1. UWM CIO Office Helen Bader School of Social Welfare Improving lives and strengthening communities through research, education and community partnerships Criminal Justice Social Work

2. UWM CIO Office Effects of Child Maltreatment & Effective Approaches to Treatment Dimitri Topitzes, PhD, LCSW

3. UWM CIO Office Agenda Define maltreatment trauma Discuss primary and second symptoms of trauma Explore variations of trauma informed care (trauma- sensitive, trauma-informed, trauma-focused) Examine phases of trauma-focused interventions Review promising approaches

4. UWM CIO Office Potential Traumatic Event Trauma is a two-fold phenomenon: exposure and symptoms Potential traumatic event (as defined by DSM V): Death/threatened death, actual/threatened serious physical injury, actual/threatened sexual violence Direct experience, witnessing, or learning about love one (if death, then sudden), secondary exposure (VT) Examples…childhood physical abuse, witnessing IPV, invasive medical procedures, war, violent crime, car accident, etc. Is this an exhaustive definition? Chronic childhood neglect? Chronic emotional abuse in childhood or adulthood?

5. UWM CIO Office Child Maltreatment Official measures Acts of commission or commission Actor/s Immediate consequences –Physical/emotional harm, sexual abuse or exploitation –Danger of or imminent risk of harm Generally a strict definitional standard

6. UWM CIO Office Yearly Incidence 2006: 905,000 children substantiated for CAN (1 in 80) National Child Abuse and Neglect Data System 2006: National Incidence Study-4: 2.9 million children victims CAN (1 in 25). 2012: 686,000 maltreated children in the United States, a rate of 9.2 per thousand Since 2012, abuse and neglect on decline. Abuse on declining faster, neglect declining more slowly Why the decline? Yet, when broaden definition many more children affected

7. UWM CIO Office Complex Trauma Multiple Incident: Type II –Often prolonged or enduring –Relational field –Context of social exploitation –Leads to complex symptom presentation –Often in childhood (due to vulnerable nature of children): CDT –Can be adulthood: DV, POWs, Victims of Sex Trade, etc.

8. UWM CIO Office Primary Symptoms of Trauma Intrusion (re-experiencing, intrusive memories, nightmares, dissociative flashbacks) Avoidance (effortful, thoughts and feelings, external reminders) Cognition &/or mood alterations (memory disturbance, self and world schemas, negative mood) Hyperarousal (hypervigilance, sleep disturbance, aggression and irritability, concentration problems) With children, more behaviorally based, regressive play, etc…

9. UWM CIO Office Secondary Symptoms of Trauma (II) Secondary Symptoms or Trauma Consequences –Extensive –Short and long-term Cascade Effects: within Multifinality: across

10. UWM CIO Office Short Term Secondary Symptoms Internal representations of self and others Attention regulation Affect regulation Behavior regulation Cognitive development Social adjustment Academic performance Motivational development Self-concept

11. UWM CIO Office Long-Term Effects of Complex Trauma Mental health impairments Behavioral health impairments Physical health impairments Educational attainment Human capital Criminality Exercise

12. UWM CIO Office Levels of Trauma-Informed Services Trauma-Sensitive Trauma-Informed Trauma-Focused

13. UWM CIO Office Principles of Trauma-Informed and Trauma-Focused Interventions Assess both acute and chronic forms of trauma –Trauma history affect course of treatment –Complex childhood trauma increases risk for acute adult trauma –Trauma can underlie multiple presentations

14. UWM CIO Office Principles (cont’d) Address primary sx’s, secondary sx’s & causes: –Primary symptoms: Address safety & safety appraisal –Secondary Symptoms, short and long-term: Emotion regulation AODA treatment –Causes or Trauma Memories Trauma memory resolution

15. UWM CIO Office Principles of T.I.C. Relationship – –Therapeutic alliance The Lower Brain Interventions– –Calm, non-reactive interventionist always –Somatosensory strategies Motivation– –Individualized interventions that intrinsically motivates (e.g., client choices) –Therapeutic window Coordinated systems of care Interventionist self care to prevent vicarious trauma –Personal support network –Personal hobbies –Spirituality –Supervision and consultation

16. UWM CIO Office Phase-Based or Multi-Stage Treatment Models (Indv.) 1. Safety (ID areas of danger or perceived danger) 2. Enhance networks of care 3. Attention/Emotion/Behavior Regulation 4. Building Other Self-Capacities, e.g., problem solving 5. Cognitive Restructuring or Reprocessing 6. Trauma Resolution through Play/Memory/Narrative Work 7. Meaning Making or Future Self

17. UWM CIO Office Models TF-CBT (cognitive processing demonstration #3) Trauma Systems Therapy Integrative Treatment of Complex Trauma Expressive Therapies Trauma Narrative Therapy Parent Child Interaction Therapy

18. UWM CIO Office Thank you Dimitri Topitzes, PhD, LCSW Associate Professor Helen Bader School of Social Welfare University of Wisconsin-Milwaukee topitzes@uwm.edu 414-229-3004