1. WHY IS IT SO HARD TO MOVE ON? WHY IS IT SO HARD TO MOVE ON? The impact of trauma on transition aged youth “The world breaks everyone, and afterward, some are strong in broken places.” -Ernest Hemingway Allison Elias, L.C.S.W., Thresholds, Chicago, IL Cindy Berry, Psy.D., University of Illinois Chicago, Chicago, IL

2. Trauma versus Complex Trauma “Complex trauma” describes the experience of multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (eg. sexual or physical abuse, war, community violence) and early life onset. –Bessel A. van der Kolk –Bessel A. van der Kolk

3. The Impact of Trauma in Childhood Research has shown that trauma in childhood is correlated with: *depression*suicide attempts *alcoholism*drug abuse *sexual promiscuity *domestic violence *cigarette smoking*obesity *sexually transmitted disease [Felitti, Nordenberg et al., 1998] Physical abuse and neglect are associated with very high rates of violent offenses Physical abuse and neglect are associated with very high rates of violent offenses 75% of perpetrators of child sexual abuse report to have been sexually abused as children 75% of perpetrators of child sexual abuse report to have been sexually abused as children [van der Kolk, 2003]

4. Complex Developmental Trauma: Complex Developmental Trauma: Difficulty regulating (controlling) emotions Difficulty regulating (controlling) emotions Impulsive decision making/engaging in risk taking behaviors Impulsive decision making/engaging in risk taking behaviors Intense feelings of guilt, shame and low self-worth Intense feelings of guilt, shame and low self-worth Problems with interpersonal boundaries and relationships Problems with interpersonal boundaries and relationships Struggle with trusting others Struggle with trusting others Difficulties seeing another person’s point of view Difficulties seeing another person’s point of view More likely to report physical ailments More likely to report physical ailments May engage in emotional numbing and social withdrawal May engage in emotional numbing and social withdrawal Sense of hopelessness about the future Sense of hopelessness about the future Increased feelings of anxiety Increased feelings of anxiety

5. The Impact of Chronic Trauma on Functioning  Interferes with neurobiological development  Compromises the capacity to integrate information  sensory information  emotional information  cognitive information

6. Difficulty with Affect Regulation Impairs the ability to control emotions Impairs the ability to control emotions Vacillates between: Vacillates between:  emotional flooding (hypervigilance/arousal)  numbing (dissociation) Switches tend to be drastic in intensity and frequent in nature Switches tend to be drastic in intensity and frequent in nature

7. Conditions that Impact Affect Regulation Five Senses: Five Senses:  Smell  Touch  Taste  Sight  Sound

8. Difficulty with Cognitive Functioning Attention Attention Decision making Decision making Working memory Working memory  Sensory/Non-verbal memories vs. Autobiographical Memories

9. Treatment: Four Central Goals Safety Safety  environment  Personal Skills Development Skills Development  emotion regulation and  interpersonal functioning

10. Treatment: Four Central Goals Meaning-making Meaning-making  About past traumatic events in order to consider more positive, adaptive views of themselves in the present  To help experience hope about their future Enhance resiliency and integrate into a social network Enhance resiliency and integrate into a social network [From Complex Trauma in Children and Adolescents, National Child Traumatic Stress Network, 2003] [From Complex Trauma in Children and Adolescents, National Child Traumatic Stress Network, 2003]

11. Research Findings* Area of Concern With Depression/Anxiety Without Depression/Anxiety Sex by age 16 62%50% Marijuana use by age 16 46%34% Other drug use 39%26% Attacked someone 41%27% Ever ran away 30%17% Charged with an adult crime by age 24 27%16% Has a biological child at age 18 (females) 24%9% *From US Department of Health and Human Services, 7/2009

12. Research Findings (con’t) Area of Concern With Depression/Anxiety Without Depression/Anxiety Do not earn HS diploma 35%15% Employed on 24 th Birthday 66%79% Consistently connected to school or work, ages 18-24 43%61% Median Annual Earnings at age 23 $15,506$22,875

13. Research Findings Sexual, Physical, & Emotional Maltreatment group significantly elevated from low maltreatment group on Youth Self Report Withdrawn Somatic Complaints Anxious/depressed Social Problems Thought Problems Attention Problems Delinquent Behavior Aggressive Behavior

14. MOVING ON… “Independence is not linked to the physical or intellectual capacity to care for oneself without assistance; independence is created by having assistance when and how one requires it” -Brisenden, 1989

15. The Transition in Crisis Youth may start to decompensate Youth may start to decompensate  become aggressive  run away  engage in self injurious behavior Youth may blame others for their difficulties Youth may blame others for their difficulties  foster parents, staff, the program, case workers, the system,  push others away: It’s easier to “burn bridges” than to feel sad or loss May lose a job or do worse in school May lose a job or do worse in school  if employment or diploma is required for transition.

16. Why Do These Youth Seem To Undermine Their Success? TRANSITIONS ARE SCARY! TRANSITIONS ARE SCARY!  Fear of the unknown  Fear of failure  Fear of success  Out of comfort zone Complex trauma exacerbates all this Complex trauma exacerbates all this  May be a resurgence of past symptoms  Current symptoms may be magnified by transition

17. Trauma Symptoms through a Transitional Lens: Trust Issues Trust Issues  Distrust of people, system, etc.  Suspicious of others motives  Uncertain of the predictability/reliability of the world Social Issues Social Issues  Tendency towards social isolation  Difficulty taking another’s perspective  Trouble understanding one’s own contribution to what happens to them

18. Trauma Symptoms through a Transitional Lens: Executive Skills (ability to perform tasks) Executive Skills (ability to perform tasks)  Problems with focus and attention  Problems processing new information  Difficulty problem solving  Difficulty with planning and anticipating  Problems with working memory  Failures to make wise judgments  Cognitive inflexibility  Difficulty inhibiting inappropriate responses

19. Why Can’t They Just Tell Us? These youth don’t always say what they mean These youth don’t always say what they mean Don’t want to show fear Don’t want to show fear Afraid to need help or support Afraid to need help or support May not always be aware of feelings May not always be aware of feelings Look at the feelings under the words!!!!

20. Common Ways We Try To Help “Dangle a Carrot” approach “Dangle a Carrot” approach  Use an apartment, job, etc. as an incentive for youth to do well.  May just be reinforcing that the youth has to leave. Youth may only focus on the leaving (poor sense of time).  “I’m not worthy of this” Contracts Contracts  If ____, then ____. “If you have zero incidents of aggression for 30 days, then you’ll be able to leave.”  Unfortunately, youth may only hear, “You’re leaving.” OVERWHELMING!

21. “Stuck” at Transition: “Stuck” at Transition: Youth are at an early stage of their development Youth are at an early stage of their development Being on their own is overwhelming Being on their own is overwhelming Often raised in foster care/residential care Often raised in foster care/residential care  Decisions are made for them  Multiple transitions—no lasting relationships  May lack experiences with unconditional love Poor affect regulation and arousal Poor affect regulation and arousal  Staff may mention “when you’re on your own” in passing and the anticipation becomes a trigger

22. “Stuck” at Transition: Youth are present focused: Youth are present focused:  can’t always remember periods of success  very difficult to imagine the future Youth grieve the loss of their childhood: Youth grieve the loss of their childhood:  never experienced a “true” childhood  fear of being an adult Lack of social supports: Lack of social supports:  may live away from family with no contact in years  don’t know how to reconnect family or community

23. How can we help them move on? Creating a Smooth Transition for Traumatized Youth

24. Talk about the “elephant in the room” Validate stress & anxiety about transitioning Validate stress & anxiety about transitioning Identify potential fears Identify potential fears Generate discussion around peer’s transitions- successful & unsuccessful Generate discussion around peer’s transitions- successful & unsuccessful Help them grieve loss of childhood Help them grieve loss of childhood

25. Independence is not always the “carrot” When achievement parameters back fire: When achievement parameters back fire:  “Have a little faith in me”  “Just do it” High support still needed High support still needed The team must examine its own anxiety The team must examine its own anxiety

26. Build Competencies Focus on Skill Building Focus on Skill Building  independent living skills  coping/affect regulation skills  social skills BE REPETITIVE! *The ‘Dora’ method Focus on Mastery & Strengths Focus on Mastery & Strengths  identify strengths/interests  provide opportunities for success/redefine success  help them recognize previous success  build forums to celebrate accomplishments BE CREATIVE & DON’T GIVE UP!

27. Seek Appropriate Treatment Refer to trauma informed therapy Refer to trauma informed therapy  Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)  Trauma Focused- Cognitive Behavioral Treatment  Skills Training in Affect and Interpersonal Regulation (STAIR)  Dialectical Behavior Therapy (DBT)  Trauma Systems Therapy  Attachment, Self-regulation & Competence (ARC) For more information: For more information:  National Child Traumatic Stress Network http://www.nctsnet.org

28. Build Social Support Networks Build a sense of community Build a sense of community Reconnect to the past: BE DETECTIVES! Reconnect to the past: BE DETECTIVES! Support elements of healthy relationships Support elements of healthy relationships

29. Help them have different endings Role model healthy termination Role model healthy termination Combat ‘the burning of the bridge’ Combat ‘the burning of the bridge’

30. In Time Perhaps In time perhaps My wounds will heal And my pain will no longer be numb. It will disappear. The smile that I wear upon my face will be real. My locked up dreams will slowly cut themselves free from helplessness and disappointment. -Anonymous