Healing Perspectives in Therapy with Traumatized Children Presented by: Mary Baldwin, MA & Ivette Salinas, MA Psychology Doctoral Students Our Lady of the Lake University Center For Miracles at the Children’s Hospital of San Antonio
Overview Introductions • Overview of Center for Miracles • • Trauma- Informed Services Abuse and the Brain in Elementary Aged Children • • Utilizing a Strength-Based Perspective in Working with Abused Children Solution Focused Brief Therapy • • Cultural Considerations Trauma-Focused Cognitive Behavioral Therapy • • Dialectical Behavioral Therapy Case Conceptualizations • Questions & Closing Remarks •
Center for Miracles at the Children’s Hospital of San Antonio CHRISTUS Health provides complete medical and psychosocial assessments for children who are referred by Child Protective Services, law enforcement or medical professionals and who are suspected victims of abuse or neglect. Considered pediatric subspecialists, Center for Miracles pediatricians are part of a small, elite group of child abuse specialists in Texas. The team also consists of social workers, a nurse practitioner and psychology/social work interns. Center for Miracles at The Children's Hospital of San Antonio 315 N. San Saba Suite 201 San Antonio, Texas 78207 Clinic Manager: Tim Recinek PH: 210-704-3800
Trauma Informed Services with Children
Quick group activity.. Take 5 minutes to discuss in groups of 2-3 • What was your reaction to this video? Did you learn anything that surprised you? • What does trauma informed work mean to you? • • What types of trauma have you worked with before?
What is trauma and what to expect? What Is a Traumatic Event? A traumatic event is a frightening, dangerous, or violent event that poses a threat to a child’s life or bodily integrity. Witnessing a traumatic event that threatens life or physical security of a loved one can also be traumatic. This is particularly important for young children as their sense of safety depends on the perceived safety of their attachment figures. ● Physical, sexual, or psychological abuse and neglect (including trafficking) ● Natural and technological disasters or terrorism ● Family or community violence ● Sudden or violent loss of a loved one ● Substance use disorder (personal or familial) ● Refugee and war experiences (including torture) ● Serious accidents or life-threatening illness ● Military family-related stressors (e.g., deployment, parental loss or injury) (The National Child Traumatic Stress Network)
Common reactions in young children: Reactions will depend upon the severity of the trauma, their personality, previous coping skills and support: Children could regress both emotionally, behaviorally and academically May become more clinging, defiant, unhappy and needy of parental attention and comfort The children may first experience some sort of denial that the situation really happened. Increased fears, worries or nightmares Sleep disturbances or eating difficulties may happen Feelings of irritability, anger, sadness or guilt may often emerge. Somatic complaints such as headaches, stomachaches or sweating are not unusual Children and adolescents may repeatedly relive the trauma by acting it out in play or dream Other students may seek to avoid all reminders of the trauma by withdrawing from others, refusing to discuss their feelings, or avoiding activities that remind them of the people or places associated with the trauma. Some loss of interest in school, misbehavior, and poor concentration are other common reactions. These symptoms may range from mild to severe. More severe symptoms may indicate that your child is experiencing Post Traumatic Stress Disorder or Depression. (The National Child Traumatic Stress Network)
The Brain ❖ The human brain is an amazing and complex organ. It allows us to think, act, feel, laugh, speak, create and love. The brain mediates all of the qualities of humanity, good and bad. Yet the core "mission" of the brain is to sense, perceive, process, store, and act on information from the external and internal environment to promote survival. In order to do this, the human brain has evolved an efficient and logical organization structure. ❖ The brain has a bottom-up organization. The bottom regions (i.e., brainstem and midbrain) control the most simple functions such as respiration, heart rate and blood pressure regulation while the top areas (i.e., limbic and cortex) control more complex functions such as thinking and regulating emotions. https://www.youtube.com/watch?v=lPftosmseYE
Brain Development ❖ It is during childhood that the brain matures and the whole set of brain-related capabilities develop in a sequential fashion. We crawl before we walk, we babble before we talk. ❖ The process of sequential development of the brain and, of course, the sequential development of function, is guided by experience. The brain develops and modifies itself in response to experience. ❖ The simple and unavoidable result of this sequential neurodevelopment is that the organizing, "sensitive" brain of an infant or young child is more malleable to experience than a mature brain. While experience may alter and change the functioning of an adult, experience literally provides the organizing framework for an infant and child. ❖ The brain is most plastic (receptive to environmental input) in early childhood. The consequence of sequential development is that as different regions are organizing, they require specific kinds of experience targeting the region's specific function (e.g., visual input while the visual system is organizing) in order to develop normally. These times during development are called critical or sensitive periods.
Traumatic Experiences & Development ❖ With optimal experiences, the brain develops healthy, flexible and diverse capabilities. When there is disruption of the timing, intensity, quality or quantity of normal developmental experiences, however, there may be devastating impact on neurodevelopment — and, thereby, function. For millions of abused and neglected children, the nature of their experiences adversely influences the development of their brains. During the traumatic experience, these children's brains are in a state of fear-related activation. This activation of key neural systems in the brain leads to adaptive changes in emotional, behavioral and cognitive functioning to promote survival. Yet, persisting or chronic activation of this adaptive fear response can result in the maladaptive persistence of a fear state. This activation causes hypervigilance, increased muscle tone, a focus on threat-related cues (typically non-verbal), anxiety, behavioral impulsivity — all of which are adaptive during a threatening event yet become maladaptive when the immediate threat has passed. ❖ This is the dilemma that traumatic abuse brings to the child's developing brain. The very process of using the proper adaptive neural response during a threat will also be the process that underlies the neural pathology, which causes so much distress and pain through the child's life. The chronically traumatized child will develop a host of physical signs (e.g., altered cardiovascular regulation) and symptoms (e.g., attentional, sleep and mood problems) which make their lives difficult. ❖ There is hope, however. The brain is very "plastic" — meaning it is capable of changing in response to experiences, especially repetitive and patterned experiences. Furthermore, the brain is most plastic during early childhood. Aggressive early identification and intervention with abused and neglected children has the capacity to modify and influence development in many positive ways. ❖ The elements of successful intervention must be guided by the core principles of brain development. The brain changes in a use- dependent fashion. Therapeutic interventions that restore a sense of safety and control are very important for the acutely traumatized child. In cases of chronic abuse and neglect, however, the very act of intervening can contribute to the child's catalogue of fearful situation. Investigation, court, removal, placement, re-location, and re-unification all contribute to the unknown, uncontrollable and, often, frightening experiences of the abused child. Our systems, placements and therapeutic activities can diminish the fearful nature of these children's lives by providing consistency, repetition (familiarity), nurturance, predictability and control (returned to the child). Yet the poorly coordinated, over-burdened and reactive systems mandated to help these children rarely can provide those key elements.
“The programs and approaches that are flexible have the greatest potential. We tend to deliver our mental health services in a one-size- fits- all approach” (Bruce Perry, 2013)
Regaining Safety and Hope after Trauma...
A Strength-Based Perspective in working with abused children “You are Brave, You are Safe, You are a Hero” (Baldwin & Caballero, 2017) -
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