Islington trauma informed primary school, PRU and partners (TIPPPS)

1. Islington trauma informed primary school, PRU and partners (TIPPPS) Islington TIPPPS ARC developed by Blaustein & Kinniburgh, 2010

2. Responding to complex childhood trauma in primary schools: enhancing wellbeing and building resilience Dr Bunsi Shah: Islington CAMHS Helen Cameron: School Improvement Service ARC Developed By: Margaret E. Blaustein, Ph.D. Kristine M. Kinniburgh, LICSW The Trauma Center at JRI Islington TIPPPS ARC developed by Blaustein & Kinniburgh, 2010

3. Aims for this afternoon • To develop an understanding of the ‘Competency’ tier – the executive functions and self development and identity blocks • To recap the three tiers and eight blocks by considering an individual’s needs throughout the school day • To identify areas for future work at Hugh Myddleton across the ARC framework 5.45pm – home time Taking care of ourselves Islington TIPPPS ARC developed by Blaustein & Kinniburgh, 2010

4. 8 primary skills and building blocks Routines Psycho education Competency Self development and identity Executive functions Affect expression Modulation Affect identification Regulation Attunement Caregiver affect management Consistent behavioural response Attachment

5. Domain 3: Competency Self development and identity Executive functions Affect expression • Overarching Goal: • To build the foundational skills needed for healthy ongoing development and resilience, by supporting key reflective capacities, including the ability to set goals and make active choices and grow a developmentally- appropriate sense of self. Developmental tasks

6. Remember the idea of ‘developmental lag’?

7. The Main Idea: To work with children to act, instead of react, by using higher-order cognitive processes to solve problems and make active choices towards reaching goals Executive functions Executive functions are the “captain of the cognitive ship”; they provide the tools that help children navigate their world in an active, goal-directed way

8. Executive functions are primarily held in the prefrontal cortex; children who experience chronic/ongoing trauma often have overactive limbic system response, and fail to develop adequate pre-frontal controls…

9. Executive function

10. Supporting Executive Functions • Support the child in actively recognizing his or her own ability to make choices and have power (agency) • Support active evaluationof situations (affect identification / attunement) • Support and build the child’s capacity to inhibit response(modulation) • Support the child in generating alternative solutions / decision-making skills (problem-solving) Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

11. Problem solving Notice and realize that your alarm is being set off Identify the trigger and appraise for actual danger versus false alarm. (Affect Identification / attunement) Use regulation skills to establish internal safety by inhibiting fight / flight / freeze response (modulation). Understand the actual current problem, and identify goals: what is it that you want? Brainstorm all the ideas you have for reaching your goal. Evaluate the possible consequences of each idea, and then make a choice. Implement and evaluate solutions. Revise as needed. • Noticing there is a problem • Identify and understand the problem • Brainstorm options • Evaluate all consequences and make a choice • Implement and evaluate solutions

12. Entry Point:“I don’t know why everyone’s so angry.” Help children concretely define the situation they are confused about (i.e., “suddenly everyone was mad”). Track backward: what was happening five minutes before “everyone was mad”? Assess: situation, body state, feelings, thoughts, etc. Continue to move backward to the earliest cues available. Help children notice clues that there is “a problem”, i.e., that their own feelings were getting out of control, or that other people were upset. Tie in to Affect Identification skills.

13. Entry point: “But I had to...” Listen for moments when children identify a situation, either past or future, in which they did not or do not feel as if they have a choice.Goal: increase awareness of choices Entry point: “I’m gunna [insert bad choice]” Listen for moments when a child names a potentially negative choice that they plan on making.Goal: increase understanding of consequence for actions

14. Entry point: “It’s all (my mother’s, my friend’s, the teacher’s, my dog’s, etc.) fault!” Listen for moments when children externalise responsibility for a choice they have made Goal: increase understanding of consequence for actions

15. Teaching problem solving To older children through cooperative games and group goals Planning activities Brain-teasers Using structures that support problem solving: pre-planning e.g. transitions, viists processing past incidents Conflict resolution Notice and name active choices when they occur To young children through play and modelling • Hide and seek games • Sorting games • Puzzles, shapes, memory games

16. Luke and executive functions We identified that Luke had serious “lag” in all areas of executive functioning (an Educational Psychologist can help here). Psychoeducation about developmental trauma helped staff understand, he didn’t have the skills to take turns, wait or plan (allowing them to see his behaviour differently). Lunch time activities supported him: playing board games, problem solving activities. Luke was given small amounts of responsibility where he had to solve problems (stationery monitor) but with adult support to help him regulate if needed. Luke had easily achieved goals set and he was reminded of the goals and supported to solve problems that got in the way of his goals.

17. Any ideas for improving executive functions?

18. General Considerations: Reflection and attunement play a key role; ‘Trauma Experience Integration’ is embedded within the attachment / caregiving system Integration of traumatic experiences requires the capacity to observe and be curious about the range of self-experiences The holder of the reflective lens (the “curious observer”) is likely to shift over time, from external to internal Caregiver affect management and self-care is crucial Trauma Experience Integration is a process that takes place over time Self development and identity

19. Self Development and Identity: Key Concepts The main idea: Helping children towards a Coherent sense of self and personal identity. This normally develops over the course of child hood and includes: helping them to notice the positive and unique things about themselves building of coherence across time and experience helping them to imagine and work towards future possibilities

20. Trauma impacts on sense of positive identity (self esteem) • Negative experiences lead to negative view of self (including broader social messages) • Lack of exploration due to lack of secure Attachments

21. Treatment Targets: Aspects of Identity Unique Self Positive Self Cohesive Self Future Self

22. Unique Self: Individuality Goal: Help child identify personal attributes (likes, dislikes, values, talents, opinions, culture etc.) Often seen in KS1 classrooms but also useful for older children? Powerful to see something about them on the wall. Example Activities: All About Me Books Personal collage (general/specific) Group collage around single theme, with individual child sections Artistic self-expression Bulletin boards with space dedicated to each resident Activities celebrating individual diversity (i.e., culture-specific meals, holiday celebrations, etc.) My graffiti tag, coat of arms

23. Positive Self: Esteem & Efficacy Goal: Build internal resources and ability to identify positive aspects of self Example activities: Self esteem in a suitcase! Power book Pride wall Superhero self End-of-week awards Display child accomplishments—think of the refrigerator display Tune into moments of success (both relative and absolute); name them; capture them concretely (both individually and in milieu)

24. Cohesive Self: Self Across Time and Context Goal: Help child build sense of self which integrates multiple aspects of experience Working with the child to help them explore the ways in which all of their experiences have contributed to who they are and how they see themselves

25. Future self: Future orientation Goal: Build child’s ability to imagine self in future; build connections between current activities and future outcomes Example activities: Future self drawing 5-10-20 years Life book addendum Goal setting, future-planning: help kids develop goals (i.e., beyond primary school,)---help explore possibility Connect it: In conversation, pay attention to how current actions/ experiences connect to future goals

26. Executive Functions How does working on helping children to apply these skills help to integrate trauma experiences? Self Dev’t & Identity Routines Competency Psychoed Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

27. FLUID PHASIC APPLICATION OF SKILLS In the Moment Goal Intervention Emphasis Caregiver Core Goals Child Core Goals Surviving and Tolerating Present-focused distress tolerance Recognize and support coping with current perceived experience Support caregivers’ tolerance of their own experience as well as youth experience, and engage in strengths Recognizing and Addressing Build a caregiving system that accurately sees and understands youth experience Self / Other Attunement Recognize and build understanding of patterns; understanding triggers and behavioral functions Shifting and transforming Meaning Making and Future Orientation Identify and explore past experiences, expand on self in the present, and engage links to the future Support caregiver’s own meaning-making and expand family identity Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

28. FLUID PHASIC APPLICATION OF SKILLS In the Moment Goal Intervention Emphasis Examples – applications of child goals Surviving and Tolerating Present-focused distress tolerance Recognize and support coping with current perceived experience -Anchor treatment and foundational skills in positive self and identity – engage the whole child -Use caregiver scaffolding to support basic problem solving / executive functions: identifying possibilities -Cultivate agency (executive function) by providing opportunities for choice and control -Ground self-attunement work in self and identity, who you are / were / want to be Recognizing and Addressing Self / Other Attunement Recognize and build understanding of patterns; understanding triggers and behavioral functions Shifting and transforming Meaning Making and Future Orientation -Exploration of self and identity; integrating trauma narrative (narrative TEI) into broader story of self; -Engaging executive functions to anticipate and build awareness of challenges Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

29. Work with children to actively explore, process, and integrate historical experiences into a coherent and comprehensive understanding of self in order to enhance children’s capacity to effectively engage in present life. Two main approaches to “trauma experience integration” • Processing of specific events: • Building a narrative around the emotions, actions/inactions, relational styles, thoughts, physiological states, and models of self/other evoked in relation to past traumatic experiences, and incorporating these into a more coherent, realistic, and broader narrative of self • Integration of fragmented self-states: • Identifying and reflecting upon fragmented aspects of self-functioning, and linking these back to the subjective themes relevant to childhood experiences

30. TEI for complex trauma includes, but is not limited, to development of narrative, and involves the sequential development of capacity to first survive and tolerate trauma-driven moments; increasingly be in the moment; reflect upon and make meaning about those moments, and ultimately to shift and transform them.

31. Surviving the moment – teachers, school professional Recognising responses, identifying and coping with their own experiences (feelings of anger, helplessness, frustration etc.)Psycho education for carers about the meaning of behaviours and impact of trauma Structures to support family rhythms, new routines etc. that can be practised in calmer moments • Surviving the moment – child • Attunement by carers/clinician and mirroring, crucial to supporting his experience. • Naming, normalising (affect identification) • Experimenting with range of coping strategies (modulation). • Creating a team to help and support them. • Starting some psychoeducation about the impact of trauma.

32. Recognising and understanding the moment • Building an attuned care giver system, what’s the meaning of the behaviour? Involves meetings and work with both carers and child • Supporting carers in separate sessions to identify patterns and experiment with responses. • Meetings following “crisis moments” helping to make meaning and exploring problem solving. (exec funct, attunement, modulation, CAM)

33. Ultimately, the goal is for the child to be in the present moment • In-the-moment awareness of distress cues • In-the-moment capacity to engage modulation skills • Growing understanding of links between past, present, and future • Development of life narrative that goes beyond trauma based beliefs of damage, mistrust and danger and moves youth to a broad understanding of self in context that includes vulnerabilities, strengths, resources and challenges. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

34. Luke and self identity Luke had a very limited sense of self. His mum was encouraged to keep his awards etc on the cupboard at home. Mum came into school more regularly and consultations with his teacher focussed more on where he was doing really well. Luke was supported to integrate both the parts of himself that he liked and parts that he was made to feel are bad and cause him distress. TA built and “all about me “ book with Luke Luke was given time with an adult to make choices about what he liked, this was particularly obvious in setting such as “golden time”.

35. 8 Primary Skills in 3 DomainsSupported by two integrative strategiesIn service of one unifying goal of Trauma Experience Integration Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

36. Trauma informed schools • Not a whole new approach, or new lesson plans • Catching the moments as they arise as we look through a trauma lens.

37. So what next? • Surprises • Satisfactions • Learnings • Discoveries • Dis-satisfactions • Next steps Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

38. Where do I go from here? Considerations for building ARC into your practice or system Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

39. Supporting Integration and Sustainability • Build understanding in layers; deepen over time • Integrate key language and concepts (into discussion, into forms, into pastoral care plans, into goals and action steps, etc.) • Build structures that support the intervention plan/pastoral care plan • Pay attention to the details, but keep sight of the “big picture” Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

40. And the big picture is?

41. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005