The Impact of Trauma on Children and Families

1. The Impact of Trauma on Children and Families Implications for Child Welfare and the Court System Presented by C. Lynne Edwards, LCSW CASA State Conference, 2012

2. Myths #1: The effects of abuse/neglect, removal and other traumas to young children will “vanish” as long as they are in a loving home. #2: If a child has no cognitive memory of a loss, then they don’t grieve and have no long lasting effects. Presented by C. Lynne Edwards, LCSW

3. Myths and Realities #3: There is nothing that parents or anyone can do to change the impact of their child’s early traumatic experiences. #4: Behavior can best be managed by rules and consequences. Presented by C. Lynne Edwards, LCSW

4. What We Now Know Feeling safe positively affects the nervous system and provides stimulation for healthy development. Presented by C. Lynne Edwards, LCSW

5. Child Traumatic Stress • The physical and emotional responses of a child to events that threaten the life or physical integrity of the child or someone important to the child. • Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out of control physiological arousal. Presented by C. Lynne Edwards, LCSW

6. Types of Trauma ACUTE CHRONIC COMPLEX Presented by C. Lynne Edwards, LCSW

7. Complex Trauma • Multiple, chronic and prolonged, developmentally adverse events • Often of an interpersonal nature with early life onset • Effects are cumulative Presented by C. Lynne Edwards, LCSW

8. Response to Trauma Affected by… • Child’s chronological age and developmental stage • Child’s perception of the danger • Whether the child was a victim or witness • Child’s past experience with trauma • Child’s relationship to the perpetrator • Presence/availability of adults to help Presented by C. Lynne Edwards, LCSW

9. Experience of Trauma Trauma is experienced through the body, mind and spirit and has a long term impact. Presented by C. Lynne Edwards, LCSW

10. Impact on Children and Parents • Adverse Childhood Experiences Study Adverse childhood experiences: • are a major health issue • result in social, emotional and cognitive impairment • linked to higher risks for medical conditions (heart disease, severe obesity, COPD) • linked to higher risk for substance abuse, depression and suicide attempts Presented by C. Lynne Edwards, LCSW

11. Impact on “Our” Kids • Studies with antisocial youth have found self-reported trauma exposure ranging from 70% to 92% (Greenwald, 2002) • Antisocial youth have a high rates of Post Traumatic Stress Disorder (Greenwald, 2002) • Research suggests that anger and violent acting out often are symptoms of PTSD (Chemtob, Novaco, Hamada, Gross, & Smith, 1997) • Study of Foster Care Alumni revealed higher levels of PTSD in the alumni than in war veterans. Presented by C. Lynne Edwards, LCSW

12. Biology • Movement and sensation • Hypersensitivity/insensitivity • Coordination, balance and body tone • Unexplained physical symptom • Increased medical problems

13. Brain Development • Children are born with “instincts” that are the result of pre-programming in the brain • Other parts of the brain are not pre-programmed • Neurological pathways or patterns that begin to form are based on what infants SEE, HEAR, SMELL and FEEL

14. Mood Regulation • Difficulty knowing and describing their feelings • Brain can shift from feeling to thinking • State dependent responses to experiences

15. Cognition and Learning • Focusing on and completing tasks • Anticipating and planning for future events • Absence of cause and effect thinking • Range of learning difficulties • Adaptive development impaired

16. Behavioral Control • Poor impulse control • Self-destructive behavior/aggression • Sleep disturbances/eating disorders • Fear driven responses • A behavior problem is a relationship problem

17. Memory • Lack cognitive memory of events • Memory of trauma stored in the senses, the body • State dependent memory

18. Self-Concept and World View • Lack of a continuous, predictable sense of self • World is not a safe place to be • I’m a bad child; everything bad is my fault • People who love you, hurt you and/or abandon you • My feelings don’t matter

19. Attachment • rooted in biology • mutual psychological process • learned after birth Presented by C. Lynne Edwards, LCSW

20. Trauma and Attachment Both research and psychoanalytic theory have both demonstrated • a clear connection between physical, emotional, sexual abuse, neglect, multiple losses and other traumatic events during childhood and • negative changes in a child’s neurological, biological, and emotional development and on the ability to form healthy attachments. Presented by C. Lynne Edwards, LCSW

21. The Attachment Cycles Initiating Positive Interactions Parent Initiates Positive Interaction Gratification Child Responds Gratification Parent Responds Presented by C. Lynne Edwards, LCSW

22. Positive Interactions Structure Presented by C. Lynne Edwards, LCSW

23. Presented by C. Lynne Edwards, LCSW

24. Symptoms of Traumatic Stress • Reexperiencing the trauma • Avoiding trigger situations or people • Reduced range of emotions • Trouble concentrating and impulsive • Feelings of powerlessness and helplessness • Attachment challenges • Increased range of emotions(fear, anxiety, depression, self-harm, addictions, oppositional behaviors)

25. What this looks like in children… • Pervasive feelings-Fear and anxiety • Core issues-grief, loss, rejection, attachment, control, guilt, identity • Internalized beliefs-I’m a bad kid, I can’t trust adults, people who say they love you, hurt and/or leave you, the world is not a safe place to be, etc. • Control issues-children feel so out of control they try to control everything in whatever way they can Presented by C. Lynne Edwards, LCSW

26. What this looks like in children… • Sensory issues-sensitive to touch, loud noises, • Delayed adaptive development • Regulation of emotions-their brains can not shift from their emotions to their thought processes • Pull/Push-come close, now go away; afraid of getting close • High risk behaviors Presented by C. Lynne Edwards, LCSW

27. What this looks like in parents… All of the above PLUS: • Parents’ ability to appraise danger is compromised • Trauma reminders presented in children’s behaviors trigger extreme reactions. • Tendency for parents to personalize their children’s negative behavior which challenge attachment and can lead to ineffective or inappropriate discipline. Presented by C. Lynne Edwards, LCSW

28. What this looks like in parents… • Parents’ capacity to regulate their emotions is impaired. • Parent’s executive functioning is impaired which results in poor decision-making, problem solving or planning. • Parent is more vulnerable to other life stressors. • Parents have a negative view of themselves as parents and unhealthy interpersonal relationships. Presented by C. Lynne Edwards, LCSW

29. The brains of children who experience trauma are wired differently. Presented by C. Lynne Edwards, LCSW

30. Trauma Informed Care (TIC) “Trauma-Informed Care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment.” (Hopper, Bassuk, and Olivet 2009, p. 133)

31. Trauma Informed Child Welfare System “A trauma informed child welfare system is one in which all parties involved recognize and respond to the varying impact of traumatic stress on children, caregivers, and those who have contact with the system. Programs and organizations within the system infuse this knowledge awareness and skills into their organizational cultures, policies and practices. They act in collaboration, using the best available science to facilitate and support resiliency and recovery.” (Hendricks, Conradi, & Wilson, 2011, p.189)

32. Implications • CASA volunteers, attorneys, GALs and judges can help youth and create a trauma-informed system by… Presented by C. Lynne Edwards, LCSW

33. Implications …learning about trauma …helping parents and children receive appropriate services and treatment; …using what we now know to make better informed decisions; and, …advocating for trauma training across systems and with providers Presented by C. Lynne Edwards, LCSW

34. Implications • First do no harm • Prevent → Protect → Repair → Restore • The earlier the intervention occurs, the greater the opportunity for the brain to be repaired Presented by C. Lynne Edwards, LCSW

35. Implications • Interventions require the use of relational rather than confrontational approaches to behavior change Presented by C. Lynne Edwards, LCSW

36. Implications • Trauma related factors are often at the heart of placement disruptions. • Each time a child moves his opportunities to form healthy attachments are jeopardized • Understand and respond to the impact of trauma on parents Presented by C. Lynne Edwards, LCSW

37. Implications • Birth/Foster/Adoptive parents need to learn strategies for developing healthy attachments and healthy brains and reducing traumatic stress • Focus on strengths and resilience increases positive outcomes for children and families Presented by C. Lynne Edwards, LCSW

38. Implications • Use Protective Factors as the framework for services • Parental Resilience • Knowledge of child development/parenting • Concrete supports • Social connections • Parent-child relationship/nurturing • Social and emotional competence of children Presented by C. Lynne Edwards, LCSW

39. Implications • All systems of care for children who have experienced trauma and their families need to reflect trauma informed practice and address the five protective factors through… • Trauma screening • Gathering thorough trauma history • Referring families for comprehensive, trauma informed clinical assessment Presented by C. Lynne Edwards, LCSW

40. Internal Working Model Physiology Sensory integration Neurology Development Genetic Predispositions Special Needs Attachment Figures Number of Caregivers Trauma/Loss Nurturing, Structure, Engagement Adaptive behaviors Inner Working Model Presented by C. Lynne Edwards, LCSW

41. What you can do • CASA volunteers, attorneys, GALs and judges can help youth and create a trauma-informed system by… Presented by C. Lynne Edwards, LCSW

42. What you can do …learning about trauma …helping parents and children receive appropriate services and treatment; …using what we now know to make better informed decisions; and, …advocating for trauma training across systems and with providers Presented by C. Lynne Edwards, LCSW

43. What you can do • Raise the question “Will this action add to traumatic stress?” If the answer is yes, • What services and support are in place to reduce the stress for parents and children? • Request that parents and caregivers receive trauma informed services. • Support children maintaining safe connections with family and caregivers. Presented by C. Lynne Edwards, LCSW

44. What you can do • Raise the question “How will this action add promote a child’s emotional and psychological safety as well as his physical safety?” • Review the results of any trauma screening and assessments and use them to guide recommendations. • If there has not been a trauma informed assessment, request one. Presented by C. Lynne Edwards, LCSW

45. What you can do • Learn about the resources available and how they address trauma and build protective factors. • Whenever possible, allow children to live with parents and other adults with whom they are connected rather than in a foster or group home or detention facility. Presented by C. Lynne Edwards, LCSW

46. Resources • Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth http://www.childwelfare.gov/pubs/braindevtrauma.cfm • National Child Traumatic Stress Network-newsletter and developed the Child Welfare Trauma Training Toolkit. http://www.nctsnet.org/ nctsn.org/products/child-welfare-trauma-training-toolkit-2008 • Creating Trauma-Informed Child Welfare Systems: A Guide for Administrators http://www.chadwickcenter.org/CTISP/images/CTISPTICWAdminGuide.pdf Presented by C. Lynne Edwards, LCSW

47. Resources • Adverse Childhood Experiences cds.gov/ace/pyramid.htm • Child Welfare Trauma Referral Tool http://www.nctsnet.org/products/child-welfare-trauma-training-toolkit-2008#q4 • Trauma Symptom Checklist for Children www.johnbriere.com/tsc.htm

48. Resources • SAFESTART Center www.SAFESTARTCenter.org • Center for the Study of Social Policy www.cssp.org • Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth www.childwelfare.gov/pubs/brain devtraums.cfm • National Child Traumatic Stress www.nctsnet.org

49. Contact Information C. Lynne Edwards, LSCW Trauma and Attachment Therapist Prevention Consultant lynne.edwards@dss.virginia.gov 804-726-7807 What we do today can help improve others’ tomorrow. Presented by C. Lynne Edwards, LCSW