Washington County Youth Service Mentoring Youth From a Trauma Informed Perspective: lessons learned from the Youth Thrive Framework Kreig Pinkham Washington County Youth Service

Youth Thrive: Is a comprehensive framework for thinking about youth care Lays out a common set of values, vocabulary and beliefs to unify youth-care workers regardless of where they are working Provides a grounding for policy and practice thinking Provides a comprehensive youth-work training

Project Overview Multi-year initiative of the Center for the Study of Social Policy (CSSP) Examined the research from: resiliency positive youth development neuroscience impact of trauma on brain development

Project Overview How all youth can be supported healthy development and well-being reducing the impact of negative life experiences including toxic stress and trauma Focus was on vulnerable youth Not only about limiting risk factors protective and promotive factors

Youth Thrive Guiding Principles Young People are best supported by child and youth care practitioners who understand and recognize the importance of self awareness and self-care in their own professional practice.

Youth Thrive Guiding Principles Young people are best supported by child and youth care practitioners who are aware of the impact of traumatic stress and understand the need to use trauma informed methods. Trauma informed practice is a paradigm shift that focuses on trauma resolution through building resiliency. It is most concerned with what has happened to the youth and the subsequent impact to development rather than the youth’s behavior.

Youth Thrive Guiding Principles Young people are best served by child and youth care practitioners who focus on assets and use strengths-based approaches with an awareness of current research regarding neuroscience and adolescent development.

Youth Thrive Guiding Principles Young people are best supported by child and youth care practitioners who understand that attachments, connections and relationships are a primary source of growth and learning. It is in relationship and through the use of relationships that we experience ourselves, learn, practice new skills, and grow as humans.

Youth Thrive Guiding Principles Young people are best supported by child and youth practitioners who understand and provide culturally responsive services. Being culturally responsive means we take into account our culture, the culture of those individuals we serve, of the larger community, and the culture that is created within our programs and organizations.

Youth Thrive is based around 5 protective and promotive factors A knowledge of adolescent development Social Connections Cognitive and Social-Emotional Competence Concrete Supports in Times of Need Youth Resilience

Adolescent Development

Starting with Brain Development From the bottom upwards From the inside outward Basic survival functions (breathing, heart rate) to more complex (abstract thought)

Brain Development Brain Stem Cortex Limbic Mid Brain Blood Pressure Heart Rate Body Temperature Brain Stem

Brain Development Mid Brain Cortex Limbic Motor Regulation Arousal Appetite Sleep Mid Brain Brain Stem

Brain Development Limbic Cortex Mid Brain Brain Stem Attachment Sexual Behavior Emotional Reactivity Limbic Mid Brain Brain Stem

Brain Development Cortex Limbic Mid Brain Brain Stem Abstract Thought Concrete Thought Affiliation Cortex Limbic Mid Brain Brain Stem

Experience Shapes Development Brain wires itself (create connections between neurons) based on its experience of the environment Causes a unique brain to develop created specifically in response to the environment Form templates to interpret experiences

Pruning in Adolescence Pruning accelerates in adolescence Eliminates infrequently used neural connections Strengthens frequently used connections

Let’s Talk About Stress Normal Stress Traumatic Stress Age appropriate Manageable Geared toward developmental milestones Short in duration Supportive resources available Supports healthy development Beyond developmental understanding Chronic Cortisol levels go up and stay up Few or uncertain supportive resources Impacts every area of development

Recognizing the Impact of Trauma Trauma - Overwhelming event(s) results in helplessness, powerlessness and loss of safety (physical and psychological) Complex Trauma – exposure to ongoing traumatic experiences and the wide-ranging impact of that exposure

Brain Responses Change These changes in brain size and functioning result in changes in behavior and potential. Severe trauma/abuse/neglect without resolution can result in up to a 10% loss in potential intelligence. These people perceive the world differently and have difficulty processing what they are perceiving. They are challenged in making and retrieving memories. Academic and work performance can be lower.

3 Types of ACEs It is important to remember that trauma is less about the event and more about how the event is experienced by the individual. Trauma is not always about abuse, neglect, terrorism, and rape. It is also about poverty, disadvantaged or under-resourced communities and schools, and other adverse childhood experiences. The Adverse Childhood Experience Study looked at a group of over 17,000 middle class people who participated in their insurance program between 1995 and 1997. They gathered initial information from the group and continue to track their medical needs as they age. They asked this group about different adverse situations they experienced during their childhood and correlated those experience with medical issues. Almost two-thirds of our study participants reported at least one ACE, and more than one of five reported three or more ACE. The short- and long-term outcomes of these childhood exposures include a multitude of health and social problems. Only 36.1% of the people in the study reported no ACEs. 26% had 1, 15.9T has2, 9.5% had 3 and 12.5% had 4 or more. This doesn’t take into consideration poverty, which exasperated these other ACEs and adds additional stress on family members. According to the 2014 US Census, 46.7 million people (15.5 Million children under 18) are living in poverty. Of these, 6.8 million are living in Deep Poverty, defined as living at or below 50% of the poverty threshold!

ACEs Increased Health Risks Trauma, including the adverse childhood experiences, have long lasting effects and often have a negative impact of global indicators of health. The ACES study demonstrated that as the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion: Alcoholism and alcohol abuse Chronic obstructive pulmonary disease (COPD) Depression Fetal death Health-related quality of life Illicit drug use Ischemic heart disease (IHD) Liver disease Risk for intimate partner violence Multiple sexual partners Sexually transmitted diseases (STDs) Smoking Suicide attempts Unintended pregnancies Early initiation of smoking Early initiation of sexual activity Adolescent pregnancy

Impact of Trauma When a young person has experienced significant trauma Impacts all areas of development Impulsive and difficulty regulating emotions Poor view of self Interpersonal connections, trust, & relationships are affected

Brain Activation Incoming experience is compared to existing templates of past experience Human default setting is suspicion If familiar, known as safe stress system not activated If unfamiliar, unknown or known as unsafe increasing activation

States If what we see is unfamiliar, unknown or unsafe triggers our stress system: Calm Alert Alarm Fear Terror

Brain Activation As emotion increases: rational thought decreases sense of time decreases – extended future -- no sense of time move from abstract – concrete – reactive - reflexive

There were 7 sharks circling me when I took this picture

Calm State Cortex Limbic Mid Brain Brain Stem Abstract Thought Concrete Thought Affiliation Cortex Attachment Sexual Behavior Emotional Reactivity Limbic Motor Regulation Arousal Sleep and appetite Mid Brain Blood Pressure Heart Rate Body Temperature Brain Stem

Alert State Cortex Limbic Mid Brain Brain Stem Abstract Thought Concrete Thought Affiliation Cortex Attachment Sexual Behavior Emotional Reactivity Limbic Motor Regulation Arousal Sleep and appetite Mid Brain Blood Pressure Heart Rate Body Temperature Brain Stem

Alarm State Cortex Limbic Mid Brain Brain Stem Abstract Thought Concrete Thought Affiliation Cortex Attachment Sexual Behavior Emotional Reactivity Limbic Motor Regulation Arousal Sleep and appetite Mid Brain Blood Pressure Heart Rate Body Temperature Brain Stem

Fear State Cortex Limbic Mid Brain Brain Stem Abstract Thought Concrete Thought Affiliation Cortex Attachment Sexual Behavior Emotional Reactivity Limbic Motor Regulation Arousal Sleep and appetite Mid Brain Blood Pressure Heart Rate Body Temperature Brain Stem

Terror State Cortex Limbic Mid Brain Brain Stem Abstract Thought Concrete Thought Affiliation Cortex Attachment Sexual Behavior Emotional Reactivity Limbic Motor Regulation Arousal Sleep and appetite Mid Brain Blood Pressure Heart Rate Body Temperature Brain Stem

Two Responses to Activation Hyperarousal: Fight or Flight Take control of the situation Dissociation: Prepare for injury Powerlessness

Hyperarousal Vigilance – What’s going on? Resistance – You can’t make me! Defiance – I won't! Aggression – I’ll fight!

Dissociation Vigilance – What’s going on? Avoidance – Please don’t notice me. Compliance – I will do anything, just leave me alone Dissociation- I’m not here!

States Affected by Trauma History Enlarged midbrain and brain stem Cortex less developed Baseline of alert or alarm Disrupted attachment Hypersensitive to stimuli Difficulty learning new information Challenging to make new or retrieve old memories Keep in mind the more a part of the brain is needed, the more resources it receives and the bigger it becomes. That means that resources will be taken away from other parts of the brain which then don’t become as developed. When young people live in chronically stressful situations that cause them to be continuously activated to stay safe, their brain stem and midbrain becomes enlarged and their higher processing centers are relatively less developed. Another consequence is that it is very difficult for young people who have experienced toxic stress, disrupted attachments, and complex trauma to easily relax into the calm, connected state. What might that mean for us? Accept answers. Remember, brains develop in response to the environment in which they are in. Let’s revisit our discussion earlier about pruning. What did we already learn about pruning? Accept answers. Include: during adolescence the brain is focused on pruning away what is not used and strengthening connections that are used the most. When young people have experienced chronic or complex trauma, or have lived in a chaotic and unpredictable environment, their baseline state of arousal is pretty high. This means they are typically more reactive and more sensitive to incoming stimuli. A situation that might cause slight anxiety in most young people may cause fear or terror for the young person with a traumatic history. They may have difficultly learning new information because their resources are more focused on survival. Over time, their brain’s ability to process information and learn becomes increasingly different when compared to other young people the same age. Notice we did not say they cannot learn, they learn differently.

In a Calm State Can think into future Abstract thought possible Can take in information Connected to others

As Stress Goes Up… Self-centered concrete thinking Focus on survival Future orientation is limited – here and now Self-centered concrete thinking Focus on survival Connections to other less important

Social Connections

Understanding that Social Connections are a key developmental protective and promotive factor, the shift moves to how do we construct and facilitate relationships that decrease trauma and stress activation?

Connections Exterior Decorating Interior Decorating All five sense activated in a soothing way Space is uncluttered and calming Opportunities for exploration and self-direction abound Warm, dry, comfortable I’ve left my stress at the door I’m prepared to be patient I’m prepared to not take anything personally I’m not hung up on the moment succeeding by my definition I’m open to truly listening and moving the moment in the direction the youth I’m with indicates I’m prepared to hold empathy I’m prepared to be reliable

Youth Connections Scale

Cognitive & Emotional Competencies

Cognitive Competency Cognitive flexibility – seeing alternative solutions to problems and being able to shift perspective Future orientation – thinking about the potential consequences of one’s behavior and choices Emotional self-regulation – exercising control over feelings Behavioral self-regulation – staying on task even in the face of distractions Planning – having a goal and using reasoning to develop a strategy Working memory – following instructions sequentially and holding information in mind while engaging in another activity.

Social-Emotional Competence Self-awareness – a growing understanding about one’s own developmental history and needs Self-concept – a stable positive identity Self-esteem – overall good feelings about oneself Self-efficacy – realistic beliefs about one’s capabilities Self-compassion – being kind to oneself when confronted with personal failings and suffering Self-improvement and mastery – committing to and preparing to achieve productive goals Personal agency – taking responsibility for one’s self and one’s decisions and having confidence to overcome obstacles Character strengths – persistence, hard work, gratitude, respect, integrity Positive emotions – joy, love, hope, optimism, trust, faith, compassion

Resilience Narratives Think of a story in your life where you went through some difficulty. The final outcome of the story doesn’t matter as long as you can look back at the moment and identify it as hard at the time. If you are comfortable doing so, I’m going to ask you to share that story briefly with a partner, so pick a story that you are comfortable sharing. It’s perfectly acceptable not to participate.

Resilience Narratives # 1 What did that experience teach you about yourself? What has going through that experience changed about your life? What, if anything, would you change about the experience? Which Social or Emotional Competency grew because of that moment?

Resilience Narratives # 2 How did the experience shape how you think or act? How often do you think about that experience? Would your today self, be willing to go through the experience again if you knew that the outcome(s) would be the same? Why or why not? Which Social or Emotional Competency grew because of that moment?

Resiliency

Key Take Away Resiliency is not a state that is achieved in the absence of stress; it’s a state that is tempered in that fire. The tools we use in the forge are our strengths and assets. A good blacksmith is proud of their tools and takes care of them. So why is it sometimes so uncomfortable to talk about strengths?

Strength’s Workshop List out your strengths on the worksheet. No strength is too silly or insignificant to mention Reflect on and list how you see that strength helping you when you are faced with adversity. Think about what kind of adversity that particular strength helps you overcome and name that as well.

Now . . . Find a partner and talk about your strengths in the most braggadocios way possible. Congratulate each other for sharing. Find a way to have these conversations with the youth you work with.

Self care

As Youth Care workers, we stand to weather the challenges of vicarious trauma when we are being genuine about our efforts toward self-care. Let me stress that this requires real effort and is not selfish or self-serving, but a vital skill to help us serve others better. In the end, self-care is a selfless act. Great Resource for thinking about self-care from a youth service perspective www.au.reachout.com

Domains of Self Care Workplace/Professional Physical Psychological Emotional Spiritual Relationships Create a self-care plan