Core Competencies for Professional Development on Childhood Trauma

Transcription

1 Core Competencies for Professional Development on Childhood Trauma Purpose of Document The Illinois Childhood Trauma Coalition (ICTC) has identified six core competency areas for professionals from diverse sectors on childhood trauma: (1) Introduction to Trauma; (2) Nature of Trauma; (3) Impact of Trauma on the Child; (4) Prevention, Resiliency & Protective Factors; (5) Interactions and Interventions with Survivors of Trauma; and (6) Self-Care and Vicarious Trauma. The following tip sheet was developed to provide professionals from diverse sectors with a baseline of information that should be included in all Introductory Trainings/Seminars related to childhood trauma. This document includes Learning Objectives for each instructional Core Competency Area that should provide a common framework for a diverse set of professionals within and outside of the mental health and social services fields as they seek to inform, educate and train professionals in the complex field of childhood trauma. CORE CONTENT AREAS I. Introduction to Trauma Childhood Trauma can disrupt a child s normal development and lead to physical, emotional, cognitive, behavioral and social problems. Childhood Trauma is defined as the emotionally painful or distressful experience of an event by a child that results in lasting mental and physical effects. Events may occur once in a child s life or may involve chronic exposure to events at home or in the community. Childhood trauma is reported with high frequency among children served in the public sector. Traumatized children often exhibit disruptive behaviors that challenge our child welfare, education, mental health and juvenile justice systems. Difficult to recognize, childhood trauma requires long-term, coordinated care. Left untreated, it can lead to a lifetime of struggles and early death. There is hope for traumatized children, but only if we understand the context in which these issues arise. Define Childhood Trauma. Recall that Child Traumatic Stress (CTS) is a psychological reaction with both mental and physical effects that some children may have in response to their exposure to trauma.

2 Describe the many different types of traumatic events that children can be exposed to and distinguish the difference between one-time and chronic events. Understand that protective and resiliency factors may reduce the impact of exposure to trauma in childhood. Recognize the emotional and behavioral symptoms of untreated CTS. 1. The National Child Traumatic Stress Network (NCTSN) at II. Nature of Trauma Traumatic events may happen once in a child s life or may involve chronic exposure to events at home or in the community. For an event to be traumatic it must be experienced as emotionally painful or distressful by the child; in other words, it must be perceived as threatening. Natural disasters, accidents and short illnesses are examples of one-time events. Chronic illnesses, chronic exposure to violence and disruptions in attachment are examples of chronic events. Felitti and Anda identified 8 Adverse Childhood Experiences (ACES) that may happen to a child before the age of 18, which can also cause childhood trauma. For a child, ACES include: 1) Physical abuse and/or neglect, 2) Emotional abuse and/or neglect, 3) Sexual abuse, Or growing up in a household, with 4) An alcohol or drug abuser, 5) Someone who is incarcerated, 6) Someone who has a chronic mental illness, and/or is institutionalized, 7) Exposure to domestic violence, and/or 8) Exposure to a sudden loss of a parent. Learner will be able to: 1) Define childhood trauma, and describe the kinds of events, including the ACES, that can cause childhood trauma, distinguishing between one-time and chronic events. 2) Explain what is meant by an emotionally painful or distressful experience. 3) Recognize the impact a child s age and development on childhood exposure to trauma, and the long-term behavioral, emotional, and functional impact of trauma. 4) Recognize the varied manifestations of childhood trauma, including how they can manifest across the lifespan and lead to serious health and intergenerational consequences. 5) Recognize how a child s previous exposure to traumatic events and adaptations influence their reactions and adaptations to other trauma experiences.

3 6) Recognize how intrinsic (internal) factors such as age, gender, and developmental level can affect early physical, behavioral, and emotional adaptations of those exposed to trauma; 7) Recognize how extrinsic (external) factors such as social support, poverty, community characteristics can affect a child s adaptation to trauma exposure. 8) Recognize that early physical, behavioral and emotional adaptations often go unrecognized and/or are misunderstood by treatment providers and those who could provide support for the child. 9) Recognize that while some of children s behavioral and emotional reactions are unquestionably adaptive, many may be maladaptive and impede children s growth and development. 1. The National Child Traumatic Stress Network (NCTSN) at 2. Felitti & Anda The Adverse Childhood Experiences Study (ACES) at III. Impact of Trauma on the Child Childhood trauma can disrupt a child s normal development and lead to problems with brain development, learning, and relationship problems. Sometimes signs of trauma can be misunderstood as other behavioral problems or other emotional problems. If adults and caregivers do not respond to help the child immediately following a traumatic event, these problems can be longstanding. Understand and describe BOTH the short-term and long-term effects that a child may display following a traumatic event. Identify key indicators of risk and resources for linkage to further assess possible trauma symptoms or effects. Develop awareness of effective acute interventions and long-term treatment options. 1. The Illinois Childhood Trauma Coalition White Paper at 2. Cook et al. (2005). Complex Trauma in Children and Adolescents. Psychiatric Annals 35:5 3. James H. Humphrey Stages of Child Development from Sports for Children

4 IV. Prevention, Resiliency & Protective Factors Prevention includes preventing exposure to potentially traumatic events, preventing the development of trauma symptoms after experiencing a distressing event (resilience), and preventing future exposure (if an earlier exposure has already happened) or secondary trauma as a result of subsequent actions (e.g., intervention, parental response, etc.) following an initial exposure to a distressing event and/or trauma response. Resilience is the ability to handle everyday stressors and recover from occasional crises. Individuals who are emotionally resilient have a positive attitude, creatively solve problems, effectively address challenges, and are less likely to direct anger and frustration at others. Protective factors are positive attributes that strengthen all families. When working with families to increase protective factors, one also helps them to build natural support networks within their family and community, which are critical to families long-term success. Understand the key protective factors that enhance the well-being of children and their families, such as: o Nurturing and attachment o Knowledge of parenting and child development o Parental resilience o Social connections and concrete support systems o Social and emotional competence of children Understand ways to build resilience, such as: o Learn stress management techniques, i.e. exercise, relaxing with music, and meditation or prayer o Learn to prevent stress by planning ahead and anticipating difficulties o Learn how to anticipate and minimize everyday stress o Learn how to handle major stressors including accessing resources and supports from family, friends, faith communities and other resources o Learn family management techniques that include effective communication of needs and concerns Understand concepts of prevention, such as: o Support programs and services for parents and families o Early and regular child and family screening and treatment o Programs for abused children o Life skills training for children and young adults Resource Guide, Preventing Child Maltreatment and Promoting Well-Being: A Network for Action 2. Preventchildabuse.org, An Approach to Preventing Child Abuse Fact Sheet, Adapted from: Cohn Donnelly, A. (1997). An approach to Preventing Child Abuse, Chicago, IL: National Committee to Prevent Child Abuse.

5 V. Interactions and Interventions with Survivors of Trauma Post-traumatic reactions often occur following a child s direct experience of and/or witness to a harmful situation for the child and/ or involving people the child knows and cares about. Though reactions vary from child to child, common reactions often include: bodily aches, high levels of fear and worry about safety, re-experiencing the traumatic event, and avoidance of people or places associated with the traumatic event. Some children may appear to have no reactions to the event. In short, there are a myriad of reactions to childhood trauma. While the effects of this type of exposure can be lasting and can threaten normal development, early recognition and support can be powerfully protective. The ability of those around the child {the family, school and community} to recognize changes in emotions and behavior, and to support re-establishing a sense of safety will be key to positive outcomes. It is essential that treatment providers, first responders, and those that work with children and youth recognize that even very young children, including infants, can be at risk for post traumatic reactions that can adversely impact development, learning, and physical and mental health. Recognize a child s initial responses to the traumatic experience should be communicated between/by professionals and the children and their loved ones. Understand that a worker should utilize a universal precautions approach to working with survivors. Demonstrate skills oriented to psycho-education to normalize responses to abnormal events through teaching and modeling self-regulation skills. Understand the necessity of and steps to restoring the connection between the survivor, their loved ones, and the community. Understand that effective trauma interventions require coordination among the various providers in the system of care. Understand the techniques to re-establish physical & emotional safety and internal regulation when children become reactivated in the trauma narrative. Understand that organizations will need to plan for the effects of secondary traumatic stress in their staff as they are exposed to the traumatic experiences of children and families. Trauma-informed supervision and other organizational practices [e.g. case assignment, use of EAP etc.] are some of the strategies to support ongoing exposure to cases involving trauma. 1. The National Child Traumatic Stress Network (NCTSN) at 2. American Academy of Child and Adolescent Psychiatry

6 VI. Self-Care and Vicarious Trauma Many professionals who are exposed to working with survivors of trauma are vulnerable to long-term stress reactions. Sometimes caregivers suffer physically and emotionally; the most common long-term stress reactions have been described as burn-out, vicarious victimization or counter-transference, and compassion fatigue. All of these can result in changes in values and belief systems that may make some professionals even more vulnerable to distress. Define burn-out, vicarious victimization/counter-transference, and compassion fatigue. Identify physical, emotional, and behavioral symptoms of professional burnout, and identify factors that can contribute to burnout. Explore areas of potential vicarious victimization or counter-transference, and develop a plan to follow when this occurs. Understand the definition, causes, and risks of compassion fatigue. Develop awareness of the potential impact of burnout, vicarious victimization, and compassion fatigue on one s values, beliefs, and perspectives on life. Understand the factors that can contribute to these changes. Accurately prepare for exposure to trauma by building adaptive capacities and reducing daily stressors, as much as possible. Develop strategies to cope with the aftermath of exposure to trauma, especially chronic exposure. Understand and be able to implement key prevention strategies with staff and build practices into organizational structure and systems. 1. Figley, C. (1995). Compassion Fatigue. Bruner Mazel Psychosocial Stress Series 2. McCann, L. & Pearlman, (1990). Vicarious traumatization: A framework for understanding psychological effects of working with victims. Journal of Traumatic Stress, v.3.1 *NOTE: The lists of references at the bottom of each Core Content Area are meant to be an initial point of reference, and are in no way an exhaustive list of resources or references for each topic.