Trauma-informed interventions: how do they help in our work with children and families? Paula David Haruv Institute

Transcription

1 Trauma-informed interventions: how do they help in our work with children and families? Paula David Haruv Institute

2 Presentation Topics Review what we know about trauma in early childhood and its long-term effects on development Become acquainted with one intervention Child-Parent Psychotherapy (CPP) and learn how it treats early childhood trauma Discuss the possibility of developing a trauma informed lens in work with children and parents in different treatment venues.

3 What is traumatic to children? Danger to themselves Danger to their caregivers Their wellbeing is entirely tied into the wellbeing of their caretakers

4 The Stress continuum Developmental Stress Costly Stress Trauma

5 Children living in poverty, ethnic minorities, and single-parent families or with a step-parent, are exposed during their lives to more Physical abuse Sexual abuse Exposure to domestic violence )Osofsky and Lieberman, 2011)

6 Exposure to domestic violence Is considered the worst trauma in early childhood because it is caused by an attachment figure. The traumatic event most significantly predicting development of PTSD in early childhood is not one directed toward the child s body, rather the child s exposure to the threat of injury of a parent. (Dr. Miri Keren)

7 TESI- Traumatic Events Stress Inventory Sudden unexpected death of a family member Physical assault or abuse Threatened with weapon or physical harm Sexual assault or abuse Witnessed trauma Life threatening accident, injury, illness

8 TESI cont. Loss of home Placement out of home Witness domestic violence Animal attack Separation from primary caregiver

9 What are the child s main developmental tasks? Learning and cognitive development Attachment to caretakers and social development Emotional regulation Trauma has a deleterious effect on them all.

10 Trauma and the Brain Traumatic experiences in infancy and early childhood may cause physical and chemical changes in the brain for the child s entire life. Early exposure to events causing extreme fear may cause: 1. Damage to the parts of the brain tied to emotions and learning 2. Distortions in what and how the child perceives threat or danger 3. Damage to the development of the mechanisms that regulate fear and anxiety. Post partum depression of a mother at the beginning of her child s life may cause lasting changes to the structure of the child s brain.

11 Physiology of stress Shifts the body s priorities Puts on hold planning, learning, future-oriented responses Focuses on support of vigilance, focused attention, increased muscle tone and heart rate

12 Changes in parent-child relationship after trauma Loss of sense of mother/father as reliable protectors Disturbed mental representations of who is safe and who is dangerous Impaired affect regulation Either partner may develop new negative attributions based on trauma experience Changes to mental representations Traumatic expectations Parent and child may serve as traumatic reminders for one another (Lieberman & Van Horn)

13 Adverse Childhood Experiences - ACE A study of 17,000 adults in California, asked about adverse childhood experiences in childhood. They included: Parents divorce Physical abuse Emotional neglect Sexual abuse Growing up with family members who were alcoholic, addicted to drugs, or suicidal.

14 Highlights from the original ACE Study Findings: ACEs Are Common Two-thirds of participants reported at least one ACE. ACEs Tend to Occur in Groups Of persons who reported at least one ACE, 87% reported at least one other ACE. 70% reported 2 or more others, and more than half had 3 or more others!

15 ACE Study Results People with a score of 4+ tended to be: Twice as likely to smoke 7 times as likely to be an alcoholic 6 times as likely to have sexual relations before age 15 Twice as likely to have cancer Twice as likely to have heart disease 4 times as likely to get emphysema or chronic bronchitis

16 ACE study results cont. 12 times as likely to attempt suicide 10 times as likely to inject street drugs Men with a score of 7+ who did not smoke, drink, or were not overweight, nevertheless tended to get heart disease 360% more than those with a score of 0.

17 Why do parents have a hard time helping their children cope with trauma? Parents also experienced trauma Guilt Belief that if we don t talk about it, he ll forget (denial) The child is a traumatic trigger for the parent Sometimes parents are the ones who caused the trauma

18 Why do professionals often have a hard time helping children with trauma? Belief that talking about trauma will make it worse for the child Fear that it will be overwhelming for professional as well Belief that one needs special skills to talk with a child about frightening events Belief that one needs a lot of time to talk to the child Belief that other professionals can do it better.

19 CPP an intervention to treat trauma in early childhood Dyadic treatment with the primary caregiver and child Continues around a year Its goal: to strengthen the child-parent relationship, so as to restore a sense of safety, attachment, and self regulation to the child, and improve his social, cognitive and behavioral functioning Based upon spontaneous interactions and free play between parent and child.

20 CPP objectives Encourage normative development Regulate feelings Encourage reciprocity in intimate relationships Differentiate between reliving trauma, and remembering it. Give voice to what was previously unsayable Normalize the traumatic response Put trauma into perspective.

21 CPP evaluation phase Relatively lengthy stage, with parents alone (Traumatic Events Stress Inventory) TESI Life Stressors Checklist (LSC) Angels in the Nursery questionnaire -

22 The Triangle in CPP (traumatic event) happened to you Since then, you (symptoms) Your parent and I want to help you to feel better

23 What does CPP teach us about traumafocused interventions?

24 A shift in talking about behavior and feelings What s wrong with you? Is replaced by What happened to you?

25 An emphasis on safety

26 The Importance of Emotional Regulation

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28 Emphasis on physical health

29 Talking about trauma

30 Tying symptoms to trauma

31 Differentiating between reliving and remembering

32 And what about work with parents? There is no such thing as he doesn t know, he was sleeping when it happened, he doesn t understand, he will forget. Ask parents about the effects of their child s trauma upon them (for example, the birth of a preemie needing much medical care, serious illnesses in childhood, accidents) Work with parents on how to help their kids regain a sense of safety and internal regulation Remember how powerful guilt is to parents and work with that in mind.