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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

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Creating a trauma informed learning environment

Creating a Trauma Informed Learning Environment

Presented by:

Kym Asam, LICSW, QMHP


Objectives
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
Polling Question #1

  • How many audience participants have had some training on developmental or complex trauma?


Grounding principles
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
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
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
Sources of Trauma

Sexual abuse

Physical abuse

Emotional abuse

Neglect

Domestic Violence

Neighborhood violence

Torture

Bullying

Prolonged exposure to traumatic stress

Intrauterine stress

Epigenetics



Pervasiveness in children
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
The brain develops from the bottom up

Cortex

Limbic

Diencephalon

Brainstem

Prefrontal Cortex

Cerebral Cortex

Limbic

and the

inside out

Diencephalon

Brain Stem



Brain function
Brain Function

Abstract Thought

Concrete Thought

Affiliation/Reward

Attachment

Sexual Behavior

Emotional Reactivity

Motor Regulation

Arousal

Appetite /Satiety

Sleep

Blood Pressure

Heart Rate

Body Temperature

Cortex

Encourage Abstract Thought

Facilitate Socio-emotional Growth

Introduce Somato-Sensory Integration

Establish State Regulation

Limbic

Diencephalon

Brainstem

Perry, B. 2006


The still face experiment
The still face experiment

http://www.youtube.com/watch?v=apzXGEbZht0


Neuronal connections
Neuronal Connections

http://www.youtube.com/watch?v=8NA_o1jOjsQ




Polling question 2
Polling question #2

  • How many of you have students who frequently go to the nurse?


Negative interactions
Negative Interactions

Social experiences with caregivers become biologically embedded

.


Effects of trauma on brain functioning
Effects of Trauma on Brain Functioning

Thalamus

Visual, auditory, olfactory,

kinesthetic, gustatory

Prefrontal Cortex

(Integration and Planning)

Amygdala

(Intensity/significance)

Hippocampus

(cognitive map)


Normative danger responses autonomic nervous response system
Normative Danger ResponsesAutonomic Nervous Response System

  • Fight

  • Flight

  • Freeze

  • Flock




Arousal continuum
Arousal Continuum

Perry, B. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children. New York, NY: Guilford Press




Arousal and cognitions
Arousal and Cognitions

As arousal increases cognitive ability decreases. Hyper-aroused children may be defiant, resistant and/or aggressive.

They are stuck in survival mode and may freeze, fight, or flee.

Cognitive Ability

Arousal Level

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
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
Targeting the Tiers, PBiS approaches

Brain stem/diencephalon

Intensive

limbic

targeted

universal

cortex


Building up from the base
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

    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.

Brainstem

Bruce Perry (2006)


Building up from the base1
Building up from the base

Introduce Somato-Sensory Integration – targeted, intensive

Diencephalon

  • Large motor and fine motor

  • Music and movement

  • 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.

Bruce Perry (2006)


Polling question 3
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 base2
Building up from the base

Facilitate Socio-emotional Growth – targeted

Limbic

  • Turn-taking

  • Team play

  • Win & lose

  • Sharing

    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.

Bruce Perry (2006)


Building up from the base3
Building up from the base

Encourage Abstract Thought – Universal

Cortex

  • Humor

  • Language

  • Art

  • Games

  • Conflict resolution, problem solving

  • Self-development and identity

  • Self-esteem

    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.

Bruce Perry (2006)


Polling question 4
Polling Question #4

  • Who in webinar land is familiar with the ARC model?


Arc model 10 building blocks
ARC Model - 10 Building Blocks

Trauma Experience Integration

Dev’tal Tasks

Executive Functions

Self Dev’t & Identity

Affect Expression

Affect Identification

Modulation

Routines and Rituals

Caregiver Affect Mgmt.

Attunement

Consistent Response

Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005


attachment

intensive

Caregiver Affect Mgmt

Routines and Rituals

Attunement

Consistent Response

Affect Identification

Affect Expression

Modulation

targeted

Self-regulation

Dev’tal Tasks

Executive Functioning

Self Dev’t & Identity

universal

competency

Trauma Experience Integration

Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005


4 key principles of attachment
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
Healthy Attachment Sequence

Physical or psychological need

Security, trust, attachment, self-regulation, object constancy

Relaxation (parasympathetic ANS)

State of high arousal

Attunement/satisfaction of need

Beverly James


Unhealthy attachment sequence
Unhealthy Attachment Sequence

Physical or psychological need

Shame, mistrust, disregulation, disturbed mental blueprint

Anxiety, rage, numbing

State of high arousal

Needs are disregarded/attunement disrupted

Beverly James


Affect management
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
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.


Attunement1
Attunement

  • Communicating unmet needs

  • What is the function of the behavior?

  • Being a feelings detective!


Consistent response
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 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 a stepped approach
Self-Regulation A Stepped Approach

  • Affect Identification

  • Affect Modulation

  • Affect Expression


Islands of competence
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
Competency3 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
Jessica

http://www.youtube.com/watch?v=qR3rK0kZFkg


Possible collision points at school
Possible Collision Points at School

  • Schools focus on preparing children for and information related to the external world

    • Students with DT focus on the present and internally to stay safe.

  • Much of school is motivated by connection and participation with others

  • Schools often use delayed gratification

    • 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
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
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
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
ReleventLinks

  • http:/studentsfirst.org

  • http:/howardcenter.org

  • http://www.nctsn.org/

  • http://mentalhealth.vermont.gov/

  • http://healthvermont.gov/

  • http://www.ptophelp.org/



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