Treating Complex Childhood Trauma in Primary Schools: Targeting the Building Blocks of Resilience

1. Treating Complex Childhood Trauma in Primary Schools: Targeting the Building Blocks of Resilience Presentation by Helen Aspland and Siobhan Foley Islington CAMHS October 2017 Day 1 ARC Developed By: Margaret E. Blaustein, Ph.D. Kristine M. Kinniburgh, LICSW The Trauma Center at JRI

2. Introductions Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

3. Ground rules: Kindnessto self and others Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

4. The Plan for today • 1. What is trauma? • 2. How does early trauma impact brain development? • 3. Why trauma informed schools? • 4. Introduction to the ARC model. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

5. +10 +5 0 -5 Let’s talk about energy How high (or low) is your energy right now?

6. Totally comfortable Really uncomfortable Let’s talk about energy - How comfortable does that energy feel in your body? - How good a match is you energy level to what you are doing?

7. Take a minute to hold a child in mind Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

8. Luke aged 9 • Hypervigilant • Finds it hard to sit on his chair, fidgety • Has few friends • Reacts disproportionately to minor disagreements with peers • Can be uncommunicative • Hides under tables when asked to undertake new learning activities • Can be violent and aggressive to pupils and staff

9. Luke is the eldest of 4 children • His mother was 17 when he was born • Mother subject to DV at the hands of his father • Mum and Luke left home town to live in refuge • Mum has diagnosis of depression • Stepfather (father of two youngest children) recently imprisoned • Luke has attended 3 different schools • Currently awaiting rehousing due to arguments and threats from neighbours

10. What is trauma? -Any experience that threatens life or physical integrity and overwhelms an individual’s capacity to cope. -Perception is more important than reality - Can be an acute event or chronic

11. Trauma is Complex: Dimensions of Traumatic Experience Ways in which the type of exposure can vary… • Age/developmental stage during exposure • Origin of exposure • Public versus private • Chronicity • Lasting impact e.g. physically • Social support • Contextual issues (culture, family, community) • Presence/absence of additional resources • Presence/absence of additional vulnerabilities • Individual differences (cultural factors, coping style, cognitive, temperament) • Factors that make profound difference to outcome is • how much social support you have • If the trauma was interpersonal

12. Developmental Trauma Overwhelming experiences of childhood, often occurring within the attachment relationship, such as neglect, psychological maltreatment, attachment separations and impaired caregiving systems. van der Kolk, 2005

13. What sorts of events or experiences may your students have experienced that could be seen as “trauma”? Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

14. https://youtu.be/eFwNWi9F6tA?t=46 0.46-2.11 Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

15. Worksheet….Which of the following do you think might apply to the child you are holding in mind today? • Situations that can be traumatic: • Physical or sexual abuse • Abandonment • Neglect • The death or loss of a loved one • Life-threatening violence in a caregiver • Witnessing domestic violence • Automobile accidents or other serious accidents • Bullying • Life-threatening health situations and/or painful medical procedures • Witnessing or experiencing community violence (e.g., shootings, stabbings, robbery, or fighting at home, in the neighbourhood, or at school) • Witnessing police activity or having a close relative incarcerated • Life-threatening natural disasters • Acts or threats of terrorism (viewed in person or on television) • Living in chronically chaotic environments in which housing and financial resources are not consistently available • —NCTSN Child Trauma Toolkit for Educator

16. Trauma Derails Development Exposure to trauma causes the brain to develop in a way that will help the child survive in a dangerous world: • On constant alert for danger • Quick to react to threats (fight, flight, freeze) The stress hormones produced during trauma also interfere with the development of higher brain functions. Source: Teicher., M. H. (2002). Scars that won't heal: The neurobiology of child abuse. Scientific American,286 (3),68-75.

17. Experience Grows the Brain • Think of one thing you feel like you could “do in your sleep”: why does it feel so easy? • All of us develop a repertoire of strategies for managing the world (i.e., behavioral patterns) guided in part by our previous experience: what we’ve used in the past, and how successful those strategies have been • Brain development happens from the bottom up: • From primitive (basic survival) • To more complex (rational thought, planning, abstract thinking)

18. Experience Grows the Brain(Continued) • The brain develops by forming connections. • Interactions with caregivers are critical tobrain development. • The more an experience is repeated, the stronger the connections become.

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

23. Fight, flight, freeze – brain song • https://www.youtube.com/watch?v=Mp-Q_UU6Ksk • low road/express way ’v’ high road Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

24. PTSD • Requires exposure to a traumatic event, then symptoms of persistent re-experiencing, • Avoidance and emotional numbing, • Persistent symptoms of increased arousal not present before • For more than 1 month • PTSD is not the most common diagnosis for youth who have experienced more chronic adversities - • Youth (and adults) who have experienced chronic adversities frequently meet criteria for a range of other diagnoses, and individuals with PTSD experience frequent comorbidity • Traumatic memories are stored differently – • Often disjointed, • High sensory content and • Have a ‘now’ quality • Triggering can be beyond conscious awareness

25. What is the effect of trauma on outcomes? • Adverse childhood experiences study • https://youtu.be/95ovIJ3dsNk?t=168 2.50-9.30 • Primed to focus on survival • Developmental lag Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

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

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

28. Van der kolk– ‘the body keeps the score’

29. What helps the child survive? Survival trumps everything Assumption of danger - it is about ‘felt safety’ not necessarily actual safety Rapid mobilisation in the face of perceived threat – fight, flight or freeze Self-protective stance Development of alternative strategies to meet developmental needs – ‘how have these young people learn to get by?’ e.g. controlling, provoking expected response/seeking out conflict, avoiding help-seeking, unhelpful attempts to self-sooth, dissociation, sensation seeking etc Many distressing behaviors represent the child/adolescent’s attempt to cope;

30. We all Define Danger Differently • Our individual filters – based on experience - guide our interpretation of the world.

31. There are Only a Few Possible Responses to Danger –fight, flight, freeze *and ALL of them REQUIRE a surge of arousal.

32. Behavior is Generally Functional and makes sense in the context it which it developed - but may not in other contexts/reLAtionships • The same behaviormay serve a different functionfor different people (one person may use drugs to feel alive; another person may use them to turn off / shut down) or at different times.

33. Our Ability to Shift From “Survival Mode” (survival-based behaviors) To Active Engagement (learning brain) Is Impacted By Our Internal and External Resources Trust Affect management Frustration tolerance Problem-solving ability Ability to read others Social connection and support Biological vulnerabilities

34. Trauma’s Dual Influence on Development • Prioritization of those domains of skill / competency / adaptation which help the child survive their environment and meet physical, emotional, and relational needs • De-emphasis of domains of development which are less immediately relevant to survival Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

35. While kids are getting really good at survival, what are they not getting? Curriculum - Blaustein

37. Using the Trauma Lens: Understanding Luke What has Luke experienced in his life? How might his experiences have affected him? What has he learned about himself? About relationships? How has he learned to manage his internal experience? In what ways are his behaviors adaptive? How has he learned to survive his world? Where were the opportunities to intervene?

38. Luke is the eldest of 4 children • His mother was 17 when he was born • Mother subject to DV at the hands of his father • Mum and Luke left home town to live in refuge • Mum has diagnosis of border line personality • Stepfather (father of two youngest children) recently imprisoned • Luke has attended 3 different schools • Currently awaiting rehousing due to arguments and threats from neighbours

39. trauma informed schools Survival brain v learning brain 0.19-3.47 https://youtu.be/KoqaUANGvpA?t=19 Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

41. How Does it Effect School outcomes? • One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior. • Trauma can impact school performance. • Lower academic attainment • Higher rate of school absences • Increased drop-out • More suspensions and expulsions • Decreased reading ability

42. In groups: What does this look like in your classrooms/work with children? Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

43. In school Traumatized children may present with physical and emotional distress. • Poor control of emotions or may seem very ‘shut down’ • Inconsistent academic performance • Unpredictable and/or impulsive behavior /difficulty with behaviour control • Over or under-reacting to bells, touch , doors slamming, sirens, lighting, sudden movements • Resisting or significantly unsettled by transition and/or change • Intense reactions to reminders of their traumatic event: • Adversely affect attention, memory, and cognition • Physical symptoms like headaches and stomach aches • Reduced ability to focus, organize, and process information • Impaired problem solving and/or planning • overwhelming feelings of frustration and anxiety • Thinking others are violating their personal space, i.e., “What are you looking at?” • Blowing up when being corrected or told what to do by an authority figure • Fighting when criticized or teased by others • Failure to develop age-appropriate coping strategies • Difficulty relating with peers or communicating experiences to other

44. https://www.youtube.com/watch?v=49GzqPP7YYk • 0.00-4.01 Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

45. Young Children (0–5)

46. School-Aged Children (6–12)

47. To recap… Trauma effects • Attention, planning and problem solving • The ability to relate to others • The ability to regulate behaviour and emotion Can lead to.. • Reduced time in class and increased exclusions, • Association with lower attainment, attendance, • Poorer outcomes – substance abuse, offending, teen pregnancy, joblessness, and poverty. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

48. In a trauma-informed school, the adults in the school community are prepared to • recognize and respond to those who have been impacted by traumatic stress (include administrators, teachers, staff, parents, TA’S) • In addition, students are provided with clear expectations and communication strategies to guide them through stressful situationsrather than assuming they are functioning at their chronological age. • The goal is to not only provide tools to cope with extreme situations but to create an underlying culture of respect and support Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

49. Ed Talks Mark Sander 11-20.37 – TIS • https://youtu.be/QAGx2PyMh_o?t=586 Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

50. Some of the Key components of a trauma informed school • Enhancing trauma- awareness throughout the school community and stepping back to look at all aspects of the school environment and practice through a ‘trauma lense’ and working to actively foster a sense of ‘felt safety’ • Conducting a thorough assessment of the school climate • Inclusiveness • Specific risk and protective factors for each individual school community • Senior leadership ‘buy in’ • Attention to how staff are supported • Knowing there will be skeptics • Developing trauma informed discipline policies • Awareness of the prevalence and impact of secondary traumatic stress for teachers and staff • EXERCISE – What aspects of the school environment might be more difficult for a child with a trauma history?