Opportunities for Enhanced Practice: Childhood Response and Resiliency to Family Violence. September 21, 2017

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1 Opportunities for Enhanced Practice: Childhood Response and Resiliency to Family Violence September 21, 2017

2 The Intersection of Community Violence and Family Violence CHDI Carol O Connor, LCSW TF-CBT Senior Project Coordinator 2

3 Why Talk About Trauma? Tough topic, but we need to talk about it Need to provide safe space for children and families to talk about trauma Trauma doesn t go away because we don t talk about it Some families have experienced traumatic events Why this is important to your work You have a unique role Your relationships with families is important Families face multiple stressors Families have different resilience and coping strategies 3

4 What is Trauma? Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically and emotionally harmful or threatening and that has lasting adverse effects on the individual s physical, social, emotional, or spiritual well-being. The experience is Overwhelming Changes our thoughts Reduces our sense of control/ safety What Experiences Might Be Traumatic? 4

5 Prevalence Do Traumatic Events Happen Often? Approximately 26% of children in US witness or experience a trauma by the age of 4 Victims of abuse & neglect: 26.8% are under % are 3-5 years old Between 25% and 43% of children are exposed to sexual abuse; Between 39% and 85% of children witness community violence. More than half of children report experiencing a traumatic event by age 16 (Presidential Task Force on PTSD and Trauma in Children and Adolescents, 2008). 1 of every 6 children receive a psychiatric diagnosis between ages 2-5 5

6 National Prevalence of Trauma Exposure in Early Childhood Exposure Type Physical Assault Sexual Victimization Abuse/Negle ct Witness Violence Ag e % Age 2-5 Age 6-9 Age % 49% 40% 1% 1% 2% 16% 6% 10% 12% 20% 8% 14% 12% 43% Most trauma exposure is unreported Finkelhor et al. (2013) 6

7 Community Violence As many as 96% of youth report having experiencing or witnessing community violence Examples: bullying, fights, shootings, terrorist attacks, sexual assaults, robberies (Community Violence Collaborative Group, National Traumatic Stress network. 2013) Family Violence 5-15 million children in the United States are exposed to IPV each year 2014 DCF data shows 21% Reports with allegations of IPV Case reviews have shown up to 70% of families have a history of IPV 7

8 Trauma Impact Adverse Childhood Experiences (ACE) Study CDC and Kaiser Permanente Collaboration 17,000 participants Looked at the relationship between 10 ACEs in childhood and health outcomes in adulthood The Adverse Childhood Experiences study otherwise known as the ACE study is a now 14 year collaboration between the CDC and Kaiser Permanente in San Diego. It the largest study of its kind ever done. Over 17,000 HMO Members were interviewed and answered a series of questions about their childhood experiences. (The questions are in your handouts) The purpose of this study was to look at the possible health and social effects of adverse childhood experiences over the lifespan. The findings are groundbreaking, have vast public health implications, and are being discussed all over the world today. 8

9 9 3 McLauughlin et al (2012). Archives General Psychiatry

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11 The Lifelong Costs of Trauma $1.8 million per child in lifetime costs 1 20 years of life Graphic from Pew Issue Brief Paying Later: The high costs of failing to invest in young children 1 Suffer the Little Children: An Assessment of the Economic Costs of Child Maltreatment. The Perryman Group (2014) 11

12 12 Trauma Impact

13 Effects of Trauma on Young Children Aggression/anger/irritability Regressive behavior Behavior problem Inattention More fearful/easily startled Repeating events in talk/play Aches & pains Clingy/Difficulty separating from parent 13

14 Effects of Trauma on Young Children Regressive behavior Aggression/anger/irritability Behavior problems Inattention More fearful/easily startled Repeating events in talk/play Aches & pains Clingy/Difficulty separating from parent Executive functioning problems Sleep problems Social withdrawal Appetite changes Sadness 14

15 Effects of Trauma on Young Children Regressive behavior Aggression/anger/irritability Behavior problems Inattention More fearful/easily startled Repeating events in talk/play Aches & pains Clingy/Difficulty separating from parent Executive functioning problems Sleep problems Social withdrawal Appetite changes Sadness 15 Hypervigilance thoughts Intrusive thoughts Anxiety, & Terror Flashbacks numbing Avoidance Negative Fear, Emotional Shame/Guilt

16 Trauma Impact Acute response (Flight, Fright, Freeze) Alarm system/ False Alarms Child impact Family impact Community impact Multi generational trauma impact Impact of parent trauma history on parenting What are the observable behaviors, norms? 16

17 Trauma Impact on Early Childhood Myth: Young children aren t affected because they didn t understand/don t talk about it Children may think they are responsible for the event and blame themselves for not being able to change the event Children cannot express their feelings through words In IPV situations, the child/caregiver relationship is affected Child doesn t have an adult who can help them to regulate their emotions. Adverse experiences or the exposure to chronic stress, such in the case of IPV, interrupt a healthy emotional and cognitive development Overlaps with common developmental concerns in young children range of normal makes trauma difficult to identify 17

18 What Happens? Intersection of trauma, development and attachment Not able to distinguish between threatening non- threatening situations Seven primary domains are compromised in children who have experienced complex trauma Attachment Biology Affect regulation Dissociation (alteration in consciousness) Behavioral regulation Cognition Self-concept 18

19 Trauma Reminders Sensory interpretation of the environment What do I see, hear, smell, feel, taste Harmless reminders that may activate Automatic survival mode May result in flashbacks/loss of control/emotional dysregulation May explain sudden/extreme behavior problems Child or parent may not be aware of their reminders Examples Reminders cause reactions 19

20 Trauma Reactions What Does Trauma Look Like? There is a wide range of responses to trauma Regression (lose skills) behavior, emotions, verbal skills May threaten belief that caregivers/adults can keep them safe (and won t hurt them) Hyperarousal (jumpy, easily startled) Avoidance (attendance, participation) Intrusive thoughts (excessive worry) Re experiencing (sensory reminders) Altered Threat Perception (not able to distinguish between threat)s 20

21 Little Flags: Common Reactions in Young Children Sensory Yelling/loud noises Being touched/people too close (especially strangers) When caregivers appear angry/irritated Physical resemblance to abuser Feeling vulnerable Being threatened Harsh discipline Separated from loved one/isolated Life transitions/holidays/anniversaries 21

22 Trauma Impact on Families Impact on individual family members Resilience Physical health (headaches, sleep problems) Mental health (PTSD, depression, anxiety) Developmental growth Impact on relationships with each other Parent/ caregiver support is vital for child s recovery Parent struggling with their own reactions Support from extended family Impact on family functioning Ability to meet family s basic needs Access to resources Maintaining daily routines and important traditions 22

23 Now the Good News Children and families are resilient Young brains are malleable Prevention & treatment work Trauma informed systems exist Posttraumatic growth is possible Even when children experience a traumatic event, they don t always develop traumatic stress 23

24 What Can We Do? Use a trauma lens Build Routines Talk With Families Help Kids Learn About Upsetting Events Create a safe, predictable environment 24

25 Use a Trauma Lens Avoidance is a hallmark of trauma (talk about it) Talk about trauma in relation to feelings things that make us feel scared Understand the behavior: What happened to you? Not What s wrong with you? If a child talks about trauma listen, discuss feelings, use soothing strategies Think about safety Think about generational trauma Understand the connection between trauma reminders and behavior problems 25

26 Build Routines Goal: establish structure and predictability so that modulation and safety are felt Target areas of challenge, predict the natural pitfalls Create Comfort Zones Help child/ family build a Toolbox Establish healthy routines Structure Predictability BE REALISTIC 26

27 Talk With Families About Trauma Be transparent why is it important to discuss stressful events? Health & safety; mandated reporting reqs. Provide information about trauma Preventative/inoculation Listen, empathize, normalize, and instill hope engagement Disclosure has a big impact on recovery Assess your own comfort 27

28 Helping Kids Learn About Upsetting Events What s it called? What does that mean? There are many kinds of these events, what has happened to you Who does this happen to? Are there a lot of kids who experience this? Why does this happen? Makes people feel very afraid, helpless Use the 5 senses Turn down the volume Talk about upsetting feelings Recognize when child is experiencing trauma reminders Understanding emotions, intensity, regulation Turn down the volume, change the channel 28

29 Create a safe, predictable environment Positive, supportive climate Physical safety prevent re-traumatization Psychological safety Limit exposure to reminders Maintain healthy routines/schedules Make transitions predictable 29

30 Resources Child Health and Development Institute The National Child Trauma Stress Network Books I Was So Mad (Mercer Mayer) The Invisible String (Patrice Karst) The Lion Who Lost His Roar (Marcia Shoshana Nass) Maybe Days: A Book for Children in Foster Care (Jennifer Wilgocki) My Many Colored Days (Dr. Seuss) Peaceful Piggy Yoga (Kerry Lee Maclean) A Terrible Thing Happened (Margaret Holmes) 30