1. ………………..…………………………………………………………………………………………………………………………………….. Relationships: The Foundation for Early Childhood Trauma Work Presented by Katrina Ruege, PCC and Lisa Golden, LISW-S Nationwide Children’s Hospital Behavioral Health Early Childhood Mental Health Programs

2. ………………..…………………………………………………………………………………………………………………………………….. Objectives Participants will gain knowledge of how to identify children exposed to trauma and the impact to social, emotional and cognitive development Participants will learn intervention strategies to improve the child/caregiver relationship as the foundation for further treatment Participants will learn ways to engage key stakeholders in advocating for children 0-6 in the community such as child welfare, early education and health care settings

3. ………………..…………………………………………………………………………………………………………………………………….. The Impact of Relationships Child Caregiver Community

4. ………………..…………………………………………………………………………………………………………………………………….. Trauma in Early Childhood Physical Trauma AccidentsAbuse The National Child Traumatic Stress Network Neglect Community Violence Domestic Violence

5. Complex Trauma Exposure to multiple traumatic events Severe and pervasive Usually starts early in life Can impact ability to form secure attachments

6. ………………..…………………………………………………………………………………………………………………………………….. What we hear about early childhood trauma “Freddy’s too young. He wasn’t aware it was happening.” “Mira seems to be fine. She doesn’t cry at all.” “It happened to Jayden when he was two. He doesn’t remember.” “It’s her older brother I’m worried about. He has such bad behavior. Sarah is fine. She just keeps to herself. She doesn’t understand what happened.”

7. ………………..…………………………………………………………………………………………………………………………………….. Assessment

8. ………………..…………………………………………………………………………………………………………………………………….. What does trauma in Early Childhood look like? Early Childhood Trauma Cognitive Emotional SocialPhysical

9. ………………..…………………………………………………………………………………………………………………………………….. Assessment Process Consult with caseworker Score screening tools Meet with caregivers to gather history and current concerns Complete Caregiver/Child Play Observation Send Diagnostic Summary and Referral to caseworker

10. ………………..…………………………………………………………………………………………………………………………………….. Parent/Child Observation

11. ………………..…………………………………………………………………………………………………………………………………….. Case Study

12. ………………..…………………………………………………………………………………………………………………………………….. Intervention

13. ………………..…………………………………………………………………………………………………………………………………….. What models/trainings inform our care? Georgetown Model of Consultation Incredible Years Parent Child Interaction Therapy Concepts from the Neurosequential Model Tile and Grout approach Theraplay Child Parent Psychotherapy Conscious Discipline DECA/ FLIP It Trauma Focused Cognitive Behavioral Therapy Play Therapy trainings Art Therapy Community Support Services

14. ………………..…………………………………………………………………………………………………………………………………….. Case Study

15. ………………..…………………………………………………………………………………………………………………………………….. Our most effective intervention techniques Special Play time/ Child Directed Play Lotion/paint hand print Movement/music Sensory activities Bubble Breathing Superhero narrative Tucker Turtle Self-regulation cards Psychoeducation on complex trauma Circle of security education Body safety education

16. ………………..…………………………………………………………………………………………………………………………………….. Engaging Partners

17. ………………..…………………………………………………………………………………………………………………………………….. Readiness to Partner Recognizing there is a shared population Understanding the role and expertise of each entity Having a shared philosophy Establish systems for ongoing communication Ability to commit time and resources Willingness to participate in joint or shared professional development

18. ………………..…………………………………………………………………………………………………………………………………….. Our Partnerships Medical Child Welfare Educational

19. ………………..…………………………………………………………………………………………………………………………………….. Case Study

20. “ Trauma and our responses to it cannot be understood outside the context of human relationships. Whether people have survived an earthquake or have been repeatedly sexually abused, what matters most is how those experiences affect their relationships - to their loved ones, to themselves and to the world.” - Dr. Bruce Perry, The Boy Who Was Raised As A Dog, 2006

21. ………………..…………………………………………………………………………………………………………………………………….. Questions? Katrina Ruege PCC –Katrina.ruege@nationwidechildrens.orgKatrina.ruege@nationwidechildrens.org Lisa Golden LISW-S –Lisa.Golden@nationwidechildrens.orgLisa.Golden@nationwidechildrens.org