Resiliency and Recovery Post-Trauma Texas Children s Health Plan CME November 18, 2017 Megan Mooney, Ph.D. Assistant Professor, Baylor College of Medicine Training Coordinator, Trauma and Grief Center at Texas Children s Hospital
Trauma and Grief (TAG) Center for Youth Part of the National Child Traumatic Stress Network Primary Goals: Adapt, implement, and evaluate evidence-based treatments for traumatized and/or grieving youth, including Trauma and Grief Component Therapy (Saltzman et al., in press) Provide training in best practices for grieving youth, including bereavement-informed assessment and intervention Essential first steps: Theory: What does adaptive/maladaptive grief look like in children? How does grief differ from PTSD? Assessment: How do we accurately measure grief in children? Empirical Research: Can our research help to identify important therapeutically modifiable risk and protective factors? 2017 Julie B. Kaplow, Ph.D.
What is Trauma?? A trauma is an exceptional experience in which powerful and dangerous events overwhelm the person s capacity to cope. - Child Witness to Violence Project Acute Trauma Chronic Trauma car accident domestic violence natural disaster death in the family child abuse and neglect chronic illness terrorist act poverty community violence imprisoned parent 2017 Megan A. Mooney, Ph.D.
The Impact of Trauma Depends on many factors such as... The child Age Developmental Stage Temperament History of emotional problems The social environment Availability of primary care givers to help Level of family stress and coping ability Presence of family routine and stability Availability of social supports in the community The type of event Acute vs. Chronic Intensity of the trauma Proximity of the child to the traumatic event Loss or injury of primary caregiver Extent of physical injury to the child Relationship to perpetrator 2017 Megan A. Mooney, Ph.D.
Recognizing Signs of Traumatic Stress Regression in developmental milestones or skills Fear and worry about the safety of self, family, friends Anxiety related to future possible trauma Increased activity level Decreased concentration and attention Increased irritability Changes in sleep or appetite Withdrawal Angry outbursts Aggression Aches and pains Decline in grades Problems with peers Substance abuse, dangerous behaviors, unhealthy sexual behaviors 2017 Megan A. Mooney, Ph.D.
Hidden Impacts of Trauma Impact of trauma on the Brain: The traumatized brain learns : To be hyper-alert To stay in fight or flight mode To be anxious and afraid To neglect higher level thinking and problem solving Functional and Structural Changes: Decreased size in areas of Corpus Callosum in children with PTSD Significant memory impairments Generally negative impacts in areas of the brain related to executive functioning, emotional regulation, and the ability to remember/learn from your mistakes 2017 Megan A. Mooney, Ph.D.
Attachment Hidden Impacts of Trauma Communication between mothers and infants is organized around the face, voice, gesture, and gaze Secure attachment and communication directly influence and are influenced by brain development Inconsistent care or neglect can lead to insecure attachments Loss of caregiver can lead to anxiety about safety in future relationships Abuse may make a child wary of all future relationships Poor attachment related to later severe symptoms such as dissociation 2017 Megan A. Mooney, Ph.D.
Hidden Impacts of Trauma Social & Emotional Deficits Lower social competence Less empathy for others Difficulty recognizing others emotions Difficulty recognizing their own emotional states 2017 Megan A. Mooney, Ph.D.
What is Bereavement? Grief? Bereavement = the experience of deprivation or loss by death Grief = psychological or behavioral response arising from bereavement 2017 Julie B. Kaplow, Ph.D.
2017 Julie B. Kaplow, Ph.D. Bereavement exerts the strongest effect on school outcomes (school grades, school drop-out, connectedness) above and beyond any other form of trauma (including physical abuse, sexual abuse, witnessing violence). - Oosterhoff, Kaplow, & Layne (under review). Death of a loved one identified as most common and most distressing form of trauma among adults and youth in general population (Breslau et al., 2004; Kaplow, Saunders, Angold, & Costello, 2010).
How Do Children Typically Respond to the Loss of a Loved One? Typical grief reactions hard to define Very few large studies of bereaved children even fewer studies of bereaved children followed over time and even fewer have targeted underserved minority youth Grief reactions influenced by: developmental level previous life experiences relationship to deceased culture religious/spiritual beliefs family social environment circumstances of death 2017 Julie B. Kaplow, Ph.D.
Which Youth are Most At Risk? Previous experience of death of a loved one History of trauma Injury (themselves or a loved one) Property damage Separated from caregivers at any point Forced to move (new home, school, etc.) Lack of social support (e.g., lack of available caregivers) Financial difficulties prior to or as a result of the event History of developmental, cognitive, or social delays Physical or medical impairments LGBTQ youth Racial and ethnic minorities 2017 Julie B. Kaplow, Ph.D.
What to do to help kids after a trauma or loss? 2017 Megan A. Mooney, Ph.D.
Provide safety First... Be prepared to answer questions about safety plans Be prepared for fear or sadness when there is a reminder about the event (e.g. start of hurricane season) Let kids know that they can talk to you if/when needed 2017 Megan A. Mooney, Ph.D.
Provide structure & routine Stick to normal daily schedules for activities, school, dinner time, etc. Be able to be flexible within this for specific children if needed 2017 Megan A. Mooney, Ph.D.
Be consistent Keep to rules and consequences set up clear expectations as you usually would. Be flexible and understanding as needed 2017 Megan A. Mooney, Ph.D.
You Can t Know (or Do) Everything Have good lists of resources at hand (e.g. CYS guide) Have bookmarked websites and guides childrenatrisk.org/hurricane-harvey/ www.nctsn.org Know who your resource personnel are Kinds of information kids may be wondering about: Shelter Food/Water Clothes Utilities Transportation Missing loved ones (including pets) 2017 Megan A. Mooney, Ph.D.
Most children are naturally resilient and with appropriate supports in place may not need professional services after a trauma or loss 2017 Megan A. Mooney, Ph.D.
When Does A Child Need More? Behaviors continue for more than six weeks following the event Behaviors interfere with functioning in any major life domain (school, home, with peers) Developmental regressions Extreme signs of depression (tearful, not able to get out of bed in the morning) Any gesture related to self-harm or mention of suicidal ideation Signs of possible PTSD: - Reexperiencing (feeling like it s happening all over again) - Avoidance (not wanting to think about or talk about it) - Negative cognitions/mood (persistent anger or guilt) - Arousal and reactivity (exaggerated startle); in adolescents, this can include reckless or self-destructive behavior 2017 Julie B. Kaplow, Ph.D.
What Kind of Support is Needed? For Which Kids? And When? 2017 Julie B. Kaplow, Ph.D.
Tiered Mental Health Service Delivery Model Post-Disaster Individual Treatment Intermediate Group Treatment FORMAL THERAPY WITH INDIVIDUALS IDENTIFED AS HAVING MORE SEVERE SYMPTOMS PRACTICAL HELP AND EDUCATION FOR ALL INDIVIDUALS EXPOSED TO TRAUMATIC EVENT Intermediate Resiliency Education Immediate Practical Help Adapted from: Mercy, Project Fleur-de-lis, Doug Walker, PhD and Laura Danna, LCSW
Tiered Model of Care For Children & Adolescents Individual Trauma-informed Treatment Trauma and Grief Component Therapy (TGCT) > 3 MONTHS > 3 MONTHS Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) Skills for Psychological Recovery (SPR) Psychological First Aid (PFA) > 3 WEEKS IMMEDIATE Adapted from: Mercy, Project Fleur-de-lis, Doug Walker, PhD and Laura Danna, LCSW
How our TAG Center is Helping after Harvey Disseminating resources for caregivers/teachers through trainings and website/blog (texaschildrens.org) Developed and now piloting a screening tool to use across schools/clinics Training in trauma-informed assessment competencies Completed a Learning Collaborative:Trauma and Grief Component Therapy Provide ongoing evidence-based assessment and intervention through our Harvey Resiliency and Recovery Clinic over the long-term
Contact Information Megan A. Mooney, Ph.D., Assistant Professor, Trauma and Grief Center for Youth Baylor College of Medicine/Texas Children s Hospital www.texaschildrens.org/departments/trauma-and-grief-center mooney@bcm.edu 832.822.4910