trauma informed care

Trauma-informed care is a ________ framework

strengths-based

trauma-informed care is grounded in an understanding of and responsiveness to the ______ of _____, that emphasizes _______, ________, and ___________ for both providers and survivors

impact of trauma; physical, psychological, and emotional safety

trauma-informed care creates opportunities for survivors to rebuild a sense of _____ and __________

control and empowerment

How is this topic even relevant to our course? give two reasons

1. The global COVID-19 pandemic/now an endemic phase.. has impacted people across different cultures.

2. trauma-informed care is important information to keep in mind when treating our own patients in various settings

what is an essential part of our job as clinicians?

Striving to understand trauma and to provide informed care

results from an event, series of events, or set of circumstances that experience by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individuals functioning and mental, physical, social, emotional, or spiritual well-being.

trauma

trauma is a result from an ____, series of events, or set of circumstances that experience by an individual as _____ or _____ _____ or ____ _____ and that has lasting adverse effects on the individuals _______ and ____, _____, ____, ___, or ______ well-being.

event; physically or emotionally harmful or life threatening; functioning and mental, physical, social, emotional, or spiritual well-being.

what are the 3 Es?

event, experience, effects

potential traumatic events that occur in a child's life

examples are physical abuse, emotional abuse, sexual abuse, domestic violence, parental substance abuse, mental illness, suicide or death, crime or imprisoned family

ACEs

what does ACEs stand for?

adverse childhood experiences

trauma experience that impacts entire groups of people, communities, or societies. impacts: relationships, policies and governmental processes, the way the society function, social norms

collective trauma

emotions are over-controlled

what maladaptive response?

internalizing behavior

directed inward

what maladaptive response?

internalizing behavior

somatic symptoms

what maladaptive response?

internalizing behavior

what you may see:

• sad, depressed, withdrawn, and/or fearful

• overly shy or timid

• reluctant to participate

• self-injury

what maladaptive response?

internalizing behavior

emotions are under-controlled

what maladaptive response?

externalizing behavior

directed outward

what maladaptive response?

externalizing behavior

more readily noticed

what maladaptive response?

externalizing behavior

what you may see:

• inappropriate language

• physical aggression

• noncompliance

• inappropriate use of technology

what maladaptive response?

externalizing behavior

physiologic of the stress response systems

nervous and endocrine system

nervous system vs endocrine system

nervous:

• faster and more specific

• SLUDD vs fight-flight-freeze

endocrine:

• slower and more diffuse

• epinephrin, norepinephrine, cortisol

what do each mean?

• fear and anxiety, heart rate and pressure is up

• begin to dissociate of reality, past fight-or-flight

• calm and ready to interact with others

• fight or flight

• freeze

• rest and digest

upstairs brain vs downstairs brain

• upstairs brain- frontal lobe (need to use this brain)

• downstairs brain- amygdala (move out of this brain- you can't learn)

how does this relate to school?

once they back to the upstairs brain, they want to eat, they are tired, they need to go to the bathroom, trauma causes us to be in a constant state of stress (need to go to the bathroom or hungry), we shouldn't put the blame on the student- power struggle, trauma takes power away from students

____ and ____ are often misrepresented as the same

trauma and ADHD

a troubling pattern

maladaptive behaviors→ exclusionary discipline→ academic performance→ special ed referral—>chronic absenteeism→ increased risk of dropping out

separate the DEED from the DOER

every behavior is purposeful not intentional

trauma-informed: key assumptions

• ________ about trauma

• ________ of the signs and symptoms of trauma

• ________ that incorporate knowledge of trauma

• _________ of re-traumatization

• realization

• recognition

• responses

• resistance

instead of saying “whats wrong with you?” you say…

“what happened to you?”

Trauma-informed IEPs

• ________ of the process for families

• consider the impacts of trauma when _________

• lower _________ of reports

• focus on the ____ not the ____

• goals and services focused on ________, __________, and _______

• reduced stress

• conducting assessment

• readability levels

• child; test

• skill-building, improved relationships, and self-regulation

reframe accommodations in the classroom from ________ to __________

traditional to trauma-informed

impact of COVID

• sudden change of routine

• loss/change of relationships

• stress of home

• reliving a trauma

• experiencing similar stress reactions

• reawakening memories of the initial trauma

re-traumatization

• develop caring relationships

• communicate high expectations and positive beliefs

• provide opportunities for student voice and choice

promoting resilience

DOs and DONTs

Do:

• create a safe space

• establish predictability

• offer choices

• stay regulated

Don't

• punish behaviors

• label their emotions

• modeling self-control strategies

• redirect

• support

• positive reinforcement

• clear expectations

co-regulate for young children

learning new paradigms

• hybrid-remote-online-distance-synchronous-asynchronous

• stressful!

• be aware of potential inequities in:

  • access

  • support

  • comfort

from the survival brain to the learning brain; the three Rs (steps 1-3)

regulate, relate, reason

students feel physically and emotionally calm and settled

regulate

regulate

• → Calm 🧘‍♀

  • Think: Before learning, students must feel safe and settled.

  • Strategies: Routines, breaks, self-regulation

strategies for regulation

• HALT: Hungry, Angry, Lonely, Tired

• square breathing

• provide a menu of activities to self-regulate with→ choices are empowering

communicating high expectations and high beliefs

warm demander

example of warm demander

how about as a clincian?

• "is everything ok?" "i see you have your head down..." address it without being punitive

• as a clinician: letting them know that you see their behaviors- acknowledgment, letting them know you are adjusting the trials to make things easier for them, present a menu of activities

students feel emotionally connected through safe and supportive relationships attuned to their needs

relate

relate

• → Connect 🤝

  • Think: Relationships build trust and motivation.

  • Strategies: Reframe behaviors, respond not react, model positivity

students feel ready and able to engage with formal instruction and learning

reason

reason

• → Cognition 🧠

  • Think: Now students are ready to learn.

  • Strategies: Break tasks down, use multiple instructions, make learning relevant

tips for caregivers

• make time for yourself

• prioritize healthy choices

• be realistic

• set boundaries

• reconnect with things you enjoy