Who we help Community of people with Developmental Disabilities and co-occurring mental health diagnoses People deemed “too challenging” for typical agencies Most common factor is a trauma history

Where we’re going Effective, therapeutic crisis response! (But before that, we have to get there) Trauma and its effect on the brain Behavioral reenactments Strategic Self Regulation Therapy (SSRT) Stage Model MANAGE system for crisis Response Acute crisis interventions

Symptoms of the people we serve Violence Aggression Manipulation Emotional outbursts Lack of motivation BAD BEHAVIOR

A more thoughtful look at “bad behavior” Developmental Trauma Van Der Kolk (2005) “Developmental Trauma Disorder: Towards a Rational Diagnosis for Chronically Traumatized Children

A. Exposure 1. Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death). 2. Subjective Experience (rage, betrayal, fear, resignation, defeat, shame).

B. Triggered pattern of repeated dysregulation in response to trauma cues Dysregulation (high or low) in presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness. Affective Somatic (physiological, motoric, medical) Behavioral (e.g. re-enactment, cutting) Cognitive (thinking that it is happening again, confusion, dissociation, depersonalization). Relational (clinging, oppositional, distrustful, compliant). Self-attribution (self-hate and blame).

C. Persistently Altered Attributions and Expectancies Negative self-attribution Distrust protective caretaker Loss of expectancy of protection by others Loss of trust in social agencies to protect Lack of recourse to social justice/retribution Inevitability of future victimization

D. Functional Impairment Educational Familial Peer Legal Vocational Sound like anyone you’ve met?

What trauma does to the brain

The Bipartisan Brain Feeling Limbic System Thinking Frontal Lobes

Functions of the Brain Systems ACTION! Limbic System Thinking Frontal Lobes

Stop, Think, Solve Problems Behaviors of the Systems Behaviors Freeze, Flight, Fight Behaviors Stop, Think, Solve Problems Behaviors of the systems

Turned off by Limbic System Triggering Events Limbic System Freeze, Flight, Fight Frontal Lobes Turned off by Limbic System

Turned off by Limbic System When something in the world is perceived as dangerous… Frontal Lobes Turned off by Limbic System Limbic System Freeze, Flight, Fight

Internal Triggers Frontal Lobes Stop and Think… Limbic System ACTION!

Something happens in the World OR in the Body… Frontal Lobes A Problem to Solve… Limbic System DANGER!

The Social Brain Engagement Approach… Disengagement AVOID!

Turned off by Limbic System Language Effects Limbic System Freeze, Flight, Fight Frontal Lobes Turned off by Limbic System Broca’s Region Language Production and Comprehension

Turned off by Limbic System Confabulation Frontal Lobes Turned off by Limbic System Limbic System Freeze, Flight, Fight Broca’s Region Language Production and Comprehension

The Brain is… The brain is an anticipation machine. It mostly anticipates what it has experienced. It gathers information from the perceived (and “remembered”) social and external world as well as conscious and unconscious memory and process. It then decides on, and prepares for, what it believes is coming next.

Treatment implications A traumatized brain sees the world and everything in it as a potential threat Luckily, neuroplasticity allows for “rewiring” Basis for treatment is reestablishing fundamental attachments The SSRT state/stage model allows for conceptualizing the path of treatment

The State Or Stage Model   Stage 1 “Wrap The World Around Them” Stage 2 “Lay The Groundwork For Understanding Themselves & The World” Stage 3 “Wrap Them Around The World” Goals Stop blowing up Learn skills Understanding Targets The body The skills The mind Predominant State Anger Pain Hope Treatments Parasympathetic tools The Map Traditional psychotherapy Outcomes Stops blowing up Can map events Understand what makes them tick Common Misperceptions We Are Reinforcing Bad Behavior We Are Being Manipulated We have Extinguished the Behavior

M A N A G E anage yourself and the environment while modeling reasonable behavior A gree, acknowledge, and listen N avigate thoughts and perceptions A id in generating solutions and problem solving G enerate reasonable consequences and take personal responsibility E nd by repairing relationships