Creating a Trauma Informed Learning Environment Presented by: Kym Asam, LICSW, QMHP Objectives • • Differentiate between PTSD and developmental trauma Understand the impact of trauma on the brain utilizing the Neuro-Sequential Model of Therapeutics (NMT) • • • • Impact on students’ capacity to learn Brain regions and a tiered (PBiS) approach to intervention Understand the students’ states of arousal and how it impacts their functioning in school Key skills in working with children who have experienced developmental trauma • ARC and its intersect with a tiered approach • • Adults Students Polling Question #1 How many audience participants have had some training on developmental or complex trauma? Grounding Principles Trauma-Sensitive Schools benefit all children – those whose trauma history is known, those whose trauma will never be clearly identified and those who may be impacted by their traumatized classmates. Schools are the Central Community for most children. Definitions What is trauma? Trauma is not an event itself, but rather a response to a stressful experience in which a person’s ability to cope is dramatically undermined. What is Developmental Trauma? • • • • • A psychological and neurobiological injury that results from protracted exposure to stressful events Derails typical development across all domains (neurological, psychological, cognitive, social, self/identity) Experiences often occur in the caregiving system. Impact is immediate and long term Effects will require all tiers of intervention Sources of Trauma Sexual abuse Physical abuse Emotional abuse Neglect Domestic Violence Neighborhood violence Torture Bullying Prolonged exposure to traumatic stress Intrauterine stress Epigenetics Toxic Stress Pyramid Pervasiveness in children Overall substantiated child maltreatment in 2011 = approximately 681,000 (705 in Vermont) 9.1% experienced sexual abuse (67% in Vermont) 17.6% experienced physical abuse (37.1% in Vermont) 78.5% experienced neglect (2.6% in Vermont) 48.6% were males 51.1% were females Source = National Children’s Alliance and US Department of Health and Human Services, 2011 report Child Welfare League of America The brain develops from the bottom up Cortex Limbic Diencephalon Brainstem and the inside out Early childhood synaptic growth Brain Function Encourage Abstract Thought Facilitate Socioemotional Growth Introduce SomatoSensory Integration Establish State Regulation Perry, B. 2006 Cortex Limbic Diencephalon Brainstem Abstract Thought Concrete Thought Affiliation/Reward Attachment Sexual Behavior Emotional Reactivity Motor Regulation Arousal Appetite /Satiety Sleep Blood Pressure Heart Rate Body Temperature The still face experiment http://www.youtube.com/watch?v=apzXGEb Zht0 Neuronal Connections http://www.youtube.com/watch?v=8NA_o1j OjsQ Impact of Neglect on the Brain Stages of Sleep Polling question #2 How many of you have students who frequently go to the nurse? Negative Interactions Social experiences with caregivers become biologically embedded . Caregiver’s indicate displeasure: yell at or ignore baby Early experiences shape the developing nervous system and determine how stress is interpreted and responded to in the future Baby’s brain releases stress hormones , primarily cortisol Too much cortisol compromises the immune system and decreases dopamine and serotonin The toddlers set point for cortisol is established. The number of receptors in the brain is reduced by repeated early exposure to stress Effects of Trauma on Brain Functioning Thalamus Prefrontal Cortex (Integration and Planning) Visual, auditory, olfactory, kinesthetic, gustatory Amygdala Hippocampus (cognitive map) (Intensity/significance) Normative Danger Responses Autonomic Nervous Response System Fight Flight Freeze Flock Emotional Identification Facial Expression Recognition Arousal Continuum State Calm Arousal, Attention Alarm Fear Terror Adaptive Response Rest Vigilance Freeze Fight Flight Regulation Brain Region Neocortex Cortex Cortex Limbic Limbic Midbrain Midbrain Brainstem Brainstem Autonomic Deesecalating Adult Responses Talking, adult presence, rocking Eye contact, simple directives, quiet voice Quiet words, invited physical touch Disengagement, quiet adult presence Wait, leave group, allow child to calm, no words Escalating Adult Responses Noise, confrontation Complex directives, anger, ultimatums Raised voice, shaking finger Chaos, frustration, yelling grabbing, shaking screaming Cognition Abstract Concrete Emotional Reactive Reflexive. Perry, B. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children. New York, NY: Guilford Press Typical path to reactions Express Route to Reactions! Arousal and Cognitions As arousal increases cognitive ability decreases. Hyperaroused children may be defiant, resistant and/or aggressive. They are stuck in survival mode and may freeze, fight, or flee. A child in a hyper-aroused state can not be reasoned with, she needs you to help her reduce her arousal level. How to Intervene Somatosensory interventions Targeting the part of the brain that was impacted by developmental insults EVERY DAY EVERY GRADE EVERY BODY Targeting the Tiers, PBiS approaches Intensive targeted universal Brain stem/diencephalon limbic cortex Building up from the base Establish State Regulation -Intensive School staff can be thinking about short, predictable, repetitive, patterned interactions throughout the day which would include: Touch Rhythmic activities (rocking) Eye contact drumming Brainstem Bruce Perry (2006) Respond to physiological cues. A child’s heart rate is a great indicator of levels of arousal (low end 80, high end 120). When interacting become an affective co-regulator for the child. Building up from the base Introduce Somato-Sensory Integration – targeted, intensive Diencephalon Large motor and fine motor Music and movement Bruce Perry (2006) Sensory stimulation Predictable routines (eating, transitions, sleeping) Consider beginning the day with predictable, structured, patterned, rhythmic music and movement activities. Studies have indicated that children have increased self-regulation throughout the day when sensory integration occurs early. Remember that the brain fatigues after 7 minutes. Polling Question #3 How many of you work with students who receive targeted or intensive level of supports who struggle with playing games or taking turns? Building up from the base Facilitate Socio-emotional Growth – targeted Turn-taking Team play Win & lose Sharing Limbic Bruce Perry (2006) Consider that social development is a progression and the ability to form satisfying reciprocal interactions may depend on backing up and purposefully creating opportunities for parallel play or learning opportunities in a dyad with an adult and then a dyad with a peer before group play or group learning will be successful. Building up from the base Encourage Abstract Thought – Universal Humor Language Art Games Conflict resolution, problem solving Self-development and identity Self-esteem Cortex Bruce Perry (2006) Children who have foundational skills will be able to utilize their prefrontal cortex successfully. However, for children with disrupted or traumatic early experiences, adults will need to emphasize the earlier skills. Remember, stage not age. Polling Question #4 Who in webinar land is familiar with the ARC model? ARC Model - 10 Building Blocks Trauma Experience Integration Executive Functions Self Dev’t & Identity Dev’tal Tasks Affect Identification Caregiver Affect Mgmt. Modulation Attunement Affect Expression Consistent Response Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 Routines and Rituals attachment intensive Caregiver Affect Mgmt Attunement Affect Identification targeted Modulation Dev’tal Tasks Executive Functioning Affect Expression Selfregulation Self Dev’t & Identity universal competency Trauma Experience Integration Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 Routines and Rituals Consistent Response 4 Key Principles of Attachment Build school staff capacity to manage affect Build school staff-child attunement Build consistency in school staff response to child behavior Build routines and rituals into classroom and school Healthy Attachment Sequence Physical or psychological need Relaxation (parasympathetic ANS) Security, trust, attachment, selfregulation, object constancy Attunement/satisfaction of need Beverly James State of high arousal Unhealthy Attachment Sequence Physical or psychological need Anxiety, rage, numbing Shame, mistrust, disregulation, disturbed mental blueprint Needs are disregarded/attunement disrupted Beverly James State of high arousal Affect Management When caregivers modulate their own affect and emotional responses, they can create an emotionally safe environment in which children a can learn Attunement Caregivers accurately read cues to respond to underlying emotion rather than overt behavior. Behavior is usually a front for feeling that a child has difficulty expressing in a more effective way. Attunement Communicating unmet needs What is the function of the behavior? Being a feelings detective! Consistent Response Caregivers respond in a consistent way to both positive (desired) and negative/unsafe behaviors. Predictability reduces the child’s need for control. Routines and Rituals Routines increases predictability and the child’s ability to anticipate next steps. Establishing classroom and school-wide routines helps reduce trouble spots (transitions, substitute teachers, unstructured activities/days). SELF REGULATION Self-Regulation A Stepped Approach Affect Identification Affect Modulation Affect Expression Islands of Competence “When the student is allowed to be successful in his or her area of competence, the learning process can begin to take hold and develop. Focusing on an island of competence should not be misunderstood as “dumbing-down” an activity or lesson; rather, it is tailoring learning to a child’s interests in order to achieve academic success. Not only does success bolster learning, but it is also central to developing a positive, trusting relationship with the student.” (From, “Helping the Traumatized Child Learn”) Competency 3 Key Principles Build student executive functioning skills Target self-development and identity Target additional key developmental tasks The child develops an ability to evaluate situations, inhibit impulsive responses and actively make choices. Jessica http://www.youtube.com/watch?v=qR3rK0k ZFkg Possible Collision Points at School Schools focus on preparing children for and information related to the external world Much of school is motivated by connection and participation with others Schools often use delayed gratification Students with DT focus on the present and internally to stay safe. Students with DT are focused on the present to stay safe. Delaying gratification is dangerous and unpredictable. Teachers often set limits/goals for the common good Youth with DT don’t operate with a template that understands the common good. Competing Demands Survival vs. learning It is nearly impossible to dedicate your full attention and energy to survival and learning at the same time. The Healthy Mind Platter Physical time Sleep time Focus time Time in (flossing your brain) Down time Plan time Connecting time The Whole Brain Child, Dan Siegal Keys to Successful Intervention The 6 R’s Relevant (developmentally matched) Repetitive (patterned) Rewarding (pleasurable) Relational (safe) Rhythmic (resonant with neural patterns) Respectful (child, family, culture) Relevent Links http:/studentsfirst.org http:/howardcenter.org http://www.nctsn.org/ http://mentalhealth.vermont.gov/ http://healthvermont.gov/ http://www.ptophelp.org/ Questions?????