1. MDCH Children’s Trauma Initiative
Errin Skinner-Liell, Initiative Coordinator
May 4, 2015

2. Contents:
I. Overview of trauma II. Components of the Initiative III. Child outcome data IV. Summary

3. What is Trauma Trauma is an event or experience that:
Threatens the life or physical integrity of a person or of someone critically important to that person (such as a spouse, child, parent, sibling)
Produces intense physical and emotional reactions, including:
An overwhelming sense of terror, helplessness, and horror
Physical sensations such as rapid heart rate, trembling, dizziness, or loss of bladder or bowel control
As the name implies, an acute trauma is a single event that lasts for a limited period of time.
<Click to bullets 1 through 3> Being in a car accident, being bitten by a dog, witnessing (or being a victim of) a school shooting, and going through a natural disaster like a tornado are all examples of acute traumas.
What else might qualify as an acute traumatic experience?
Give participants time to suggest additional forms of acute trauma before clicking to the last two bullets.
Even during a relatively brief traumatic event, a child will go through an amazing—and confusing—number of feelings, thoughts, and physical responses as he or she assesses and reassesses the danger faced and the prospect of safety
As the event unfolds, the child’s pounding heart, out-of-control emotions, and other physical reactions just add to his or her terror and sense of being overwhelmed.
If the trauma involves other children or adults, seeing their reactions can also contribute to the child’s distress. Some children report after an event such as a natural disaster that the scariest part was seeing their parents frightened and unable to take any action.

4. Defining Child Trauma
A sudden, unexpected, non- normative event that overwhelms the child’s capacity to cope.

5. Types of Trauma Acute trauma is a single, time-limited event, such as:
A serious accident
An act of community violence or crime
A natural disaster (earthquakes, wildfires, floods)
The sudden or violent loss of a loved one
A physical or sexual assault (e.g., being shot or raped)
As the name implies, an acute trauma is a single event that lasts for a limited period of time.
<Click to bullets 1 through 3> Being in a car accident, being bitten by a dog, witnessing (or being a victim of) a school shooting, and going through a natural disaster like a tornado are all examples of acute traumas.
What else might qualify as an acute traumatic experience?
Give participants time to suggest additional forms of acute trauma before clicking to the last two bullets.
Even during a relatively brief traumatic event, a child will go through an amazing—and confusing—number of feelings, thoughts, and physical responses as he or she assesses and reassesses the danger faced and the prospect of safety
As the event unfolds, the child’s pounding heart, out-of-control emotions, and other physical reactions just add to his or her terror and sense of being overwhelmed.
If the trauma involves other children or adults, seeing their reactions can also contribute to the child’s distress. Some children report after an event such as a natural disaster that the scariest part was seeing their parents frightened and unable to take any action.

6. Types of Trauma, Continued
Chronic trauma is the experience of multiple traumatic events:
May be recurrent trauma of the same kind—such as physical or sexual abuse—or varied traumas such as witnessing domestic violence and then becoming a victim of community violence
The effects of chronic trauma tend to build on each other, as each event serves as a reminder of past trauma and reinforces its negative impact
Chronic trauma is when a child experiences many traumatic events, often over a long period of time.
Chronic trauma can mean <Click to bullet 1> recurrent traumatic events of the same kind, such as longstanding physical or sexual abuse. It can also refer to the experience of many different traumatic events—such as a child who has seen a violent fight between his parents, and later gets hurt in a drive-by shooting and has to spend weeks in the hospital.
Even in cases of chronic trauma, such as physical abuse, there may be particular events that stand out as being especially terrifying, such as the night Mommy was so drunk I was sure she was really going to kill my sister.
What are some other experiences that could qualify as chronic trauma?
Give participants time to respond. If participants raise the topic of neglect as a form of chronic trauma, take the opportunity to segue into a brief discussion of the role of neglect. If not, raise the issue.
Neglect is defined as the failure to provide for a child’s basic needs. To an infant or very young child who has been left alone in a crib, in a dirty diaper, and suffering from the pain of hunger, neglect can feel like a very real threat to survival. Even in older children, neglect often opens the door to other forms of trauma (since they are not receiving proper care, attention, and supervision) and may make a child less able to recover from trauma’s effects.
<Click to bullet 2> Because the effects of chronic trauma tend to build on each other, a child who has been exposed to a series of traumas may become more overwhelmed by each event that follows and more convinced that the world is not a safe place. As we shall see, repeated traumatic experiences—particularly in very young children—can actually alter crucial pathways in the developing brain. Over time, a child who has felt overwhelmed over and over again may become so sensitized to trauma that he or she has problems tolerating and responding to even minor, everyday stresses.

7. What we see What is this? Ask audience there input.
This is what we see, an iceberg.

8. What is underneath
Even though we saw the top of the iceberg it is different from what is really under the surface.
What about thinking about a child or adult that you know as the top of the ice berg
This is what we see and what they are presenting to the community
But if you look beyond the surface you see that there is so much more that is affecting the child or adult
So during the course of this trauma training course try keeping this in the back of your mind when we talk about people that are going thru traumatic life events

9. “80% of the children we serve at CMH have multiple traumatic experiences”
CMHSP administrator

10. Essential Elements of the Children’s Trauma Initiative
Caregiver Education
Trauma Assessment and Treatment
Trauma Informed Screening
Trauma Informed Screening
Trauma Assessment and Treatment
Caregiver Education
Supported by all levels of the CMH System
Administration
Supervisors
Direct Service Staff
Support Staff
Caregivers

11. Values of the Initiative
Integration and support of trauma informed practice across system
Family driven, youth guided practice
Quality practice and use of Evidence Based Practice

12. Trauma Informed Screening
Goal is to ensure early identification of trauma
Screening interventionists (in person and via telephone)
Intake Workers

13. Trauma Focused Cognitive Behavioral Therapy (TF-CBT)
Goal is to reduce trauma symptomolgy through trauma treatment using TFCBT
Clinicians and their supervisors are trained in the evidence based TF-CBT model and implement the model with children and their families.
Home-based / Outpatient clinicians and their supervisors

14. Treatment Model – TF-CBT Components
P = Psychoeducation & Parenting skills R = Relaxation A = Affect regulation C = Cognitive coping T = Trauma Narrative I = In-vivo exposure C = Conjoint session E = Enhancing safety & social skills

15. Caregiver Education through Resource Parent curriculum
Goal is for CMHSP’s to provide trauma education to caregivers in their local community who are raising traumatized youth
Training of trainers model enables sustainability
Goal is for participating sites to incorporate this into their system of services available for children, their families, and their community
CMH’s share this resource with caregivers in their system and community
Desired outcome is to equip caregivers and the community to effectively intervene and support the healing of children with a history of trauma

16. Resource Parent Training Modules
Introductions
Trauma 101
Understanding Trauma’s Effects
Making a Safe Place
Dealing with Feelings and Behaviors
The Importance of Connection
Becoming an Advocate
Taking Care of Yourself

17. Numbers served through Initiative
Total of 12 cohorts completed; 2 cohorts currently being trained
Approximately 20 screening interventionists trained, 406 clinicians and 130 supervisors trained to implement TFCBT, and 340 parents and staff facilitators trained to conduct local Resource Parent trainings
40 CMHSP’s trained covering 73 counties

18. Child Outcome Data `

19. Evaluation Summary `

20. Outcomes: Screening
Implementation of validated trauma screening instrument during intake assessment process
Integration of the trauma principle “if you don’t ask, they won’t tell” at the first point of contact

21. Outcomes: TFCBT
Continued statistically significant and clinically relevant outcomes across all measures: UCLA trauma symptoms based on DSM criteria, CAFAS child measure, and CAFAS parent measure.
Data for young children shows positive results with home, mood, and behavior toward others on the PECFAS, supported by results on the TSCYC.

22. Outcomes: Caregiver Education
Parents, professionals, and community providers trained as facilitators of psychoeducational trauma curriculum
Positive feedback from caregivers on the impact of participating in the parent groups

23. Lessons Learned
Support and commitment at all levels to build a trauma informed system
Development of an action plan to address secondary traumatic stress
Integration of essential elements (screening, assessment/ treatment, and caregiver education)
Individual and/or group supervision to support implementation of model and new tools

24. Contact Information
Mary Ludtke, MDCH Consultant
Telephone Number: (517)
Errin Skinner Liell, Initiative Coordinator
Telephone Number: (517)
Kathy Fitzpatrick, Technical Assistance Specialist
Telephone Number: (517)