Welcome & Traditions

Welcome & Traditions • PC Team • SNAPS! • ASL APPLAUSE! • EXPLOSIVE POUNDS!

Trauma and Resilience in Young Children Demy Kamboukos, PhD Assistant Professor of Population Health and Child and Adolescent Psychiatry

Overview • Trauma and Toxic Stress in Childhood • Prevalence Rates • Consequences and Common Reactions to Trauma and Stress • Factors Influencing Reactions and Coping • Resilience • Strategies for School-Based Personnel & Mental Health Professionals

Trauma • An emotional response (to an adverse or stressful event) often with long-lasting effects.

Traumatic Events • Community Violence • Family Violence and Neglect • Living Conditions • Medical Interventions • Loss and Death of Family or Friends • Overexposure to Media

Prevalence Rates • 68% of children are exposed to a traumatic event before the age of 16. • 52.5% of 2-5 year olds have experienced a significant stressor • 31% of children in NYC live in poverty • Over the course of a year 1 in 5 children witness domestic and/or neighborhood violence • About 5% of children and adolescents experience a crucial loss before the age of 15

Three Types of Stress Responses Positive Stress Response • A physiological state that is brief and mild to moderate in magnitude • Dealing with frustration, getting an immunization, anxiety associated with the first day at child care or preschool • Growth-promoting element of normal development • Provide important opportunities to observe, learn and practice healthy adaptive responses to adverse experiences

Three Types of Stress Responses Tolerable Stress Response • Exposure to non-normative experiences that present a greater magnitude of adversity or threat • Natural disaster, act of terrorism, death of family member, serious illness

Three Types of Stress Responses Toxic Stress Response • Child abuse or neglect, parental substance abuse, maternal depression • Adverse Childhood Experiences • Possible disruption of brain circuitry and other organ and metabolic systems during sensitive developmental periods. • Strong, frequent or prolonged activation of the body’s stress response systems in the absence of the buffering protection of a supportive adult relationship.

Child Factors

Family & Community Factors

Common Reactions • Traumatic Symptoms: • Increased Arousal (Irritability, anger, nervousness, startle) • Avoidance of thoughts, feelings, places, events • Reactivity (tantrums, crying) Emotional Functioning: • Mood swings, Sadness, Anxiety, Fear • Worry about safety of loved ones or own well-being Behavioral Functioning: • Aggression • Non-Compliance, oppositional and defiant behaviors • Impulsiveness, risk taking

Common Reactions • Cognitive Functioning: • Difficulties concentrating and remembering • Repetitive talk or thinking about the event • Social Functioning: • Social withdrawal • Feeling “different” • Separation anxiety, clinging to adults • Conflicts • Academic Functioning: • Academic or learning problems • Failure

Common Reactions • Physical Functioning: • Increased or decreased activity level • Sleep problems, nightmares • Increased or decreased appetite • Bed wetting • Somatic complaints • Developmental Milestones: • Delays • Daily Living Skills

Mental Health Consequences • About a third of children develop significant psychiatric difficulties and adverse effects on their development • More than 20 million children are affected by PTSD • Wide range of symptoms and reactions • Fluctuations in symptoms over time • Children are vulnerable into adulthood • Majority cope effectively

Promoting Resilience • Caring and responsive adults who help children cope with stressors can mitigate the negative effects of the response to toxic stress. • The buffering protection of caring and responsive adults can prevent physiologic harm and long-term consequences for health and learning.

http://developingchild.harvard.edu/resources/multimedia/videos/theory_of_change/http://developingchild.harvard.edu/resources/multimedia/videos/theory_of_change/

Resilience • A process of, capability for, or outcome of successful adaptation despite challenging or threatening circumstances (adversity, trauma, tragedy, threats or significant sources of stress) • Affected by individual and environmental factors, both determined by context • (Masten, Best, & Garmezy, 1990)

Resilience • Children who do well in the face of adversity • Beliefs, feelings and thoughts that emerge with adversity and stress • Resilience can be enhanced or fostered by building on protective factors

Resilience Associated with individual factors:

Strategies for School Personnel & Mental Health Professionals • Identify Warning Signs • Provide Information & Explanation • Communicate • Involve and Empower • Be a Role Model • Seek Help

Identify Warning Signs • Understand normative reactions • Expect fluctuations in behavior and mood • Expect questions and preoccupations • Expect changes in academics, behaviors, emotions • Expect regressive behaviors • Know your student’s history • Look for significant continued impairment • Include parents in identification and evaluation

Provide Information • Collaborate with parents about information shared and discussed • Educate parents • Open, informed conversation about warning signs and consequences • Answer questions directly • Offer referrals and resources • Provide information to children in developmentally-appropriate ways

Communicate • Follow the child’s lead • Give a child space to talk • Avoid making assumptions • Welcome discussions and questions • Create activities that will give children opportunities to communicate (e.g., book report) • Connect with the family • Be aware of changes & resources at home • Model communication

Empower • Give choices when possible • Listen to children’s opinions and thoughts • Give children independence and permission to pursue their interests and hobbies • Encourage children to become involved in the community, giving back, raising money

Adults as Role Models • Children pick up on cues and feelings • Remain calm • Monitor Media • Model and encourage open communication • Model problem solving and coping skills

Seek Support • Ask for help • Seek professional guidance • Build on social networks • Create a list of referrals

Table Debrief • What can you do (as an individual, site, community member) to address the trauma of the children with whom you work? • In what way have traumatic events in children’s lives or your community impacted your work? • How can we support each other as professionals in dealing with these issues?

What’s Parenting Got To Do with It?: The state of the evidence for investing in families Laurie Miller Brotman, Ph.D. Bezos Family Foundation Professor of Early Childhood Development Center for Early Childhood Health and Development Department of Population Health NYU Langone Medical Center What's parenting got to do with it?

a universal approach that brings together parents in the school community to create a sustainable network of effective and involved parents to help young children succeed family-centered, school-based intervention that is culturally-relevant and accessible to all families in high-need communities as their children enter school Diversity of children and families Primacy of parents and families

ParentCorps Video https://www.youtube.com/watch?v=BVPHmVUeh3U

Family Participation Trial • 88% of Pre-K student population participated Family Program (early evening 13 session group series) • 58% of families participated • Ranging across schools (44 - 75%) • Increasing over the 4 years of implementation (50 - 65%) • 39% received “full dose” (> 5 sessions) • Ranging across schools (28 - 64%) • Increasing over time (32 - 45%) Predictors of Family Program Participation • Participation was NOT predicted by risk status or the majority of demographic factors considered

Welcome & Traditions