Interventions with Traumatized Children: TLC’s SITCAP Model

1. Interventions with Traumatized Children: TLC’s SITCAP Model By: Jean West MSW LCSW CTS

2. Today’s Presentation • What is trauma? • How is trauma related to homelessness? • How does trauma affect behavior and learning? • The SITCAP model • How is our school district using this model? • Hands on activities

3. What is trauma? • Trauma is an overwhelming sense of terror, powerlessness, and the absence of a sense of safety. • Following exposure to a potentially trauma inducing incident, survivors may become frozen in an activated state of arousal. • Arousal refers to a heightened state of alert and fear for one’s safety. (wreck)

4. Experiences which can cause trauma • Physical and/or sexual abuse • Domestic violence • Living with substance abusing parents • Witnessing parental homicide • Homelessness • Burns/other serious accidents • Car fatalities • Divorce • Natural disasters

5. The Role of the Brain and the Nervous System

6. The Autonomic Nervous System Part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness. It helps people adapt to changes in their environment. Typically function in opposition to create homeostasis. Parasympathetic: rest and digest (brake) Sympathetic: flight, fright, or freeze (gas)

7. The Autonomic Nervous System

8. Midbrain • Our midbrain is the central relay system for the senses. • Our senses travel through the brain stem and quickly go to the hypothalamus. • The hypothalamus links the nervous system to the endocrine system via the pituitary gland. • The hypothalamus either sends the message to the cortex and it says everything is o.k. or it sends to the pituitary gland to start the fight/ flight /freeze process • Neurotransmitters are released to respond to crisis. • Freeze is when the cascade of neurotransmitters are frozen.

9. Midbrain cont… • Hypothalamus codes memories. • Amygdala: It’s primary role is to process and remember emotional reactions, state dependent recall (test, room, anniversary dates) • Hippocampus: extremely vulnerable to traumatic stress, slow growing part of the brain grows even slower with extreme stress can result in profound difficulties in recalling their childhood. • “Children won’t remember what you said or did but how you made them feel”

10. Implicit Memory • Right hemisphere/reptilian/limbic/brain stem • How an event is remembered by the body and central nervous system • Sensory memories-sight, sound, touch, smell, taste • Iconic symbolization • Trauma experience is stored via images and sensations • No language-no words to describe (apple pie, petting dog) • The body has a memory (suffocation)

11. Explicit Memory • Left hemisphere /neocortex • Contains cognitive processes • The ability to take in information and make sense of it • Language-words to describe • Ability to reorder this changed, therefore…

12. Trauma and Homelessness • “Trauma- physical, sexual, and emotional –is both a cause and a consequence of homelessness.” HCH1999

13. Trauma and Homelessness cont… “The experience of homelessness can be best understood as highly stressful, and, in some instances, traumatic. While homelessness is enormously stressful to individuals of any age, children’s experiences are unique in that it involves multiple losses during critical developmental periods. Children who are homeless are likely to be forced to leave behind valued possessions, experience disruptions in friendships and other significant relationships, and both change and infrequently attend school. Additional emotional strains are tied to enduring the social stigma of homelessness .” Cowan 2007

14. Trauma and Homelessness Cont… Homelessness results in a loss of community, routines, possessions, privacy, and security. • According to The National Traumatic Stress Network, more than 90% of sheltered and low-income mothers have experienced physical and sexual assault over their lifespan. • The experience of homelessness puts families in situations where they are at greater risk of additional traumatic experiences such as assault, witnessing violence, or abrupt separation. • The stresses associated with homelessness can exacerbate other trauma-related difficulties and interfere with recovery due to ongoing traumatic reminders and challenges. NCTSN2005

15. The Emotional Impact • More then one-fifth of homeless preschoolers have emotional problems serious enough to require professional care, but less then one-third receive any treatment. • Homeless children have twice the rate of learning disabilities and three times the rate of emotional and behavioral problems as nonhomeless children. • Half of school-age homeless children experience anxiety, depression, or withdrawal compared to 18% of nonhomeless children. • By the time homeless children are eight years old, one in three has a major mental disorder. NCTSN 2005

16. Trauma and Homelessness Cont… • Trauma is THE predominant mental health issue for homeless mothers. • Research confirms that the strongest predictor of emotional and behavioral problems in poor and homeless children is their mother’s level of emotional distress. HCH 2003 • Emotional help is needed for both the parents and their children in order to be most effective.

17. What does trauma do to the developing brain? • Sympathetic nervous system takes over. • Cortisol and adrenaline goes up and stays up and acts like an acid rain on the rest of the nervous system. • Suppressed serotonin levels • Affect dysregulation • Depressed executive function organization, planning,

18. Traumas Effect on Learning • In the arousal (anxious) state it becomes difficult to process information, follow directions, recall information, and focus (Doctor’s office) • Poor problem solving, attention, disorganized • Often only hear half of the words spoken by their teachers • Cognitively will generally be far behind their peers, children can often learn at three times the rate compared to when engulfed in trying to survive

19. Traumas Effect on Behavior • Hypervigilance • Difficulty sleeping • Easily startled • Clinging • Nightmares • Disobedience • Impaired social skills • Anger /rage • Can’t self sooth or modulate emotions • Depression • Attention problems • Impulsivity • Aggression • Fearful • Risk taking • Panic attacks • Hypersensitive to touch, movement, some sounds and smells

20. Assessment Tool from TLC • Reexperiencing • Flashbacks • Intrusive thoughts, images • Traumatic dreams • Physiological reactions

21. Assessment Tool Cont… • Arousal • Cognitive dysfunction/ focus, retain etc… • Hypervigilance • Attachment reaction • Startle responses • Sleep difficulty • Irritability, aggressiveness, assaultive • Constant state of readiness (sleeping on the floor)

22. Assessment Tool Cont… • Avoidance • Dissociative behavior • Detachment, numbing • Not wanting to talk about it • Diminished interest • OCD like behavior • Phobic-like behavior

23. Secondary Victimization or Wounding • Secondary victimization or wounding occurs when the people and organizations you turn to for help respond in subtle ways that cause you additional pain. • Denial and disbelief • Discounting and minimizing • Blaming you • Treating you as defective

24. SITCAP Research 2005 / Georgia/ 85 at-risk adjudicated adolescents 100 % reported reduction of trauma symptoms 90 % indicated they definitely felt better using 9 and 10 (out of ten) to rate the difference One year following the field test, 85 % HAD NO ADDITIONAL CONTACT WITH THE COURT

25. SITCAP Research Cont… • 2007-2008/four elementary schools grades 2-5 • Most children demonstrated outstanding reductions in most trauma symptoms and problem behaviors as a result of their participation • Confirms findings of 1996-1997 study of 168 children in which statistically significant reductions of PTSD symptoms was demonstrated

26. SITCAP: Primary Issues with Trauma • Fear / Terror • Worry • Hurt • Anger • Revenge • Accountability • Power • Safety • Survivor vs. Victim

27. Symptoms Versus Behaviors • Reduction of PTSD symptoms can be experienced without focusing on symptoms. Begin to restore a sense of safety and power in the child and symptoms will diminish.

28. Sessions • Eight sessions 1st and 7th session the parents are encouraged to attend It is a critical component of the model to educate the parents or caregivers on trauma Session2 Addresses fear and worry Session 3 Addresses physical and emotional hurt Session 4 Addresses anger, revenge, and accountability Session 5 Addresses future orientation Session 6 Prepares child for meeting with parent Session 7 the child shares his story with the parent Session 8 review, reassessment of where child is at

29. Drawing • Draw me a picture of what happened that you can tell me a story about • Psychomotor activity that helps to trigger the sensory memories when it is trauma focused • Engages the child in active involvement in their healing • Helps us to see what the child sees • Helps the child externalize the experience and move it to a safe place (the paper) outside himself which he has control over

30. Drawing cont… • Provides visual representation • To communicate visually what we do not always have words to describe • Safe vehicle to communicate details • Recreates a renewed sense of power and safety which gives them hope for the future

31. 17 year old male

32. 10 year old female

33. 8 year old female

34. 8 year old female

35. 8 year old female

36. 11 year old female

37. 19 year old female

38. 13 year old male

39. The Child Must Feel Safe • Begin and end each session in a safe place • It’s not about how skilled you are but how safe you are!

40. Questions to Elicit Details • After the child has drawn their experience, begin to ask trauma-specific questions about the story • What do you remember seeing or hearing? • Do you sometimes think about what happened even when you don’t want to? • Do certain sounds, smells, etc… suddenly remind you of what happened? • What would you like to see happen to the person or thing that caused this to happen? • Do you sometimes think it should have been you instead?

41. How do we Discuss trauma with our clients? • Safety • Structure • Becoming a witness • We must be aware of how our own experiences effect our ability to help

42. SJSD McKinney-Vento Initiatives • Priority Level 1 building • Staff training • Parent training • Screening of students • Groups of 6-8 students, highest need using SITCAP model • School Counselor and Social Workers training • Trauma questions on local mental health centers assessment /intake forms • Community training for clinicians which included key shelter staff

43. Hands on Activities • How big is your worry? • Grounding exercise • Safety

44. “Atrocities refuse to be buried…..Remembering and telling the truth about terrible events are prerequisites both for restoration of the social order and for the healing of individual victims.” Judith Herman Quote

45. Resources • Information in presentation obtained from The National Institute for Trauma and Loss in Children • www.starrtraining.org/tlc • Cowan, Beryl Ann, "Trauma exposure and behavioral outcomes in sheltered homeless children: The moderating role of perceived social support" (2007). Psychology Dissertations. Paper 39. http://digitalarchive.gsu.edu/psych_diss/39 • HCH Health Care for the homeless Clinician’s network. Trauma and Homelessness.(1999) Vol.3, No.3 • HCH Health Care for the homeless clinician’s network. Homelessness and family trauma: The Case for early intervention. (2003) Vol. 7, No. 2 • NCTSN The National Child Traumatic Stress Network. Facts on Trauma and homeless children. (2005) www.NCTSNet.org • jean.west@sjsd.k12.mo.us