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Developmental Trauma:Child Advocacy CenterHope Changes Everything ConferenceWhat is “Stress” any uncomfortable "emotional experience accompanied bypredictable biochemical, physiological and behavioral changes."APA Dave Melnick, LICSWNortheastern Family Institute, Vermont (NFI)StressWhat is Trauma Trauma is an unexpected, body based event or experience thatoverwhelms a person’s ability to elopmental Trauma:(focus on interpersonal trauma)1.It is an Event, Experience and EffectVulnerabilityMultiple incidents of trauma, over longperiods of time2. Perpetrator is within the child’s intimate circleof adults: “The Care-giving System”Traumatic Stress:Signature Clinical IssuesWhat was adaptive (survival behavior) at the timeof the trauma, is now maladaptive when the threat(objective) no longer exists.3. The 7 Domains of Impairment1

Stress Response System:FFFFTraumatic Stress:Signature Clinical Issues“The alarm system for the emotional body is fear”“Being traumatized means continuing to organizeyour life as if the trauma were still going on—unchanged and immutable—as every newencounter or event is contaminated by the past”—van der KolkFightFEARFlightFreezeAdapted from "The Mastery of Love" DonMiguel RuizTrauma Informed Systems“A Trauma-informed System Realizes the widespread impact of trauma and understandspotential paths for recovery; Recognizes the signs and symptoms of trauma in clients,families, staff, and others involved with the system; and Responds by fully integrating knowledge about trauma intopolicies, procedures, and practices, and seeks to actively resist retraumatization.” Restorative--SAMSATrauma-Informed Systems:Primary ResourcesGeneral Concepts: Trauma-informedAdult Assets of the Caregiver1.1. National Child Traumatic Stress Network:http://www.nctsn.org/2. UCSF HEARTS: http://www.coe.ucsf.edu/coe/spotlight/ucsf hearts story.html3. The Sanctuary Model: http://www.sanctuaryweb.com4. THRIVE Maine: http://thriveinitiative.org5. SAMSA: http://www.samhsa.gov6. The Trauma-Informed Care Project:http://www.traumainformedcareproject.org7. Child Welfare Information ding/trauma/2.3.A resilient sense of self: Open minded Self reflective Curious, even when stressed Acceptance of emotional discomfort Ability to enjoy youthOffer a secure base: with an understanding of child development andtrauma Identify attachment patterns and child's miscues Being sensitive and able to challenge MindfulRelational capacity: ability to build and sustain relationship especiallyin times of stress Balance of authoritative and warm Setting good boundaries Attunement Capacity to connect with emotional distress Reparative focus4. Ability to manage behavior connect then correct Flexible response patterns Good impulse control Attune to internal experience whilemisbehavior is occurring5. Ability to handle rejection6. Willingness and openness to exploring ownattachment history7. Engaged in a reflective practiceAdapted from: "Assessing Adoptive andFoster Parents" Alper and Howe2

The Impact of Developmental Trauma:NCTSN: The 7 Domains of Impairment1.2.3.4.5.6.7.Impact of Developmental Trauma:Domain #1: Physical Health(Brain and Body)Physical Health: Body and BrainAttachment & RelationshipsEmotion ResponsesThinking and LearningBehavioral ControlDissociationSelf-Concept & FutureNational Child Traumatic Stress Network:Seven Domains of ImpairmentOrientationWe don’t truly know ourselves unless we canfeel and interpret our physical sensations”(Bessel van der Kolk, MDhttp://www.nctsn.org/The Brain: Form and FunctionThe Brain: Form and FunctionAreas of the BrainAreas of the BrainNeocortex: Logic & ReasonPrimary Strategy:Logic and ReasonLimbic: Relationship & Emotions:Primary Strategy:RelationshipPrimary Strategy:Co-RegulateHousekeeping FunctionsReptilian: Survival NFI Vermont 2016 NFI Vermont 2016adapted from materials by www.ChildTrauma.orgadapted from materials by www.ChildTrauma.org3

Percentage of available resources:Regulated ChildPercentage of available resources:Distressed/Alarmed/Reactive Child50%30%30%50%SurvivingSurviving20%20% NFI Vermont 2016 NFI Vermont 2016Percentage of available resources:Dysregulated/Reflexive ChildInterventionsNeocortex: Logic & Reason10%40%Surviving50% NFI Vermont 2016 NFI Vermont 2016adapted from materials by rtex: Logic & ReasonNeocortex: Logic & ReasonLimbic: Relationship & Emotions:Limbic: Relationship & Emotions: PACE Validation Movement,breathing Sensory breaks The 4 “R’s“ Rhythms andsynchrony Touch Get to YesReptilian: Survival Reptilian: Survival NFI Vermont 2016Physical HoldMovementPhysical contactEmpathyCo-regulationSilenceAdult affect regulation NFI Vermont 2016adapted from materials by www.ChildTrauma.orgadapted from materials by www.ChildTrauma.org4

Interventions The Brain on DessertNeocortex: Logic & ReasonCBT/DBTPrior behavior reference pointsContingency planningPoint/level systemsFBALimbic: Relationship & Emotions: PACE Validation Movement,breathing Sensory breaks The 4 “R’s“ Get to Yes!Reptilian: Survival NFI Vermont 2016MovementPhysical contactEmpathyCo-regulationSilenceAdult affect regulationadapted from materials by www.ChildTrauma.orgAdditional strategies:PACE (Dan Hughes, PhD.)Strategies: Biology and Brain1. Congruence and “matching systemsPlayfulness:2. Provide a coherent and predictable response to their stress:Acceptance/Attunement:3. Enriched Relational Experiences: This leads to co-regulation4. Get to Yes!5. Rhythm and Movement6. Mindfulness Generates hope Reduces resistance/shame and increases joy/pleasure Authenticates experienceBreeds connection before correctionCuriosity: Decreases defensive positioningHelps caregivers inhibit their first reactions to a teen.Empathy: Cannot exist at the same time as anger—cannot co-existEmotional and body based experienceauthenticates NFI Vermont 2016Impact of Developmental Trauma:Domain #2: Attachment and RelationshipDomain #2: Attachment and RelationshipGeneral Concepts ‘The emotional energy that lives in our home (as young children) is going to tune ouremotional body to that frequency” Ruiz page 33 Relationship are the “firewall” that pretends the virus of trauma from spreadingthroughout all three operating systems of our brains We must create a disparity between what the child expects (the rhythm of his earlylife) and your caregiving/professional rhythm We must be “bigger, stronger, wiser and kind (circle of security) Lieberman“Being able to feel safe with other people is probably thesingle most important aspect of mental health” van der Kolk NFI Vermont 20165

Healthy Attachment Sequence:Unhealthy Attachment:physical or psychological onState of higharousalMental MapsOrRoad Mapsphysical or psychological needActivation ofthe “StressResponse System”Insecurity & Self DoubtMistrustShamePoor Self-RegulationState of high Arousal“Road Map”Attunement/satisfaction of needNeeds are disregarded/attunement disrupted(Beverly James)(Beverly James) NFI-Vermont, 2013Domain #2: Attachment and RelationshipReenactmentsWhy negative reenactments occurs: (Sandra Bloom)1.Disrupted attachments: 2.direct request for comfort were not met.Child learns to indirectly signal for what they need.State Dependent Learning: The adult ‘help’ often repeats past patterns4.The Addictive Potential of Arousal:5.Loss of Language: trauma can be speechless.6.Guilt and shame: 1. Over-reactive to nonverbal comm. Poorly evaluate the client’s intentions3. The stress activates a defensivestance: Become at odds with your client (competitive,angry),the child’s original action plan did not stop the trauma.The persons signals are misread by others and ‘are often responded to in ways that directly counter what the traumatized person requires in order tochange”.Strategies: Attachment1.(Dan Hughes, Ph.D & JonBaylin, Ph.D.)fear becomes deeply imbedded in child’s minds This emotion memory is outside of his/her conscious awareness.A trauma trigger provokes a behavioral sequence from the child that originated in the “context of something frightening or life threatening” “The reward is temporary relief of the fear” p.763.Professionals: Impact of Stress2. Experience their client as a threatFear Conditioning: “Reenactment” NFI-Vermont, 2013Impact of Developmental Trauma:Domain #3 Emotion ResponsesAdult Affect Regulation: You must be able to understand and feel your own emotions in order to empathize with others Traumatized youth are highly influenced by the affect state of adults2.Attunement: Create a “we state”: Relationships mediate stress3.4.5.6.Enriched relationship: recreate purposeful interactional patterns ofcontinuity, trust, containment. Be “bigger, stronger, wise and kind”Co-regulate affectMinimize/Prevent Reenactment: Deconstruct the relational patternsto understand what the child is playing out. It takes time.“ Stage Not Age”—the child’s functional age is driven by the stressresponse system and self-regulation ability Brandt NFI-Vermont, 20136

Emotion RegulationFunction of Emotions:Self-Regulation:1. Tell us what is meaningful2. Readies us for actionCatalogue ofpriorexperienceAttunement/MisattunementBody BasedAwarenessEmotionResponse3. “Evokes Motion”Adapted From: "Working with EmotionalIntelligence", Daniel GolemanHow Trauma Effects EmotionRegulationEmotion RegulationOur initial decisions are made by gut feelings and we cannot “dictate” what we aregoing to feelDissociation:Retreat from the external sensory world We cannot control our emotions or initial physiological response. We can controlour response to these emotions and physiology. This is what is meant by emotionregulation.Anger mobilizes energy and focuses attention to remove an obstacle to achieve agoal.–Anger is a motor experience while empathy is a sensory/attachment experience NFI Vermont 2016Common Forms: Avoidance, Refusals, Indifference ‘Spaced out’, inattentive, ‘trance like’, stilling, mental escape,detached, not embodied, numbing Surrender, Possum, Capitulate, Retreat and Defeat, Submissive,obedience, feigned death, collapse Helpless, freezing, indifferent, apathy, passive, victim, lifeless NFI Vermont 2016Getting to YesEmotion Regulation: Strategies:1. Getting To Yes!2. .and “Listen more and Lecture Less“people behave their worst when they feel the most powerless” (Mark Goulston, MD)Goal:Method:1.Step #1: Make Contact:Help move a brain frompanic to control. Thisgives the cortex a “toehold” and you can . “I bet you feel that nobody really understands just how .” “It sounds like you think I ” “I bet you think that I am trying to ” ”It sounds as though you think that nobodyunderstands you”Step #2: Name it 1. “It seems that you are .is that correct?”Step #3: “Scale it” “How are you right now”?7