WHY IS IT SO HARD TO MOVE ON? The impact of trauma on transition aged youth The world breaks everyone, and afterward, some are strong in broken places. -Ernest Hemingway Cindy Berry, PsyD, University of Illinois Chicago, Chicago, IL Allison Elias, L.C.S.W., Thresholds, Chicago, IL
Trauma versus Complex Trauma Complex trauma multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (eg. sexual or physical abuse, war, community violence) and early life onset. Bessel A. van der Kolk
Trauma and the Brain "Our brains are sculpted by our early experiences. Maltreatment is a chisel that shapes a brain to contend with strife, but at the cost of deep, enduring wounds." --Teicher, 2000, p. 67
Neurobiology of Trauma Arousal State Calm Arousal Alarm Fear Terror Primary Brain Area Neocortex Subcortex Limbic Midbrain Brainstem Cognition Abstract Concrete Emotional Reactive Reflexive Adaptive Response Rest Vigilance Freeze Flight Fight Hyperarousal Continuum Rest Hypervigilance Resistance Defiance (posturing) Aggression Dissociative Continuum Rest Avoidance Compliance Dissociation (numbing) Self-harm
Neurobiology of Trauma: Cognitive effects Distrust of others Overestimation or preoccupation with danger Low self esteem and selfblame Polarized thinking Control misconceptions Perspective taking Hopeless, shortened sense of future
Neurobiology of Trauma: Emotional effects Difficulty regulating (controlling) emotions Hyper vigilance Emotional Numbing Restricted range of affect Increased anxiety Intense feelings of guilt and shame
Neurobiology of Trauma: Behavioral effects Impulsive decision making/risk taking Poor interpersonal boundaries Somatic complaints Hyperactivity and distractibility Aggression
RESEARCH FINDINGS Childhood trauma correlates with multiple negative long term health outcomes.
Research Findings Sexual, Physical, & Emotional Maltreatment group significantly elevated from low maltreatment group on Youth Self Report Withdrawn Somatic Complaints Anxious/depressed Social Problems Thought Problems Attention Problems Delinquent Behavior Aggressive Behavior
Research Findings: Life Outcomes for Youth in Foster Care 1 in 5 will become homeless Only 60% will finish high school by age 19 By age 25, less than 3% will have a B.A Increased risk for jail, early pregnancy, lack of employment Disconnected from social supports
Research Findings* Area of Concern Drug use Attacked someone Ever ran away Has a biological child at age 18 (females) Do not earn diploma Consistently connected to school or work, ages 18-24 Median Annual Earnings at age 23 With Depression/Anxiety Without Depression/Anxiety 39% 41% 30% 24% 26% 27% 17% 9% 35% 43% 15% 61% $15,506 $22,875 *From US Department of Health and Human Services, 7/2009
MOVING ON Independence is not linked to the physical or intellectual capacity to care for oneself without assistance; independence is created by having assistance when and how one requires it -Brisenden, 1989
Typical Developmental Tasks of Transition Aged Youth Area of Development Cognitive Development Tasks Increased capacities for Thinking abstractly Thinking hypothetically (if X, then Y) Having insight or self-awareness Simultaneous consideration of multiple ideas Future planning Calibrating risks and rewards Regulating undue peer influence on judgment Social Development Friendships become more complex, involving mutuality, intimacy and loyalty Increased perspective taking Influence of peer relationships peak, then decline into adulthood Social context shifts from lots of daily contact with many classmates to smaller social networks and work social settings
The Transition in Crisis: What does it look like? Youth may start to decompensate Youth may blame others for their difficulties May lose a job or do worse in school
Why Do These Youth Seem To Undermine Their Success? TRANSITIONS ARE SCARY! Complex trauma exacerbates fears May be a resurgence of past symptoms Current symptoms may be magnified by transition
Trauma Symptoms through a Transitional Lens: Cognitive Effects Problems with focus and attention Problems processing new information Difficulty problem solving Difficulty with planning and anticipating Problems with working memory Failures to make wise judgments Cognitive inflexibility Difficulty inhibiting inappropriate responses
Trauma Symptoms through a Transitional Lens: Social/Emotional Effects Distrust of people, system, etc. Suspicious of others motives Uncertain of the predictability/reliability of the world Tendency towards social isolation Difficulty taking another s perspective Trouble understanding one s own contribution to what happens to them
Why Can t They Just Tell Us? These youth don t always say what they mean Don t want to show fear Afraid to need help or support May not always be aware of feelings Look at the feelings under the words!!!!
Common Ways We Try To Help Dangle a Carrot approach Contracts
Stuck at Transition: Youth are at an early stage of their development Being on their own is overwhelming Often raised in foster care/residential care Poor affect regulation and arousal
Stuck at Transition: Youth are present focused Youth grieve the loss of their childhood Lack of social supports
HOW CAN WE HELP THEM MOVE ON? Creating a Smooth Transition for Traumatized Youth
Talk about the elephant in the room Validate stress & anxiety about transitioning Identify potential fears Generate discussion around peer s transitions- successful & unsuccessful Help them grieve loss of childhood
Independence is not always the carrot When achievement parameters back fire High support still needed The team must examine its own anxiety
Build Competencies Focus on Skill Building Focus on Mastery & Strengths BE CREATIVE & DON T GIVE UP!
Seek Appropriate Treatment Refer to trauma informed therapy Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) Trauma Focused- Cognitive Behavioral Treatment Skills Training in Affect and Interpersonal Regulation (STAIR) Dialectical Behavior Therapy (DBT) Trauma Systems Therapy Attachment, Self-regulation & Competence (ARC) National Child Traumatic Stress Network http://www.nctsnet.org
Build Social Support Networks Build a sense of community Reconnect to the past: BE DETECTIVES! Support elements of healthy relationships
Help them have different endings Role model healthy termination Combat the burning of the bridge
In Time Perhaps In time perhaps My wounds will heal And my pain will no longer be numb. It will disappear. The smile that I wear upon my face will be real. My locked up dreams will slowly cut themselves free from helplessness and disappointment. -Anonymous