Children, Young People & Trauma

Transcription

1 Children, Young People & Trauma 28 th May 2010 Belinda Cooley Lily Lee

2 Workshop Outline Expectations of Workshop Definition of Trauma Attachment and Neurobiology Impact of Trauma Framework for Intervention Case studies and Discussion Final Questions Evaluation

3 Expectations of Workshop Question you hope will be answered Topic you are hoping will be covered

4 The person s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganised or agitated behaviour) (Criteria A2). (DSM-IV-TR, p. 463) What is trauma? Trauma is a direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one s physical integrity; or witnessing an event that involves death, injury, or threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A).

5 What is trauma? An event is traumatic if it is extremely upsetting and at least temporarily overwhelms the individual's internal resources. People who experience major threats to psychological integrity can suffer as much as those traumatised by physical injury or life threat. Bariere (2006 p. 4)

6 Types of Trauma Domestic violence Child Protection Issues Child Sexual Assault Children and YP in Out of Home Care COPMI (Children and YP of parent with mental illness) Bullying Refugee trauma Disasters eg fire, flood

7 Attachment and Neurobiology The kind of care we get as children links to our brain s capacity for wellbeing in adulthood. Wellbeing thrives with resilience, the ability to overcome upsets and return to a calmer, happier state. That is training of the OFC circuitry for managing distress. OFC = Orbitofrontal cortex

8 Attachment and Neurobiology The orbitofrontal cortex sits at the apex of the limbic system, and controls the sympathetic and parasympathetic branches of the autonomic nervous system. Schore conceptualizes psychobiological attunement as "direct right brain to right brain communication" in which the mother's right brain, "involved in the unconscious expression and processing of emotional information," serves as a template for the infant's developing neural circuitry (Schore, 1997).

9 The Attachment Styles & Neural Circuits involving in fear response The Low Road circuit involves including anterior temporal pole (ATP) for sadness; anterior cingulate for emotional fare; and the hippocampus for memory.

10 Neurobiology and Abuse Abuse, neglect and chronic states of misattunement lead to an over pruning of synapses in the right orbitofrontal cortex, leaving individuals with impaired ability to modulate and regulate emotion in response to stress. High levels of cortisol, a stress hormone that may well be released in the brain during states of distress, has been shown in some animal studies to destroy synapses. Schore (1996 & 1997)

11 The Reparative Experience The neural site for emotional malfunction is primarily in the orbitofrontal cortex (OFC) and the very growth of OFC depends on a child s experience. The way repeated experiences sculpt the shape, size, the number of neurons and their synaptic connections. Some potent shaping occurs in our key relationships by repeatedly driving our brain into a given register. Nurturing relationships later in life can to some extent rewrite the neural scripts that were encrypted in brain during childhood. Allan Schore, UCLC.

12 The degree of attuned emotional support the child receives from supportive adults is the most important determinant of the level of psychological stress he or she will experience after trauma. These adults are usually parents, but they can be others with whom the child has meaningful relationships. Their support validates the child s experience and helps him feel cared about and understood even he is terrified and overwhelmed. (Sargent 2009)

13 Predictive Social/Familial Factors Having a close relationship with at least one parent/guardian Having at least one person who recognised achievements A close/supportive relationship with adult mentor/role model (56%): family members, friends, teachers.

14 Domestic Violence Prevalence of domestic violence one in four young people surveyed was aware of domestic violence against mother (Flood and Fergus 2008)

15 Impact on Children and Young People Domestic violence has a clear and negative impact on children s and young people s behavioural, cognitive and emotional functioning and social development Children and young people s education and later employment prospects are harmed by domestic violence An Assault on Our Future: The impact of violence on young people and their relationships Michael Flood and Lara Fergus, 2008

16 Impact of living with trauma infants/toddlers poor health, frequent illness poor sleeping patterns crying, excessive screaming aggression with peers severe shyness low self esteem chaotic routines/refusing food withdrawn clinging, anxious exaggerated startle response attachment to mother significantly and deliberately disrupted by perpetrator Improving our responses to domestic violence South East Illawarra Area Health Service Manual (2000)

17 Impact of living with trauma primary school aggression - belief that violence is way to deal with conflict fighting with peers unwilling to complete tasks may regress to former stages of development feel responsible for violence difficulties with school work not wanting to go to school depression lack of energy and concentration lower social competence Improving our responses to domestic violence South East Illawarra Area Health Service Manual (2000)

18 Impact of living with trauma adolescents anxiety depression difficulties with school work aggressive behaviour risk taking behaviour substance abuse self harm/suicide blaming mother for violence running away from home truancy Improving our responses to domestic violence South East Illawarra Area Health Service Manual (2000)

19 How will these children and young people present: in the classroom at the school counsellors office

20 Impact on Children and Young People Physical, emotional and sexual abuse of children and young people is significantly more likely in families where domestic violence is occurring. Children, Young People and Domestic Violence L Laing, 2002

21 Impact on Children and Young People Domestic violence is the leading cause of homicide of women and children The Silence of Violence J Webster, 1995

22 Fatal child abuse & domestic violence Child Death Review Team, Annual Report NSW (2008) In 2008, 12 children aged 0-17 years in NSW died as a result of assault in eight separate incidents. Half of the children were identified as vulnerable. Definition of vulnerable child - any child or sibling involved in child protection reports to Community Services within past three years.

23 Fatal child abuse & domestic violence Child Death Review Team, Annual Report NSW (2008) Vulnerable children have a much higher likelihood of external causes of death than non-vulnerable children. Of the 12 deaths by assault, 10 occurred in the context of familial relationships - injuries were inflicted by parents, step parents or other family members.

24 Impact on Schooling and Education Research has shown that young people who experience domestic violence are at risk of: Education difficulties not completing secondary school unplanned pregnancy unemployment An Assault on Our Future: The impact of violence on young people and their relationships Michael Flood and Lara Fergus, 2008

25 Awareness of Children and Young People Children and young people living with domestic violence are victims of violence not witnesses The majority of children and young people are aware of the abuse, often more so than parents realise This may include being interrogated or involved in the violence, coming home after violence has occurred, perpetrator harming family pets

26 Safe Beds for Pets The RSPCA NSW Safe Beds for Pets program assists women and children escaping domestic violence The program started as a small pilot project between the St George DV Counselling Service and the RSPCA - Yagoona

27 Framework for Intervention Optimal response recognises men s abuse of women impacts significantly on children and young people Helpful question is - what makes it difficult for woman to separate NOT why doesn t she leave

28 Clinical Intervention Clinical interventions such as behavioural, parenting or family therapy when children and young people are living with trauma including DV do not increase safety or reduce impact of trauma Safety interventions must be the primary intervention when children and young people are living with trauma related to domestic violence, child protection and sexual assault

29 Clinical Interventions Safety interventions also include addressing self harm, depression and other identified problems for children and young people. However this must be done in the context of the impact of trauma on children and young peoples including their ongoing mental health.

30 Safety Planning safety planning includes physical, emotional and psychological safety safety planning needs to be constant and ongoing needs to identify safety strategies client already using, supporting these with additional ideas and resources

31 Safety in school setting AVOs and Contact Orders Safety assessment before doing joint appointments with mother and father Report to Community Services (Dept Human Services)

32 Ongoing safety issues after separation Violent partner leaving the home does not equal safety ongoing emotional and psychological abuse can escalate and continue after separation - often hidden from police and other services Contact orders with violent parent granted in most family law matters with children remaining exposed to domestic violence

33 Trauma Focused Therapies Examples: EMDR Cognitive Behaviour Intervention Sensorimotor Psychotherapy Etc.

34 Case studies

35 Useful resources Australian Domestic & Family Violence Clearinghouse National Child Protection Clearinghouse Additional resources and readings see handout

36 Belinda Cooley Ph belinda.cooley@sswahs.nsw.gov.au Lily Lee Ph lily.lee@sswahs.nsw.gov.au