Building Loving Connections

1. Building Loving Connections The Impact of Trauma on Development and Attachment for Children in Placement Presented by C. Lynne Edwards, LCSW

2. Myths • The effects of abuse and trauma to young children will “vanish”. 2. If a child has no cognitive memory of a loss, then they don’t grieve. 3. Behavior can be managed by rules and consequences.

3. Reality • The earlier a trauma occurs, the more difficult it is for the child to recover. • Memories are how the brain stores information for easy retrieval. • Behavior of children who have been traumatized can best be managed through relationships.

4. Trauma • a physical or emotional injury, event or series of events • painful, distressful or shocking • results in mental and physical effects

5. Complex Trauma • Multiple, chronic and prolonged, • developmentally adverse events • Often of an interpersonal nature with • early life onset • Effects are cumulative

6. Complex Trauma • Most devastating trauma is when source of the trauma is the attachment figure. • Children served through child welfare have experienced complex trauma. • Removal, moves in foster care and even return home or adoption add to the trauma.

7. 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

8. Long-term Impact on Children • Biology • Attachment • Mood Regulation • Cognition • Behavioral Control • Memory • Cause and Effect • Self-Concept

9. Biology • Prenatal and perinatal health problems -developmental issues stemming from SA, prematurity, low birth weight • Disrupted neurodevelopment • Biologically-based challenges-movement, sensation, hypersensitivity to physical contact, insensitivity to pain, coordination, balance, unexplained physical symptoms, increased medical problems

10. Attachment • rooted in biology • mutual psychological process • learned after birth

11. The Neurology of Attachment • Feeling safe positively affects the nervous system and provides stimulation for healthy development. • Children are born with “instincts” that are the result of pre-programming in the brain.

12. The Neurology of Attachment • 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.

13. The Attachment Cycles Trust/Need Needs Relief Relaxation Arousal Displeasure Gratification: eye contact touch smile movement feeding

14. The Attachment Cycles Initiating Positive Interactions Parent Initiates Positive Interaction Gratification Child Responds Gratification Parent Responds

15. Positive Interactions

17. Characteristics of Securely Attached Children • Development of trust • Attachment/Bonding • Conscience development • Emotional Regulation • Self-esteem

18. Characteristics of Securely Attached Children • Cause and effect thinking • Behavioral performance • Positive/hopeful belief system • Independence • Resilience

19. Attachment • Research has demonstrated a clear connection between physical, emotional, sexual abuse, neglect and multiple losses during childhood and negative changes in a child’s neurological development.

20. Attunement The powerful emotional connection in which the caregiver connects with and shares the child’s “inner state”

21. Attunement • Knowing the motivations and feelings of your child • Being able to analyze your child's actions and interpret cues accurately • Provide a correct response that meets the child’s underlying emotional needs

22. What happens when the primary caregiver does not respond?

23. Signs of Attachment Challenges • Inappropriate affection with unfamiliar adults • Lack of appropriate boundaries • Superficially engaging and charming • Poor eye contact • Inappropriately demanding and clinging • Poor impulse control

24. Signs of Attachment Challenges • Controlling behavior • Lying about the obvious • Stealing • Lack of cause and effect thinking • Difficulty with peer relationships • Abnormal eating patterns

25. Signs of Attachment Challenges • Sleep problems • Learning lags • Sensory integration challenges • Destructive to self, others and/or property • Delayed conscience development

26. What this looks like… • 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

27. What this looks like… • Sensory issues-sensitive to touch, loud noises • Delayed adaptive development-children’s social, academic and intellectual development is usually 3 to 5 years behind their chronological age • Regulation of emotions-their brains cannot shift from their emotions to their thought processes • Pull/Push-come close, now go away; afraid of getting close

28. The brains of children who experience trauma are wired differently.

29. Implications • The earlier the intervention occurs, the greater the opportunity for the brain to be repaired. • Each time a child experiences a trauma and a change in caretakers his opportunities to form healthy attachments are jeopardized. • Birth/Foster/Adoptive parents need to learn strategies for developing healthy attachments and healthy brains; some strategies are counterintuitive. • The behavior challenges that traumatized children exhibit have a different origin than other children’s behavior problems and require a different response.

30. Implications • In order to reduce the impact of the trauma, a multidimensional assessment is essential-must take into account the physical, neurological, sensory, emotional, developmental impact. • Both case management and clinical services need to reflect the short- and long-term impact of trauma. • 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.

31. Trauma Informed Practice • Universal Access to Prenatal Development and Post Natal Parent Support: Early Prevention Services Efforts to support optimal brain development should start as early as pregnancy. Services after delivery have the most impact and are the most cost effective when provided to children from birth to 5 years of age, when the brain is developing most rapidly. It’s better to build a bridge at the top of the cliff than to station an ambulance at the bottom of the cliff.

32. Trauma Informed Practice • All programs that serve children and families who have experienced trauma should include services designed to enhance all of the protective factors: • Nurturing and attachment • Knowledge of parenting and of child and youth development • Parental resilience • Social connections • Concrete supports for parents.

33. Trauma Informed Practice • Building and Enhancing Healthy Parent-Child Relationships One of the most important facts in a child’s development is the support of a parent or caregiver who consistently meets children’s needs, responds to their underlying emotional needs, and engages in positive interactions with them.

34. Trauma Informed Practice • Establishing Nurturing Routines The predictability of a daily routine helps children understand the world is a safe place where they can learn and grow without fear. Children need to feel that their caregiver is in charge.

35. Trauma Informed Practice • Supporting the Mental Health of Children and families When children are affected by a traumatic event, they and their parents could benefit from a mental health provider and case managers who: • understand the long term physical, neurological and emotional impact of trauma on their health and development. • involve them in decisions about their mental health care. • reduce the stigma attached to mental health services. • help them develop a “cover story” to share with others. • respect and protect the privacy of family members.

36. Trauma Informed Practice • Supporting Teenage Brain Development Trauma and its effects are not limited to young children. Teens benefit from quality time with their caregivers and adult mentors who help them: • organize tasks. • practice making decisions. • master new skills. • adopt healthy lifestyles and take positive risks. • minimize stress.

37. Trauma Informed Practice • Supporting Health and Nutrition Helping a family gain access to quality, affordable health care and make healthy decisions regarding diet and nutrition are important for supporting a child’s brain development both before and after birth.

38. Trauma Informed Practice • Addressing the Effects of Trauma Parents and children need help processing their feelings. Common emotional responses of children and parents to traumatic events include: • trying to make sense of the event; • re-experiencing the trauma; • avoiding reminders of the event; • anxiety or sleep problems; and • acting impulsively.

39. Trauma Informed Practice • Behavior Management Children do what their parents want to keep them close. Children who have experienced trauma at the hands of a caretaker get mixed messages. For them, the key to changing behavior is meeting their underlying emotional needs and developing the attachment relationship.

40. Trauma Informed Practice • Educating Schools The physical and emotional distress that traumatized children experience as well as the potential developmental delays that follow may lead to behavioral problems in school, poor academic performance and difficulty making social connections. Establishing a relationship is a necessary first step, even in the classroom.

41. Trauma Informed Practice • Offering Financial Education Many families experience stress resulting from poverty and could benefit from information about budgeting, financial resources available to assist with needs, banking information, job search, etc. This is also known as asset building.

42. Trauma Informed Practice • Using Community-Based Services No single system can address all the issues a child and family may experience as a result of stress and trauma. Collaborative partnerships with early intervention programs, early care and education, respite care, home visiting services, and many others who provide trauma informed services are a necessary component.

43. Trauma Informed Practice Realigning Resources to Promote Early Prevention Services • Funding • Staffing • Service integration based on knowledge of the impact of trauma • Using the protective factors across child welfare Presented by C. Lynne Edwards, LCSW

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