Anything that interferes with the attachment relationship of a child is experienced as traumatic and affects development

Transcription

1 The basis of normal human development is attachment Anything that interferes with the attachment relationship of a child is experienced as traumatic and affects development Traumatic experience at any time disrupts attachment Disrupted attachment can interfere with every human capacity and that interference looks different in different people Sandra L. Bloom, M.D.,

2 Positive stress Adverse experiences that are short lived Normal and part of developmental processes Tolerable stress More intense but relatively short lived With adequate support, unlikely to cause long term problems Toxic stress Sustained adversity Children unable to manage this by themselves and can lead to permanent changes in brain development Impairs connection of brain circuits and in extreme cases, results in smaller brain development May cause development of low threshold for stress, resulting in overreactivity (chronic hyperarousal) High levels of stress hormones, including cortisol, can suppress body s immune response Sustained high levels of cortisol can damage the hippocampus, responsible for learning and memory. Cognitive deficits can continue into adulthood. Sandra L. Bloom, M.D.,

3 Physical problems Existential problems Emotional problems Learning problems Social problems Sandra L. Bloom, M.D.,

4 Largest study of its kind ever (almost 18,000 participants) Examined the health and social effects of adverse childhood experiences over the lifespan Majority of participants were 50 or older (62%), were white (77%) and had attended college (72%). CHILDHOOD ADVERSITY BY CATEGORIES (18 years or younger) Abuse Psychological (by parents) Physical (by parents) Sexual (anyone) Emotional neglect Physical neglect Household Substance Abuse Mental Illness Parental separation/divorce Mother Treated Violently Imprisoned Household Member Sandra L. Bloom, M.D.,

5 ACE Study Strong, graded relation to childhood adversity Sandra L. Bloom, M.D.,

6 Detroit, Chicago, Los Angeles, and New Orleans suggest that about a quarter of youth surveyed have witnessed someone shot and or killed during their lifetime (Bell & Jenkins, 1993; Jenkins & Thompson, 1986; Osofsky, Wewer, Hann, & Fick, 1993; Pynoos, 1985; Schubiner, Scott, & Tzelepis, 1993). Children at pediatric clinic in Boston: 1 out of every Children at pediatric clinic in Boston: 1 out of every 10 children witnessed a shooting or stabbing before the age of 6 (Groves, Zuckerman, Marans, & Cohen, 1993). Sandra L. Bloom, M.D.,

7 Computer Microchips Hard Drive Monitor Input Devices Motherboard! Human DNA Proteins Cells Organs Brain Body A master program that controls a computer's basic functions and allows other programs to run on a computer if they are compatible with that operating system. Sandra L. Bloom, M.D.,

8 Computer Foundation or Operating System (Windows, MacOS, Linux, Unix, etc) Human Foundation or Operating System Applications (Word, Powerpoint, Excel, Outlook, etc) Applications (Memory, Language, Voluntary Movements, etc) Sandra L. Bloom, M.D.,

9 HARDWARE Operating System APPLICATION SOFTWARE MIND Sandra L. Bloom, M.D.,

10 Internalizes both sides learns caregiving gwhile receiving care. Affective and cognitive components Model determines what info is attended to, which memories are evoked, what behavior to employ Sandra L. Bloom, M.D.,

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12 How to care for self and others How to manage emotions How to behave What should be expected or anticipated What to remember and what to forget Sandra L. Bloom, M.D.,

13 AN INFORMAL SURVEY: Out of 350 people working in social services Psychological abuse (Parents) 37% Physical abuse (parents) 29% Sexually abused 25% Emotional neglect 35% Physical neglect 12% Substance abuser in household 40% Separated from one/both parents 41% Witnessed DV 21% Imprisoned household member 10% Sandra L. Bloom, M.D.,

14 Organizations, like individuals, are living, complex, adaptive systems and that being alive, they are vulnerable to stress, particularly chronic and repetitive stress. Organizations, like individuals, can be traumatized and the result of traumatic experience can be as devastating for organizations as it is for individuals. Feelings Behaviors Thoughts Sandra L. Bloom, M.D.,

15 Feel unsafe Angry/aggressive Helpless Hopeless Hyperaroused Fragmented Overwhelmed Confused Depressed Feel unsafe Angry/aggressive Helpless Hopeless Hyperaroused Fragmented Overwhelmed Confused Demoralized Is unsafe Punitive Stuck Missionless Crisis Driven Fragmented Overwhelmed Valueless Directionless Sandra L. Bloom, M.D.,

16 Around the world a full 70% of change efforts in companies fil fail How many change efforts directed at the children, adults, families will fail? Change efforts are usually based on social engineering Surfing the Edge of Chaos Pascale, Millemann, Gioja, p.6 Living Systems isn t a metaphor for how humaninstitutionsoperate operate. It s the way it is. Sandra L. Bloom, M.D.,

17 Respond to the needs of injured children and adults Become sensitive to the reality of terrible experience in the lives of most people Become sensitive to the ways trauma has affected entire groups Become sensitive to the ways in which trauma impacts organizations and entire systems From diverse backgrounds With a wide variety of experiences On the same page Speaking the same language Sharing a consistent, coherent and practical theoretical framework Sandra L. Bloom, M.D.,

18 Is it possible to transform organizational culture? Can a transformed organizational culture createa a parallel process ofrecovery? The Sanctuary Model of Organizational Change Sandra L. Bloom, M.D.,

19 Approaches that already are improving the odds of recovery should be kept Approaches that do more harm than good should be eliminated New approaches are needed People support what they help to create Theory based Trauma informed Whole culture approach Evidence supported Clear and structured methodology Sandra L. Bloom, M.D.,

20 Treatment Classification System 1. Well supported, efficacious treatment 2. Supported and probably efficacious treatment 3. Supported and acceptable treatment 4. Promising i and acceptable tbl treatment t t 5. Novel and experimental treatment 6. Concerning treatment. Sandra L. Bloom, M.D.,

21 Decreased verbal aggression (significant trend) Imagine that you re in line for a drink of water. Someone your age comes along and pushes you out of line. What would you do?; You see your friend fighting with another person your age. What would you do? Increased internal locus of control (significant trend): Are you often blamed for things that just aren t your fault?; Do you believe that whether or not people like you depends on how you act? Decreased incendiary communication and increased tension management (significant difference): (..Get angry and yell at people?.. Blame others for what s going wrong?.) Significant differences in: Support: how much clients help and support each other; how supportive staff is toward clients Spontaneity: how much the program encourages the open expression of feelings by clients and staff Autonomy: How self sufficient sufficient and independentclients are in making their own decisions Personal Problem Orientation: the extent to which clients seek to understand their feelings and personal problems Sandra L. Bloom, M.D.,

22 Significant differences in: Safety: The extent to which staff feel they: can challenge their peers and supervisors can express opinions in staff meetings will not be blamed for problems have clear guidelines for dealing with clients who are aggressive. Present Research Projects Andrus Implementation Study Office of Children and Family Services, NY SUNY, Stonybrook Department of Public Welfare, PA University of Pittsburgh Sandra L. Bloom, M.D.,

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24 Assessment Psychoeducation Treatment planning Emergent situations Problem solving Evaluating progress Managing change Sandra L. Bloom, M.D.,