Transcript 2 - Illinois Counseling Association

YOUNGEST SURVIVORS
Identifying concepts for
combating child and
adolescent trauma
experienced by refugees
during crisis events.
Nate Perron, PhD, LCPC, NCC, ACS
Angela Erickson, BS, MA Candidate
Northwestern University
Nate’s connection to the topic
Intensive training with
young people
Service to refugee
youth populations
Ethnographic research
in refugee communities
in Thailand
Counseling culturallydiverse families
Teaching within a crosscultural context
Intensive training for
supporting crisis needs
Extensive crisis
response counseling
Extensive Research into
international counseling
Ongoing literature
review and media
exposure
. . . despite natural personal limitations
Angela’s connection to the topic
Community
and School
Based
Service
Counseling
Complex
Trauma
Populations
Multicultural
Training
Research
the effects
of trauma on
children
Kids are resilient?
“The ability to adapt well to adversity, trauma, tragedy,
threats, or even significant sources of stress.”
(2012, August 1)
“Let's stop aiming for resilient children, which is just an
excuse for minimal care, and start thinking about thriving
children.”
(2012, August 1)
Presentation goals
Understand- Types of trauma
There are 12 specific types of trauma indicated by The National Child
Traumatic Stress Network (NCTSN):
1. Community and School Violence
2. Complex Trauma
3. Domestic Violence
4. Early Childhood Trauma
7. Neglect
5. Medical Trauma
8. Physical Abuse
6. Natural Disasters
9. Refugee and War Zone Trauma
10. Sexual Abuse
11. Terrorism
12. Traumatic Grief
)
(2015)
Understand- Clinical diagnoses
Posttraumatic
Stress Disorder
(PTSD)
Acute Stress
Disorder (ASD)
• Adjustment Disorders, Obsessive-compulsive
disorder, Reactive-attachment disorder, Psychotic
Disorders or features, or Substance-induced
Disorders or features APA (2013)
• Dissociative Disorders & Depressive Disorders
(Cohen, Deblinger, & Mannarino, 2006; Diseth &
Christie, 2005; Weber, 2008)
Understand- Types of trauma symptoms
Affective
symptoms
• Fear
• Depression
• Anger
• Affective dysregulation
Behavioral
symptoms
• Avoidance
• Emotional numbing
• Modeling/ traumatic bonding
• Impaired peer social relationships
• Maladaptive behaviors (e.g.
aggression)
Cohen et al. (2006)
Understand- Types of trauma symptoms
Cognitive
symptoms
Psychobiological
symptoms
•Irrational beliefs (of self and others)
•Cognitive distortions (e.g.
overgeneralizations)
•Loss of faith in justice, God, and their
future
•Negative outlook
•Altered neurotransmitter and
hormonal activity both in the brain and
in other parts of the body (e.g. adrenal
glands)
•Increased heart rate, respirations, and
blood pressure
•Diversion of blood flow to skeletal
muscles
•Increased physical tension
Cohen et al. (2006)
Understand- Complex PTSD symptoms
Complex
PTSD
• Affective regulation/ Severe mood
instability
• Highly conflicted relationships and
difficulty maintaining friendships
• Poor self-esteem and self-efficacy
• Impaired academic and vocational
functioning
• Poor maintenance of personal
safety
• Lack of interpersonal trust
• Self-injurious behaviors
Cohen et al. (2006)
Understand- Risk factors
Social, economic, &
cultural environment
•Specific cultural values and
norms, political/legal policies,
preventative care, social
welfare, conflicts or war
Local community
•Poverty
•Social capital
Family
•
•Sex
•Family structure
& resources
•
•Family size
Individual
•Age
•Sex
•Special needs
Personality &
behavioral
characteristics
Prior history of abuse
• Violence
(2013)
UnderstandProtective factors
• Nurturing parenting skills
• Stable family relationships
• Parental employment
• Household rules and child monitoring
• Supportive family environment and
social networks
• Adequate housing
• Access to health care and social services
• Caring adults outside the family who can
serve as role models or mentors
(2013)
• General significance of parenting and homelife
Muong & Sochanvimean (2013)
Unique challenges among refugee groups
Ellis et al. (2013) identified unique circumstances of
refugee young people:
• Experiences of injustice and
violence in their home countries
• Severe post-resettlement stressors
• Family trauma and loss
• Vast differences in culture
• Discrimination from minority racial
and ethnic backgrounds
• Limited access to mental health
services
• Numerous language and cultural
barriers to seeking and receiving
mental health services.
Your thoughts?
Please share any stories you experienced
related to the challenges of recognizing trauma
Useful Approaches- Prevention
Effective Treatment For Refugee Children & Adolescents
Adequate training for
mental health support
•Mental Health
Facilitator (MHF)
training in multiple
countries of the
world (Hinkle, 2014)
•Psychological First
Aid (PFA) in Syria
(Akoury-Dirani, et al.,
2015).
•Counselor self-care
Supporting
awareness/ advocacy
•Important
components
highlighted in the
ACA (2014) code of
ethics
Useful Approaches- Intervention
Effective Treatments For Refugee Children & Adolescents
Addressing the crisis
• Utilize child-friendly trauma
assessments and treatment
modalities (Perron & Pender, 2015)
• Assessment-Treatment
Flowchart can help address
priority problems (Briere, 2012)
• CRAFTS model can help consider
which life domains require
greater attention (Cohen,
Deblinger, & Mannarino, 2006)
• Utilize child-friendly techniques
• Play therapy, sand tray, CBT, etc.
Useful Approaches- Intervention
Effective Treatments For Refugee Children & Adolescents
Verbal
Processing of
Past
Experiences
Trauma Systems
Therapy
(Ellis, Miller, Baldwin,
& Abdi, 2011)
Trauma Focused
CBT (TF-CBT)
& CBT
(Unterhitzenberger,
et al., 2015)
Narrative
Exposure
Therapy
(Onyut et al., 2005;
Cantani et al., 2009)
Useful Approaches- Intervention
Effective Treatments For Refugee Children & Adolescents
Painting,
Drawing, &
Writing
(Kowitt, et al., 2016)
Play Therapy
Child Centered &
Sandtray
(Schottelkorb, Doumas, &
Garcia, 2012; Ferreira, Irma,
Kukard, & Kriegler, 2014)
Creative
Expression
Music & Drama
(Quinlan, Clin,
Schweitzer, Khawaja,
& Griffin, 2016)
Useful Approaches- Intervention
Effective Treatments For Refugee Children & Adolescents
Dealing
with past
memorie
s
Individual
Family/Parent
Classroom
There is a need for a systemic
family perspective, including a
narrative therapy approach when
considering the development,
maintenance, prevention, and
resolution of PTSD in refugee
youth (Bjorn, Boden, Sydsjo, &
Gustafsson, 2013).
Dealing
with
present and
future
challenges
Useful Approaches- Recovery
Effective Treatments For Refugee Children & Adolescents
Back to basics
•Remember important
clinical skills, theories,
practices
•Reinforce systems and
plans for ongoing growth
•Validate the uniqueness
of each individual
experience
•Value cultural support
systems for healing
Your thoughts?
Describe some interventions or recovery methods you
have found most helpful in your practice with young
survivors.
Application- 4 U’s
References
Akoury-Dirani, L.; Sahakian, T. S.; Hassan, F. Y.; Hajjar, R. V. & Asmar, K. E.
Psychological First Aid Training for Lebanese Field Workers in the
Emergency Context of the Syrian Refugees in Lebanon. Psychological
Trauma: Theory, Research, Practice, and Policy, 7(6), 533-538.
American Academy of Child & Adolescent Psychiatry (AACAP). (2010, April).
Practice parameter for the assessment and treatment of children and
adolescents with posttraumatic stress disorder, Journal of the American
Academy of Child & Adolescent Psychiatry 49(4), 414-430.
American Psychiatric Association. (2013). Diagnostic and statistical manual of
mental disorders (5th ed., text rev.). Washington, DC: Author.
American Psychological Association. (2012). Resilience guide. Retrieved
from
Briere, J. (2002). Further development of an integrative model. In J.E.B.
Myers, L. Berliner, J. Briere, C.T. Hendrix, T. Reid, & C. Jenny (Eds.)
(2002). The APSAC handbook on child maltreatment, 2nd Edition.
Newbury Park, CA: Sage Publications.
References
Centers for Disease Control and Prevention (CDC). (2013). Child Maltreatment.
Retrieved from:
Centers for Disease Control and Prevention (CDC). (2013). Child Maltreatment.
Retrieved from:
Cohen, J. A. Deblinger, E., Mannarino, A. P. (2006). Treating trauma and
traumatic grief in children and adolescents : A clinician's guide. New York,
NY: Guilford Press.
Diseth, T. H., & Christie, H. J. (2005). Trauma-related dissociative (conversion)
disorders in children and adolescents: An overview of assessment tools and
treatment principles. Nordic Journal Of Psychiatry, 59(4), 278-292.
doi:10.1080/08039480500213683
Ellis, B. H.; Miller, A. B.; Abdi, S.; Barrett, C.; Blood, E. A.; Betancourt, T. S. (2013).
Multi-Tier Mental Health Program for Refugee Youth, Journal of Consulting
and Clinical Psychology, 81(1), 129-140.
References
Field, N. P.; Muong, S. & Sochanvimean, V. (2013). Parental Styles in the
Intergenerational Transmission of Trauma Stemming From the Khmer
Rouge Regime in Cambodia. American Journal of Orthopsychiatry, 83(4),
483-494.
Hinkle, J. S. (2014). Population-based mental health facilitation (MHF): a
grassroots strategy that works. The Professional Counselor, 4(1), 1–18.
The National Child Traumatic Stress Network (NCTSN). (2013). Types of
Traumatic Stress. Retrieved from
Narvaez, D. (2012). Psychology Today. Believing “children are resilient" may be
a fantasy. Types of Traumatic Stress. Retrieved from
Perron, N.C.D. & Pender, D.A. (2015). Meeting the Need: Applying Concepts for
Assessment and Planning With Child and Adolescent Trauma. Journal of
Child and Adolescent Counseling, 1(1), 37-49, DOI:
10.1080/23727810.2015.1023607
Terr, L. C. (1995) . Childhood traumas: An outline and overview. In J. M. Lating &
G. S. Everly (Eds.). Psychotraumatology: Key papers and core concepts in
post-traumatic stress. (pp. 301-330). New York: Plenum Press.
References
U.S. Department of Health & Human Services (USDHHS). (2010). Child
Maltreatment 2010. [Data file]. Retrieved from
Walker, D. F., Reese, J. B., Hughes, J. P., & Troskie, M. J. (2010). Addressing
Religious and Spiritual Issues in Trauma-Focused Cognitive Behavior
Therapy for Children and Adolescents. Professional Psychology: Research &
Practice, 41(2), 174-180. doi:10.1037/a0017782
Weber, S. (2008). Diagnosis of trauma and abuse-related dissociative symptom
disorders in children and adolescents. Journal Of Child & Adolescent
Psychiatric Nursing, 21(4), 205-212. doi:10.1111/j.1744-6171.2008.00156.x
World Health Organization (WHO). (2013). Prevention of child maltreatment.
Author. Retrieved from
World Health Organization (WHO). (2013) Child abuse and neglect by parents
and other caregivers. [Data file]. World report on violence and health.
Author. Retrieved from