Karyn Harvey, PhD Assistant Executive Director, Clinical Supports The Arc Baltimore Baltimore, MD

Transcription

1 Karyn Harvey, PhD Assistant Executive Director, Clinical Supports The Arc Baltimore Baltimore, MD Trauma Informed Care and Positive Strategies for Healing April 6, 2017 APA Hotel Woodbridge, Iselin, NJ The attached handouts are provided as part of The Boggs Center s continuing education and dissemination activities. Please note that these items are reprinted by permission from the author. If you desire to reproduce them, please obtain permission from the originator. Rutgers, The State University of New Jersey Liberty Plaza, 335 George Street, New Brunswick, NJ rwjms.rutgers.edu/boggscenter p f

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3 TRAUMA-INFORMED CARE Presented by Karyn Harvey, Ph.D. Materials at: Pid.thenadd.org Books at Amazon.com Sources of Trauma for Individuals with IDD Report on Abuse of People with Disabilities 2013 Spectrum Institute Over 70% of people with Disabilities report being victims of abuse - 90% of them said it was on multiple occasions Only 37% reported the abuse to the authorities Sexual Abuse Hingsberger 8 out of 10 females sexually abused more than once with developmental disabilities Males 6 out of 10 Social Trauma Bullying, Name- calling, Verbal Abuse Psychology of Exclusion Stimulation of Anterior Cingular Cortex Trauma of Institutionalization, Foster-care Placements Trauma of Physical Abuse and Neglect 1

4 Big T and Little t Traumas Major Events Sexual Abuse Physical Abuse Neglect Negative Events Grief and Loss Little t Trauma Family Violence Neighborhood Violence Social Exclusion Exclusion from Family Frequent foster care or group home placements and lack of stability Trauma of Attachment Disorders: Insecure Attachments Avoidant Attachments Patterns for life-long social interactions are set Bucharest Early Intervention Orphan Study 138 children between 6 and 31 months who were in an orphanage in Bucharest were studied 68 kept in institution 68 placed in a new foster care system full time paid parenting Results: After 54 months ( 41/2 years): Compared to 138 children raised in birth families PPT%20BEIP%20Group%20for%20website.pdf 2

5 Issues: Institution Foster Care Biological Axis 1 Disorders Emotional Disorders Behavioral Disorders Intellectual Disability Average IQ Score 55% 35% 13% 49% 29% 8% 32% 25% 6.8% MIRROR NEURONS: Interaction during infancy is needed for brain wiring The Effects of Cocaine and/or Alcohol Exposure During Gestation Amphetamines Alcohol 3

6 Effects of Fetal Alcohol Spectrum Disorder Smooth Philtrum ( space between nose and mouth) Half-opened lids and mouth Upturned nose if Caucasian Flattened nose if African- American Issues with Cause and Effect, Cannot understand or process how what they do brings them a certain effect Cannot understand that their actions bring consequences: Consequences don t work only frustrate them and make them angry Coaching works! Psychological Trauma past is present How did the brain react? Neocortex The rational brain: Intellectual tasks Limbic The intermediate brain: Emotions Reptilian The primitive brain: Self preservation, aggression The Triune Brain 11 Trauma Responses Due to Buttons Pushed Trigger Response Something happens in the present that reminds the person of the negative past - person goes into fight, flight or freeze mode: Thinking he or she is in Trauma Trigger Danger! Fight Attachment Issues Flight Freeze 4

7 Trauma-Mind/Trauma Response Activation of Fight, Flight or Freeze trauma response Dan Siegel - People will revert to the age that trauma first occurred when in trauma response mode! Rational Mind Shuts Down If people are in trauma response and we treat them as though they are being manipulative - we will lose their trust and they will become further alienated. This is not the Teachable Moment! What To Do When Someone is Triggered Symptoms of Trigger (Activation of Sympathetic nervous system) Fight Flight Freeze - What does this looks like for individuals with ID? Cool Down System ( Activation of Parasympathetic nervous system) Calming Breathing Getting away from trigger Being Safe 5

8 The Behavioral Pyramid Behavioral Issues: Emotions Expressed Often Rooted in Trauma BEHAVIOR EMOTION TRAUMA When we only address the behavior, we miss the true cause and root of difficulties 4 Areas of Symptoms of PTSD 1. Re-experiencing ( interfering with present to different degrees) Intrusive Memories Nightmares Flashbacks- Person can disconnect from reality and be convinced he or she is being attacked, hurt or threatened due to a memory that becomes present 2. Avoidance Blunted emotions/ Shut down responses Person can become obsessive about details concerning self and safety Disconnection and withdrawal Symptoms of PTSD Continued 3. Negative Alterations in Cognition and Mood Persistent negative-trauma related emotions ie. fear, horror, anger, guilt and shame Constricted emotion inability to express positive emotion Alienation and withdrawal from others 4. Arousal Easy to startle Agitated can lead to property destruction Periodically Combative Impulsive Also associated with reckless or self-destructive behavior 6

9 If you try to treat someone s illness without knowing its cause, you will only make the person sicker than before. Nichiren Daishonin Ingredients Necessary for Post traumatic Recovery Perceived Safety Empowerment Connection The IRAQ PTSD STUDY 7

10 Ted Waldinger - Harvard Study Looked at 724 men half Harvard graduates half from poorest sections in Baltimore Longitudinal 75 years 60 still alive Interviewed regularly Results nothing to do with fame or money Relationships Are Everything!! The people who were the most satisfied in their relationships at age 50 were the healthiest at age 80. And good, close relationships seem to buffer us from some of the slings and arrows of getting old. Our most happily partnered men and women reported, in their 80s, that on the days when they had more physical pain, their mood stayed just as happy. But the people who were in unhappy relationships, on the days when they reported more physical pain, it was magnified by more emotional pain. Robert Waldinger The Power of Positive Regard Mice and Bob Rosenthal Signs were put up for experimenters Smart Rats Dumb Rats All rats were actually the same Experimenters had rats run mazes Big difference between the performances Smart rats ran mazes twice as fast!! 8

11 Carol Dwek, Ph.D. How you see someone determines how they are able to see themselves! Teachers who thought they had gifted children got a significantly better performance from classes they were told were average. Even though they were the same! Daniel Kish Who is This? 9

12 He now teaches other blind individuals how to do this! Resiliency Studies Positive Regard Statements: 1. I like you 2. I care about you 3. You are Cool! 4.You can do this! Positive Regard Actions: 1. Listening 2. Coaching 3. Supporting the Pursuit of Happiness 10

13 The connections cruises Singles Club the Love Boat! From Recovery to Happiness Seligman Flourish!" Five levels of Happiness: 1. Pleasure 2. Engagement 3. Positive Relationships 4. Achievement 5. Meaning *Happiness Assessment 11

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15 References and Recommended Reading Prepared by Karyn Harvey, PhD Bennett, D.S., Bendersky, M., and Lewis, M. (2008). Children s cognitive ability from 4 to 9 years old as a function of prenatal cocaine exposure, environmental risk and maternal verbal intelligence. Developmental Psychology, 44,(4) Chasnoff, I.S., Griffith, D.R., Freier, C., and Murray, J. (1992). Cocaine/Polydrug Use Pregnancy: Two Year Follow-up. Pediatrics 89. (2) Frank, D.A., Augustyn, M., Knight, W.G., Pell, T. and Zukerman, B. (2001). Growth, development, and behavior in early childhood following prenatal cocaine exposure: a systematic review. Journal of American Medical Association, 285, (12) Chiriboga, C.A. (1998). Neurobiological Correlates of Fetal Cocaine Exposure. Annals of New York Acadamy of Sciences, 846, Eisenberger, N., Lieberman, M., Williams, K. (2003). Does Rejection Hurt? An fmri Study of Social Exclusion. Science Vol 302, no Pp Harvey, K. Trauma Informed Behavioral Interventions (2012). AAIDD Press, Washington. Harvey, K. Positive Identity Development (2009). NADD Press, Kingston. Herman, J. (1997). Trauma and Recovery. New York: Basic Books. LeDoux, J. (1996). The Emotional Brain. New York: Simon And Schuster. Chapter 8. Mercier F., Kwon Y.C., Douet V. (2012). Hippocampus/amygdala alterations, loss of heparan sulfates, fractones and ventricle wall reduction in adult BTBR T+ tf/j mice, animal model for autism. Neuroscience 2 pp Natoli, J.L., et al. (2012). Prenatal Diagnosis of Down Syndrome: A Systematic Review of Termination Rates ( ). Prenat. Diagn., 32: doi: /pd.2910 Seigel, D. (2009). The Mindful Therapist. New York: W.W. Norton and Company. Chapter 10. Seligman, M. (2006). Authentic Happiness. New York: Vintage Books. Singh, N., Lancioni, G., Winton, A., Singh, A.,.Adkins, A. and Singh, J. (2009). Mindful Staff Can Reduce the Use of Physical Restraints When Providing Care to Individuals with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities 22, pp

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