Children Exposed to Trauma: Immediate and Lifelong Impacts Are Common

1. Children Exposed to Trauma:Immediate and Lifelong Impacts Are Common Angela Keen Survivors, Inc.

2. Trainer • Angela Keen • Supervisor of Direct Services, Survivors, Inc. • Victims’ Services Professional with 17 years experience • Keystone Crisis Intervention Team (KCIT) Certified Trainer • KCIT Team Member since 2005 KCIT 2015

3. Survivors, Inc. Envisions an end to domestic violenceand sexual assault.Our mission: Domestic violence and sexual assault violate the sanctity and the safety of our relationships, homes, and communities. We provide comprehensive services and advocacy to those seeking lives free of violence.

4. RESOURCE • QUICK response to hospital or police department • 24 hour hotline 717-334-9777or800-787-8106 • Secure Shelter • Safety Planning individualized & can include PFA

5. SERVICES • Supportive Individual & Group Counseling • Legal Advocacy • Bilingual & Bicultural Staff • Children’s Support Group & Activities • Significant Other Support • Emergency Shelter • Transitional Housing • Community Education

6. Participants will: • Articulate physical and emotional reactions to trauma • Recognize trauma impacts on learning, physical health and human development • Be familiar with the ACE Study • Make connections between individual trauma exposure and community health • Identify trauma informed practices to implement in community work

7. Trauma Is Common “Knowledge about the prevalence and impact of trauma has grown to the point that it is now universally understood that almost all of those seeking services in the public health system have trauma histories.” (SAMHSA)

8. Trauma Individual Trauma: A “blow to the psyche that breaks through one’s defenses so suddenly and with such force that one cannot respond effectively.” - Kai Erickson, In the Wake of a Flood, 1979 Collective Trauma: A “blow to the tissues of social life that damages the bonds attaching people together.” - Kai Erickson, In the Wake of a Flood, 1979

9. Fluctuating Equilibrium Normal Stress Eu-stress Distress

10. Impact of Trauma on Equilibrium

11. Sensory Path: Everyday Functioning Brain Cortex- Neo Cortex Thalamus Amygdala Hippocampus

12. Trauma is a sensory experience It is not cognitive!

13. Sensory Path: Traumatized Brain Cortex- Neo Cortex Thalamus Amygdala Hippocampus

14. During a Traumatic Event The pathways between the right and left brain experience a disconnect. Right Brain Left Brain • Making Sense • Problem Solving • Decision Making • Language • Impulse Control • Memory • Sensory • Affect Regulation

15. Fight, Flight, or Freeze?

16. Crisis Reactions KCIT 2015

17. Crisis Reactions

18. Crisis Reactions KCIT 2015

19. Maslow’s Hierarchy of Needs KCIT 2015

20. Loss of Equilibrium in Trauma Adaptive Capacities Stressors Love and Belonging Basic Survival needs Self-esteem & Meaning Self Actualization Cognitive Functioning Safety & Security KCIT 2015

21. Stressors: Good and Bad KCIT 2015

22. Trauma is any event that leaves a person feeling hopeless, helpless, fearing for their life and/or their safety.

23. Trauma is the unique individual experience of an event or enduring condition, in which: • The individual experiences a threat to life, bodily integrity, or sanity • The individual’s coping capacity and/or ability to integrate his or her emotional experience is overwhelmed

24. Trauma Impairs • Feeling internally connected over time to caring others • Experiencing oneself as deserving and worthwhile • Managing Feelings: • Recognize, tolerate, modulate, integrate feelings

25. Potential Impact of Repeated Trauma Decreased ability to… • Manage feelings • Self-soothe • Thoughtfully plan • Develop Empathy • Utilize feelings • Connect with others • Trust others/reach out for and respond to help

26. Potential Impact of Repeated Trauma Increased… • Tension, anxiety, emotional unpredictability/over reaction • Need for control, aggressive behavior • Avoidance, constriction, dissociation • Use of drugs, alcohol, other addictions to manage feelings • Risky behaviors

27. Traumatic Stress Shifts people away from emotional safety, emotional balance and predictability. Disrupts the ability to return-to-center.

28. Human Development Across the Lifespan • Erikson • Psychosocial Stages defined by successful completion/mastery of developmental conflicts. • Piaget • Cognitive development progressive reorganization of mental processes; biological and environmental influences. • Maslow • Hierarchy of Needs Refer to Handout

29. Maslow’s Hierarchy of Needs Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396. doi:http://dx.doi.org/10.1037/h0054346

30. Developmental Impact of Trauma • Children develop sense of trust in world from relationships with early caretakers • Learn from trusting others to internalize feelings of trust & safety • When mistreated, sense of self affected, world viewed as unsafe

31. Developmental Impact of Trauma • Neurobiology disrupted; Ability to comfort & protect oneself impaired • Systems of meaning, feelings about self & ability to trust in others & oneself deeply affected

32. ACE Study • More than 17,000 adult participants • 25 studies since 1998 • CDC & Kaiser Permanente’s Department of Preventative Medicine in San Diego Partnership • Average age 57 • 80% White; 10% Black; 10% Hispanic/Latino • “solidly middle class”

33. Adverse Childhood Experiences • Emotional Abuse • Physical Abuse • Sexual Abuse • Mother abused • Raised in single parent family • Household member incarcerated

34. Adverse Childhood Experiences • Household member abusing drugs/alcohol • Household member chronically depressed, suicidal, mentally ill, psychiatric hospitalization • Emotional/Physical Neglect • Not raised by both biological parents

35. ACE Study Results • Trauma is far more prevalent than previously recognized. • The impacts of trauma are cumulative and often occur in clusters. • That unaddressed trauma underlies a wide range of health problems and social problems. • ACEs are related to risky health behaviors in childhood and adolescence.

36. 1 or More ACEs Increase Risk of: • Cancer • Heart disease • STDs • Liver disease • Smoking • Alcohol abuse • Obesity • Drug dependence • IV Drug Use • Early intercourse, pregnancy

37. 1 or More ACEs Increase Risk of: • Depression • Anxiety disorders • Hallucinations • Sleep disturbances • Memory disturbances • Anger problems • Domestic violence risk • Job problems • Relationship problems

38. ACE Study Results • Exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence. • 54% of women and 36% of men with depression had ACE score of 4 or higher • Compared to 18% of women and 10% of men with 0 ACE Score

39. ACE Study Results • 20% to 70% increased likelihood of alcohol use initiated during mid adolescence (15-17 years). • 7 to 10 fold more likely to report illicit drug use problems. • Physical abuse and verbal abuse were most strongly associated with body weight and obesity.

40. ACE Study Results Childhood trauma has long-term, damaging consequences.

41. Trauma exposure impacts community health.

42. How can you help?

43. Trauma Informed Care Most individuals seeking public behavioral health services and many other public services, such as homeless and domestic violence services, have histories of physical and sexual abuse and other types of trauma-inducing experiences. (SAMHSA)

44. Trauma Informed Programs/Services are: • based on an understanding of the vulnerabilities or triggers of trauma survivors • so that these services and programs can be more supportive and avoid re-traumatization

45. Changing Lenses What’s wrong with you? vs. What’s happened to you?

46. Resiliency & Coping Resiliency: A person’s inherent capacity to moderate and recover from a traumatic experience. KCIT 2015

47. Resiliency & Coping Coping: When a person constantly changes cognitive and behavioral efforts to manage specific extern/internal demands that are taxing or exceeding the resources of that individual. KCIT 2015

48. Resiliency & Coping Biological Vulnerabilities + Perceived Stressors – Coping = Severity of Impact KCIT 2015

49. “The solution of adult problems tomorrow depends in large measure upon the way our children grow up today.”Margaret Mead

50. RESOURCES • National Center on Domestic Violence, Trauma & Mental Health www.nationalcenterdvtraumamh.org/ • Substance Abuse & Mental Health Services Administration www.samhsa.gov/nctic/ • Keystone Crisis Intervention Team www.kcitpa.org/ • Centers for Disease Control www.cdc.gov