Transcript Connect for Success 2016 Trauma Session

TRAUMA & YOUTH MENTAL
HEALTH FIRST AID
DR. VIVIAN STITH-WILLIAMS
SCHOOL SOCIAL WORK SPECIALIST
VIRGINIA DEPARTMENT OF EDUCATION
CONNECT FOR SUCCESS INSTITUTE
SEPTEMBER 19,2016
Goals & Objectives
Goal: To better understand the impact of trauma and the
interrelationship of trauma, mental health and learning.
Objectives:
Increase comfort and understanding of trauma and mental
health and how it looks in children in school settings.
Identify and implement strategies to help children
experiencing traumatic stress and mental health symptoms.
Manage personal and professional stress in their helping
professions.
WHY TRAUMA AND
YOUTH MENTAL HEALTH
FIRST AID
WHAT IS MENTAL HEALTH?
 Mental health includes our emotional,
psychological, and social well-being. It
affects how we think, feel, and act. It
also helps determine how we handle
stress, relate to others, and make
choices. Mental health is important at
every stage of life, from childhood and
adolescence through adulthood.

All children and adolescents experience
stressful events which can affect them both
emotionally and physically. Their reactions
to stress are usually brief, and they recover
without further problems.
 A child or adolescent who experiences a
catastrophic event may develop ongoing
difficulties known as posttraumatic stress
disorder (PTSD). The greater the degree of
exposure, the higher risk for emotional harm.
What is Trauma?
 An event that overwhelms a person’s ability to
cope or integrate the ideas and emotions
involved with that experience
 a single physical or emotional injury, event or
series of events
 painful, distressful or shocking
 results in mental and physical effects
What is Trauma? Continued
One-Episode Trauma also called Type I posttraumatic stress disorder (PTSD), single-blow
trauma produces a number of characteristic
symptoms
Trauma may occur in 2 ways:
•Direct experience
•Second-hand (vicarious) experiences
Examples of stressful events include exposure to:
• Community and domestic violence
• Natural or man-made disasters (situational
trauma)
• Automobile accidents
• Neglect, emotional abuse, physical abuse, sexual
abuse
• Bullying
• Death of a parent
• Homelessness
The Data Story
 One in five children in the United States has a mental health
condition.
 One in four children/adolescents experience at least one potentially
traumatic event before the age of 16.1
 In a 1995 study, 41% of middle school students in urban school
systems reported witnessing a stabbing or shooting in the previous
year.
 Four out of 10 U.S. children report witnessing violence; 8% report a
lifetime prevalence of sexual assault, and 17% report having been
physically assaulted.
 Supporting Data
 African American Males:
disproportionately experience violence;
are 5 times more likely to be incarcerated than Whites;
have high incidence of chronic disease;
have highest unemployment rate.
 Latino Males:
are most likely to live in extreme poverty;
have lowest rates of high school completion;
in CA, over 40% earn <200% of Poverty Line;
have highest rates of uninsured.
(Davis 2009)
Complex Trauma
 Multiple, chronic and prolonged, developmentally adverse
events
 Often of an interpersonal nature with early life onset
 Effects are cumulative
 Repeated Trauma also Called Type II post-traumatic stress
disorder, repeated trauma occurs in children who have been
abused often and for a long time.
 Chronic trauma is also common in children who have been
reared in violent neighborhoods or war zones; in children
who witness violence in the home or in their communities.
Response to Trauma Affected by
 Child’s chronological age and developmental
stage
 Child’s perception of the danger
 Whether the child was a victim or witness
 Child’s past experience with trauma
Response to Trauma Affected by
 Child’s
relationship to the perpetrator
 Presence/availability
 Cultural

of adults to help
influences and beliefs
A child's risk of developing PTSD is related
to the seriousness of the trauma, whether
the trauma is repeated, the child's proximity
to the trauma, and his/her relationship to the
victim(s).
 According to a study by the CDC about
Adverse Childhood Experience, children with
mental health conditions—defined as “serious
deviations from expected cognitive, social, and
emotional development”– find it difficult to
make friends, perform well in school, and
build strong relationships. These children are
at greater risk of developing health problems
later in life.
What happens When a Child Experiences Trauma?
 Overwhelms one’s ability to use normal coping mechanisms
to adapt
 Disrupts an individual’s frame of reference (beliefs about
oneself and the world)
 Their world feels unsafe and insecure
 An emotional or physical reaction – crying, temper
tantrums, withdrawal, conflict with others
What happens When a Child Experiences Trauma?
 Nightmares are also common
 Recollections of the traumatic event that occur during waking hours
and intrude into the child’s thoughts.
 Impaired memory
 Emotional exhaustion (feelings of despair, loss of self esteem and
depression)

Each type of psychic trauma has characteristic signs.
 No single behavior proves that a child has been exposed to
trauma.
Symptoms of PTSD in Children and Adolescents
 Unexplained changes in behavior
 Shows changes in school performance
 Gets in trouble at home or school
 Fights with peers or adults
 Refusal to go to school
Symptoms of PTSD in Children continued:
 May also become less responsive emotionally, depressed, withdrawn,
and more detached from their feelings
 May re-experience the traumatic event by: having frequent
memories of the event and in young children, play in which some or
all of the trauma is repeated over and over
 Having upsetting and frightening dreams
 May avoid situations or places that remind them of the trauma.
Children with PTSD may also show the following symptoms:
•Worry about dying at an early age
•Losing interest in activities
•Having problems falling or staying asleep
•Showing irritability or angry outbursts
Symptoms continued:
 Many of the same symptoms that accompany Type I
or single-episode trauma occur, as well as additional
ones with Type-II, chronic trauma.
 Because the trauma is repeated or prolonged, the
child develops a sickening anticipation and dread of
another episode. After being repeatedly brutalized,
children may have a confusing combination of
feelings, at times angry and sad, at others fearful.
Often these children appear detached and seem to
have no feelings. Such emotional numbness is a
hallmark of this type of trauma.
Childhood trauma can be closely related to
other serious emotional disorders both in
childhood and later in adulthood. It is not
uncommon to discover that a child who is brought
to a mental health professional for other
problems – conduct disorder, major depression,
attention- deficit hyperactivity disorder,
obsessive-compulsive disorder, panic disorder,
antisocial or violent behavior – has also
experienced an intense, terrible trauma or series
of traumatic events.
Incidences of Trauma
 One out of every 4 children attending school has
been exposed to a traumatic event that can affect
learning and/or behavior.
 Trauma can impair learning.
 Single exposure to traumatic events may cause
jumpiness, intrusive thoughts, interrupted sleep
and nightmares, anger and moodiness, and/or
social withdrawal—any of which can interfere with
concentration and memory.
Chronic exposure to traumatic events, especially during a
child’s early years, can:
• Adversely affect attention, memory, and cognition
• Reduce a child’s ability to focus, organize, and process
information
• Interfere with effective problem solving and/or planning
• Result in overwhelming feelings of frustration and anxiety
Trauma can impact school performance.
• Lower GPA
• Higher rate of school absences
• Increased drop-out
• More suspensions and expulsions
• Decreased reading ability
REGARDLESS OF THE SETTING, A TRAUMA
INFORMED SYSTEM OF CARE WILL DO THE
FOLLOWING:
 Be more aware of and responsive to the needs of
vulnerable and traumatized children so that they
are not further traumatized by their involvement
with the system itself.
REGARDLESS OF THE SETTING, A TRAUMA INFORMED
SYSTEM OF CARE WILL DO THE FOLLOWING:
1.
Maximize the child’s sense of safety.
2. Ensure that youth have access to professionals who can assist
them in reducing overwhelming emotions.
3. Ensure that the youth have access to professionals who can help
them develop a coherent understanding of their traumatic
experiences.
4. Ensure that the youth have access to professionals who can help
them integrate traumatic experiences and gain mastery over their
experiences.
REGARDLESS OF THE SETTING, A TRAUMA INFORMED
SYSTEM OF CARE WILL DO THE FOLLOWING:
5. Understand and address the ripple effects of trauma that will
be seen in the child’s behavior, development, relationships, and
survival strategies.
6. Provide support and guidance to the child’s family.
7. Ensure that professional caregivers manage their own
professional and personal stress.
Trauma and Culture
 Research indicates that children and adolescents from minority
backgrounds are at increased risk for trauma exposure and
development of Posttraumatic Stress Disorder (PTSD). For
example, African American, American Indian, and Latin American
children are overrepresented in reported cases of child
maltreatment, and in foster care.
 Disasters pose particular burdens in mental health for ethnic
minority and developing country populations, especially for children,
due to social, economic, and political marginalization, deprivation,
and powerlessness.
Trauma and Culture continued
Consequently, minority children fare worse in the aftermath of
trauma, often experiencing more severe symptomatology for longer
periods of time, than their majority group counterparts.
Cultural competence, therefore, include representation of other
populations who are often excluded from discussions of race and
ethnicity, such as immigrant and refugee youth, disabled youth
(e.g., deaf and hard of hearing), homeless youth, lesbian, gay,
bisexual and transgendered youth, religious/spiritual youth, and
youth living in rural areas
WHAT YOU CAN DO TO HELP!
Develop an understanding of trauma and its impact on children
Know and watch for signs of possible exposure to stress/trauma
Get to know children and their background
Establish a safe physical and emotional environment or setting where
basic needs are met
WHAT YOU CAN DO TO HELP!
 Ensure cultural competence and acknowledge how cultural context
influences one’s perception of events
 Acknowledge that each child and situation is different
 Listen and respond to students’ stories/disclosures
 Assure children and adolescents that whatever happened was not
their fault
WHAT YOU CAN DO TO HELP continued
oOutline clear expectations and set boundaries for behaviors
oSeek student input in the decision-making
oConnect with others who provide services to the child/family
oShow that you care, establish a positive relationship with the child
oBe patient
WHAT YOU CAN DO TO HELP continued:
oEmphasis needs to be placed upon establishing a feeling of safety.
o Support the healing process
o Coordinate efforts to support the child
oRefer the child to other professionals for ssessment/intervention
o Participate in continuing education about trauma and violence
Helping children cope
Develop communication with other resources and professionals.
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Contact colleagues in other schools/agencies similar to yours to
find out if you can use or borrow from their action plan.
Identify the support people and community resources that might
assist you if the need arises.
Work with mental health experts for advice on students with
complex issues, and communicate their advice to the referring
providers.
Helping children cope continued:
 Identify a referral network for those students
who might require more in-depth services.
 Work as a team with your network of referring
providers to insure that the students' needs are
met.
 Early intervention in childhood psychic trauma is
important.
 Provide advocacy and screening as appropriate
Helping children cope continued
 Support from parents, school, and peers is important.
 Families that offer support, understanding, and a sense of safety
as close to the time of the traumatic event as possible can
effectively limit the effects of trauma on a child.
 Children’s physicians may also recommend consulting a child and
adolescent psychiatrist or other mental health professional for
evaluation and treatment.
 Work with parents and other caregivers.
Here are 10 ways YOU can help youth increase their
resilience:
1. Encourage optimism by emphasizing youth’s abilities, focusing on
their strengths and helping them think about possibilities rather
than limitations.
2. Promote “cognitive flexibility” by helping youth to think about
their experiences in different ways so they can begin to heal
from past trauma and feel able to confront current challenges.
3. Help youth develop a personal moral compass or set of beliefs.
4. Help youth develop a sense of altruism. Research is starting to
show that there are changes in brain “neural circuits” related to
moral decision making and altruism.
5. Assist youth with identifying a “resilient” role model in a mentor
or a heroic figure. This is important because imitation is a
powerful mode of learning.
6. Help youth learn to face their fears so they can learn and practice
the skills needed to get through their fears.
7. Facilitate the development of active coping skills by helping youth
create positive statements about themselves, especially in relation
to a threat.
8. Help youth to establish and nurture meaningful relationships and
encourage them to seek active support through others.
9. Encourage youth to keep fit. Exercise not only is good for physical
well-being but also enhances emotional development.
10. Support the development of a sense of humor and laughter.
Self-care for Staff
Be aware of the signs:
increased irritability or impatience with students
decreased concentration
difficulty planning classroom activities
Don’t go it alone.
Recognize compassion fatigue as an occupational hazard.
Self-care for Staff continued:
Seek help with your own traumas.
If you see signs in yourself , seek counseling, talk to a professional.
Attend to self care.
Know your triggers
Youth Mental Health First Aid
 Youth Mental Health First Aid USA is an 8 hour public
education program which introduces participants to the
unique risk factors and warning signs of mental health
problems in adolescents, builds understanding of the
importance of early intervention, and teaches individuals
how to help an adolescent in crisis or experiencing a
mental health challenge.
 Mental Health First Aid uses role-playing and
simulations to demonstrate how to assess a mental
health crisis; select interventions and provide initial
help; and connect young people to professional, peer,
social, and self-help care.
The course teaches participants the risk
factors and warning signs of a variety of
mental health challenges common among
adolescents, including anxiety, depression,
psychosis, eating disorders, AD/HD,
disruptive behavior disorders, and substance
use disorder. Participants do not learn to
diagnose, nor how to provide any therapy or
counseling
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Participants learn to support a youth developing signs
and symptoms of a mental illness or in an emotional crisis
by applying a core five-step action plan:
Assess for risk of suicide or harm
Listen nonjudgmentally
Give reassurance and information
Encourage appropriate professional help
Encourage self-help and other support strategies
The Youth Mental Health First Aid USA curriculum is
primarily focused on information participants can use to
help adolescents and transition-age youth, ages 12-18.
Topics Covered:
Depression and mood disorders
Anxiety disorders
Trauma
Psychosis
Substance Use disorders
Mental Health First Aid teaches about recovery and
resiliency – the belief that individuals experiencing these
challenges can and do get better, and use their strengths
to stay well.
Resources
The National Child Traumatic Stress Network – www.NCTSNET.org
The National Center on Family Homelessness – www.familyhomelessness.org
Trauma-Informed Organizational Toolkit – Guarino, Soares, Konnath (2009)
Safe Start Center – www.safestartcenter.org
Helping Children and Teens Cope with Traumatic Events and Death: The Role
of School Health Professionals - Anita Gurian, PhD, Kenneth Spitalny, M.D. &
Robin F. Goodman, Ph.D.
National Child Traumatic Stress Network. (2008) Child Trauma Toolkit for
Educators.
www.nctsn.org/resources/audiences/school-personnel/trauma-toolkit