(Saving Private Ryan &) Saving James
Promoting Successful Futures By Addressing Child Traumatic Stress
Kristine Buffington, MSW, LISW-S
kbuffington46@hotmail.com
Acknowledgements
• Presentation based on Technical Assistance Bulletin entitled: Ten
Things Every Juvenile Court Judge Should Know About Trauma and
Delinquency. [Available from NCJFCJ or NCTSN]
• Buffington, K., Dierkhising, C. B., Marsh, S. C. (2010). Ten things every
juvenile court judge should know about trauma and delinquency. Reno,
NV: National Council of Juvenile and Family Court Judges.
• Collaborative project between NCTSN and NCJFCJ.
• Supported by funding from the Office of Juvenile Justice and
Delinquency Prevention [Grant No. 2007-JL-FX-0007 awarded to
NCJFCJ]
#1
A traumatic experience is an
event that threatens someone’s
life, safety, or well-being.
Trauma overwhelms one’s capacity to cope.
• Acute Trauma: A single
traumatic event limited in time.
• Chronic Trauma: Multiple,
consistent, or varied exposure
to traumatic events.
• Youth in JJ typically have
experienced chronic trauma.
Examples of Traumatic Events
• Child maltreatment
• Witnessing violence
• Interpersonal
victimization
• Terrorism/War
• Natural disasters
• Loss of loved ones
• Serious accidents
• Medical trauma
#2
Child traumatic stress can lead
to Post Traumatic Stress
Disorder (PTSD).
Characteristics of the event:
Characteristics of the child:
 Nature and intensity of the
event
 Child or family member’s
experience of direct harm
 Proximity to event
 Pattern and duration of the
event
 Parent’s and other’s reaction to
the event
 Exposure to the event through
media and other mechanisms
 Subjective experience of the
event
 Prior history of exposure to
trauma
 Prior psychiatric history
 Coping style
 Strengths & supports
 Family relationships
 Cultural issues
 Gender
 Age
PTSD
Avoidance
Avoiding Traumatic
Reminders
Re-experiencing
Hyperarousal
Nightmares,
Intrusive memories
“Abnormally increased
arousal, responsiveness
to stimuli, and scanning
for threats” (1)
Trauma and PTSD are prevalent in the
Juvenile Justice System
• 92% of youth incarcerated had experienced one or more traumas
(Teplin et al., 2002)
• 92% of incarcerated adolescents knew someone who had been killed;
57% saw someone being killed; 72% report being shot or shot at; 29%
report having been sexually assaulted (Wood et al., 2002)
In a study of youth in the California Youth Authority facilities, Steiner and
colleagues (1997) found:
• 32% of boys met full criteria for diagnosis of PTSD
• 49% of girls met full criteria for diagnosis of PTSD
“Rates of PTSD in juvenile justice involved youth are estimated between
3% 50% (Wolpaw & Ford, 2004) making it comparable to the PTSD
rates (12%-20%) of soldiers returning from deployment in Iraq (Roehr,
2007).” –Buffington et al. 2010
#3
Trauma impacts a child’s
development and health
throughout his or her life.
Trauma Impacts Various Domains of Child and
Adolescent Development
Biopsychosocial Impact of Trauma
• Altered Biological Stress Systems and Neural
Circuitry/Structure
• Disruptions in Attachment Behavior
• Changes in Social Development and Understanding
of Social Stimuli
Neurodevelopment:
Body’s Natural Alarm System
Danger 
 Evaluate  Respond or
Relax
Trauma changes our biology, including brain
development which can result in very welldeveloped emergency response systems in the brain
at a cost to the executive functions of our brain that
enhance learning and self-regulation…
*Buffington, Dierkhising, Marsh, 2010
Social Development
– Social Information Processing:
•Hostile attribution bias
•Larger repertoire of aggressive responses
•Aggression as an acceptable response
• The Court’s Role:
– Prevent further trauma
– Assess for trauma
– Provide interventions (treatment works!)
“It is essential for court’s and communities
to work together to prevent traumatic
events where possible (such as child
abuse and neglect) and to provide early
interventions to treat traumatic stress
before a youth becomes entrenched in a
pattern of maladaptive and problematic
behavior.”
ACE Study Findings
People with 4 or more ACEs were:
• Nearly 2 times more likely to smoke cigarettes,
or have heart disease, cancer, obesity
• 7 times more likely chronic alcoholism; engage
in sex with > 50 partners.
• 11 times more likely to engage in IV drug use
• 19 times more likely to attempt suicide
Higher Utilizers of Mental Health Study (Oregon Dept. of
Mental Health, 1999)
During a 3 year time period in the mid 1990’s a group of 69
adults used 3.1 million dollars in mental health services;
Over 90% of these adults had experienced childhood sexual
and/or physical abuse.
#4
Complex trauma is associated
with risk of delinquency.
Courtesy of Western
Types of Traumatic Stress,
cont'd
• Complex trauma describes both exposure to chronic trauma—usually
caused by adults entrusted with the child’s care—and the impact of such
exposure on the child.
• Children who experienced complex trauma have endured multiple
interpersonal traumatic events from a very young age.
• Complex trauma has profound effects on nearly every aspect of a child’s
development and functioning.
Source: Cook et al. (2005). Psychiatry Ann,35(5):390-398.
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9
Effects of Trauma Exposure on Children
When trauma is associated with the
failure of those who should be
protecting and nurturing the child, it
has profound and far-reaching effects
on nearly every aspect of the child’s
life.
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2. Trauma shapes the survivor’s basic beliefs about
identity, world view and spirituality
2. Trauma shapes the survivor’s basic beliefs
Why did this happen? (“Abuse is inevitable)
Why did this happen to me? (“It was my fault”)
What does this experience mean? (“Nothing I
do will make any difference”)
Healing involves transformation of harmful overgeneralized
negative beliefs about self, others, world, and spirituality
Julian Ford, University of Connecticut
“Post Traumatic Stress is
responding to normal stressors
and life events as if they are
threats to your survival…”
Post Traumatic Stress
Biased Perception
24
People who have experienced child traumatic
stress…
• Often distrust people in authority and see them as threats
because of being abused or harmed by adults that are
supposed to protect them…
• Abuse perpetrated by adults violates our social contract with
children
• Police, Teachers, Principals, bosses, etc…can be perceived as
threats
• So, there are some situations where using a forceful or
intimidating or authoritative manner might evoke stronger
violence or increase resistance
Responses to people in PTSD Mode
• Be aware of traumatic reminders and PTSD bias
• Work to establish a sense of safety as a way to achieve a safe
outcome for all involved
• Know when authoritarian responses are needed and when they
are not
• Help the person calm down and focus
• Help them explore safe options to work through the situation at
hand
• Follow what is taught in CPI training
#5
Traumatic exposure,
delinquency, and school
failure are related.
Youth who are exposed to chronic trauma often must
learn to function in a constant state of alert and
preparedness for threats and danger… a state a
hyperarousal or in chronic alarm mode… This
survival ability conflicts with the focus and self
control needed for youth to succeed in school…
Trauma changes our biology, including brain
development which can result in very welldeveloped emergency response systems in
the brain at a cost to the executive
functions of our brain that enhance
learning and self-regulation…
Normal v. Abused Brain
Normal Child
Abused/Neglected Child
(As cited by Felitti & Anda,
Triggers and False Alarms
• Triggers include seeing, feeling, or hearing
something that reminds us of past trauma.
• Triggers activate the alarm system.
• When there is actually no current danger, it is a
false alarm.
• But the person reacts as if there is current
danger….PTSD, ASD, DTD
Impact: School Failure
• At least half of all maltreated children will
experience serious school problems, especially
conduct issues. (Putnam)
• Maltreated children have 3x the drop out rate of
the general population (Focal Point, 2007)
• Children with emotional and behavioral disorders
who are also in special education classes have
the highest school drop out rate of any disability
group--50%
Copyright 2007 WSU Area Health
Education Center
•
Complex Trauma May Disrupt
Cognition
Difficulty learning and
processing verbal
information
• Difficulty using
language to
communicate
• Difficulty organizing
and retrieving
information
• Difficulty
understanding cause
and effect
• Difficulty focusing on
and completing tasks
at hand
• Disrupted orientation
in time and space
• Tend to have poor
problem solving skills
• Difficulty planning and
anticipating
Copyright 2007 WSU Area Health
Education Center
System issues also can increase a youth’s
risk of school failure…
• Missing school because of changes in foster or
adoptive home placements or placement in
detention centers
• Delays in transferring records from one school to the
next
• Delays in receiving special education services
• Moving to a new school district
• 70-95 % rates of school failure and drop out for
youth in child welfare and/or juvenile detention or
incarceration
What can a the court and community
professionals do?
• Put meeting a youth’s educational needs a
top priority—it is life saving!!!
• Find ways to link youth with educational
advocates and programs that support
youth educational success
• Judging it essential that youth who must
transfer schools have very timely record
transfers, access to school assistance,
and extra support!
#6
Trauma assessments can
reduce misdiagnosis, promote
positive outcomes, and
maximize resources.
• Many youth come to the attention of the court with
previous diagnoses.
• Risk for misdiagnosis (and inappropriate treatment)
– Behaviorally, trauma can present as ADHD, ODD,
CD, and/or RAD
• Proper assessment = Proper treatment
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–
–
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Child Welfare Trauma Screening Tool
Traumatic Events Screening Inventory
UCLA PTSD Reaction Index
Trauma Symptom Checklist for Children
Courtesy of Western Michigan
University Child Assessment Clinic
Purpose of Assessment
• Thorough assessment can identify a child’s reactions
and how his or her behaviors are connected to the
traumatic experience.
• Thorough assessment can also predict potential risk
behaviors and identify interventions that will
ultimately reduce risk.
• Use assessment results to determine the need for
referral to appropriate trauma-specific mental health
care or further comprehensive trauma assessment.
*Adapted from the NCTSN Child Welfare Toolkit
• James is a 13 year old Caucasian male who had been living in a
battered women’s shelter for 4 months.
• Mom had just left her boyfriend Don after living with him for 6 years.
Don nearly killed mom on 4 occasions through strangulation. He
threatened to kill James and his mom with a gun from his extensive gun
collection. Don physically abused James and his mom. Mom admits
she has been with abusive men all of James’ life.
• James visits his dad who for 3 years has been living with an angry
women who abuses alcohol. She emotionally abuses James and his
dad.
• James has been suspended from school for stabbing a kid with a pen,
cussing out his teacher, refusing to follow rules, and fighting.
• He has nightmares, is afraid to sleep alone, and worries someone will
kill mom or dad.
• Between the ages of 2-4 years old, James’ mom was actively drug
addicted and dropped James off at his dad’s house and disappeared
for two years. James was in foster care for 4 months at the age of 3
years old.
• Mom has a very out of control Bipolar disorder and gets easily angered
and yells and cusses at James.
What if all you knew was…?
James cusses at his teachers, starts
fights with other youth, and he
recently stabbed a classmate at
school?
“For years our court treated these
cases as “bad behavior” and “lack
of self control.” It is only in the last
several years that we, as a court,
have educated ourselves about
trauma. As a result, we now know
that it is important to ask about
trauma. Indeed, we often discover
a history of trauma that has gone
undetected, despite attempts to
help the child through traditional
counseling services.”
– Judge Michael L. Howard &
Robin R. Tener, PhD.
#7
There are mental health treatments
that are effective in helping youth
who are experiencing child
traumatic stress.
• Effective mental health treatments
must address the trauma’s and
adversities that youth have
experienced.
• We no longer have to do guess work to
find the highest quality treatments…
Key components of evidence-based
trauma-focused treatments
include:
• Randomized controlled studies proving their
effectiveness
• Manualized treatment, specialized training,
and supervision
• Structured and clear treatment components
that comprehensively address the
developmental impact of trauma on youth,
including traumatic reminders
Trauma-Focused Cognitive Behavioral Therapy
Judith Cohen, MD., Anthony Mannarino, Ph.D.
& Esther Deblinger, Ph.D.)
• Psychoeducation about impact of trauma, coping and parenting
• Relaxation techniques
• Affect modulation work: recognizing, expressing, and managing
emotions
• Cognitive Coping: addressing the traumatic perspectives
• Trauma Narrative: a safe, structured, protocol for developing
and sharing the trauma story
• In-vivo Desentization: the trauma no longer controls them
• Conjoint and family sessions
• Enhancing Safety and Social Skills
TARGET-A Model
Dr. Julian Ford, Ph.D., University of Connecticut
• Addressing the emotional and behavioral dysregulation
resulting from complex trauma
• Addresses managing alarm reactions
• Uses the FREEDOM Steps as skill development areas
• Being evaluated and implemented in juvenile justice and
residential settings and outpatient settings
Child Parent Psychotherapy
Alicia Lieberman, Ph.D., and Patricia Van Horn,
Ph.D., UCSF
• Primary designed for youth ages 0-6 and their non-offending
caregiver
• Assists in addressing the trauma of both the caregiver and the
child
• Helps the caregiver to support their child in regaining
momentum and progress in their healthy development
• Studies have shown an increase in IQ scores of the youth
completing this treatment
Treating Traumatic Stress in
Children and Adolescents: How to
Foster Resilience through
Attachment, Self-Regulation, and
Competency
By Margaret E. Blaustein &
Kristine M. Kinniburgh
As summarized by Kristine Buffington, MSW
Blaustein &
What is ARC?
• A components-based model
• Three core domains of intervention for youth exposed to trauma
and their caregiving system:
– Attachment
– Self-Regulation
– Competency
Blaustein &
What is ARC?
Trauma
Experience
Integration
Executive
Functions
Affect
Identification
Caregiver Affect
Management
Self
Development
and Identity
Modulation
Attunement
Blaustein &
Affect
Expression
Consistent
Response
Routines and
Rituals
Resources
• www.nctsn.org
Treatments that Work and specialized
resources for juvenile court professionals.
• Training curriculums for child welfare
workers, juvenile court detention centers,
foster and adoptive parents, second
responders to disasters, and much more…
#8
There is compelling need for
effective family involvement.
• Supportive and involved families have
the potential to promote healing,
rehabilitation, and resiliency.
• Families of court-involved youth may
also need support to cope with their
own traumatic experiences so that they
can provide support and guidance to
their children.
• Obstacles to Effective Family Involvement:
– Feeling shame and/or feeling judged
– Feeling intimidated in a large and confusing
system
– Previous bad experiences in the past by human
service professionals and public systems
– Language barriers
– Lack of financial and transportation resources
especially when a youth is placed a far distance
from home
– Restrictive definitions of family
– Assumptions that all family systems are negative
What can a the judicial and other systems dodge do?
• Set a culture within his/her court that priorities
positive family engagement
• Ask families what supports they need so they can be
more involved in their child’s treatment and
rehabilitation
• Make sure referrals for mental health services are to
providers who are trauma-informed and who are
accessible and respectful to families
• Help families access resources so they may visit with
and communicate with their child
• Train court professionals to be able to communicate
in culturally competent and respectful ways with
families
#9
Youth are Resilient!!!!
• Resiliency is the capacity to thrive in the face of
adversity.
• Function of risk and protection.
• Risk and protective factors exist across ecological
domains.
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–
–
–
–
Individual
Family
Peer
School
Community
• Goal: reduce risk factors and increase protective
factors.
• Take home message: Children and youth CAN get
better.
What can a child welfare, judicial, and treatment
professionals do?
Deficit Model  Positive Youth
Development
• Ask about protective factors – not just risk (i.e., avoid a “deficit model”)
• Consider risk and protection in multiple domains (i.e., don’t focus just
on the individual and family)
• Encourage connection with prosocial adults (i.e., facilitate connections
with “persons of character”)
• Promote youth’s strengths instead of focusing on
weaknesses/problems
• Reframe problems to highlight personal competencies and strengths
#10
The juvenile justice system
needs to be trauma-informed
at all levels.
Trauma affects behavior in detention
• In a study by DeLisi and colleagues at the CYA,
researchers found those with higher levels of
traumatization;
– Had higher levels of institutional misconduct,
– 3x the suicidal activity,
– 3.5x the sexual misconduct,
– Upon intake, greater scores for depression, anxiety,
suicidal ideation, substance abuse, and anger
compared to their offender counterparts with low or no
traumatization.
*DeLisi, Drury, Kosloski, Caudill, Conis, Anderson, Vaughn, & Beaver, 2010
• Work to ensure a sense of safety for youth.
• Monitor for and reduce exposure to traumatic
reminders.
• Collaboration across stakeholders.
• Involve family.
• Nurture culture of respect, honesty, and
humility.
• Collect and evaluate data.
• Draw on existing resources and “lessons
learned”.
Essential Elements of Trauma-Informed Child
Welfare Practice
1. Maximize the child’s sense of safety.
2. Assist children in reducing overwhelming emotion.
3. Help children make new meaning of their trauma history and
current experiences.
4. Address the impact of trauma and subsequent changes in the
child’s behavior, development, and relationships.
5. Coordinate services with other agencies.
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Essential Elements of Trauma-Informed Child
Welfare Practice
6. Utilize comprehensive assessment of the child’s trauma
experiences and their impact on the child’s development and
behavior to guide services.
7. Support and promote positive and stable relationships in the life
of the child.
8. Provide support and guidance to child’s family and caregivers.
9. Manage professional and personal stress.
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The Science of Implementation
Fixsen, Dean L.; Blase, Karen A.; Naoom, Sandra F.; & Wallace,
Frances. “Lessons Learned From Research on
Implementation.” National Implementation Network, Oregon RTI
Meeting, 2007.