Trauma-Informed Youth Programming STYA Provider days 9/22 & 23, 2016

Objectives Trauma and its impact on youth Strategies to address trauma What can PYD offer to work with youth living with trauma?

What is Trauma? Acute Chronic

Defining Trauma Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being. SAMHSA 2014 Ask what type of events

Stress Response Increased: Fight, flight, freeze response Hypervigilance, arousal, paranoia Perceptual and information processing distortions Pain tolerance Emotional blunting Aggression and irritability Decreased: Memory processing and retrieval Reality testing Body and emotional awareness Immune response

Post Traumatic Stress Disorder (PTSD) Symptoms last longer than a month after event Intrusive re-experiencing of the trauma, avoiding trauma reminders (triggers), and persistent state of alert Related emotional and behavioral problems Co-occurs with other disorders (anxiety, ADHD, oppositional defiant disorder, etc.) Symptoms vary according to developmental stages Estimated prevalence: 3.5% of adults, less for children and youth In adolescence Flashbacks Persistent re-experiencing of event (sometimes through risk-taking behavior) Physical symptoms Increased arousal/hyper-vigilance Failure or regression in academic skills; concentration problems Impulsive or aggressive behaviors Absence of future planning

Re-Traumatization A situation, attitude, interaction, or environment that replicates the events or dynamics of the original trauma and triggers the overwhelming feelings and reactions associated with them Sample Triggers: - Touch, sounds, gestures, light, opening a door without knocking

Adverse Childhood Experience (ACE) Collaboration between Kaiser Permanente of San Diego and Centers for Disease Control and Prevention (CDC). Initial phase conducted from 1995-1997 in two waves. Participants were given a standardized physical exam and completed a confidential survey on child maltreatment, family dysfunction, current health status and behaviors. Each event received numeric value 1 – not weighted by severity Unique opportunity to examine the relationships between a broad range of adverse childhood experiences (ACEs) and a wide range of health and social consequences in adulthood.

Adverse Childhood Experiences Physical abuse by a parent Emotional abuse by a parent Sexual abuse by anyone Growing up with an alcohol and/or drug abuser in the household Domestic violence Experiencing the incarceration of a household member Living with a family member experiencing mental illness Loss of a parent Emotional neglect Physical neglect Trainer: Adverse Childhood Experiences (ACEs) can fall under three categories; abuse, neglect, or loss and occur prior to the age of 18. Any one of these events can have an impact on an individual. In combination, the greater the number of these events experienced the greater the cause for concern for an individual’s well-being.

More widespread than assumed ACEs Study Findings 63% of study participants had experienced at least one category of childhood trauma. Over 20% experienced 3 or more categories of trauma 4 or more traumatic experiences greatly increased adults’ risk for alcoholism, drug abuse, suicide attempts, sexually transmitted diseases, and poor general health. 4 or more ACEs: 15% of women - 9% of men The ACE study found that the presence of four or more serious adverse experiences during childhood greatly increased adults’ risk for alcoholism, drug abuse, suicide attempts, sexually transmitted diseases, and poor general health. More widespread than assumed Education   Not High School Graduate 7.2% High School Graduate 17.6% Some College 35.9% College Graduate or Higher 39.3%

How many ACEs did you experience?

Effects of Trauma Behavioral Effects Cognitive Effects Social Effects - Risk taking - Acting out - Rule breaking Attention Memory Executive functions Verbal abilities Skills development Language Group work Problem solve Transition Impulsivity Aggression Deviance Withdrawal Challenged relationships What do they internalize? People will hurt me I’m helpless to prevent bad things from happening I’m defective I don’t matter I’m helpless I’m worthless I can’t trust anyone You will hurt me

Good News: Brain Plasticity The brain has a powerful ability to change, adapt, and rewire itself throughout life. Individual neurons grow, and new ones are added to the active circuits It changes how it uses its genetic code, in response to life experiences Stimulation, nutrition, exercise, stress, all modify this growth rate of neurons The Developing Brain: Implications for Youth Program. 2014 http://www.childtrends.org/our-research/the-kristin-anderson-moore-lecture- series/

Good News: Resilience Environmental Protective Factors Internal Protective Factors Environmental Protective Factors Social Competence Problem Solving Skills Autonomy Sense of purpose, belief in a bright future Caring Relationships High Expectations Opportunities for participation

Trauma-Informed Approach “A program, organization, or system that is trauma-informed: Realizes the widespread impact of trauma and understands potential paths for recovery; Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and Seeks to actively resist re-traumatization." http://www.samhsa.gov/nctic/trauma-interventions

Cultural, historical, and gender issues Guiding Principles Safety Trustworthiness Choice Collaboration Empowerment SAMHSA Cultural, historical, and gender issues Safety includes physical and emotional safety of service space; are all staff members attentive to signs of consumer discomfort and do they recognize these signs in a trauma informed way? Trustworthiness includes providing clear information/being transparent about what will be done, by whom, when, why and under what circumstances; respectful and professional boundaries; is unnecessary consumer disappointment avoided; is informed consent taken seriously on a consistent basis Choice includes how much choice consumers have over the services they receive (such as time of day, gender preferences for service providers, etc.); are consumers provided a clear and appropriate message about their rights and responsibilities Collaboration – true partnering and meaningful decision making; cultivating an atmosphere of doing “with” rather than doing “to” or “for”; conveying the message that the consumer is the expert in their own life? Empowerment includes recognizing and validating consumer strengths and skills; building a realistic sense of hope for the client’s future; involving consumers in planning SAMHSA adds Cultural, historical, and gender issues - The organization actively moves past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, geography), offers gender responsive services, leverages the healing value of traditional cultural connections, and recognizes and addresses historical trauma. (( Fallot and Harris. 2006

How do you implement these guiding principles in your setting?

Principles Align with PYD Family Community Peers Supports Services YOUTH Agencies Services: those undertakings done ­to or for youth intended to enhance health, safety, performance, and other forms of essential well being and physiological functioning. These are the traditional primary, secondary, and, to some extent, tertiary intervention services provided by public health systems, school districts and recreational projects / facilities. These are critical but when they stand alone are inadequate for fostering well being. Supports: Include tangible resources that are done with young people that facilitate access to interpersonal relationships and resources. Pittman et al. identify three main categories of support: emotional, motivational, and strategic – all of which work separately and together to foster positive development. Taken as a whole, supports promote a positive climate within which development occurs. Emotional support facilitates a sense of safety, nurturing and friendship. Motivational support provides positive expectations, guidance and developmentally appropriate boundaries. Strategic support facilitates access to needed resources and information. Opportunities: These are things done by young people. It is within the realm of opportunities that youth become actors rather than recipients. The “O” in the SOS trilogy represents the extent to which youth are provided meaningful and real opportunities to practice and expand on what they know and learn – either through work, service, or advanced learning. Although youth ideally encounter a diverse array of different types of opportunities, not all opportunities are created equal. Those which are sustained and in which youth are encouraged to exercise meaningful decision making roles ultimately demand and foster the greatest number of competencies in young people. Most px approaches focus on service with varying emphasis on support. YD approaches seek to assure that all youth are getting doses of all three at any given time. Not all orgs need to provide all three, but, to whatever degree they ca, it is very helpful. Serving Opportunities School Youth

Features of Positive Developmental Settings Physical and Psychological Safety Appropriate Structures Supportive Relationships Opportunities to Belong Positive Social Norms Support for Efficacy and Mattering Opportunities for Skill Building Integration of Family, School and Community Efforts National Research Council (2002) Physical and emotional safety of settings/environments Appropriate structures aligns somewhat with the guiding principle of transparency – clear rules and expectations, clear boundaries and limit setting, predictability/schedules, age appropriate monitoring

Be Pro-Active Offer safe and supportive environment Nurture resiliencies/strengths/ empowerment Give young people choices/voice (youth-centered) Provide opportunities to learn and practice skills (life skills) How does TIC and its guiding principles align with PYD? As TIC PYD is not focused on deficits, but is proactive - building positive outcomes using a strength based approach Young people are at the center; young people are engaged as partners, having choices and making decisions It nurtures and builds on young people’s strengths which empowers them to be engaged, making decisions for themselves and others It provides youth with opportunities to develop critical like skills Recognizes the importance of creating safe and supportive settings and environments

SEL Core Competencies Manage emotions Recognize one’s emotions, and behaviors to achieve one’s goals Recognize one’s emotions, values, strengths, and limitations Make ethical, constructive choices about personal and social behavior Show understanding and empathy for others Form positive relationships, work in teams, deal effectively with conflict

How do you respond to disruptive behavior?

Show and tell http://www.actforyouth.net/youth_development/professionals/sel/

Resources ACT for Youth: Positive Youth Development http://www.actforyouth.net/youth_development/ ACT for Youth: Youth Work Professionals http://www.actforyouth.net/youth_development/professionals/ SAMHSA’s Concept of Trauma and Guidance for a Trauma- Informed Approach. 2014. http://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdf CDC: Adverse Childhood Experiences Study http://www.cdc.gov/violenceprevention/acestudy/ Trauma Informed Community Initiative of WNY

Resources Ted Talk: Nadine Burke Harris www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_hea lth_across_a_lifetime?language=en The Truth About ACEs (infographic) http://www.rwjf.org/en/library/infographics/the-truth-about-aces.html ACES too High https://acestoohigh.com/got-your-ace-score/ National Child Traumatic Stress Network http://www.nctsn.org/