• Recognize the signs of trauma

• Create safe and supportive environments

• Treat children who have experienced trauma

• Work on managing emotions for the adults who care for children

who have experienced trauma

• Work with children who experienced trauma and their caregivers

to develop skills and techniques avoid crisis

The Role of OT in Trauma Informed Care

Importance of the ARC Framework

Tennessee Voices for Children

provides leadership, support, and

services that promote voice, hope, and

empowerment for the emotional and

behavioral well-being of children,

youth, and their families.

TVC’s Mission

Tennessee Voices for Children seeks to

become a diversely funded, accredited

organization providing best practice in

advocacy and services for the emotional and

behavioral well-being of children and their

families in the state of TN.

TVC’s Vision

Goals of the Experiential Component

• Educational materials for caregivers regarding the effects of trauma on children

• Community resources for staff and caregivers

• Family Connections Program brochure

• A condensed manual describing the ARC Framework and how to implement ARC

into current programs

Deliverables/Outcomes

• Caregiver Handout

• Researched trauma-informed care to

create a handout that explained the

complexity of developmental trauma and

how to work with children who have

experienced it

• Researched tips for developing

advocacy skills when working with a

team to treat children who have

experienced trauma

• Met with caregivers to explain the

handout, discuss their children and

experiences, and answer questions

about trauma and managing it

Acknowledgments

I would like to thank the following individuals for their assistance and support during my experiential

component:

• My expert mentor, Paul Highfill, MFT and Family Connection Program Director, for his guidance, feedback,

and reassurance throughout this process

• My faculty mentor, Dr. Christine Manville, EdD, OTR/L, for her constant support throughout this experience

and throughout the past three years of OT school

• Every individual I had the opportunity to work with in various programs at Tennessee Voices for Children

who took the time to teach me more about mental health and how to make a difference in the lives of

children and families who need it the most

• The Attachment, Self-regulation, and Competency Framework

(ARC) was adopted by TVC to help treat children and caregivers

who have experienced trauma

• ARC focuses on building self-monitoring skills when working

with caregivers and their children to help them challenge their

typical response to a negative situation in order to hopefully

have a better outcome than what has happened in the past

• ARC stresses the importance of thinking systemically about

trauma-informed care in order to build support and safety within

the child’s environment

Tennessee Voices for Children

Bridget Welsh, OTD/S

Educating Parents and Staff on Trauma-Informed Care

Needs of TVC

References

American Journal of Occupational Therapy, November/December 2011, Vol. 65, S11-S34.

doi:10.5014/ajot.2011.65S11

Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation,

and competency. New York: Guilford Press.

Petrenchik, T & Weiss, D. (2015). Occupational therapy’s role in mental health promotion, prevention, & intervention with children & youth childhood trauma.

American Occupational Therapy Association. Retrieved from https://www.aota.org/~/media/Corporate/Files/Practice/Children/SchoolMHToolkit/

childhood-trauma.pdf

U.S. Department of Veterans Affairs. (2016). PTSD: National center for PTSD. Retrieved from

http://www.ptsd.va.gov/professional/treatment/children/ptsd_in_children_and_adolescents_overview_for_professionals.asp.

Watson, P. (2018). What is developmental trauma/ACEs?. Retrieved from https://www.porticonetwork.ca/web/childhood-trauma-toolkit/developmental-

trauma/what-is-developmental-trauma

About the Family Connection Program

Learning Activities Completed with other TVC

Programs

Trauma-informed Caregivers

What is developmental trauma?

· Caused by overwhelming childhood

experiences

· Happens over a long period of time

· Unclear when it starts and ends

What type of overwhelming

experiences can lead to

developmental trauma?

· Prolonged adverse childhood

experiences

· Maltreatment, violence, abuse, neglect

· Physical, emotional, sexual abuse

· Severe bullying

· Witnessing domestic violence

· Insecure attachment to caregiver

· Mental illness, criminal involvement,

separation from caregiver/loved one

What are potential consequences of

developmental trauma?

· Depression, drug/alcohol use, smoke

cigarettes

· Struggle with obesity

· Social problems like teen pregnancy,

domestic violence

· Difficulty managing emotions,

relationships, and self-esteem

What are common signs that a child

has experienced developmental

trauma?

· Depends on the child’s age

· Young child: increased fussiness,

constantly searching for attention,

extreme clinginess, or avoidance of

emotional experiences

· Elementary school age: mistrust of

teachers and friends, difficulty

making friends, poor self-esteem,

acting out in class, or bullying

· Teenager: extreme self-

consciousness, poor body image,

substance use, self-harming

behaviors, sexual interactions, lack of future goals, easily pressured by

peers, or difficulty making and

keeping friends

How do we help a child who has

experienced developmental trauma?

· The key factor is developing

resilience: the child’s ability to

recover from traumatic events

· Help the child adapt to his or her

environment if the child is exposed to

challenging or difficult conditions—do this by providing resources and

support to help meet the child’s

physical, social, and emotional needs

· A child who has developed resilience

has good self-esteem, confidence,

the ability to problem solve, and

positive social relationships

What can parents do to help a child

develop resilience?

· A supportive parent-child relationship

is the best way to develop resilience

· Caregivers should be a positive role

model and should point out the

child’s strengths and abilities

· Help the child feel nurtured and safe

by offering a structured, predictable

environment

· One way to create predictability is to make child aware of rules and

consequences to breaking the rules

· The caregiver should be consistent

with how he or she responds to the child’s behavior

· It is important to note that children

will respond to trauma differently depending on the level of resilience

they possess

What can I do about my child’s

difficult emotions and behaviors?

· Help the child learn how to

understand what he or she is feeling

o Tips to do this: Pause, remain

calm, and ask the child to

name and explore the emotions he or she is

currently experiencing

· Overwhelming emotions often result in problem behaviors. Help your child

connect their behavior to the

emotions they are experiencing

· As the child’s understanding of emotions and their connections to

behavior increases, it will be easier

for the child to notice when a negative emotion is about to happen.

This will give them the ability to stop

the problem behavior before it occurs

· This process takes a long time, and it requires a lot of practice for both the

caregiver and the child. Praise the

child each time he or she is able to identify negative emotions and cope

with potentially problematic behaviors

in a positive way

How do I make my voice heard so I

can help my child?

· Develop advocacy skills

· Caregivers are just as important as the other people and professionals

working on the child’s team

· Start by identifying your needs or

your child’s needs

· Prepare what you are going to say.

Ask questions!

· Focus on building a relationship with

the other people on the team

· Handle yourself like a professional by

beginning conversations with a

positive statement and using “I-

statements” o For example, say “the

information you sent was

helpful…” followed by describing the problem. When

describing the problem,

phrase is like “I am concerned about how long it is taking…”

instead of “you are taking too

long”.

· Make a point to be available so it is easy to stay in contact with team

members

· Try to stay organized by taking notes,

keeping copies of materials, and planning specific dates to meet or

discuss problems

· Make sure you follow up: increase the amount of communication with

team members or agencies you are

working with. If problems arise, be

the first one to reach out and address the issue

• To participate, a child must have: a diagnosed emotional, behavioral, or mental

health disorder and impaired functioning at home, school, and the community

• Provides interventions to help stabilize the child’s placement with his or her family

and/or allow reunification with the family if the child is stepping down from a higher

level of care

• The family receives weekly in-home visits from a family support specialist

• The child receives weekly visits from a Youth and Family Therapist

• The goal of this program is to identify the family and child’s strengths and needs,

connect the family with services, and build necessary skills to allow the youth to

thrive at home, at school, and in the community

• Participated in the Youth Screen Program where my duties included: analyzing

results from screen and conducting clinical interviews with teens who were at risk of

suicide, making recommendations for appropriate services for at-risk teens, and

debriefing with teens after completing the screen

• Worked with the Early Childhood Program to create an occupation-based newsletter

related to self-regulation in the classroom for teachers around Tennessee

• Attended multiple conferences and networking events related to suicide prevention,

trauma, and adverse childhood experiences

• Took part in a mental health awareness video created by Tennessee Voices for

Children

• Create evidence-based educational materials related to trauma-informed care that

will benefit both caregivers and staff

• Create a thorough, organized research guide that is easily accessible to caregivers

and staff

• Create folders that include resources, helpful handouts, and parenting tips that

caregivers receive upon intake

• Learn more about mental health through research and client and family interactions

• Gain skills in interviewing clients and working with families while remaining client-

centered throughout the process

• ARC Manual

• Created a condensed, user-friendly

manual to explain ARC

• Allows staff to read and understand

the framework in order to better

incorporate it into existing programs

• Resource Guide and Intake Folders

• Created comprehensive resource

guide for Middle Tennessee

• Designed Family Connections

Program brochure

• Researched helpful, simple handouts

that provide parenting tips and other

helpful information for caregivers

• Created intake folders that include:

resource guide, Family Connections

brochure, and handouts

Understanding Developmental Trauma

• Caused by prolonged adverse childhood experience (ACEs)

• Common ACEs: maltreatment, violence, abuse, assault, or neglect

caused by someone within the family or the community

• Examples: physical, sexual, and emotional abuse,

incest, molestation, severe bullying, witnessing

domestic violence, insecure attachment to caregivers

caused by mental illness, substance abuse, or criminal

involvement, and sudden separation from or traumatic

loss of caregiver or loved ones

• According to Child Protective Services (2011): 78.5% suffered

neglect, 17.6% suffered physical abuse, and 9.1% suffered sexual

abuse.

• The National Survey of Children's Exposure to Violence

reports 46.3% suffered physical assault, 10.2% experienced child

maltreatment, 6.1% experienced sexual victimization, and 25.3%

witnessed domestic abuse

• Increased risk for: depression, substance abuse, obesity, social

problems like teen pregnancy, experiencing domestic violence as an

adult, and having difficulty managing emotions, relationships, and

self-esteem

• Areas of occupation/performance that can be negatively impacted by trauma include: work, education, home management, leisure, money management, task initiation, self-confidence, coping skills, stress management, and interpersonal relationships, decision-making, judgment, problem solving, and direction following

• Best intervention: develop a supportive parent-child relationship to

help the child feel safe, nurtured, and develop resilience