Outcomes Related to Trauma

Positive stress

Mild stress in the context of good attachment

• Temporary, mild elevations in stress hormones & brief increase in heart rate

• No buffering support necessary

• Increased resilience and confidence, development of coping skills

Tolerable stress

Serious, temporary stress, buffeted by supportive relationships

• More severe, continuing cardiovascular and hormonal response

• Presence of buffering caring adult

• Adaptation and recovery with some possibility for physical/emotional damage

Toxic stress

Prolonged activation of stress response system without protection

• Disrupted development

• No adult buffers

• Increased risk of heart disease, alcoholism, memory & learning difficulties, anxiety, depression, cancer

Trauma

Witnessing or experiencing an event that poses a real of perceived threat
The event overwhelms the child’s ability to cope

Acute trauma

A single traumatic event

• ex: car accident, community violence

Chronic trauma

Repeated exposure to traumatic events

• ex: domestic violence

Complex trauma

Multiple or prolonged traumatic events

• ex: child maltreatment

Historical trauma

Personal or historic event or prolonged experience that continues to have an impact over several generations

• ex: slavery

Child traumatic stress

The physical and emotional responses of a child to events that threaten the life or physical integrity of the child or someone critically important to them

Medical trauma is a special concern for children in ______ due to their higher rates of chronic health conditions

Foster care

• Medical exams can be invasive and may trigger past traumas or uncover conditions requiring painful or prolonged treatment

• Medical trauma may become layered onto previous traumatic experiences

The same risk factors for persistent traumatic stress are particularly relevant for children in foster care who ____, ____, ____, and ____

Experience severe levels of pain during illness or injury

Are exposed scary sights and sounds in the hospital

Are separate from parents or caregivers during treatment

Have experienced prior medical trauma or had previous traumatic reactions

Potentially traumatizing events in juvenile detention and other residential settings

Seclusion; restraint; routine room confinement; strip searches and pat-downs; placement on suicide watch; witnessing physical altercations; fear of being attacked by other youth; separation from family and community

Other sources of ongoing stress for children in the welfare system

Poverty, discrimination, separation from parents/siblings, frequent moves, school problems, traumatic grief and loss, refugee or immigrant experiences

Trauma exposure and substance use…

Reinforce one another

• They may be used as a way to cope with distress, intrusive memories, anxiety, or emotional dysregulation

• Substance use can increase exposure to additional traumatic or unsafe situations

• Co-occurring trauma and substance use may complicate assessment and treatment

Poverty and financial instability can increase exposure to ____ and ____

Chronic stress and traumatic experiences

• Housing instability, food insecurity, neighborhood violence and limited access to resources may compound trauma

• Economic stress can also reduce access to mental health services and other protective supports

Chronic adversity can be ____ even when there is no ____

Traumatic; single traumatic event

Children in military families may experience stress related to changes in _____, _____, or _____.

Caregivers, routines, or family functioning

• Reintegration following deployment can create additional challenges for the family

• Family supports and stable routines can serve as important protective factors

Children with intellectual and developmental disabilities may experience increased vulnerability to ____, ____, ____, ____, or _____

Abuse, neglect, exploitation, bullying, or victimization

• Communication differences may make it hard to report or describe traumatic experiences

• Dependence on caregivers can create unique challenges when the caregiver is involved in the trauma

Children with ID and DD may express trauma through ____ or ____ rather than traditional descriptions of emotional distress

Behavioral or functional changes

____, ____, and ____ can promote safety and recovery for people with IDs and DDs

Familiar routines, trusted caregivers, and appropriate communication supports

Homeless youth may experience multiple and ongoing forms of adversity including: _____, _____, _____, and _____

Violence, abuse, exploitation, and community violence

• Housing instability can create chronic uncertainty and undermine a sense of safety

• Repeated exposure to traumatic experiences may occur without adequate opportunity for recovery

Protective factors for homeless youth include _____ and _____

Stable housing and supportive relationships

• Lack of consistent adult support can increase vulnerability

LGBTQ+ youth may experience ____, ____, ____, ____, ____

Discrimination, bullying, harassment, family rejection, and violence

• Minority stress can compound the effects of other traumatic experiences

LGBTQ youth’s experience of rejection or lack of acceptance may affect feelings of ____, ____, and ____

Safety, belonging, and self worth

• Supportive families, peers, schools, and communities can serve as powerful protective factors

Risk and protective factors (5)

Severity of the event, proximity to the event, caregiver’s reactions, prior history of trauma, family and community factors

Severity of the event

Events involving serious injury, death, abuse, or prolonged threat may have greater impact

Perceived severity matters: a child’s interpretation of the event may be as important as the objective severity

Repeated or chronic exposure may increase risk

Proximity to the event

Direct exposure generally increases risk for trauma-related symptoms

Witnessing harm to an important person can be highly distressing

Physical distance does not necessarily eliminate impact because…

Children may be affected by repeated exposure through media or community experiences

A child’s sense of ____ and ____ can influence the impact of a traumatic event

Personal safety and vulnerability

Caregiver’s reactions matter because…

Children often look to caregivers to determine whether an event is dangerous and whether they are safe

____, ____, and ____ caregivers can promote regulation and recovery

Calm, supportive, and emotionally available

• Caregiver distress, fear, or trauma symptoms may increase a child’s distress

Caregiver’s ability to provide _____ and _____ can serve as a protective factor

Consistent routines and reassurance

Prior history of trauma matters because…

Previous trauma may increase vulnerability to subsequent traumatic experiences

• previous trauma does not mean a child will inevitably develop trauma-related symptoms

Multiple or chronic traumatic experiences can affect ____ and ____

Stress regulation and coping

____ and ____ following previous adversity may contribute to resilience

Positive experiences and successful coping

Stable, supportive family and community relationships can serve as important protective factors because they can provide ____, _____, ____.

Safety, emotional regulation, and opportunities for recovery

Culture, family, community, history, and previous experiences influence how an event is ___ and ___

Perceived and interpreted

• The same event may be experienced differently across individuals and cultural groups

Cultural beliefs can shape ____ and influence how distress is ____ and ____

Trauma responses; expressed and communicated

• Beliefs may be about safety, suffering, mental health, help-seeking, and recovery

Historical experiences can influence how ____ are understood and experienced

Contemporary events

Cultural practices, spirituality, community connection, family relationships, and collective identity may support ___ and ___

Coping and recovery

The need for ___, ___, and ___ is universal, but the way people experience and respond to trauma is _____

Safety, connection, and recovery; culturally shaped

The necessity to respond to trauma is universal

Many children who enter the child welfare system are from groups that experience ___, ___, ___, and ___

Discrimination, negative stereotyping, poverty, high rates of exposure to community violence

They may not have access to mental health support

May have more severe symptomatology for longer periods of time

Sources of stress for immigrant families might include:

Traumatic and stressful events during migration process

Resettlement and acculturation stress

Deportation and fear of

Domestic violence and poverty

Social marginalization and isolation

Inadequate housing

Changes in family structure and functioning

Sources of stress for refugee families might include:

Violence (as witnesses, victims, and perpetrators)

Ethnic cleansing and loss of loved ones

Historical trauma and war

Lack of food, water, and shelter

Physical injuries, infections, and diseases

Torture, forced labor, and sexual assault

Lack of medical care

Historical trauma is a ____ held personally and transmitted over generations

Psychological injury