A Trauma Informed Approach for Teen Pregnancy Prevention

1. A Trauma Informed Approach for Teen Pregnancy Prevention Joann Schladale, LMFT Resources for Resolving Violence, Inc. 28 Marshview Drive Freeport, Maine 04032 Schladale@aol.com 207-232-3195 Resourcesforresolvingviolence.com

2. Objectives: • Engage and motivate youth who have experienced trauma to prevent unplanned and unwanted pregnancies • Communicate hope and optimism • Integrate a clearly defined trauma informed approach for teen pregnancy prevention into systems of care • Promote and model self-regulation skills for health and well-being

3. Hope is a powerful contraceptive.The way you help young people avoid pregnancy is by providing them with real evidence that good things can happen in their lives. Michael Carrera

4. Many of these youth have experienced: • Poverty • Disadvantaged family background • Child abuse • Sexual harm • Exposure to substance abuse • Interpersonal violence • Academic struggles • Lack of adequate health care

5. Let’s meet T.J.

6. Most vulnerable youth are: • In foster care • Incarcerated • Homeless • Marginalized

7. Blackbird singing in the dead of night,Take these broken wings and learn to fly.All your life… John Lennon & Paul McArtney

8. Complex trauma describes: • The dual problem of children’s exposure to traumatic events and the impact of this exposure on immediate and long-term outcomes • Children’s experiences of multiple traumatic events that occur within the care giving system • Simultaneous or sequential occurrences of child maltreatment

9. Multiple domains of impairment: • Self-regulatory, attachment, anxiety and affective disorders • Addiction, aggression, social helplessness and eating disorders • Dissociative, cardiovascular, metabolic, and immunological disorders • Sexual disorders • Revictimization

10. Primary domains of impairment: • Attachment • Biology • Affect regulation • Dissociation • Behavioral regulation • Cognition • Self-concept

11. Affect RegulationSchore (2003) A person’s ability to manage emotions without causing harm

12. Arousal To evoke or awaken a feeling, emotion or response

13. Disturbance of Arousal An experience that tests a person’s ability to manage their feelings, or affect. When people get upset they have thoughts, feelings and physiological reactions that influence their behavior. Behavior then influences outcomes.

14. Let’s look at some flow charts

15. EducationDOES NOT equal change!

16. Affect regulation requires:Stien & Kendall (2004) • Safety and stabilization • Exercise and body movement • Healing touch • Expression through art, drama, dance and music • Skill building

17. Tasks for Harm Reductionvan der Kolk (2004) • Mindfully observe internal experience • Stay organized in the threat of psychological upheaval • Change body activity when addressing pain • Remember and celebrate survival resources • Learn to state success • Honor life!

18. Successful intervention addresses: • Optimal elements of child development • Resilience and protective factors • Positive youth development • Motivation for change • Healing trauma • Affect regulation • Best practices for youth violence prevention • Competency development

19. Evaluation and Assessment • Documenting a comprehensive review and accumulation of information at a given time. • An ongoing process of face-to-face interviews and observations in order to collect information relevant for service planning and delivery. • Objective measures, when available, should be included.

20. Effective intervention involves:Duncan, Miller, Wampold & Hubble (2011) • Technique (15%) • Instilling hope & expectation for change (15%) • Warm, non-judgmental, empathic, and genuine relationship (30%) • Client characteristics: strengths, resources, protective factors (40%)

21. If you treat an individual as he is, he will stay as he is, but if you treat him as if he were what he ought to be and could be, he will become what he ought to be and could be. Johann Wolfgang von Goethe

22. Core Approaches to all Evidence- Based Practices for Child AbuseSaunders, Berliner & Hanson (2004) • Prioritize work with caregivers • Are goal directed • Provide a structure approach • Focus on skill building to manage emotional distress and behavioral disturbances • Use techniques that involve repetitive practice of skills with feedback

23. Skills Common to all Evidence-Based PracticesSaunders, Berliner & Hanson (2004) • Emotional, or affect regulation: the ability to identify, modulate, and express emotions in pro-social ways • Anxiety management • Cognitive restructuring • Problem solving

24. Possible risk factors for rapid repeat pregnancies (Brindis, 2011): • Age and ethnicity • Partner relationships • Cognitive limitations • Poor self-esteem • Lack of internal locus of control • Emotional stress influencing contraceptive behavior • Interference with contraceptive behavior

25. These young people need: • A vision for healthy relationships • Academic and workforce development skills • Adequate health care • Parenting information and mentoring • Transportation • Legal services • Housing assistance • Optimal child care (don’t’ we all!)

26. Services should: • Be provided in their home, school, community and medical setting • Be developmentally congruent • Involve coaching by service providers • Include trauma informed therapy

27. Engaging youth in trauma informed services involves: • Positive youth development • Motivational interviewing • Using the four factors that influence successful outcomes in psychotherapy

28. Trauma Outcome Process • Trauma means bad things that have a lasting effect on your life • Outcome is a result, or consequence • A process is a particular way of doing something Your trauma outcome process is the way you choose to deal with very bad things that happened to you

29. Let’s look at one last flow chart

30. Core Competency Domains • Social skills: Interaction, Cognition and Self-Control • Moral Reasoning • Academic Skills • Workforce Development • Independent Living

31. Let’s meet Jasmine

32. Do not be daunted by the enormity of the world’s grief. Walk humbly now. Do justly now. Love mercy now. You are not obligated to complete the work. But neither are you free to abandon it. The Talmud

33. Thank you! for showing up in the lives of these young people