Treating Complex Childhood Trauma in Primary Schools: Targeting the Building Blocks of Resilience

1. Treating Complex Childhood Trauma in Primary Schools: Targeting the Building Blocks of Resilience Presentation by Kati Taunt For Islington Education Service September 2017 Day 2 part 2 ARC Developed By: Margaret E. Blaustein, Ph.D. Kristine M. Kinniburgh, LICSW The Trauma Center at JRI

2. Domain 3: Competency Developmental tasks Self Development & Identity Executive Functions Affect Expression t

3. Domain 3: Competency Overarching Goal: Build the foundational skills needed for healthy ongoing development and resiliency, by supporting key reflective capacitates, including ability to set goals and make active choices and developmentally- appropriate sense of self.

4. Remember the idea of “developmental lag”?

5. Executive Functions The Main Idea: Work with children to act, instead of react, by using higher-order cognitive processes to solve problems and make active choices in service of reaching identified goals Executive Functions

6. Executive functions are the “captain of the cognitive ship”; they provide the tools that help children navigate their world in an active, goal-directed way

7. Executive functions are primarily held in the prefrontal cortex; children who experience chronic/ongoing trauma often have overactive limbic system response, and fail to develop adequate pre-frontal controls….

8. Supporting Executive Functions • Support the child in actively recognizing his or her own ability to make choices and have power (agency) • Support active evaluationof situations (affect identification / attunement) • Support and build the client’s capacity to inhibit response(modulation) • Support the client in generating alternative solutions / decision-making skills (problem-solving) Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

9. What is “Agency” • “A means of exerting power or influence; instrumentality” • “The ability to exercise free will.” Simplistically: believing that what you do matters. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

10. Problem solving • 1. Noticing there is a problem 2. Identify and understand the problem • 3. Thought shower all options • 4. Evaluate all consequences and make a choice • 5. Implement and evaluate solutions.

11. Trauma- Problem Solving • 1. Notice and realize that your alarm is being set off (Affect Identification / attunement). • 2. Identify the trigger and appraise for actual danger versus false alarm. (Affect Identification / attunement) • 3. Use regulation skills to establish internal safety by inhibiting fight / flight / freeze response (modulation).

12. Trauma problem solving (cont) • 4. Understand the actual current problem, and identify goals: what is it that you want? • 5. Thought shower all the ideas you have for reaching your goal. • 6. Evaluate the possible consequences of each idea, and then make a choice. • 7. Implement and evaluate solutions. Revise as needed.

13. Entry points…..get in there!!! • Problem solving skills are often best applied “in – the- moment”: It is important to listen for opportunities to use and apply this skill. • Any recent examples….of the following….

14. Entry Points:“I don’t know why everyone’s so angry.” Help children concretely define the situation they are confused about (i.e., “suddenly everyone was mad”). Track backward: what was happening five minutes before “everyone was mad”? Assess: situation, body state, feelings, thoughts, etc. Continue to move backward to the earliest cues available. Help children notice clues that there is “a problem”, i.e., that their own feelings were getting out of control, or that other people were upset. Tie in to Affect Identification skills.

15. “But I had to...” Entry point: Listen for moments when children identify a situation, either past or future, in which they did not or do not feel as if they have a choice. Goal: Increase awareness of choices “I’m gonna…[insert bad choice here]” • Entry point: Listen for moments when children name a potentially negative choice that they plan on making. • Goal: Increase understanding of consequences • for actions.

16. “It’s all (my mother’s, my friend’s, the teacher’s, my dog’s, etc.) fault!” Entry point: Listen for moments when children externalise responsibility for a choice they have made. Goal: Increase understanding of consequences for actions.

17. Teach Problem Solving to young children through play and modeling Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

18. 1. Hide and Seek Games Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

19. 2. Sorting Games Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

20. 3. Puzzles, Shapes, Memory Games Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

21. Teach Problem-Solving to Older Children and Adolescents Through Cooperative Games and Group Goals Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

22. Planning activities

23. Luke and executive functions We identified that Luke had serious “lag” in all areas of executive functioning (an Educational Psychologist can help here). Psychoeducation about developmental trauma helped school staff understand, he didn’t have the skills to take turns, wait or plan. (allowing them to see his behaviour differently). Lunch time activities supported him, playing board games, problem solving activities.

24. Luke and executive functions The cubs!!! (or similar!) Luke was given small amounts of responsibility where he had to solve problems (stationary monitor etc) but with adult support to help him regulate if needed. Luke had easily achieved goals set and he was reminded of the goals and supported to solve problems that got in the way of his goals.

25. Any ideas for improving executive functions?

26. Small group review of executive functions? • So what resources do you as an individual / a school have that already work well in helping children develop executive functions ? • What more might you need? • Who might you need support from? • “Yes Buts” and Next Steps?

27. Self Development and Identity

28. Self and Identity The Main Idea: Helping children towards an understanding of self and personal identity, including: Helping them notice the positive and unique things about themselves building of coherence across time and experience, helping them to imagine and work towards future possibilities. Self Dev’t & Identity

29. Self Development and Identity:Key Concepts Growth of a coherent sense of self and personal identity normally develops over the course of childhood.

30. Trauma…….cont • Lack of exploration due to lack of secure attachments.

31. Trauma impacts on sense of positive identity (self esteem) • Negative experiences lead to negative view of self (including broader social messages)

32. Treatment Targets: Aspects of Identity Unique Self Positive Self Cohesive Self Future Self

33. Unique Self: Individuality Goal: Help child identify personal attributes (likes, dislikes, values, talents, opinions, culture etc.) Example Activities: All About Me Books Personal collage (general/specific) Group collage around single theme, with individual child sections Artistic self-expression Bulletin boards with space dedicated to each resident Activities celebrating individual diversity (i.e., culture-specific meals, holiday celebrations, etc.)

34. My coat of arms…

35. Positive Self: Esteem & Efficacy Goal: Build internal resources and ability to identify positive aspects of self Example activities: Power book Pride wall Superhero self End-of-week awards Display child accomplishments—think of the refrigerator display Tune into moments of success (both relative and absolute); name them; capture them concretely (both individually and in milieu)

36. Self esteem is a suitcase..

37. Cohesive Self: Self Across Time and Context Goal: Help child build sense of self which integrates multiple aspects of experience Working with the child to help them explore the ways in which all of their experiences have contributed to who they are and how they see themselves

38. Future self: Future orientation Goal: Build child’s ability to imagine self in future; build connections between current activities and future outcomes Example activities: Future self drawing 5-10-20 years Life book addendum Goal setting, future-planning: help kids develop goals (i.e., beyond primary school,)---help explore possibility Connect it: In conversation, pay attention to how current actions/ experiences connect to future goals

39. Luke and self identity Luke had a very limited sense of self. His mum was encouraged to keep his awards etc on the cupboard at home. Mum came into school more regularly and consultations with his teacher focussed more on where he was doing really well. Luke had an idea that there was a “good Luke” and a “bad Luke”. Worked with Luke to see these as both being him.

40. Luke and self identity TA built and “all about me “ book with Luke. Luke had an idea that there was a “good Luke” and a “bad Luke”. Worked with Luke to see these as both being him. Luke given time with an adult to make choices about what he liked, this was particularly obvious in setting such as “golden time”.

41. Small group review of self- identity? • So what resources do you as an individual / a school have that already work well in helping children learn to build a sense of self identity? • What more might you need? • Who might you need support from? • “Yes Buts” and Next Steps?

42. Any self identity ideas?

44. Key Concepts Historical experiences often interfere with children’s capacity to effectively navigate current life Present moments may elicit fragmented self-states (feelings, thoughts, actions/ inaction, relational styles, etc.) which originally arose to serve some function for the child (like survival) Children may be impacted by specific memories of or thoughts about historical events

45. How does past impact present? • Historical experiences often interfere with children’s capacity to effectively navigate current life • As described in PTSD Cluster B symptoms, children may be impacted by specific intrusive memories of or thoughts about historical events Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

46. General Considerations: Reflection and attunement play a key role; TEI is embedded within the attachment / caregiving system Integration of traumatic experiences requires the capacity to observe and be curious about the range of self-experiences The holder of the reflective lens (the “curious observer”) is likely to shift over time, from external to internal Caregiver affect management and self-care is crucial TEI is a process that takes place over time

47. Where do I go from here? Considerations for building ARC into your practice or system Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

48. 8 Primary Skills in 3 DomainsSupported by two integrative strategiesIn service of one unifying goal Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

49. Supporting Integration and Sustainability • Build understanding in layers; deepen over time • Integrate key language and concepts (into discussion, into forms,into pastoral care plans, into goals and action steps, etc.) • Build structures that support the intervention plan/pastoral care plan • Pay attention to the details, but keep sight of the “big picture” Luke had an idea ta t there Luke” and a “bad Luke”. Worked with Luke to see these as both being him. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

50. And the big picture is?