Assessing Trauma in Children and Adolescents University of Wisconsin-Madison Conference on Child Sexual Abuse, Oct. 31-Nov 2, 2016 Geraldine Crisci, M.S.W. Geraldine Crisci, 2016 The information being presented in this workshop is copywritten and is intended for instructional use by the participants of this workshop only. Reproduction and distribution of this material is strictly prohibited. This information cannot be distributed electronically, or duplicated in any fashion without written permission of the authors. Geraldine Crisci, M.S.W. gcrisci@ckmconsultation.com 55 Eglinton Avenue East Suite 506 Toronto, Ontario M4G 1P4 What are we assessing? What is the focus of the assessment? 1
Has Trauma Occurred? Victimization vs Traumatization How event is experienced What it means to child It is traumatizing at this specific time in a child s life Trauma Principle #1 If everything is trauma, nothing is trauma. The National Child Traumatic Stress Network 2
Trauma Principle #2 It is the child s experience of the event, not the event itself, that is traumatizing. The National Child Traumatic Stress Network Trauma Principle #3 If we don t look for or acknowledge trauma in the lives of children and adolescents, we end up chasing behaviors and limiting the possibilities for change. The National Child Traumatic Stress Network Trauma Principle #4 The behavioral and emotional adaptations that maltreated children make in order to survive are brilliant, creative solutions, and are personally costly. The National Child Traumatic Stress Network 3
How do you determine whether or not trauma has been experienced? Components of a Comprehensive Trauma Assessment 1. Symptoms Components of a Comprehensive Trauma Assessment 2. Perceived Sense of Responsibility 4
Components of a Comprehensive Trauma Assessment 3. Developmental Disruption Components of a Comprehensive Trauma Assessment 4. Sensorial Reminders How does the Symptom function to protect the child? 5
Interview component 1. Symptom Exercises Example Symptom Exercise Symptom I have nightmares I have headaches I have stomach-aches I have back-aches I worry I get sad I get scared I have feelings I don t like I have thoughts I don t like How often is it a problem 6
Youth Symptom Checklist Symptom Checklist: Check any of the items that seem to fit for you: Coping Behaviors Yes No How Often? When? Forgetting about the abuse Act as though the abuse didn t affect you Imagine yourself somewhere else (not in your body) Use drugs or alcohol to block out the pain Difficulty concentrating Problems at school/work Crisci 2016 Symptom Checklist: Check any of the items that seem to fit for you: Coping Behaviors Yes No Getting into trouble with the police Feel like running away Experience extreme shifts in moods and emotions Try to or want to hurt yourself How Often? When? Feel as if you re going crazy Feel confused about your sexuality Crisci 2016 7
Symptom Checklist: Check any of the items that seem to fit for you: Coping Behaviors Yes No Have problems with intimacy Feel ashamed much of the time Thinking about killing yourself Suicide attempts How Often? When? Becoming/being sexually active Poor relationships with friends Poor relationships with family Crisci 2016 Symptom Checklist: Check any of the items that seem to fit for you: Coping Behaviors Yes No Having difficulty trusting others Angry or hostile Poor self-confidence Sadness or depression How Often? When? Feel guilty Feel fearful Feel like you lost your childhood Crisci 2016 Symptom Checklist: Check any of the items that seem to fit for you: Coping Behaviors Yes No Have identity problems Have problems with dating/intimate relationships Stay super alert Avoid situations because they remind you of the abuse How Often? When? Other Crisci 2014 8
Component 2. Responsibility Identification of responsibility or self-blame issues is essential to preventing the development of self-destructive behaviours Draw a picture scene of event Why did this happen? Why was I chosen? Could someone have helped????? 9
Triangle of responsibility Child A very complex concept A 6 sided relationship Child s Support System Offender Component 3. Developmental Disruption Does the child present as chronologically on track? Social skills/peer relationships Management of emotions Relationship to caregivers School performance 10
Component 4. Sensorial Reminders Sensorial : What do your eyes remember about the event? Sensorial: What do your ears remember about the event? 11
Sensorial: Are there smells that remind you of what happened? Sensorial: Are there things you taste that remind you of what happened? Sensorial: Are there things you touch that sometimes remind you of what happened? 12
Sensorial: What else does your body remember about the event? Sensorial: What did you see? Sensorial: What was said? 13
Sensorial How did your head feel? How did your throat feel? How did your heart feel? How did your stomach feel? Sensorial: How often do you think about these things? (on a scale of one to ten) 1 2 3 4 5 6 7 8 9 10 Not at all All the time References Arnold, Cheryl, PhD, Ralph Fisch, PhD. (2011). The Impact of Complex Trauma on Development. Jason Aronson:Toronto-New York. Finkelhor, David. (2004). The victimization of children: A developmental perspective. American Journal of Orthopsychiatry, Vol 65(2), Apr 1995, 177-193. doi:10.1037/h0079618 Heller, Laurence, PhD, Aline LaPierre, PsyD. (2012). Healing Developmental Trauma: How early Trauma Affects Self-Regulation, Self Image, and the Capacity for Relationships. North Atlantic Books-California. Hindman, Jan. (1989). Just Before Dawn From the Shadows of Tradition to New Reflexions in Trauma Assessment and Treatment of Sexual Victims. Aleandria Associates, The University of Virginia. Paris Goodyear-Brown, Ed. (2012). Handbook of Child Sexual Abuse: Identification, Assessment and Treatment. Section 11, Chapters 4, 5, 6. Wiley. Perry, B.D. (2010). Aggression and Violence: the Neurobiology of Experience. Retrieved from: http://teacher.scholastic.com/professional/bruceperry/aggression_violence.htm on June 15, 2010 Perry, Bruce. D., M.D., Ph. D., and Szalavitz, Maia. (2006). The Boy Who Was Raised As A Dog and Other Stories from a Child Psychiatrist s Notebook. Perseus Book Group: Philadelphia. Van der Kolk, Bessel. M.D. (2014). The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. Viking Adult. 14
Geraldine Crisci, M.S.W. Geraldine Crisci, M.S.W. 55 Eglinton Avenue East, Suite 506 Toronto Ontario Canada M4P 1G8 gcrisci@ckmconsultation.com (416) 483-8118 Geraldine Crisci, M.S.W. 2016 Disclaimer/Copyright Information: The information being presented in this workshop is copy written and is intended for instructional use by the participants of this workshop only. Reproduction and distribution of this material is strictly prohibited. This information cannot be distributed electronically, or duplicated in any fashion without written permission of the authors. 15