Trauma Informed Home Visiting
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1 Trauma Informed Home Visiting Presented by C. Lynne Edwards, LCSW Home Visiting Consortium October 28, 2014 Presented by C. Lynne Edwards, LCSW 1
2 THE IMPACT OF TRAUMA ON CHILDREN AND PARENTS Presented by C. Lynne Edwards, LCSW 2
3 Presented by C. Lynne Edwards, LCSW 3
4 Trauma is experienced through the body, mind and spirit and has a long term impact. Presented by C. Lynne Edwards, LCSW 4
5 A traumatic experience... Threatens the life or physical integrity of a person or someone important to that child (parent, grandparent, sibling) Overwhelms an individual s capacity to cope and elicits feelings of terror, helplessness and powerlessness Triggers the stress response system in the brain (both short term and long term) Presented by C. Lynne Edwards, LCSW 5
6 ACUTE CHRONIC COMPLEX Presented by C. Lynne Edwards, LCSW 6
7 Multiple, chronic and prolonged, developmentally adverse events Often of an interpersonal nature with early life onset Effects are cumulative Toxic stress Presented by C. Lynne Edwards, LCSW 7
8 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 Presented by C. Lynne Edwards, LCSW 8
9 Description: National study of 1700 individuals exposed as children to child abuse, domestic violence and other traumatic stressors Results: There is a direct correlation between adverse childhood experiences and short and long term health and social problems social, emotional and cognitive impairment higher risks for medical conditions (heart disease, severe obesity, COPD) higher risk for substance abuse, depression and suicide attempts Presented by C. Lynne Edwards, LCSW 9
10 Trauma impacts how brain functions Neurological pathways or patterns that begin to form are based on what infants SEE, HEAR, TOUCH, SMELL and FEEL Your first set of associations becomes your template Presented by C. Lynne Edwards, LCSW 10
11 Physical sensations such a rapid heart rate, trembling, dizziness or loss of bladder or bowel control Movement and sensation Hypersensitivity/insensitivity Coordination, balance and body tone Unexplained physical symptom Increased medical problems Presented by C. Lynne Edwards, LCSW 11
12 Difficulty knowing and describing their feelings Brain can t shift from feeling to thinking State dependent responses to experiences Communication impaired Presented by C. Lynne Edwards, LCSW 12
13 Focusing on and completing tasks Anticipating and planning for future events Absence of cause and effect thinking Range of learning difficulties Adaptive development impaired Presented by C. Lynne Edwards, LCSW 13
14 Children s behavior is state dependent-fear driven It s a message-an indication of an unmet, underlying emotional need Interventions require the use of relational rather than confrontational approaches Behavior problem is a relationship problem Presented by C. Lynne Edwards, LCSW 14
15 The younger the trauma, the more likely to use dissociation, rather than the flight or flee response Babies can t do either Presented by C. Lynne Edwards, LCSW 15
16 Lack cognitive memory of events Memory of trauma stored in the senses, the body State dependent memory Presented by C. Lynne Edwards, LCSW 16
17 Rooted in biology Mutual psychological process Learned after birth Presented by C. Lynne Edwards, LCSW 17
18 Trust/Need Needs Relief Relaxation Arousal Displeasure Gratification: eye contact touch movement feeding smile Presented by C. Lynne Edwards, LCSW 18
19 Initiating Positive Interactions Parent Initiates Positive Interaction Gratification Parent Responds Gratification Child Responds Presented by C. Lynne Edwards, LCSW 19
20 N Nurturing E Engagement C Challenge S Structure Presented by C. Lynne Edwards, LCSW 20
21 Presented by C. Lynne Edwards, LCSW 21
22 Lack of a continuous, predictable sense of self World is not a safe place to be I m a bad child; everything bad is my fault People who love you, hurt you and/or abandon you My feelings don t matter No one listens Presented by C. Lynne Edwards, LCSW 22
23 high risk behaviors Flight Fight Freeze Suppresses the child s voice Barriers to intimacy FEAR Alters brain chemistry Stops Empathy Shuts off cortex Presented by C. Lynne Edwards, LCSW 23
24 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 Presented by C. Lynne Edwards, LCSW 24
25 Sensory issues-sensitive to touch, loud noises, Delayed adaptive development Regulation of emotions-their brains can not shift from their emotions to their thought processes Pull/Push-come close, now go away; afraid of getting close High risk behaviors Presented by C. Lynne Edwards, LCSW 25
26 Children s learned developmental coping strategies can be a challenge for caregivers Presented by C. Lynne Edwards, LCSW 26
27 Pervasive feelings-fear and anxiety Core issues-grief, loss, rejection, attachment, control, guilt, identity Internalized beliefs-i m a bad person/parent, I can t trust adults, the world is not a safe place to be, etc. Control issues Delayed adaptive development Regulation of emotions High risk behaviors Presented by C. Lynne Edwards, LCSW 27
28 PLUS: Parents ability to make appropriate judgments about safety is compromised Trauma reminders presented in children s behaviors trigger extreme reactions. Tendency for parents to personalize their children s negative behavior which challenge attachment and can lead to ineffective or inappropriate discipline. Presented by C. Lynne Edwards, LCSW 28
29 Parents capacity to regulate their emotions is impaired. Parent s executive functioning is impaired which results in poor decision-making, problem solving or planning. Parent is more vulnerable to other life stressors. It s hard for them to form and maintain secure, trusting relationships Presented by C. Lynne Edwards, LCSW 29
30 Things, events, situations, places, sensations and even people connected with a traumatic event can trigger traumatic stress Being confused or mistaken about details Avoiding talk about anything remotely related to the traumatic event Withdrawal from ordinary activities to avoid being confronted by trauma reminders Presented by C. Lynne Edwards, LCSW 30
31 Those same developmental coping strategies learned as children become their pattern of behavior as parents and our challenges as change agents. Presented by C. Lynne Edwards, LCSW 31
32 IMPLICATIONS & STRATEGIES FOR PRACTICE Handout: DOMAINS OF IMPAIRMENT Presented by C. Lynne Edwards, LCSW 32
33 Trauma is the rule, not the exception Presented by C. Lynne Edwards, LCSW 33
34 Manipulation Triangulation Aggression Control Resistance Presented by C. Lynne Edwards, LCSW 34
35 Presented by C. Lynne Edwards, LCSW 35
36 Presented by C. Lynne Edwards, LCSW 36
37 Create a Trauma Informed Healing Environment Presented by C. Lynne Edwards, LCSW 37
38 Presented by C. Lynne Edwards, LCSW 38
39 Applying the trauma lens to everyday practice and weaving the trauma perspective into what workers already do Takes into consideration developmental levels and reflects sensitivity to family, culture and language Achieves the goals of safety, permanency and well-being Implementation does not require more time, but rather a redirection of time. Presented by C. Lynne Edwards, LCSW 39
40 Safety Self-regulation Self-reflective information processing Integration of traumatic experiences Relational engagement Positive affect enhancement Presented by C. Lynne Edwards, LCSW 40
41 Presented by C. Lynne Edwards, LCSW 41
42 Presented by C. Lynne Edwards, LCSW 42
43 Presented by C. Lynne Edwards, LCSW 43
44 Ability to recognize and acknowledge and manage the feelings that go along with challenging situations. Feeling hopeful and confident Connected to a positive role model/mentor Ability to take action in the midst of difficult events and feelings Presented by C. Lynne Edwards, LCSW 44
45 Presented by C. Lynne Edwards, LCSW 45
46 Presented by C. Lynne Edwards, LCSW 46
47 Presented by C. Lynne Edwards, LCSW 47
48 Presented by C. Lynne Edwards, LCSW 48
49 HANDOUT: MOVING FROM PROBLEM FOCUSED TO SOLUTION FOCUSED Presented by C. Lynne Edwards, LCSW 49
50 $$$, access to resources, building relationships The willingness and ability to accept help Problem solving skills Presented by C. Lynne Edwards, LCSW 50
51 One on One Within the family, and community Presented by C. Lynne Edwards, LCSW 51
52 The Rock - A person(s) who will remain in your life during the difficult times and continue to love you unconditionally. The Wise - A person(s) who will always tell the truth even when it is not what you want to hear. The Learner A person(s) who will learn alongside of you. The Helping Hand - A person(s) who understands and is aware when you may need a break and steps in to assist. Advocate - A person(s) who will always stand up for you and continue to support you. HANDOUT: CIRCLE OF SUPPORT Presented by C. Lynne Edwards, LCSW 52
53 Building resiliency Presented by C. Lynne Edwards, LCSW 53
54 Managing strong emotions Developing/maintaining a strong relationship with at least one competent, caring adult Feeling connected to a positive role model/mentor Having talents/abilities nurtured and appreciated Feeling some control over their life Learning how to get along with peers Presented by C. Lynne Edwards, LCSW 54
55 Meeting children s emotional and physical needs Engaging in positive interactions Providing structure, not control Coaching children when their challenges Being there in close proximity Presented by C. Lynne Edwards, LCSW 55
56 N Nurturing E Engagement C Challenge S Structure Presented by C. Lynne Edwards, LCSW 56
57 Presented by C. Lynne Edwards, LCSW 57
58 Presented by C. Lynne Edwards, LCSW 58
59 10% of what they read. 20% of what they hear. 30% of what they see. 50% of what they see & hear 70% of what they say & write. 90% of what they say as they do something. Presented by C. Lynne Edwards, LCSW 59
60 To know the reason for learning something and the immediate relevance to their situation To be actively engaged in the process (internal vs. external motivators) To be involved in the planning and evaluation of their instruction To be responsible for their decisions Presented by C. Lynne Edwards, LCSW 60
61 Presented by C. Lynne Edwards, LCSW 61
62 Presented by C. Lynne Edwards, LCSW 62
63 Take Care of Yourself Presented by C. Lynne Edwards, LCSW 63
64 Presented by C. Lynne Edwards, LCSW 64
65 The cumulative effect of the stress resulting from working with survivors of traumatic life events Presented by C. Lynne Edwards, LCSW 65
66 INDIVIDUAL Flight/fight/freeze Irritable/depressed/anxious Preoccupation with clients stories Intrusive thoughts/flashbacks Feeling isolated or trapped Difficulty separating personal and professional life SYSTEM Becoming stuck/rigid/punitive Crisis-driven High staff turnover Vulnerable to attacks from outside the system Presented by C. Lynne Edwards, LCSW 66
67 Authentic connections with colleagues Exceptional self-care Validation by your organization of the importance of the work you do HANDOUT: SELF-CARE INVENTORY Presented by C. Lynne Edwards, LCSW 67
68 Thank you for the sacrifices you make Thank you for making a difference in thelivies of the families you touch Thank you for helping to correct a deep imbalance in our system THANK YOU FOR YOUR SERVICE Presented by C. Lynne Edwards, LCSW 68
69 Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth National Child Traumatic Stress Network-newsletter and developed the Child Welfare Trauma Training Toolkit. nctsn.org/products/child-welfare-trauma-training-toolkit-2008 Creating Trauma-Informed Child Welfare Systems: A Guide for Administrators Guide.pdf Presented by C. Lynne Edwards, LCSW 69
70 Adverse Childhood Experiences cds.gov/ace/pyramid.htm Child Welfare Trauma Referral Tool Brain Connection Presented by C. Lynne Edwards, LCSW 70
71 National Alliance of Children s Trust Fund and Prevention On-line Protective Factors Training FRIENDS National Resource Center for Prevention Parents As Teachers Presented by C. Lynne Edwards, LCSW 71
72 Resilience Trumps Aces Trust Based Relational Interventions developed by Dr. Karyn Davis and Dr. David Cross at the TCU Institute of Child Development The Compassion fatigue workbook: Creative tools for transforming compassion fatigue and vicarious traumatization. Mathieu, F. (2012). New York and London: Routledge, Taylor & Francis Group. Presented by C. Lynne Edwards, LCSW 72
73 C. Lynne Edwards, LSCW Trauma and Attachment Therapist Consultant and Trainer What we do today can help improve others tomorrow. Presented by C. Lynne Edwards, LCSW 73
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