Welcome & Traditions
• PC Team
• SNAPS!
• ASL APPLAUSE!
• EXPLOSIVE POUNDS!
Trauma and Resilience in Young Children
Demy Kamboukos, PhD
Assistant Professor of Population Health and Child and Adolescent Psychiatry
Overview
•
Trauma and Toxic Stress in Childhood
•
•
Consequences and Common Reactions to Trauma and Stress
•
•
•
Prevalence Rates
Factors Influencing Reactions and Coping
Resilience
Strategies for School-Based Personnel & Mental Health
Professionals
Trauma
•
An emotional response (to an adverse or stressful
event) often with long-lasting effects.
Traumatic Events
•
•
•
•
•
•
Community Violence
Family Violence and Neglect
Living Conditions
Medical Interventions
Loss and Death of Family or Friends
Overexposure to Media
Prevalence Rates
•
•
•
•
•
68% of children are exposed to a traumatic event
before the age of 16.
52.5% of 2-5 year olds have experienced a significant
stressor
31% of children in NYC live in poverty
Over the course of a year 1 in 5 children witness
domestic and/or neighborhood violence
About 5% of children and adolescents experience a
crucial loss before the age of 15
Three Types of Stress Responses
Positive Stress Response
•
•
•
•
A physiological state that is brief and mild to moderate in magnitude
Dealing with frustration, getting an immunization, anxiety associated
with the first day at child care or preschool
Growth-promoting element of normal development
Provide important opportunities to observe, learn and practice healthy
adaptive responses to adverse experiences
Three Types of Stress Responses
Tolerable Stress Response
• Exposure to non-normative experiences that present a
greater magnitude of adversity or threat
• Natural disaster, act of terrorism, death of family
member, serious illness
Three Types of Stress Responses
Toxic Stress Response
•
•
•
Child abuse or neglect, parental substance abuse, maternal
depression
Adverse Childhood Experiences
Possible disruption of brain circuitry and other organ and
metabolic systems during sensitive developmental periods.
• Strong, frequent or prolonged activation of the body’s
stress response systems in the absence of the buffering
protection of a supportive adult relationship.
Child
Factors
Family &
Community
Factors
Parent
Siblings
Family & Parenting
Family &
Community
Factors
School & Teacher
Resources
Cultural Beliefs & Norms
Nurturing Environements
Communication & Cohesion
Social Support
Type of Trauma
Common Reactions
•
Traumatic Symptoms:
•
•
•
Increased Arousal (Irritability, anger, nervousness, startle)
Avoidance of thoughts, feelings, places, events
Reactivity (tantrums, crying)
Emotional Functioning:
•
•
Mood swings, Sadness,
Anxiety, Fear
Worry about safety of loved
ones or own well-being
Behavioral Functioning:
•
•
•
Aggression
Non-Compliance, oppositional
and defiant behaviors
Impulsiveness, risk taking
Common Reactions
•
Cognitive Functioning:
•
•
•
Repetitive talk or thinking about the event
Social Functioning:
•
•
•
•
•
Difficulties concentrating and remembering
Social withdrawal
Feeling “different”
Separation anxiety, clinging to adults
Conflicts
Academic Functioning:
•
•
Academic or learning problems
Failure
Common Reactions
•
Physical Functioning:
•
•
•
•
•
•
Increased or decreased activity level
Sleep problems, nightmares
Increased or decreased appetite
Bed wetting
Somatic complaints
Developmental Milestones:
•
•
Delays
Daily Living Skills
Mental Health Consequences
•
About a third of children develop significant psychiatric
difficulties and adverse effects on their development
•
•
More than 20 million children are affected by PTSD
Wide range of symptoms and reactions
•
Fluctuations in symptoms over time
•
Children are vulnerable into adulthood
•
Majority cope effectively
Promoting Resilience
• Caring and responsive adults who help children cope
with stressors can mitigate the negative effects of the
response to toxic stress.
• The buffering protection of caring and responsive
adults can prevent physiologic harm and long-term
consequences for health and learning.
•
http://developingchild.harvard.edu/resource
s/multimedia/videos/theory_of_change/
Resilience
•
A process of, capability for, or outcome of
successful adaptation despite challenging or
threatening circumstances (adversity, trauma,
tragedy, threats or significant sources of stress)
•
Affected by individual and environmental factors,
both determined by context
•
(Masten, Best, & Garmezy, 1990)
Resilience
• Children who do well in the face of adversity
• Beliefs, feelings and thoughts that emerge with
•
adversity and stress
Resilience can be enhanced or fostered by
building on protective factors
Resilience
Associated with individual factors:
•
•
•
•
•
•
Easy temperament
Empathic, friendly, easy
going
High self-esteem
Expressive
Shows positive
emotions
Sense of control
•
•
•
•
•
Problem solving skills
Goal-oriented
Belief in just world
Seeks out support
Area of perceived
competence valued by
others
Associated with environmental factors:
•
•
•
•
•
*Positive relationship
with supportive adult
Supportive, warm
family environment
Parents’ psychological
functioning
Parenting style
Supportive, engaging
school environment
•
•
•
•
Positive role models
Peer relations,
friendships
After-school activities,
organized social groups
Community service,
volunteer work
Strategies for School Personnel &
Mental Health Professionals
•
•
•
•
•
•
Identify Warning Signs
Provide Information & Explanation
Communicate
Involve and Empower
Be a Role Model
Seek Help
Identify Warning Signs
•
•
•
•
Understand normative reactions
•
•
•
•
Expect fluctuations in behavior and mood
Expect questions and preoccupations
Expect changes in academics, behaviors, emotions
Expect regressive behaviors
Know your student’s history
Look for significant continued impairment
Include parents in identification and evaluation
Provide Information
•
•
•
Collaborate with parents about information
shared and discussed
Educate parents
• Open, informed conversation about
warning signs and consequences
• Answer questions directly
• Offer referrals and resources
Provide information to children in
developmentally-appropriate ways
Communicate
•
•
•
•
•
Follow the child’s lead
• Give a child space to talk
• Avoid making assumptions
Welcome discussions and questions
Create activities that will give children
opportunities to communicate (e.g., book
report)
Connect with the family
• Be aware of changes & resources at home
Model communication
Empower
•
•
•
•
Give choices when possible
Listen to children’s opinions and thoughts
Give children independence and
permission to pursue their interests and
hobbies
Encourage children to become involved in
the community, giving back, raising money
Adults as Role Models
•
•
•
•
•
Children pick up on cues and feelings
Remain calm
Monitor Media
Model and encourage open
communication
Model problem solving and coping skills
Seek Support
•
•
•
•
Ask for help
Seek professional guidance
Build on social networks
Create a list of referrals
Table Debrief
◌ What can you do (as an individual, site,
community member) to address the trauma of
the children with whom you work?
◌ In what way have traumatic events in children’s
lives or your community impacted your work?
◌ How can we support each other as
professionals in dealing with these issues?
What’s Parenting Got To Do with It?:
What's
parenting
got
to
do
with
it?
The state of the evidence for investing in families
Laurie Miller Brotman, Ph.D.
Bezos Family Foundation Professor of Early Childhood Development
Center for Early Childhood Health and Development
Department of Population Health
NYU Langone Medical Center
a universal approach that
brings together parents
in the school community to
create a sustainable network
of effective and involved parents
to help young children succeed
family-centered, school-based intervention
that is culturally-relevant and accessible to
all families in high-need communities as
their children enter school
Diversity of children and families
Primacy of parents and families
ParentCorps Video
https://www.youtube.com/watch?v=BVPHm
VUeh3U
Family Participation
Trial
• 88% of Pre-K student population participated
Family Program (early evening 13 session group series)
•
58% of families participated
•
•
•
Ranging across schools (44 - 75%)
Increasing over the 4 years of implementation (50 - 65%)
39% received “full dose” (> 5 sessions)
•
•
Ranging across schools (28 - 64%)
Increasing over time (32 - 45%)
Predictors of Family Program Participation
• Participation was NOT predicted by risk status or the majority of
demographic factors considered
Brotman, L.M., Calzada, E., Kingston, S., Huang, K., Dawson-McClure, S.R., Kamboukos, D., Rosenfelt, A., Schwab, A.,
& Petkova, E. (2011). Promoting effective parenting practices and preventing conduct problems among ethnic minority
families from low-income, urban communities. Child Development, 82(1), 258-276.
Brotman, L. M., Dawson-McClure, S.R., Huang, K. Y., Theise, R., Kamboukos, D., Wang, J., Petkova, E., & Ogedegbe,
G. (2012). Family intervention in early childhood and long-term obesity prevention among high risk minority youth.
Pediatrics, 129, e621-e628.
Brotman, L. M., Dawson-McClure, S.R., Calzada, E. J., Huang, K. Y., Kamboukos, D., Palamar, J., & Petkova, E.
(2013). A cluster (school) RCT of ParentCorps: Impact on kindergarten academic achievement. Pediatrics, 131, e15211529.
Dawson-McClure, S.R., Calzada, E.J., Huang, K.Y., Kamboukos, D., Rhule, D., Kolawole, B., Petkova, E., & Brotman,
L.M. (2014). A population-level approach to promoting healthy child development and school success in low-income
urban neighborhoods: Impact on parenting and child conduct problems. Prevention Science, Epub ahead of print.
Dawson-McClure, S.R., Brotman, L.M., Theise, R., Palamar, J., Kamboukos, D., Barajas, G., & Calzada, E. (2014). Early
childhood obesity prevention in low-income, urban communities. Journal of Prevention & Intervention in the
Community,42 (2), 152-166.
Table Debrief
◌ What are the challenges of interacting with a child who
has difficulties with self-regulation?
◌ In what way is a child’s behavioral or emotional
dysregulation challenging to a parent? Or a teacher?
◌ Are there specific policies or practices that you would
like to see in your setting to engage and support
families, especially those with children who have low
self-regulation?
ParentCorps and University Settlement:
Partnering Together to Build Resilience in Children
What's parenting got to do with it?
Bukky Kolawole, PsyD
Dana Rhule, PhD
Katherine Rosenblatt, LCSW
Center for Early Childhood Health and Development
Mary Castillejos, LMSW, M.S. Ed.
University Settlement
Fill in the blank…
The most important thing my
parents did for me to help me deal
with stress and adversity was:
___________________________
Goals for Today
• Understand your experiences as it
relates to building resilience
• Provide you with some information about
building resilience
• Share our ParentCorps approach to
building resilience
• Share a University Settlement case
example
Your Value For Resilience
•
•
•
•
What does a “resilient child” look like to you?
What does a “resilient parent or family” look like to
you?
Why do you care?
In terms of your work, what are your:
•
•
strengths in this area?
challenges?
Building Resilience in Children
To help, adults can:
•
•
•
•
•
•
•
•
•
•
Maintain structure and routines
Maintain rules and consequences
Prepare children and anticipate changes
Focus on open communication
Focus on emotions and validate feelings
Build positive experiences and memories through activities
Build self concept and sense of self
Build strong parent-child relationship
Empower—give choices and independence whenever
possible
Seek out support
Resilient Parent = Resilient Child
• “Parents are the first environmental
protective agents for development”
(Masten, Best, & Garmezy, 1990)
How to Build a Resilient
Parent & Child
•
•
•
Connection
Concrete Skills
Confidence/Competence
The Three C’s
Connection
Concrete Skills
Confidence/
Competence
Collaboration – Autonomy – Culture – Community – Evidence
ParentCorps
Beliefs and Values
Inform
Spirit
Governs
Specific Behaviors
Non-Verbal &Verbal
Timing
Content
•
Approach to family engagement
–
–
–
–
–
•
Flexible: “Come whenever you can, even if it means coming late”
Repeated invitations: “We’re not giving up on you”
Inclusive: “Your whole family is welcome to come”
Direct: “What is your reason for coming? How will you make it back
next week?”
Fliers home, outreach at drop-off/pickup, phone calls, stickers on
children
Culturally-informed environment of value
–
–
–
Explicit focus on cultural values, norms and goals
Partnerships between parents and teachers
Collaborative and autonomy-supporting
The Three C’s
Connection
Concrete Skills
Confidence/
Competence
Collaboration – Autonomy – Culture – Community – Evidence
Connection – Parents
• A process and an outcome of Parent
Group
• Support and empathy for struggles
• Sharing about culture, history
• Nonjudgmental, environment of value
• Celebrate successes
Connection – Children
•
•
•
•
•
•
Sharing about culture, individual
differences
New friendships, time with friends
Individual attention from teachers
Parent-child interaction
Support for struggles
Celebrate successes, reaching goals
The Three C’s
Connection
Concrete Skills
Confidence/
Competence
Collaboration – Autonomy – Culture – Community – Evidence
Building Resilience in Children
To help, adults can:
•
•
•
•
•
•
•
•
•
•
Maintain structure and routines
Maintain rules and consequences
Prepare children and anticipate changes
Focus on open communication
Focus on emotions and validate feelings
Build positive experiences and memories through activities
Build self concept and sense of self
Build strong parent-child relationship
Empower—give choices and independence whenever
possible
Seek out support
Concrete Skills – Parents
•
Specific skills to build character, coping, sense of control,
& contribution
•
•
•
•
•
•
Routines and responsibilities (predictability,
consistency, sense of control, contribution)
FUN skills (building the relationship, empowering child)
FEEL technique (emotional responsiveness and
building problem solving and expressiveness)
Positive reinforcement (self-esteem, goal-oriented)
Limit setting (maintain structure, belief in just world)
Self-care
Skills
Follow the child’s lead!
You do what they do!
Say what you see and hear!
• https://www.youtube.com/watch?v=F1gn
XBNJuPo
Positive Reinforcement
Limit Setting
Practice Self-care
Concrete Skills – Children
•
Specific skills to build character, coping, sense of
control, & contribution
•
•
•
•
•
Friendship skills (helping, sharing)—builds
connection, competencies, character, involvement
Dealing with feelings—coping skills, ability to show
positive feelings
Self-esteem, Individual difference
Problem solving skills
Mindfulness—CBT strategies to manage thoughts,
feelings, and body experiences
The Three C’s
Connection
Concrete Skills
Confidence/
Competence
Collaboration – Autonomy – Culture – Community – Evidence
Confidence/Competence
• Practice of skills
• Parent-child activity
• Honest sharing about abilities and
experiences
• Barriers and troubleshooting
• What would you say to a family member?
• Individualizing
• Graduation
The Power of EMPATHY
http://brenebrown.com/2013/12/10/rsabear/
Thoughts?
Reactions??
Case presentation
•
•
•
Isolation
Confusion
Anxiety
Case presentation
•
•
•
Isolation  CONNECTION
Confusion  CONCRETE SKILLS
Anxiety  CONFIDENCE / COMPETENCE
Table Debrief
◌ What’s one thing you are taking away in
terms of building resilience for parents and
children?
◌ How does the video about empathy apply
to your work with children and families?
◌What other thoughts did you have regarding
the specific family presented?