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 Kati Taunt For Islington Education Service September 2017 Day 2 ARC Developed By: Margaret E. Blaustein, Ph.D. Kristine M. Kinniburgh, LICSW The Trauma Center at JRI

2. Introductionsand how is it going? Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

3. Ground rules: Kindness Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

4. ARC – a framework for intervention Core principles Trauma derails healthy development Trauma happens in a context, and service provision has to address the context 3 Core Domains to address: A safe caregiving system (Attachment) The ability to regulate and tolerate experience (Regulation) Support in the mastery of an array of tasks crucial to resilient outcome (Competency)

5. To curiously explore in order to make sense of and understand (age appropriately) who they are. Making sense of the things that have happened to them and how this may affect them. So that they can fully get on with all aspects of their lives.

6. 8 Primary Skill Targets • Caregiver Affect Management • Caregiver Attunement • Caregiver Consistent Response • Self Awareness • Modulation Skills • Children’s Relational Engagement • Improve Problem Solving • Enhance Self and Identity

7. 2 Integrating Strategies • Routines • Psychoeducation Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

8. 3 Primary Domains • Attachment • Regulation • Competency Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

9. Executive Functions Modulation Expression Identificat. Attunement Behavioural Response Caregiver Affect Mgmt. 8 Primary Skills: Building Blocks Self Dev’t & Identity Competency Routines Regulation Psychoed Attachment Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

11. 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. Those adults include administrators, teachers, staff, parents, and law enforcement. In addition, students are provided with clear expectations and communication strategies to guide them through stressful situations. 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

12. 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.

13. Think of a child/ young person

14. Remember the idea of “developmental lag”?

15. Domain 2:REGULATION Affect Identification Modulation

17. REGULATION Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

18. Regulation Overarching goal: Support children to safely and effectively (at age- and stage-appropriate levels) manage experience on many levels: emotional, physiological, cognitive, and behavioral; this includes the capacity to identify, access, modulate, and share various aspects of experience Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

19. The Role of the Care givers in Regulation Reflection: The lens through which the child learns to interpret experience. Modelling: Learning how people “do emotions” Stimulation and soothing: regulating a child

20. Target skill-building to child needs • Challenges in “self-regulation” may present in multiple ways; in what ways is the child or adolescent currently attempting to modulate? • Many distressing behaviors represent the child/adolescent’s attempt to cope; work to understand the function behind the behavior, and support alternative strategies Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

21. What issues with regulation does your child have?

22. +10 +9 +8 +7 +6 +5 +4 +3 +2 +1 0 -1 The POWER zone – living in hyperarousal THE ROLLER-COASTER – Comfort zone? What comfort zone? The KEEP-IT-COOL zone – any arousal is scary Individual Differences:The Comfort Zone Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

23. Remember this? Observe Modulate Do ………and repeat Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

24. Attunement skills support youth regulation • Observe: Your child: pick up on those “clues” of need/distress as early as possible. Increasingly try to anticipate (“get in front of”) by observing and anticipating patterns. • Observe: yourself (caregiver): notice your own cues of distress, support needs or loss of control. • Modulate: Yourself: If you can only stay in control of one thing, make it you.

25. Attunement skills support youth regulation • Co- Modulate; Your child, mirror what you see and cue support and reinforce use of regulation strategies. Pay attention for opportunities for control • Do after everyone is calm: reflect process, limit set, problem solve. • Don’t waste your “do” on the limbic system (yours or the child’s).

26. The Main Idea: Work with children to build an awareness of what is going on emotionally for them, the ability to recognize and name emotional states, and an understanding of where these states come from. Identification: Affect Identification

27. A game……

28. Key Concepts 1. Traumatic stress overwhelms the limited coping skills available to a developing child, often forcing them to either disconnect from their feelings or to use other unhealthy coping skills.

29. 2. Because of these factors children who have experienced trauma are frequently disconnected from or unaware of their own emotional experiences, and may also have difficulty reading the cues of others.

30. Things to teach to kids first. • Everyone has feelings • Feelings come from somewhere • It is not always easy to know what we feel • There are cues that can tell us what we might be feeling • Knowing about feelings helps us understand ourselves, the situation we are in, and whether we need to do something to manage the feeling.

31. Primary Targets 1. Help children to accurately identify, at an age-appropriate level internal experience (emotions, energy/arousal) • Language for emotions energy/arousal • Connection among feelings, body sensations, thoughts and behaviours: understanding the links and using these as “clues” to understand experience • Context in which experiences bring which emotions or increase arousal 2. Help children and youth to identify (age appropriately) emotions in others.

32. 1. Identifying Emotion in Self An inability to recognize different emotions. (I’m fine…. “I don’t know”) Physiological or behavioural expression of an emotion. (hyperactivity, silliness etc) A lack of understanding of the connection between physiological states and the experiences that elicit them.

33. Strategies For Building Basic Identification Skills 1. Invite the child to share daily emotional experience; incorporate check-ins into appropriate routines: i.e., How are you feeling today?

34. 2. Name or invite reflection on emotions in the context of specific experiences • “How did it feel when you got that test back?”

35. 3. Reflect on what you can see: describe what you see: “ It looks like you might be feeling worried.”

36. 4. Normalise and validate emotions; pay attention to mixed emotion: “ other children would probably feel this way too, if it had happened to them.”

37. 5. Build an environment that acknowledges emotion

38. Advanced affect Identification • Incorporates two primary targets: • Understanding the connection of emotions to other aspects of experience (“ I know I’m feeling happy because…..”) • Understanding the context of emotion ( the reason I’m feeling happy is……)

39. Connection of Emotions • Support child in “becoming feelings detectives” about self and others.. • Build an understanding of the way in which people express emotions ( how does a teacher show she is angry vs how a child might) • Pay attention to differences within a child’s own expressions of emotions…( sometimes when I am sad I … other times I….)

40. The wonderful world of Triggers. Trauma Context: The Body’s Alarm Teach to children and adolescents: Normative danger response Danger response and arousal The overactive alarm What triggers the alarm How do you know if your alarm Has gone off?

41. Triggers: 7 Key Teaching Points: • The Body’s Alarm System: “The human brain has built in systems that recognize danger and help to keep us safe”. • Normative Danger Response: “When our brain recognizes danger, it prepares our body to deal with it”. Fight, Flight, Freeze

42. 3. The Link Between Danger Response and Arousal: “When it is time for our body to fight, or run, or freeze, we need a lot of energy to do that”.

43. 1 - Understanding Triggers: 7 Key Teaching Points The Overactive Alarm: “When the danger signal goes off, the “thinking” part of our brain checks out what’s going on around us. If it is a false alarm, and there is no real danger, the “thinking” part of the brain shuts the alarm off and we can keep doing what we’re doing. When kids have had a lot of dangerous things happen to them, the alarm may go off too much! The “thinking” part of the brain has got tired of checking things out- the “doing” part has taken over.

44. 5. The False Alarm & Triggers: “False alarms can happen when we see, hear or feel something that reminds us of bad things that used to happen or happened in the past” 6. How Triggers Manifest: “ Once our alarm turns on, our body fills with fuel to prepare us for dealing with danger. When our body has that much fuel- it needs to do something.” 7.Recognising Triggers: “ We are going to work on learning about what kinds of reminders might feel dangerous to you and how your body reacts when reminders are around.”

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

46. Affect Identification: Example Activities Routine check-ins Feelings Flashcards Feelings Charades Word Play Feelings Detectives Body Awareness Worry Head Feelings Book

47. Energy/Body Mapping • Show me where you feel Happy? Sad? • Where is Your Energy Right now: • Notice heart rate • Notice body temperature • Notice breathing • Notice muscle tension Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 1.7

48. 2.Identifying Emotion in others • This relies on being able to read cues such as body language, voice tone and behaviour, and to accurately interpret them within the context in which they occur.

49. Affect Identification - Other Children may also have difficulty reading others’ cues. This difficulty may present as: Selective hyper vigilance. ie,. looking out for danger all the time Insufficient attunement. i.e. Missing cues in social situations –others are frustrated, annoyed, proud, etc. Inaccurate attunement Misinterpreting things as negative– i.e. interpreting a joke as rejection, fatigue as anger, etc.

50. 4 primary Intervention Strategies • 1. Normalization • 2. Build curiosity and reflective awareness about the emotion they observed. • 3. Use Visual Cues • 4. Caregiver modelling.