lower grade-point average (Hurt et al., 2001) • More days of school absence (Hurt et al., 2001) • Decreased rates of high school graduation (Grogger, 1997) • Increased expulsions and suspensions (LAUSD Survey)

8. Impact of being in Child Welfare System for Foster Care Children • 25% will be incarcerated within first 2 years of aging out of the system • More than 20% will become homeless • Only 58% will have a High School Diploma • Less than 3% will have a college education by age of 25 • Many will re-enter the system as parents • For children under age of 5, increase likelihood of developmental delays 13-62% compared to 4-10% • Conradi, L. (2012) Chadwick Trauma Informed System Project p. 54 • Leslie et. al. (2005). Developmental and Behavioral Pediatrics 26(3), 177-185

9. 1 year of violence=124 billion dollars in recovery costs • The breakdown per child is: • •       $32,648 in childhood health care costs • •       $10,530 in adult medical costs • •       $144,360 in productivity losses • •       $7,728 in child welfare costs • •       $6,747 in criminal justice costs • •       $7,999 in special education costs

10. 223,400,000 223,400,000 317,572,282

11. ACE SCREEN

12. Alcoholism and alcohol abuse • Chronic obstructive pulmonary disease (COPD) • Depression • Fetal death • Health-related quality of life • Illicit drug use • Ischemic heart disease (IHD) • Liver disease • Risk for intimate partner violence • Multiple sexual partners • Sexually transmitted diseases (STDs) • Smoking • Suicide attempts • Unintended pregnancies • Early initiation of smoking • Early initiation of sexual activity • Adolescent pregnancy

14. Unlocking the Brain At least for today…3 brain levels-they each speak a different language Brainstem-housekeeping of the Body, sleeping, eating, breathing Limbic-smoke alarm, implicit memories Cortex-planning, logic, reason, judgment

15. A Person’s Response to Perceived Danger Trauma Event Danger Response Fight Flight Freeze Aggression Run Away Dissociate Verbal attack Substance Abuse Non-emotionality Slide from Ellen Williams, LCSW Center for Child & Family Services

16. Looking Through The Eyes of a Traumatized Child-How it looks to Us…. Slide from Ellen Williams, LCSW Center for Child & Family ServicesServices

17. How it looks to The Traumatized Child Slide from Ellen Williams, LCSW Center for Child & Family ServicesServices

18. The Hand Model of the Brain http://www.youtube.com/watch?v=DD-lfP1FBFk

19. The Handy Model

20. Trauma and the Brain • Hippocampus-remembers the facts but not the emotions. • It records the time-frame of significant events, the start, the middle, the end of an event and sends the facts to the cortex-the thinking part of the brain (logic, reason, common sense).

22. Chasing Behaviors Agitation Hopelessness Intrusive Memories Nightmares Insomnia Defiance Poor Impulse Control Numbing Traumatic Event Shame & Self-Hatred Depression Dissociation PanicAttacks Somatic Symptoms Withdrawal Self-DestructiveBehavior Eating Disorders Substance Abuse T Slide by Trish Mullen, Chesterfield CSB

23. We must …… Respond to the need …. Not react to the behavior

24. Resilience Trumps Aces From Trish Mullen, Chesterfield Community services Board

25. Trauma and Attachment

26. Attachment Many argue that these early relationships (experiences) shape neuronal circuits which regulate emotional and social functioning Information and slide part of Dr. Allison Sampson's Trauma Presentation

27. Attachment’s PurposeSiegel, 1999 Evolutionary Level – biological Infant Survival (Bowlby) Mind Level – biological and social • Caregiver’s brain helps child’s brain to organize regulation • Caregiver’s brain teaches child self-soothing • Child experience of safety allows for exploration Information and slide part of Dr. Allison Sampson's Trauma Presentation

28. Attachment’s Purpose Experience of safety is encoded in child’s implicit memory and provides secure base from which to grow and access higher levels of information processing Information and slide part of Dr. Allison Sampson's Trauma Presentation

29. Trauma and the Brain

30. Understanding “why” … • http://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm Information and slide part of Dr. Allison Sampson's Trauma Presentation

31. Brain and Stress • When stress is predictable and moderate, stress can facilitate resiliency and enhance memory • When stress is unpredictable and severe, stress can create vulnerability and memory impairment • Severe and chronic stress in childhood via multiple traumas from caregivers can impact affect regulation, interpersonal relationship skills, and states become traits (fight/flight/freeze… disassociation or hyper arousal) Information and slide part of Dr. Allison Sampson's Trauma Presentation

32. Types of Stress Information and slide part of Harris (2013) Buzz on Brain and Babies Presentation

33. Three parts of the brain … • Brain Stem • Limbic Brain • Cerebral Cortex Information and slide part of Dr. Allison Sampson's Trauma Presentation

34. Stress and the Brain

36. Vulnerability Mountain Information and slide part of Dr. Allison Sampson's Trauma Presentation

37. What does this mean for children who have experienced trauma? EXPERIENTIAL EXERCISE

38. Attachment and BRAIN … what we already know • Review of the exercise … what did you notice about caregiver touch between the two sets of pictures … • What do you think the implicit memories are about caregiving relationships ? About authority figures? About their ability to be safe ? Information and slide part of Dr. Allison Sampson's Trauma Presentation

39. The needs of the adults and caregivers with trauma …. are no different

40. Cross-Generational TraumaHendricks (2012) Chapter 12 of Creating Trauma Informed Child Welfare SystemsUsing Trauma Informed Services to Increase Parental Protective Factors Women who have experienced trauma are more likely to self- medicate with a substance (55-99%) (1) Intergenerational transmission of trauma (Depression, PTSD) (2) Unresolved childhood trauma can lead to reenactments with partners in adult relationships and/or with their children (3) Unresolved childhood trauma can lead to difficulty forming secure attachments with their children (4) Childhood trauma can result in parenting styles that include threats & violence (2) Childhood sexual abuse survivors can miss “red flags” of sexual abuse with their own children due to avoidance of trauma memories themselves (2) • Najavits, Weiss, & Shaw (1997) The American Journal on Addiction, 6 (4), 273-283 • Hendricks, A. (2012). Using Trauma-Informed Services to Increase Parental Factors (pp. 89-91) • Walker (2007) Journal of Social Work Practice, 21 (1), 77-87. • Main & Hess (1990) In M. Greenberg, D. Cicchetti, & E. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 121-160)

41. BIG PICTURE with Caregivers • Often the caregivers … are the kids we as a system “missed” • They come to us with their own trauma histories • Successful outcomes with our clients means successful work with the family • Screening all caregivers and finding them services is critical to the prevention/treatment/reduction of recidivism for children entering the juvenile justice system

42. Cross-Generational Trauma Hendricks (2012) Chapter 12 of Creating Trauma Informed Child Welfare SystemsUsing Trauma Informed Services to Increase Parental Protective Factors Caregiver functioning following a child’s exposure to trauma is a major predictor of child’s functioning (1 & 2) If we want to improve a child’s outcome, we must address parent’s trauma history … failure to do so can result in (2) … - Failure to engage in treatment services - An increase in symptoms - An increase in management problems - Retraumatization - An increase in relapse - Withdrawal from service relationship - Poor treatment outcomes • Linares et al (2001) Child Development, 72, 639-652 • Liberman, Van Horn, & Ozer (2005) Development and Psychopathology, 17, 385-396 • Hendricks, A. (2012) pp. 91

43. A Person’s Response to Perceived Danger Trauma Event Danger Response Fight Flight Freeze Aggression Run Away Dissociate Verbal attack Substance Abuse Non-emotionality Slide from Ellen Williams, LCSW Center for Child & Family Services

44. Chasing Behaviors Agitation Hopelessness Intrusive Memories Nightmares Insomnia Defiance Poor Impulse Control Numbing Traumatic Event Shame & Self-Hatred Depression Dissociation PanicAttacks Somatic Symptoms Withdrawal Self-DestructiveBehavior Eating Disorders Substance Abuse T Slide by Trish Mullens, Chesterfield CSB

45. We must …… Respond to the need …. Not react to the behavior

46. PARADIGM SHIFT

47. What does TIC look like?

48. Core areas of focus in Complex TraumaCourtois, C. & Ford, J. (2009), Introduction (p.2) Information and slide part of Dr. Allison Sampson's Trauma Presentation • Self-Regulation • Affect Regulation • Disassociation (difficulty in being “present”) • Somatic Dysregulation • Self-Identity • Impaired Self-Concept • Impaired Self-Development • Co-regulation • Secure working model of caring relationship • Disorganized Attachment Patterns

49. Creating a Culture for TIC Five Core Values (Fallot, 2009) • Safety • Trustworthiness • Choice (and Voice !!) • Collaboration • Empowerment We can offer CAPPD to those with work with … http://www.multiplyingconnections.org/ Information and slide part of Dr. Allison Sampson's Trauma Presentation

50. Phase Oriented Care