Trauma and Development: An Integrated Best Practice Approach

Transcription

1 Trauma and Development: An Integrated Best Practice Approach ATTACH Conference- September 27, 2015 Kathy Ryan, Ph.D., LCSW Clinical Coordinator, Circle Preschool Program, GRSCAN, Richmond, VA Denise Powers, M.Ed. Early Childhood Specialist, Circle Preschool Program, GRSCAN Shelly Lane, Ph.D., OTR, FAOTA Faculty of Health and Medicine Department of Occupational Therapy Newcastle University, Callaghan, NSW, Australia

2 Workshop Objectives Participants will explain the impact of developmental trauma on function within the relational, regulatory, and cognitive domains. Participants will list 5 essential treatment techniques to support healing in a child who has experienced developmental trauma. Participants will create a treatment plan for a young child who has experienced developmental trauma.

3 And Who Are You?

4 Circle Preschool Program GRSCAN (Stop Child Abuse Now) Richmond, VA Therapeutic Classroom within a typical preschool setting 3-5 year olds; trauma backgrounds + unsuccessful adaptation to typical settings Provision of therapeutic, play- based, educational milieu, psychotherapy, occupational therapy Family/ Caregiver therapy group and individual Goal- To transition into typical setting and healing from trauma Length of stay- dependent on need or age

5 Typical Development

6 Development is a neuro- biologic process v Epigenetics & Genetics v Brain says Survival is key! v Organization & functional capacity of brain is hierarchical & sequential v Use dependent development v State based dependency

7 Brain is Use Dependent The brain changes in response to specific patterns of activation (experience )

8 Sensation as Nourishment Essential for brain functioning A starting place for the development of adaptive environmental interactions Critical for Attachment and social relationships Arousal regulation Organization of action

9 Emphasis: body centered sensory systems Vestibular

10 Sensory intake and processing Sensory intake: Receptors Organization of sensation: brain structures Brain hierarchy Lays a foundation for regulation of alertness and emotions Results in production of an adaptive response

11 Sensory Modulation Ability to grade behavioral responses in relation to intensity, complexity, or novelty of sensation When modulation is working well, child can automatically Filter out non- relevant stimuli Notice relevant stimuli

12 The State of the BRAIN Function is STATE Dependent From calm to alert to alarm to fearful to terror. With increasing level of arousal, the primary area of neural activity shifts to lower levels within the brain

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14 Sensitive periods of Development Experience can change the mature brain, but experience during the critical periods of early childhood organizes brain systems. Perry, 2006

15 Trauma

16 Trauma is Experiences which are overwhelming, and over stimulating - - more than a person can cope with at the time. Physical abuse, sexual abuse, emotional abuse (relational), domestic violence, chronic neglect Severe disasters, witnessing violence

17 Healthy Development vs. Developmental Trauma What Children Need: Dependent on predictable consistent nurturing attention Secure attachment patterns Fewer primary caregivers Co- regulation is needed à independence What children experience: Primary caregivers abuse Repeated abuse from adults Highly aroused, negative environments Domestic violence Severe Neglect Insufficient nurturing

18 Symptoms of Trauma Guilt & Shame Alcohol & substance abuse Relational difficulties Abstract thought Concrete Thought Affiliation/reward "Attachment" Sexual Behavior Emotional Reactivity Motor Regulation Depressive and Affective symptoms DA NE SER "Arousal" Appetite/Satiety Sleep Trauma Core symptoms Blood Pressure Heart Rate All rights reserved Bruce D. Perry and The ChildTrauma Academy ANS - body Body Temperature

19 Trauma: Will symptoms develop? Genetic vulnerabilities and gifts Age at which trauma occurred Nature of the trauma Pattern of the trauma Style of adaptation Relational supports Therapeutic experiences Bruce D Perry

20 When Children Are: Caregivers tend to feel Worried Anxious Aroused and Reactive Alone & Helpless Hopeless RESULTING IMPACT ON CHILD?

21 5 min.

22 4 yr. old Michael

23 M s Functional Domains

24 Trauma- informed Interventions: An Integrated Approach

25 Treatment Goals & Interventions Regulate Relate then Reason Perry, 2010

26 Respond to the developmental age

27 Quality Relationships- Essential, YET With Complex Trauma: people are perceived as dangerous, until PROVEN otherwise.. Even then by the nature of interventions. you may be perceived as a threat

28 Play- The Language of children Child has an intrinsic motivation to play Starts with child s strengths and interests Aids in developing positive therapeutic alliance

29 Co- Regulation with Sensory- Motor Materials Bubbles in Jar Sand in Sensory Bin Basket of Weights to Pull Quiet Space, Bean Bags, Balls Weighted Super Hero Vest

30 Reduce sensory overload from the environment; provide a safe place Lane, 2014

31 The 1 st Step. RESPONSIVITY Noah Soft Voice VALIDATE Gentle Tone Kind Face

32 Healthy Attachment Responses + Regulation Adult Helps Child to Regulate Child s Trauma is Triggered Child Begins to Self- Regulate with Adult s Coaching

33 Self- Esteem in the beginning.. YOU ARE

34 After a Positive Relational Climate. I am an artist

35 Cognitive Development emerges when. Relationships with Safe Adults Co-Regulation Successful Interactions and Experiences Embedded Learning

36 Michael age 4 Strengths Vivacious greetings Outgoing, highly social Gross motor skills; sports Long term memory Empathetic to other s physical pain Stable home Challenges Interactions shallow Play skills Hungry - hoards food, normal wt. Severe ADHD, anxiety Changes à anxiety Fear of being left out Easily aroused - Hard to down regulate Loud, aggressive verbally & physically

37 Provide continual sensory motor opportunities

38 TRAUMA TREATMENT- Setting a Positive Relational Climate Following Interests to Represent the World Series and Concession Stand

39 Interventions with Michael Individual Proprioceptive, vestibular, tactile: Gum, Play Dough Therapy ball Rhythmic activity Regulatory walks with staff Auditory: Quiet, non- reactive voices (adults) Rhythmic beats/music Predictable Change; Repetition Milieu and Play therapy Therapeutic holds with rocking and soothing Family Parent psycho- educational Impact of trauma Sensory Integration & Regulation tools Family change is gradual process Ongoing need strong relationship based interactions appreciation for severity of illness Family acquired new language and experienced a paradigm shift in caregiving

40 Trauma informed Interdisciplinary Interventions Education Mental Health Occupational Therapy 1. Interest/ strength- based 2. Regulation 3. Relational safety 4. Play- based 5. Embedded learning

41 Questions and Your Case Examples

42 Take Away Messages Early trauma à neurodevelopmental impact à functional consequences (regulation, relationships, cognition) HEALING from predictable, consistent, repeated, positive experiences Safe relationally Safe physically- Sensory- Motor interventions, Play- based, then Cognitive Regulate Relate Reason

43 STATE LEVEL and BRAIN FUNCTION

44 Responsive Teachable Moments Everyone wants to be heard: LISTEN to the child WAIT until the child LISTENS to YOU LISTEN to EACH CHILD in the GROUP BRIDGE the GROUP S IDEAS Go meet sensory needs and try again DEFUSING THE FIGHT

45 Trauma informed- Therapeutic Interventions Child Care- givers School Community

46 CPP does make a difference Even when healing continues. Of the 22 children who have attended Circle Preschool for over 3 months in the past 3 years. 17 have entered typical kindergarten rooms with some special supports 2 have left precipitously 3 have required special ed classroom 20 have required ongoing support to caregivers / child therapy Overall- caregivers give positive feedback- especially in noting the increased play skills and regulation skills children are demonstrating.

47 Symptoms of Trauma Changes in resting heart rates Chronic health problems, breathing issues, eating issues, sleep difficulties Arousal/ Dissociative Issues Clumsiness, motor delays Emotional reactivity, attachment difficulties Social skill issues lack of empathy Impulsivity, distractibility, Cognitive delays uneven cognitive picture Limited play skills perseveration poor problem solving

48 Trauma- informed Interdisciplinary Contributions Mental Health Therapy with regulation & relational focus Family therapy Occupational Therapy Trauma sensitive- relationships Sensory Integration increasing regulation Education Trauma sensitive relationships Multiple regulation opportunities Strength- based learning

49 Sensation as a Tool Relationships Sensory integration and processing Trauma informed care

50 Regulating arousal Deep pressure and proprioception Vestibular Rhythmic, repetitive inputs