2. Trauma is just the beginning of the story Create Safety Instill Hope Build Resilience Give people the power to write their own endings

4. Sexual, Physical, or Emotional Abuse Neglect, whether physical, medical, emotional, educational Traumatic grief, loss, or abandonment of a loved one Natural Disasters Medical Trauma Interpersonal or Domestic Violence Community or School Violence Terrorism or Refugee Trauma Military Combat Serious Accidents Human events……

5. Primary (Direct) Trauma Secondary (Indirect) Trauma Acute Chronic Complex Organizational Trauma/Stress Vicarious Trauma / Secondary Traumatic Stress

6. Primary Trauma (direct trauma) is trauma experienced personally either as a victim or witness of the actual event, and includes both physical and psychological injury. Primary trauma is also the basis for the definition of Child Traumatic Stress which states that the physical and emotional responses of a child to events that threaten the life or physical integrity of the child or someone critically important to the child (such as a sibling or parent). The traumatic event(s) overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out-of –control physiological arousal.

7. Secondary trauma (indirect trauma) is where the individual may not have physically experienced or witnessed the traumatic event, but it still had a direct impact on them. Acute trauma is exposure to a single event and lasts for a limited period of time. Chronic trauma refers to an individual experiencing multiple traumatic events, often over a prolonged period of time. Complex trauma generally refers to when an individual experiences chronic trauma in early childhood as a direct result of the actions of parents or other adult caregivers who should have been caring for and protecting them.

8. Vicarious trauma/secondary traumatic stress is the phenomenon of transmission of traumatic stress by bearing witness to the stories of the traumatic event. Only professionals and caregivers who work directly with victims of traumatic events experience it. Organizational trauma and organizational stress are often used interchangeably. However, they are two different terms, with different meanings.

10. www.acestudy.org The ACE Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente. Led by Co-principal Investigators Robert F. Anda, MD, MS, and Vincent J. Felitti, MD, the ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.

17. A child with 4 or > ACEs: 250% increase of sexually transmitted disease, which increase with score 390% more likely to develop COPD 460% more likely to suffer from depression 1,220% increase in suicide attempts, with higher ACE scores that went up 3,000-5,100% A male child with 6 ACEs has a 4,600% increased risk of adult IV drug use. www.acestudy.org

18. (use your toolkit)

20. Intrusion Symptoms Negative Mood & Cognitions Dissociative Symptoms Avoidance Symptoms Arousal Symptoms

21. Intrusion: Re-experiencing o Distressing Memories and Intrusive thoughts o Nightmares or recurrent dreams o Dissociative symptoms like Flashbacks where recurring o Distress & reactivity at exposure to reminders, internal or external o Psychological Reactivity to reminders o Physiological Reactivity to reminders

22. Avoidance: Avoidance, Emotional Numbing, Addictions Avoidance of thoughts, memories, feelings Avoidance of external reminders

23. Arousal Symptoms Increased Arousal Irritability and Angry Outbursts Reckless or Self Destructive Behaviors Hypervigilance Exaggerated startle response Problems with Concentration Sleep Disturbances

24. Dissociation: Dissociation Continuum o Depersonalization o Derealization

25. Mood and Cognition: Inability to remember Negative personal and world view Negative emotional state – fear, horror, anger, guilt, shame Diminished interest or participation Feelings of detachment of estrangement Inability to feel positive emotions

27. The effects of trauma depend on developmental level, resiliency, and other predisposing factors

28. Brain development and learning difficulties Emotional problems Behavioral problems Disrupted attachment relationships – being capable of being involved in safe and trusting relationships

29. It’s NOT: “What’s wrong with you?” It’s: “What happened to you?” Or: “What didn’t happen to/for you?”

30. The GOOD News is: Research supports that the SINGLE BIGGEST thing that helps kids RECOVER from trauma and maltreatment is a STABLE SUPPORTIVE ADULT, who BELIEVES them, SUPPORTS them, and MODELS & TEACHES effective coping.

31. www.nctsn.org/nctsn_assets/pdfs/ cwt3_sho_inventory.pdf www.seekingsafety.org Taking Care of You

32. National Child Traumatic Stress Network The mission of the National Child Traumatic Stress Network is to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States. This website offers resources for parents, counselors, teachers, and communities. www.nctsnet.org This is also the location of the child welfare trauma training toolkit.www.nctsnet.org Child Trauma Academy The Child Trauma Academy is a unique collaboration of individuals and organizations working to improve the lives of high-risk children through direct service, research, and education. The.com site offers free online courses, while the.org site offers a myriad of educational resources. www.childtraumaacademy.com and www.childtraumaacademy.orgwww.childtraumaacademy.com www.childtraumaacademy.org Trauma Focused Cognitive Behavioral Therapy Offers a free web-based training for Trauma Focused – Cognitive Behavioral Therapy. www.musc.edu/tfcbtwww.musc.edu/tfcbt Cognitive Processing Therapy Offers a free web-based training for Cognitive Processing Therapy http://cpt.musc.eduhttp://cpt.musc.edu CEBC: California Evidenced-Based Clearing House for Child Welfare http://www.cebc4cw.org/http://www.cebc4cw.org/

33. Katie Bottoms, MHR Coordinator of Child Trauma & Resilience Oklahoma Department of Mental Health And Substance Abuse Services 1200 NE 13 th Oklahoma City, OK 73152 405-522-1678 Katie.Bottoms@odmhsas.org