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Choosing to See Individuals and Families Through a Trauma Lens. Maggie Cveticanin & Linda Wilson 2019 Florida Coalition for Children Annual conference. Learning Objectives. Stress Continuum. An individual can be affected but not traumatized. Momentary distress is not trauma.
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Choosing to See Individuals and Families Through a Trauma Lens Maggie Cveticanin & Linda Wilson 2019 Florida Coalition for Children Annual conference
Stress Continuum • An individual can be affected but not traumatized. • Momentary distress is not trauma. • Trauma impacts quality of life, sense of security, and sense of safety.
Trauma • A traumatic event is a frightening, dangerous, or violent event that poses a threat to an individual’s life or bodily integrity. • Witnessing a traumatic event that threatens life or physical security of a loved one can also be traumatic. Source: www.nctsn.org
Trauma can occur at any age Trauma can effect any age Race Gender Ethnicity Social economic groups Community workforce
Acute Trauma • A single traumatic event that is limited in time. • Serious accidents, painful medical treatments, natural disasters etc. • Individuals go through a variety of feelings, thoughts and reactions that are frightening. Source: www.nctsn.org
Chronic/ Complex Trauma • Experience of multiple traumatic events. • These may be varied events- such as a child being exposed to domestic violence, involved in a serious car accident or becoming a victim of community violence. • Or, longstanding trauma such as physical or sexual abuse. • Each event services to remind the child of the prior trauma and reinforces it’s negative impact. Source: www.nctsn.org
Historical Trauma • A personal or historical event or prolonged experience that continues to have an impact over several generations. • Cultural, racial and immigrant oppression • Slavery • Removal of homelands • Relocations • Massacres and genocides Source: www.nctsn.org
Neglect as Trauma • Failure to provide for a child’s basic needs. • Perceived as trauma by anyone who is completely dependent on adults or others for care. • Opens the door to other traumatic events. Source: www.nctsn.org
Variability of Responses to Trauma • The impact of a potential traumatic event is determined by both: • The factual nature of the event • The emotional response to the event. • Something that may be traumatic for one person may not be traumatic for another person. Source: www.nctsn.org
Impact of Traumatic Events • By age 16, two-thirds of children in the US are exposed to a potentially traumatic event. • For many children, these traumatic events can be associated with serious and life-long medical and mental health problems such as depression, suicidal ideation alcohol and substance use, obesity, aggression, lower occupational attainment, increased use of social services, and increased medical costs. Source: www.nctsn.org
The Adverse Childhood Experiences (ACE) Study • Provides the evidence base for doing careful and comprehensive screening of young children for a history of exposure to maltreatment or adverse conditions. • Strong link between ACE and adult onset of chronic illness- those with ACE scores 4 or more had significantly higher rates of heart disease and diabetes that those with ACE scores of zero. • Multiple ACE’s connected to early death. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs. Source: Newlin, C.
Variability of Responses to Trauma • The impact of a potential traumatic event is depends on several factors: • Age and developmental stage • Perception of the danger faced • Victim or a witness • Relationship to the victim or perpetrator. • Past experience with trauma. • Presence/availability of someone who can offer help and protection. Source: www.nctsn.org
Effects of Trauma Exposure • Trauma has profound effects on nearly every aspect of an individual’s life. Source: www.nctsn.org
Attachment • A biological instinct in which proximity to an attachment figure is sought when the child senses or perceives threat or discomfort. • Trauma-exposed children feel that the world is uncertain and unpredictable. • Their relationships can be characterized by problems with boundaries, as well as distrust and suspicion. Source: www.nctsn.org
Attachment Patterns • Attachment emerges gradually over first months of life, peaking during second year • By 6-7 months, infant shows Separation Anxiety: • Measured through Strange Situation: • Mother leaves child alone in room with toys • Child is joined by friendly stranger • Mother returns to room and greets the child Source: Kowalski, R., & Westen, D
Attachment: Strange Situation Task • Secure (most common) • Welcomes mother’s return and seeks closeness • Avoidant • Ignores mother when she returns • Ambivalent • Infant angry and rejecting while simultaneously indicating a clear desire to be close to the mother • Disorganized • Contradictory behavior involving helpless efforts to elicit soothing responses from the mother • Actions hard to predict; situation unclear to infant Source: Kowalski, R., & Westen, D
The Stress Response System 3 “Thinking brain” • The amygdala senses threat and sets off the alarm. • Thinking brain assesses the situation. • Thinking brain goes off-line. Emotional brain activates fight or flight response. • Thinking brain helps shut off the alarm and helps us to calm down. 2 4 1 “Emotional brain”
The Stress Response and Trauma 3 “Thinking brain” • An experience becomes TRAUMATIC when it overwhelms our system for responding to stress. • The emotional brain continues to sound the alarm and send messages to fight or flee, even after the threat has passed. 2 4 1 “Emotional brain”
Impact on Mood Regulation • Individuals exposed to trauma can have difficulty regulating their emotions, as well as difficulty knowing and describing their feelings. • They can have difficulty appropriately communicating wishes and desires to others. • May have difficulty comforting or self soothing self. Source: www.nctsn.org
Impact on Behavioral Control • Poor impulse control • Quiet/Withdrawn • Self destructive behaviors • Aggression against others • Sleep disturbances • Eating disturbances Source: www.nctsn.org
Impact on Cognition • Some trauma-exposed adolescents demonstrate learning difficulties and problems with language development (typical onset 0-3 years). • Individuals exposed to trauma can have problems focusing on and completing tasks, as well as difficulty planning and articulating. Source: www.nctsn.org
Impact on Self-Concept • Interference with mastery of age appropriate tasks and skills. • Individuals exposed to trauma can experience a lack of sense of self. • They can suffer from disturbances of body image, low self-esteem, shame and guilt. Source: www.nctsn.org
How Can Trauma Affect Caregivers? • Trauma can compromise caregivers’ ability to make appropriate judgments about their own and their child’s safety. • Overprotective • Not recognize situations that could be dangerous for a child. • Impair caregivers’ capacity to regulate their emotions. • Impair a parent’s decision-making ability. • Result in “triggers” – an extreme reaction to situations that seem non-threatening to others.
Systemic Retraumatization • Having to continually retell a story • Being treated as a number • Procedures that require disrobing • Being seen as a label (ex. Schizophrenic) • No opportunity to give feedback about their experience with the service delivery
Resiliency Research • What are the ingredients that make some survivors into thrivers? • How is it that some persons who suffer through similar conditions of adversity fare much better in the long run than others with comparable circumstances?
Resiliency Research • Wolin's and Wolin's (1993) research found that some survivors are endowed with certain strengths, strengths which they have categorized into seven types of resiliencies. Lietz, C. A. (2004)
