1. WHAT IS PSYCHOLOGICAL TRAUMA?
Creating a Trauma Informed School

2. Welcome! Defining Trauma and Creating Trauma Informed Schools – with Margaret Joyal, MA How to login: You will be connected to audio using your telephone after joining the Webinar. Please dial the following info that will also appear on your screen: Toll: 1 (914) Access Code: Audio PIN: Shown after joining the Webinar Please DO NOT connect using your computer’s microphone and speakers.

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5. Trauma Informed System
Trauma-informed services are not designed to treat symptoms or syndromes related to abuse or trauma.
Instead, the primary purpose is to deliver services and supports in a manner that acknowledges the role that violence and victimization play in the lives of children and families.
Why are we doing the training?
AHS re-org and the commitment for ahs and its designees to be trauma informed
Intro of trauma/co-occurring workgroup
Definition: review don’t read; apply to particular services; employment services; administrative services; audience members

6. Trauma Informed System
This understanding is used to design service systems that accommodate the vulnerabilities of trauma survivors and allow services to be delivered in a way that will facilitate consumer participation that is appropriate and helpful to the special needs of trauma survivors.
Harris, M., & Fallot, R. EDS. (2001) Using trauma Theory to Design Service Systems, Jossey-Bass, San Francisco.

7. Questions?

8. Empowering and Collaborative Relationships
What Works
RICH
Respect
Information
Connection
Hope
Empowering and Collaborative Relationships
(Risking Connection, Karen Saakvitne)
Explain in the context of a trauma informed systems
We can be a part of people’s recovery
Interactive session elicit discussion from people’s workplace,
How does this apply to you? And your place of work?

9. What Does Not Authoritarian Relationships Lack of power and control
Client blaming attitudes
Lack of Respect
Lack of Choice
Discuss staff burnout/vicarious traumatization

10. Definition of a Traumatic Event
A traumatic event is any event or events, which overwhelms our core capacity to cope. It results in an experience of personal threat to our safety and/or the integrity of our identity.
READ;
Trauma is subjective what’s traumatic to me isn’t necessarily traumatic to you.
Explain the difference between a really scary event and a traumatic event
Traumatic events always include a loss of power over the immediate environment
Trauma overwhelms our usual way of ‘doing business’
Trauma is like a tsunami
Do the exercise, elicit reactions of a traumatic event; not traumatic details

11. Complex Trauma
Complex trauma describes both exposure to chronic trauma—usually caused by adults entrusted with the child’s care—and the impact of such exposure on the child.
Children who experienced complex trauma have endured multiple interpersonal traumatic events from a very young age.
Complex trauma has profound effects on nearly every aspect of a child’s development and functioning.
Source: Cook et al. (2005). Psychiatr Ann,35(5):

12. What Is Child Traumatic Stress?
Child traumatic stress refers to the physical and emotional responses of a child to events that threaten the life or physical integrity of the child or of someone critically important to the child (such as a parent or sibling).
Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out-of-control physiological arousal.

13. Types of Traumatic Stress
Acute trauma is a single traumatic event that is limited in time. Examples:
Serious accidents
Community violence
Natural disasters (earthquakes, wildfires, floods)
Sudden or violent loss of a loved one
Physical or sexual assault (e.g., being shot or raped)
During an acute event, children go through a variety of feelings, thoughts, and physical reactions that are frightening in and of themselves and contribute to a sense of being overwhelmed.

14. Types of Traumatic Stress
Chronic trauma refers to the experience of multiple traumatic events.
These may be multiple and varied events—such as a child who is exposed to domestic violence, is involved in a serious car accident, and then becomes a victim of community violence—or longstanding trauma such as physical abuse, neglect, or war.
The effects of chronic trauma are often cumulative, as each event serves to remind the child of prior trauma and reinforce its negative impact.

15. Questions?

16. 7 Domains of Impairment in Children Exposed to Complex Trauma
1. ATTACHMENT:
Uncertainty about the reliability and predictability of the world
Problems with boundaries
Distrust and suspiciousness
Social isolation
Interpersonal difficulties
Difficulty attuning to other people’s emotional states
Difficulty with perspective taking
Difficulty enlisting other people as allies

17. 7 Domains of Impairment in Children Exposed to Complex Trauma
2. BIOLOGY:
Sensorimotor developmental problems
Hypersensitivity to physical contact
Analgesia
Problems with coordination, balance, body tone
Difficulties localizing skin contact
Somatization
Increased medical problems across a wide span, e.g., pelvic pain, asthma, skin problems, autoimmune disorders, pseudo seizures

18. 7 Domains of Impairment in Children Exposed to Complex Trauma
3. AFFECT REGULATION:
Difficulty with emotional self-regulation
Difficulty describing feelings and internal experience
Problems knowing and describing internal states
Difficulty communicating wishes and desires
4. DISSOCIATION:
Distinct alterations in states of consciousness
Amnesia
Depersonalization and derealization
Two or more distinct states of consciousness, with impaired memory for state-based events

19. 7 Domains of Impairment in Children Exposed to Complex Trauma
5. BEHAVIORAL CONTROL:
Poor modulation of impulses
Self-destructive behavior
Aggression against others
Pathological self-soothing behaviors
Sleep disturbances
Eating disorders
Substance abuse
Excessive compliance
Oppositional behavior
Difficulty understanding and complying with rules
Communication of traumatic past by reenactment in day-to-day behavior or play (sexual, aggressive, etc.)

20. 7 Domains of Impairment in Children Exposed to Complex Trauma
6. COGNITION:
Difficulties in attention, regulation and executive functioning
Lack of sustained curiosity
Problems with processing novel information
Problems focusing on and completing tasks
Problems with object constancy
Difficulty planning and anticipating
Problems understanding own contribution to what happens to them
Learning difficulties
Problems with language development
Problems with orientation in time and space
Acoustic and visual perceptual problems
Impaired comprehension of complex visual-spatial patterns

21. 7 Domains of Impairment in Children Exposed to Complex Trauma
7. SELF-CONCEPT:
Lack of a continuous, predictable sense of self
Poor sense of separateness
Disturbances of body image
Low self-esteem
Shame and guilt

22. Prevalence of Trauma—United States
Each year in the United States, more than 1,400 children—nearly 2 children per 100,000—die of abuse or neglect.
In 2005, 899,000 children were victims of child maltreatment. Of these:
62.8% experienced neglect
16.6% were physically abused
9.3% were sexually abused
7.1% endured emotional or psychological abuse
14.3% experienced other forms of maltreatment (e.g., abandonment, threats of harm, congenital drug addiction)
Source: USDHHS. (2007) Child Maltreatment 2005; Washington, DC: US Gov’t Printing Office.

23. U.S. Prevalence
One in four children/adolescents experience at least one potentially traumatic event before the age of 16.1
Chicago survey found that 75% of yr olds had witnessed a shooting or stabbing.
Four out of 10 U.S. children report witnessing violence; 8% report a lifetime prevalence of sexual assault, and 17% report having been physically assaulted.3
1. Costello et al. (2002). J Traum Stress;5(2):
2. (Raia, J.A., Ph.D, Clinical Quarterly, Nat'l Ctr for PTSD, Fall, 1999)
3. Kilpatrick et al. (2003). US Dept. Of Justice.

24. Vermont Children Affected by Trauma
DCF 2011:
15,500 calls
4908 investigations
1037 children in custody (DCF 2011 Annual Report)
DCF intakes w/ domestic violence identified
1892 (Domestic Violence Fatality Review Commission Report, 2009)
Children served by Network Programs
1212 (VT Network Against Domestic and Sexual Violence, 2011)
Emergency Room Injury Child Victims
15,012 (10% referred to CMH)
Percentage in DCF custody served by CMH
24% (February 6, 2004).Vermont Mental Health Performance Indicator Project. Young Trauma Victims served in Mental Health Programs.

25. Six Core Strengths for Children:
ATTACHMENT: being able to form and maintain healthy emotional bonds and relationships
SELF-REGULATION: containing impulses, the ability to notice and control primary urges as well as feelings such as frustration
AFFILIATION: being able to join and contribute to a group
ATTUNEMENT: being aware of others, recognizing the needs, interests, strengths and values of others
TOLERANCE: understanding and accepting differences in others
RESPECT: finding value in differences, appreciating worth in yourself and others “Meet Dr. Bruce Perry” page at

26. Essential Elements of Trauma Informed Child Practice
Support and promote positive and stable relationships in the life of the child.
Provide support and guidance to child’s family and caregivers.
Manage professional and personal stress
Trauma-informed child mental health practice mirrors well-established child mental health practices.

27. Maximize the Child’s Sense of Safety
Traumatic stress overwhelms a child’s sense of safety and can lead to a variety of survival strategies for coping.
Safety implies both physical safety and psychological safety.
A sense of safety is critical for functioning as well as physical and emotional growth.
While inquiring about emotionally painful and difficult experiences and symptoms, workers must ensure that children are provided a psychologically safe setting.

28. Assist Children in Reducing Overwhelming Emotion
Trauma can elicit such intense fear, anger, shame, and helplessness that the child feels overwhelmed.
Overwhelming emotion may delay the development of age-appropriate self-regulation.
Emotions experienced prior to language development maybe be very real for the child but difficult to express or communicate verbally.
Trauma may be “stored” in the body in the form of physical tension or health complaints.

29. Help Children Make New Meaning of their Trauma History and Current Experiences
Trauma can lead to serious disruptions in a child’s sense of safety, personal responsibility, and identity.
Distorted connections between thoughts, feelings, and behaviors can disrupt encoding and processing of memory.
Difficulties in communicating about the event may undermine a child’s confidence and social support.
Staff must help the child feel safe, so he or she can develop a coherent understanding of traumatic experiences. 29 29

30. Address the Impact of Trauma
Traumatic events affect many aspects of the child’s life and can lead to secondary problems (e.g., difficulties in school and relationships, or health-related problems).
These “secondary adversities” may mask symptoms of the underlying traumatic stress and interfere with a child’s recovery from the initial trauma.
Secondary adversities can also lead to changes in the family system and must be addressed prior to or along with trauma-focused interventions. 30 30

31. Support and Promote Positive and Stable Relationships in the Life of the Child
Separation from an attachment figure, particularly under traumatic and uncertain circumstances, is highly stressful for children.
Familiar and positive figures—teachers, neighbors, siblings, relatives—play an important role in supporting children who have been exposed to trauma.
Minimizing disruptions in relationships and placements and establishing permanency are critical for helping children form and maintain positive attachments.

32. Provide Support and Guidance to the Child’s Family and Caregivers
Caregivers have some of the most challenging roles in the children’s mental health system.
Caregivers must be nurtured and supported so they, in turn, can foster safety and well-being.
Relatives serving as caregivers may themselves be dealing with trauma related to the crisis that precipitated child welfare involvement and placement.

33. Manage Professional and Personal Stress
Working with children who have experienced trauma is rewarding but stressful, and workers may be confronted with danger, threats, or violence.
Professionals may empathize with victims; feelings of helplessness, anger, and fear are common.
Professionals who are parents, or who have histories of childhood trauma, might be at particular risk for experiencing such reactions.

34. How does a multi-tier system of supports help?
Framework for enhancing adoption & implementation of
Continuum of evidence-based interventions to achieve
Academically & behaviorally important outcomes for
All students

35. Continuum of School-wide Instructional & Positive Behavioral Support
Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior
Intensive For a Few
Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior
Targeted
For Some
Prevention: Teaching expectations, acknowledging expectations- public ecucation
Secondary: help stop things from getting worse – mentors, social skills groups
Intensive - Wraparound
Primary Prevention: School-Classroom-Wide Systems for All Students, Staff, & Settings
Universal For ALL

36. 4 Working Elements of PBiS
Supporting Social Competence &
Academic Achievement
SYSTEMS
PRACTICES
DATA
OUTCOMES
Supporting
Decision
Making
Supporting
Staff Behavior
NOT ANOTHER INITIATIVE…PBiS is FRAMEWORK found to actually complement and support other initiatives including RC, RtI, etc.
Supporting Student Behavior

37. Questions?