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Trauma & SECONDARY Trauma. WElcome. Offered to you today as a result of a pilot partnership project between Together Georgia and the J.W . Fanning Institute for Leadership. Sandra Corbin, LCSW; Clinical Director, Multi-Agency Alliance for Children (MAAC) - PowerPoint PPT Presentation

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WaNt A good Plan? Get STRategic.

Trauma & SECONDARY TraumaWElcomeOffered to you today as a result of a pilot partnership project between Together Georgia and the J.W. Fanning Institute for Leadership

Sandra Corbin, LCSW; Clinical Director, Multi-Agency Alliance for Children (MAAC)

Brian Bride, PhD; Social Work Director & Professor, Georgia State University

David Meyers, MSW; Public Service Faculty, J.W. Fanning Institute for Leadership

Welcome and Introductions Complex Trauma: Definitions & Misdiagnoses Complex Trauma and the Caregiver LUNCH Secondary Trauma: Definitions Risk and Protective Factors Strategies for Self Care for the Practitioner Activity/Q&A AGENDAComplex trauma and the CaregiverSandra Corbin, LCSWClinical Director, Multi-Agency Alliance for Children (MAAC)What is complex trauma?The term complex trauma describes the problem of children's exposure to multiple or prolonged traumatic events and the impact of this exposure on their development. http://www.nctsn.org/

Foster kids are often exposed to multiple traumatic events before and after entering foster care. Can you think of some examples?

Lisas 911 callhttp://www.youtube.com/watch?v=G_ht2vAYPoc

How does that make you feel?

What behaviors might Lisa exhibit after living through this?

Adverse Childhood Experience (ACE) Study cdc.gov1995-97, Anda and Felitti

ADVERSE CHILDHOOD EXPERIENCES

Emotional AbusePhysical AbuseSexual AbuseNeglectEmotionalPhysical Household Dysfunction

Mother Treated ViolentlyHousehold Substance AbuseHousehold Mental IllnessParental Separation or DivorceIncarcerated Household MemberADVERSE CHILDHOOD EXPERIENCES

Mis-Diagnoses we often seeAnxiety DisordersConduct DisordersDepression/Mood RelatedADHDBehavior Disorders

PTSD DSM-5 definitionPosttraumatic Stress Disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related Disorders. This move from DSM-IV, which addressed PTSD as an anxiety disorder, is among several changes approved for this condition that is increasingly at the center of public as well as professional discussion. PTSD DSM-5 definitionThe diagnostic criteria for the manuals next edition identify the trigger to PTSD as exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual:directly experiences the traumatic event;witnesses the traumatic event in person; learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related). PTSD DSM-5 definitionThe disturbance, regardless of its trigger, causes clinically significant distress or impairment in the individuals social interactions, capacity to work or other important areas of functioning. It is not the physiological result of another medical condition, medication, drugs or alcohol.What can we do???

CopingCoping skills are essential to:Decrease anxiety

Regulate emotions

Have healthy alternatives available Lay the foundation for healingCopingYou can:Make your home a safe placeInvolve the youth in their own safety planningLearn DBT (most of the kids have learned it)Translate terms into everyday languageCoach consistent useModel your own coping skillsWhat are some?HealingWhen kids having consistent coping mechanisms in place, then the healing can begin.

Things you can do:Communicate good and concerning thingsAdvocate for an experienced therapistWork alongside the treating teamAsk what you can do at home to helpLearn about Evidenced Based PracticesDont add traumas (disruptions/police interventions)

Changing

According to new research (Jim Casey Youth Opportunities Initiative), the brain is not done growing by the age of 3 like we thought.

Kids brains can reengage by way of positive/corrective experiences.

Changing - examplesExamples:Actively involve kids in positive activities/relationships (after school, church etc.)Keep them connected to their existing connections- Partner with birth familyHelp them develop a sense of belonging to a community (church, trips home, EmpowerMEnt). Engage kids in their own planningBe strength based and positive

Changing - examplesExamples:Get peer supportTrips/Cultural ExperiencesTake care or yourselfExpect a good team around youTalk to the therapistDont add to the trauma (disruptions/police intervention)More???

ReferencesThe Adolescent Brain- Jim Casey Youth Opportunities Initiative 2011

Adverse Childhood Experiences Study (cdc.gov)

developingchild.harvard.edu

The National Child Traumatic Stress Network (nctsn.com)

http://www.upworthy.com/heres-a-story-about-what-foster-care-is-like-for-an-abused-child-removed-from-her-home-2

Contact InformationSandra L. Corbin, LCSW

Sandy scorbin@maac4kids.org 404-880-9323. www.maac4kids.org

LUNCHTrauma-Informed Practice and Secondary Traumatic StressOctober 2, 2014

Brian E. Bride, Ph.D., M.S.W., M.P.H.Professor and DirectorGeorgia State University School of Social Work23ExposureAcute Trauma refers to a single traumatic event that is limited in time, such as an auto accident, a gang shooting, a parent's suicide, or a natural disaster. Chronic Trauma refers to repeated assaults on the child's mind and body, such as chronic sexual or physical abuse or exposure to ongoing domestic violence. Complex Trauma is a term used by some trauma experts to describe both exposure to chronic trauma, often inflicted by parents or others who are supposed to care for and protect the child, and the long-term impact of such exposure on the child.

Re-experiencing SymptomsRecurrent and intrusive recollections of the event.Recurrent distressing dreams of the eventActing or feeling as if the traumatic event were recurringIntense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.25 Avoidance/Numbing SymptomsEfforts to avoid thoughts, feelings, or conversations associated with the trauma.Efforts to avoid activities, places or people that arouse recollections of the trauma.Inability to recall an important aspect of the trauma.Markedly diminished interest or participation in significant activities.Feeling of detachment or estrangement from others.Restricted range of affect.Sense of a foreshortened future.In children New fears of separation, being alone, or darkness.26Hyperarousal SymptomsDifficulty falling or staying asleep.

Irritability, frustration, or anger.

Difficulty concentrating.

Hypervigilance

Exaggerated startle response27Distress and ImpairmentSignificant Distress

Impaired FunctioningFamilySocialEducational/Occupational28Trauma Informed Approach: The Three RsRealizing the prevalence of trauma;

Recognizing how trauma affects all individuals involved with the program, organization, or system;

Responding by putting this knowledge into practice.Trauma Informed Approach: Key Principles Incorporation of trauma awareness;

Emphasis on safety;

Opportunities to rebuild control and empowerment;

Emphasis on strengths-based approaches rather than deficit-oriented models.

Evidence-based Trauma InterventionsChild-Parent Psychotherapy (CPP)

Trauma Affect Regulation: Guide for Education and Therapy (TARGET)

Trauma-Focused Cognitive-Behavior Therapy (TF-CBT)

Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

Parent-Child Interaction Therapy (PCIT)

Trauma and Grief Component Therapy for Adolescents (TGC T-A)Negative Effects of Exposure to Traumatized Populations: What do we call it?Indirect trauma

Emotional contagion

Savior Syndrome

Cost of caring

Secondary victimization

Secondary traumatic stress

Compassion fatigue

Vicarious traumatization

Burnout

32Secondary Traumatic Stress:What is it?A syndrome of symptoms nearly identical to PTSD except that exposure to a traumatizing event experienced by one person becomes a traumatizing event for the second person. (Figley, 1999, p.11)

33Secondary Traumatic Stress SymptomsExposure

Intrusion

Avoidance

Hyperarousal

Distress/Impairment 34Compassion FatigueConceptually identical to Secondary Traumatic Stress.

Introduced as a potentially less stigmatizing term.

Sometimes used to refer to the combination of secondary traumatic stress and burnout.

35Definition of Vicarious TraumatizationThe transformation in the inner experience of the therapist that comes about as a result of empathic engagement with traumatic material. (Pearlman & Saakvitne, 1995, p.31)

Profound disruptions in the therapists frame of reference, that is, his basic sense of identity, world view, and spirituality. Multiple aspects of the therapist and his life are affected, including his affect tolerance, fundamental psychological needs, deeply help beliefs about self and others, interpersonal relationships, internal imagery, and experience of his body and physical presence in the world. (Pearlman & Saakvitne, 1995, p. 280).

36BurnoutBurnout is a prolonged response to chronic emotional and interpersonal stressors on the job, determined by the dimensions of exhaustion, cynicism, and inefficacy. (Maslach, Schaufeli, & Leiter, 2001)

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