1. Trauma and our students Sarina Kot, Ph.D., R.Psych. RPT-S Sarina Kot, Ph.D., R.Psych. RPT-S 1

2. Topics: Adverse Childhood Experiences Trauma and Loss Children and youth’s brain Application Self-care 2

3. Adverse Childhood Experiences (ACEs) Research started in 1995 Centers for Disease Control and Prevention Kaiser Permanente N = 17,000 3

4. ACEs Abuse Neglect Witnessing domestic violence Growing up with substance abuse, mental illness, parental discord, or crime in the home 4

5. Common ACEs are common. 28% reported physical abuse 21% reported sexual abuse. 5

6. Cluster ACEs cluster Almost 40% of the Kaiser sample reported two or more ACEs and 12.5% experienced four or more. 6

7. Powerful Cumulative ACE score Not any particular ACE strong relationship to numerous health, social, and behavioral problems throughout their lifespan 7

8. Mechanism Neurodevelopment disrupted Impacts child’s ability to cope During adolescence, adopts dysfunctional coping mechanisms (e.g. substance use) Contributes to disease, disability and social problems 8

9. What helps Simply acknowledging the past trauma Asking about and listening to a patient's story 9

10. Doctor visits Doctor: Can you tell me how this adverse childhood experience has affected you later in your life? 35 percent reduction in doctor visits 11 percent reduction in emergency room visits during the year following 10

11. Felitti If a medication were producing these kinds of positive results, the drug would be mandated. www.acestudy.org www.humanstress.cawww.humanstress.ca (Sonia Lupien) 11

12. What is trauma Extremely stressful Life threatening Beyond one’s ability to cope 12

13. Trauma Is about the event Is about the person (brain, nervous system) 13

14. Inside the Brain Amaygdala processes emotional events Regular emotional events: processed and move on Traumatic experience: too much info, cannot process the info fast enough 14

15. Inside the brain Overwhelmed, cannot file away Once triggered, feels like things are happening at the present time 15

16. Trauma’s Aftermath Re-experiencing: flashbacks/nightmares Avoidance: fear of reminders Hyper-arousal : can’t sleep, hypervigilence, anger 16

17. What we may see Withdrawn, disengaged Aggressive, angry and oppositional Tired, falling asleep 17

18. Children and Youth Resilient? Vulnerable? 18

19. Most kids bounce back When home and school: Provide safety, routine, calmness Accept and understand youth’s reactions Provide opportunities for making sense of the trauma 19

20. Physical activity

21. Problem solving

22. Overcoming fears

23. What really hurt kids Lack of support from adults Maybe adults are traumatized too Chaos and danger repeated A series of extremely stressful, life threatening events that are beyond youth’s ability to cope 23

24. Impact Worse to have repeated trauma Danger is the norm Re-experiencing: see threats everywhere Avoidance: dissociative Hyper-arousal: opposition 24

25. Face recognition research Feeling faces are blurred gradually Abused kids can figure out an angry face when it is blurred beyond recognition Survival skills to see anger in others 25

26. Over-sensitive? Adaptive behaviour in a dangerous environment Unnecessary in the new and safe environment Safety has to be felt New learning 26

27. Another way to look at it Trauma hurt youth: mentally (to focus or to attend), emotionally (to calm themselves) and situationally (to be aware of others or their environment). 27

28. Brain research Experience is the sculptor Plasticity Relationship 28

29. Neurons that fire together wire together Neurons that fire apart wire apart Neurons that are out of sync fail to link Brain plasticity 29

30. Relationship Resilience: one secure relationship with an adult who knows the kid Need connection to people who are present, kind, and sensitive 30

31. Best trauma treatment Provide safety Meaningful relationships Help youth calm themselves Process the trauma in manageable chunks 31

32. Self-regulation Fancy way to describe - “calm yourself” Breathing Positive self-talk Walk away

33. Process trauma Notice triggers: Sensory reminders Provide comfort/calming Receive the student’s story 33

34. If a student tells you You are helping by listening: Talking involves activating the pre- frontal cortex Talking calms the amygdala Making sense/filing 34

35. Quick tips Don’t be afraid Give brief responses to show understanding End the conversation at a safe place Thank the kid for sharing “That was scary. I am glad you are ok now.” 35

36. Talking, writing, drawing.. Serve similar functions: making sense Prefrontal cortex Receive the information Show understanding 36

37. Follow up The talk with you is sufficient Risks: suicide, hurt others, family problems Tell the youth that you will check in/get someone else to join in Share with a relevant colleague 37

38. Do we want kids to forget? No, history is important Transform memory: bad memory belongs to the past Different parts of the brain 38

39. Self-care Why? Cost to helping Empathic connection to our traumatized students Student may treat you as someone else 39

40. Self-care How? Discharge Recharge through empathic connection 40

41. Just a reminder Social support Our own attachment figure Seek help Remain hopeful Spirituality/Meaning 41