Trauma Informed Services and PBiS at LSSU

Nicole Mondejar, MHAEarly Childhood Programs Administrator/WCMHS

PBiS Implementation Coach /Lamoille Region

May 24th, 2012

Brain Development & Trauma/Stress

Scope of the problem

How PBiS can help

Trauma & Toxic Stress Positive StressPositive Stress

Tolerable StressTolerable Stress

Toxic StressToxic Stress

All managed byAll managed bybrain circuits and brain circuits and hormones in thehormones in thebody .body .

Prolonged exposure Prolonged exposure to stress hormones = to stress hormones = impaired brainimpaired braindevelopment and development and functioning.functioning.

Trauma is defined as a physical or psychological threat or assault to a child’s physical

integrity, sense of self, safety or survival or to the physical safety of another person

significant to the child.

(VT CUPS Handbook)

Trauma & Toxic Stress

Children may experience trauma as a result of a number of different circumstances, such as:

Abuse including sexual, physical and/or emotionalAbuse including sexual, physical and/or emotional Abandonment or neglectAbandonment or neglect Witness to domestic violenceWitness to domestic violence Death or loss of a loved oneDeath or loss of a loved one Severe natural disastersSevere natural disasters War, terrorism, military or police actions (including media images) War, terrorism, military or police actions (including media images) Witness to community violence Witness to community violence Personal attack by another person or an animalPersonal attack by another person or an animal KidnappingKidnapping Severe bullyingSevere bullying Medical procedure, surgery, accident or serious illnessMedical procedure, surgery, accident or serious illness Living in chronically chaotic environments Living in chronically chaotic environments

Brain Development

Brain Development

Brain Development

Brain Development

Brain Development

Adversity in Early Childhood

Adversity in Early Childhood

Adversity in Early Childhood

7 Domains of Impairment in Children Exposed to Complex Trauma

1. ATTACHMENT:Uncertainty about the reliability and predictability of

the worldProblems with boundariesDistrust and suspiciousnessSocial isolationInterpersonal difficultiesDifficulty attuning to other people’s emotional statesDifficulty with perspective takingDifficulty enlisting other people as allies

7 Domains of Impairment in Children Exposed to Complex Trauma

2. BIOLOGY:Sensorimotor developmental problemsHypersensitivity to physical contactAnalgesiaProblems with coordination, balance, body toneDifficulties localizing skin contactSomatizationIncreased medical problems across a wide span, e.g.,

pelvic pain, asthma, skin problems, autoimmune disorders, pseudo seizures

7 Domains of Impairment in Children Exposed to Complex Trauma

3. AFFECT REGULATION:Difficulty with emotional self-regulationDifficulty describing feelings and internal experienceProblems knowing and describing internal statesDifficulty communicating wishes and desires

4. DISSOCIATION:Distinct alterations in states of consciousnessAmnesiaDepersonalization and derealizationTwo or more distinct states of consciousness, with impaired

memory for state-based events

7 Domains of Impairment in Children Exposed to Complex Trauma

5. BEHAVIORAL CONTROL:Poor modulation of impulsesSelf-destructive behaviorAggression against othersPathological self-soothing behaviorsSleep disturbancesEating disordersSubstance abuseExcessive complianceOppositional behaviorDifficulty understanding and complying with rulesCommunication of traumatic past by reenactment in day-to-day

behavior or play (sexual, aggressive, etc.)

7 Domains of Impairment in Children Exposed to Complex Trauma

6. COGNITION:Difficulties in attention, regulation and executive functioningLack of sustained curiosityProblems with processing novel informationProblems focusing on and completing tasksProblems with object constancyDifficulty planning and anticipatingProblems understanding own contribution to what happens to themLearning difficultiesProblems with language developmentProblems with orientation in time and spaceAcoustic and visual perceptual problems Impaired comprehension of complex visual-spatial patterns

7 Domains of Impairment in Children Exposed to Complex Trauma

7. SELF-CONCEPT:Lack of a continuous, predictable sense of selfPoor sense of separatenessDisturbances of body imageLow self-esteemShame and guilt

Scope of the Problem

Between 2004 and 2010, the National Child Traumatic Stress Network (NCTSN) collected

data on 14,088 children and adolescents served by 56 service centers across the country. This

study examined the prevalence of trauma exposure and service use among these care

recipients…

Scope of the ProblemP

erce

nt

of

Ch

ild

ren

& A

do

lesc

ents

Figure 1. Percent of children who experienced single versus multiple trauma exposures (n = 11,104)

The Good News!

Contrary to popular belief children living in highly

disadvantaged environments can be

protected from serious emotional or behavioral

consequences.

The Good News!

Studies of evidence-based interventions and recentfindings show that trauma-related, mental health

conditions are highly treatable.

1. Healthy Adult Relationships2. Promote Protective Factors

Nurturing and attachment Knowledge of parenting and of child and youth

development Parental resilience Social connections Concrete supports for parents

3. Early Identification & Access to Supports4. Increase Awareness

What We Can Do:

Best PracticesSystems Approach to Intervention

Child Protective ServicesCourt SystemSchoolsSocial Service Agencies

Interventions should:Build Strengths Reduce Symptoms

Best Practices

While residential treatment remains an importantcomponent of a system of care, for most youth,

community-based interventions representa more appropriate, less costly alternative.

Perspectives on Residential and Community-Based Treatment forYouth and Families, Magellan Health Services

Children’s Services Task Force (2008)

SupportingStaff Behavior

Supporting Student Behavior

Supporting Social Competence &

Academic Achievement

SupportingDecisionMakingSY

STEM

S

PRACTICES

DATA

OUTCOMES

Continuum of School-wide Instructional & Positive Behavioral Support

Primary Prevention: School-Classroom-Wide Systems for All Students, Staff, & Settings

Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior

Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior

Universal For ALL

Tertiary For Some

Intensive For a Few

~80% of Students

~15%

~5%

Establishing Continuum for VTPBiS

Intensive PREVENTION• Function-based support• Wraparound• Person-centered planning

Intensive PREVENTION• • • • •

Targeted PREVENTION• Check in/out• Targeted social skills instruction• Peer-based supports• Social skills club

Universal PREVENTION• Teach SW expectations• Proactive SW discipline• Positive reinforcement• Effective instruction• Parent engagement

Targeted PREVENTION• • • • •

Universal PREVENTION• • • • • •

When a student…

Doesn’t know how to read – WE TEACH!

Doesn’t know how to add – WE TEACH!

Doesn’t know how to drive – WE TEACH!

Doesn’t know how to behave – ?Doesn’t know how to behave – ?

Thank You!