RegulatetoEducate:DevelopmentalTrauma
PBISandMTSS-B
Kym Asam, LICSW
Objectives
• DifferentiatebetweenPTSDanddevelopmentaltrauma
•Understandtheimpactoftraumaonmultipledomainsoffunctioning
• Understandthestudents’ statesofarousalandhowitimpactstheirfunctioninginschool
• Keyskillsinworkingwithchildrenwhohaveexperienceddevelopmentaltrauma
• IncreaseunderstandingofalignmentbetweentraumainformedschoolsandPBIS
PollingQuestion#1
• Howmanyparticipantshavehadsometrainingondevelopmentalorcomplextrauma?
GroundingPrinciples
Trauma-SensitiveSchoolsbenefitallchildren–thosewhosetraumahistoryisknown,thosewhosetraumawillneverbeclearlyidentifiedandthosewhomaybeimpactedbytheir
traumatizedclassmates.
SchoolsaretheCentralCommunityformostchildren.
Source: Helping Traumatized Children Learn
Multi-tieredSystemofSupport
VTMTSSisacoherentcontinuumofevidencebased,system-widepracticesthatsupport:
– proactivepreventativecoreinstructionforall;
– arapidresponsetoacademicandbehavioralchallenges;
– frequentdata-basedmonitoring;and
– instructionaldecision-making
sothateachVermontstudentachieveshighstandards.
Thetriangle– Academicandsocial/emotionalinterventions
Classroom/school wide instruction
Universal regulating interventions
Targeted academic instruction
Targeted social skill and emotional regulation instruction
Intensive academic intervention
Intensive mental health intervention
Definitions
Whatistrauma?
Traumaisnotjusttheeventitself,butratheraresponsetoastressfulexperienceinwhicha
person’sabilitytocopeisdramaticallyundermined.
WhatisDevelopmentalTrauma?
• Apsychologicalandneurobiologicalinjurythatresultsfromprotracted exposuretostressfulevents
• Derailstypicaldevelopmentacrossalldomains(attachment,affect,biology,behavior,cognitive,dissociation,self-concept)
• Experiencesoftenoccurinthecaregivingsystem.• Impactisimmediateandlongterm• Effectswillrequirealltiersofintervention
“Traumaisnotastoryofwhathappenedtoyoualongtimeago,itiswhatisin
yourbody.”
BesselvanderKolk
ToxicStressPyramid
ACE study, Felitti, 2014
Source: US Department of Health and Human Services 2014 Child Maltreatment Report
Pervasivenessinchildren
� 1,892,000substantiatedabuse(Vermont=3,919)
� 26%ofchildrenexperiencetraumabefore4(Vermont59.3%)
� 11.3%increaseinreportsinVermont
� 77.2%neglect(Vermont=4%)
� 17%physicalabuse(Vermont=46%)
� SexualAbuse=8%(54%inVermont)
SourcesofTrauma• Sexualabuse• Physicalabuse• Emotionalabuse• Neglect• DomesticViolence
– Neighborhoodviolence• Torture• Bullying• Prolongedexposuretotraumaticstress• Intrauterinestress• Epigenetics
Epigenetics
https://www.youtube.com/watch?v=AvB0q3mg4sQ
Impact Areas:
qActs without thinking, interruptsqOverreacts to small issuesqUpset by changes/ transitionsqOverwhelmed, easily frustratedqResists change or tasks that are not interestingqDoes not notice the impact of their behaviorqDoes not see their part in problemsqEasily over-stimulated, difficulty calming downqForgetful, loses things, disorganizedqLoses steam quickly, cannot sustain on
challenging tasks
©NFI-Vermont,2013
7domainsofimpairment
Biologyandthebrain
Attachmentand
relationship
EmotionalRegulation
CognitionandLearning
behavior dissociation Self-concept
The brain develops from
the bottom up
Cortex
Limbic
Diencephalon
Brainstem
and the inside out
Neocortex
Limbic
Diencephalon
Brainstem
Neocortex
Limbic
Diencephalon
Brainstem
Abstract thought
Concrete Thought
Affiliation
"Attachment"
Sexual Behavior
Emotional Reactivity
"Arousal"
Appetite/Satiety
Blood Pressure
Heart Rate
Body Temperature
Sleep
Motor Regulation
All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy
ImpactofNeglectontheBrain
Bottomup,Insideout
StagesofSleep
EffectsofTraumaonBrainFunctioning
Prefrontal Cortex(Integration and Planning)
Amygdala(Intensity/significance)
ThalamusVisual, auditory, olfactory,
kinesthetic, gustatory
Hippocampus(cognitive map)
WhatcanwedoaboutDevelopmentalTraumainourkids?
InordertohelpyouthhealfromDevelopmentalTrauma,wemustprovideopportunities,
everyday,forpatterned,repetitiveexperiencesthatcounteract
establishedfunctioning.
PotentialInterventions:Thinkaboutbrainregions
• Touch• Rhythmic• Patterned• EyeContact• Drumming• Body-based
• MusicandMovement
• Yoga• Somatosensory• Parallelplay/learning
PollingQuestion#2
• Howmanyparticipantsusemovementwhenworkingwithstudents?
7domainsofimpairment
Biologyandthebrain
Attachmentand
relationship
EmotionalRegulation
CognitionandLearning
behavior dissociation Self-concept
4KeyPrinciplesofAttachment
• Buildschoolstaffcapacitytomanageaffect
• Buildschoolstaff-childattunement
• Buildconsistency inschoolstaffresponse tochildbehavior
• Buildroutines andritualsintoclassroomandschool
HealthyAttachmentSequencePhysicalorpsychologicalneed
Security,trust,attachment,self-regulation,object
constancy
State of high arousal
Attunement/satisfaction of need
Relaxation (parasympathetic ANS)
Beverly James
DisruptandConnect:Thestillfaceexperimenthttp://www.youtube.com/watch?v=apzXGEbZht0
UnhealthyAttachmentSequencePhysicalorpsychologicalneed
Shame,mistrust,dysregulation,disturbed
mentalblueprint
State of high arousal
Needs are disregarded/attunement
disrupted
Anxiety, rage, numbing
Beverly James
AffectManagement
Whencaregiversmodulatetheirownaffectandemotionalresponses,theycancreateanemotionallysafeenvironmentinwhichchildrenacan
learn
ATTUNEMENT
– Readingandrespondingtothecuesofanother– Synchronousandinteractive– Helpspreventmismatchbetweenneedandprovision
– Readingthenon-verbal,social-emotional“language”ofanother
Tantrums
�Whatdidyounotice?�Whatworkedwell?�Whatdidnotworkwell
https://www.youtube.com/watch?v=oa6znlKBFAg
CONSISTENCY
– EVERY DAY– EVERY GRADE– EVERY BODY– EVERY ENVIRONMENT
RoutinesandRituals
Routinesincreasespredictabilityandthechild’sabilitytoanticipatenextsteps.Establishingclassroomandschool-wideroutineshelpsreducetroublespots(transitions,substituteteachers,unstructuredactivities/days).
Interventions1. Dowel2. SilentSimonsays3. Ropecircleofsafety4. ChooChooTraingame:gamesthatenhancebodycontrol5. Say“no”withyourbody,say“yes”withyourbody6. Jumpingrope7. Drumming8. Mirroringorattunementactivities9. Feelingsgames
TargetingtheTiers,PBiSapproaches
Intensive
targeted
universal
Brain stem/diencephalon
limbic
cortex
7domainsofimpairment
Biologyandthebrain
Attachmentand
relationship
EmotionalRegulation
CognitionandLearning
behavior dissociation Self-concept
NormativeDangerResponsesAutonomicNervousResponseSystem
• Fight• Flight• Freeze• Flock
RecognizingAffect– EmotionalIdentification
FacialExpressionRecognition
Sequence of Engagement
Reason
Relate
Regulate
All rights reserved © 2007-2014 Bruce D. Perry
Bruce D Perry, MD, PhD © 2010 www.ChildTrauma.org
Cognition Abstract Concrete �Emotional�
Reactive Reflexive Mental State CALM ALARM FEAR ALERT TERROR
Primary secondary
Brain Areas
NEOCORTEX Subcortex
SUBCORTEX Limbic
LIMBIC Midbrain
MIDBRAIN Brainstem
BRAINSTEM Autonomic
Sense of Time
Days Hours
Hours Minutes
Extended Future
Minutes Seconds
Loss of Sense of
Time
ImpactAreas
It is often not the task or request that leads the child to
misbehave…
it is the feeling and negative thoughts that is evokes…
©NFI-Vermont,2013
Potentialstrategies
�Movement�Mindfulness�Non-verbalcommunication�Reflectivelylisten�Validation�Shhhhh�Attunement
�Matchaffectwithoutreplication
Morestrategies
• Usingasong,wordsorothercuestohelppreparechangeinactivity
• Patterned,repetitiveproprioceptiveOTactivitiessuchasisometricexercises(chairpush-ups,wall-sits,bearhugswhilechildtriestopulltheadultsarmsaway,applyingdeeppressure),
• Weightedvests,blankets,ankleweights
7domainsofimpairment
Biologyandthebrain
Attachmentand
relationship
EmotionalRegulation
CognitionandLearning
behavior dissociation Self-concept
Bottomup,Insideout
“Nomatterhowexcitingandmeaningfulandsupported
thelearningexperienceisdesignedtobe,achildcannotreap
thecognitivebenefitsofitunlessshefeels
calmenoughtobecurious.”
(McMahon,2011)
Pollingquestion#3
• Howmanyparticipantshaveamorning,coffeeroutine?
SequentialThinking
Achild’ssuccessfulcompletionofmanyacademictasksdependsontheabilitytobringalinearordertothechaosofdailyexperience.Traumaticexperiencecanlimitthisabilitytoorganizematerialsequentially,leadingto
difficultyinreading,writingandcommunicatingverbally.
FromHelpingtheTraumatizedChildLearn
Competency3KeyPrinciples
• Buildstudentexecutivefunctioningskills• Targetself-developmentandidentity• Targetadditionalkeydevelopmentaltasks
The child develops an ability to evaluate situations, inhibit impulsive responses and actively make
choices.
ALL
SOME
FEWMTSS
Math
Reading
AdultRelationships
AngerMgt.
Attendance
PeerInteraction
Science
(Universal)
(Targeted)
(Intensive)
CompetingDemands
Survivalvs.learning
Itisnearlyimpossibletodedicateyourfullattentionandenergytosurvivalandlearningatthesametime.
Potentialinterventions
Generalstrategies• Multi-modallearning• Regulatetoeducate• Buildoncompetencies• Multiplemotorbreaks• Brainbreaks• Differentiated
instruction/DifferentiatedDiscipline
Facilitatingsequentialthinking• Todolists• Visualschedules• Repeatdirections(toneof
voice)• Givenotes
7domainsofimpairment
Biologyandthebrain
Attachmentand
relationship
EmotionalRegulation
CognitionandLearning
behavior dissociation Self-concept
Bottomup,Insideout
Pollingquestion#4
• Howmanypeoplehaveusedsomesourceofheatintheirhomesinthelastweekorso?
Whatdoyouseeandwhy?
KeyTriggers� Lackofpowerorcontrol�Unexpectedchange� Feelingthreatenedorattacked� Feelingvulnerableorfrightened� Feelingshame
And…�Relationships– evenpositiveones� Intensefeelingsofanykind
But…whataboutconsequences?
Relationalandrelevant
Restorativeandreparative
Potentialinterventions/considerations
� Behaviorisaboutsurvival� FunctionANDfeelingbehindbehavior� Skilldeficit� Validation/attachment/comfortseekingvs.attentionseekingormanipulative
� Focusonconnection,notconsequence� Connect,rupture,repair� Ritualizetransitions(withmovement)� Evaluativeprocess(evenpraise)cancreatedefensiveness� Rememberwheretheyarelikelyintheirbrain
HelpfulReframes:
ChildSays: StudentBelieves:
“thisisstupid” “Iamstupid”“Ican’tdothis” “Iampowerless”“You’rean______ “Iamnotsafe”“whydoyoualways…” “Iamtoblame”“I’mouttahere” “Iamoverwhelmed”“Iwon’tdothis” “Ican’tdothis”“Youcan’tmakeme” “Ineedtoprotectmyself”
©NFI-Vermont,2013
PossibleCollisionPointsatSchool
• Schoolsfocusonpreparingchildrenforandinformationrelatedtotheexternalworld– StudentswithDTfocusonthepresentandinternallytostaysafe.
• Muchofschoolismotivatedbyconnectionandparticipationwithothers
• Schoolsoftenusedelayedgratification– StudentswithDTarefocusedonthepresenttostaysafe.Delayinggratificationisdangerousandunpredictable.
• Teachersoftensetlimits/goalsforthecommongood– YouthwithDTdon’toperatewithatemplatethatunderstandsthecommongood.
HowtoIntervene
Consistency
Predictability
Patternedand
Repetitive
Attunement
ManagingAffect
RoutinesandRituals
ALIGNING PBIS PRINCIPLES
Questions?????