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WHY IS IT SO HARD TO MOVE ON? The impact of trauma on transition aged youth “The world breaks everyone, and afterward, some are strong in broken places.” -Ernest Hemingway. Allison Elias, L.C.S.W., Thresholds, Chicago, IL Cindy Berry, Psy.D ., University of Illinois Chicago, Chicago, IL .

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slide1

WHY IS IT SO HARD TO MOVE ON?The impact of trauma on transition aged youth“The world breaks everyone, and afterward, some are strong in broken places.”-Ernest Hemingway

Allison Elias, L.C.S.W., Thresholds, Chicago, IL

Cindy Berry, Psy.D., University of Illinois Chicago, Chicago, IL

slide2

Trauma versus Complex Trauma

“Complex trauma” describes the

experience of multiple, chronic and

prolonged, developmentally adverse

traumatic events, most often of an

interpersonal nature (eg. sexual or

physical abuse, war, community

violence) and early life onset.

–Bessel A. van derKolk

the impact of trauma in childhood
The Impact of Trauma in Childhood

Research has shown that trauma in childhood is correlated with:

*depression *suicide attempts

*alcoholism *drug abuse

*sexual promiscuity *domestic violence

*cigarette smoking *obesity

*sexually transmitted disease [Felitti, Nordenberg et al., 1998]

  • Physical abuse and neglect are associated with very high rates of violent offenses
  • 75% of perpetrators of child sexual abuse report to have been sexually abused as children

[van der Kolk, 2003]

complex developmental trauma
Complex Developmental Trauma:
  • Difficulty regulating (controlling) emotions
  • Impulsive decision making/engaging in risk taking behaviors
  • Intense feelings of guilt, shame and low self-worth
  • Problems with interpersonal boundaries and relationships
  • Struggle with trusting others
  • Difficulties seeing another person’s point of view
  • More likely to report physical ailments
  • May engage in emotional numbing and social withdrawal
  • Sense of hopelessness about the future
  • Increased feelings of anxiety
the impact of chronic trauma on functioning
The Impact of Chronic Trauma on Functioning
  • Interferes with neurobiological development
  • Compromises the capacity to integrate information
    • sensory information
    • emotional information
    • cognitive information
difficulty with affect regulation
Difficulty with Affect Regulation
  • Impairs the ability to control emotions
  • Vacillates between:
    • emotional flooding (hypervigilance/arousal)
    • numbing (dissociation)
  • Switches tend to be drastic in intensity and frequent in nature
conditions that impact affect regulation
Conditions that Impact Affect Regulation
  • Five Senses:
    • Smell
    • Touch
    • Taste
    • Sight
    • Sound
difficulty with cognitive functioning
Difficulty with Cognitive Functioning
  • Attention
  • Decision making
  • Working memory
    • Sensory/Non-verbal memories vs. Autobiographical Memories
treatment four central goals
Treatment: Four Central Goals
  • Safety
    • environment
    • Personal
  • Skills Development
    • emotion regulation and
    • interpersonal functioning
treatment four central goals1
Treatment: Four Central Goals
  • Meaning-making
    • About past traumatic events in order to consider more positive, adaptive views of themselves in the present
    • To help experience hope about their future
  • Enhance resiliency and integrate into a social network

[From Complex Trauma in Children and Adolescents, National Child Traumatic Stress Network, 2003]

moving on
MOVING ON…

“Independence is not linked to the physical or intellectual capacity to care for oneself without assistance; independence is created by having assistance when and how one requires it”

-Brisenden, 1989

the transition in crisis
The Transition in Crisis
  • Youth may start to decompensate
    • become aggressive
    • run away
    • engage in self injurious behavior
  • Youth may blame others for their difficulties
    • foster parents, staff, the program, case workers, the system,
    • push others away: It’s easier to “burn bridges” than to feel sad or loss
  • May lose a job or do worse in school
    • if employment or diploma is required for transition.
why do these youth seem to undermine their success
Why Do These Youth Seem To Undermine Their Success?
  • TRANSITIONS ARE SCARY!
    • Fear of the unknown
    • Fear of failure
    • Fear of success
    • Out of comfort zone
  • Complex trauma exacerbates all this
    • May be a resurgence of past symptoms
    • Current symptoms may be magnified by transition
slide17

Trauma Symptoms through a

Transitional Lens:

  • Trust Issues
    • Distrust of people, system, etc.
    • Suspicious of others motives
    • Uncertain of the predictability/reliability of the world
  • Social Issues
    • Tendency towards social isolation
    • Difficulty taking another’s perspective
    • Trouble understanding one’s own contribution to what happens to them
slide18

Trauma Symptoms through a

Transitional Lens:

  • Executive Skills (ability to perform tasks)
    • Problems with focus and attention
    • Problems processing new information
    • Difficulty problem solving
    • Difficulty with planning and anticipating
    • Problems with working memory
    • Failures to make wise judgments
    • Cognitive inflexibility
    • Difficulty inhibiting inappropriate responses
why can t they just tell us
Why Can’t They Just Tell Us?
  • These youth don’t always say what they mean
  • Don’t want to show fear
  • Afraid to need help or support
  • May not always be aware of feelings

Look at the feelings under the words!!!!

common ways we try to help
Common Ways We Try To Help
  • “Dangle a Carrot” approach
    • Use an apartment, job, etc. as an incentive for youth to do well.
    • May just be reinforcing that the youth has to leave. Youth may only focus on the leaving (poor sense of time).
    • “I’m not worthy of this”
  • Contracts
    • If ____, then ____. “If you have zero incidents of aggression for 30 days, then you’ll be able to leave.”
    • Unfortunately, youth may only hear, “You’re leaving.”

OVERWHELMING!

stuck at transition
“Stuck” at Transition:
  • Youth are at an early stage of their development
  • Being on their own is overwhelming
  • Often raised in foster care/residential care
    • Decisions are made for them
    • Multiple transitions—no lasting relationships
    • May lack experiences with unconditional love
  • Poor affect regulation and arousal
    • Staff may mention “when you’re on your own” in passing and the anticipation becomes a trigger
stuck at transition1
“Stuck” at Transition:
  • Youth are present focused:
    • can’t always remember periods of success
    • very difficult to imagine the future
  • Youth grieve the loss of their childhood:
    • never experienced a “true” childhood
    • fear of being an adult
  • Lack of social supports:
    • may live away from family with no contact in years
    • don’t know how to reconnect family or community
how can we help them move on

How can we help them move on?

Creating a Smooth Transition for Traumatized Youth

talk about the elephant in the room
Talk about the “elephant in the room”

Validate stress & anxiety about transitioning

Identify potential fears

Generate discussion around peer’s transitions- successful & unsuccessful

Help them grieve loss of childhood

independence is not always the carrot
Independence is not always the “carrot”
  • When achievement parameters back fire:
    • “Have a little faith in me”
    • “Just do it”
  • High support still needed
  • The team must examine its own anxiety
build competencies
Build Competencies
  • Focus on Skill Building
        • independent living skills
        • coping/affect regulation skills
        • social skills

BE REPETITIVE! *The ‘Dora’ method

  • Focus on Mastery & Strengths
        • identify strengths/interests
        • provide opportunities for success/redefine success
        • help them recognize previous success
        • build forums to celebrate accomplishments

BE CREATIVE & DON’T GIVE UP!

seek appropriate treatment
Seek Appropriate Treatment
  • Refer to trauma informed therapy
  • Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)
  • Trauma Focused- Cognitive Behavioral Treatment
  • Skills Training in Affect and Interpersonal Regulation (STAIR)
  • Dialectical Behavior Therapy (DBT)
  • Trauma Systems Therapy
  • Attachment, Self-regulation & Competence (ARC)
  • For more information:
  • National Child Traumatic Stress Network

http://www.nctsnet.org

build social support networks
Build Social Support Networks
  • Build a sense of community
  • Reconnect to the past: BE DETECTIVES!
  • Support elements of healthy relationships
help them have different endings
Help them have different endings

Role model healthy termination

Combat ‘the burning of the bridge’

slide30

In Time Perhaps

In time

perhaps

My wounds will heal

And my pain will no longer be numb.

It will disappear.

The smile that I wear upon my face

will be real.

My locked up dreams

will slowly

cut themselves free

from helplessness and disappointment.

-Anonymous