Presented by Sharon Law, M.A., M.F.T.
Expert Conference - The Therapeutic Communities
Ebenfurth, Austria
Ebenfurth, Austria
September 18, 2009
Presentation Text
_______________________________________________________________________
A Team Approach to Develop Resilience in Traumatized Children and Youth
Expert Conference
The Therapeutic Communities
Ebenfurth, Austria September 18, 2009
1
_______________________________________________________________________
Presenter: Sharon Law, M.A. Marriage and Family Therapist
www.SharonLawMFT.com
Los Angeles, California, USA
2
_______________________________________________________________________
Trauma Defined
Threats to your basic well-being (danger to life
and body integrity, sudden loss, exposure to
horror, etc).
It violates your basic trust in yourself, people,
and the world.
Trauma is a part of life for many people, and
children are not excluded from it.
3
_______________________________________________________________________
Post-Traumatic
Stress Disorder (PTSD)
This “new” diagnosis was first introduced in 1980 in Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
It came to recognize the possible impact of traumatic experience on a person’s well-being.
Diagnostic features include hyperarousal, intrusive memories, numbing of feelings, avoidance of stimuli.
4
_______________________________________________________________________
PTSD in Children
It was not until 1987 that features of PTSD specific to children were added when DSM-III-R was published.
Children may not have actual memories but may enact traumatic experiences repetitively through play and artwork.
They may show regressive behaviors, especially in reaction to reminders of past traumatic experiences.
5
_______________________________________________________________________
Trauma Is More Than a Diagnosis
Trauma is a profound experience that produces cognitions, emotions, and behaviors that were not present before the trauma.
Trauma cannot be precisely measured, and the same external event will not produce the same result (symptoms) with different individuals.
How trauma affects a person’s well-being involves a complex process.
6
_______________________________________________________________________
Discussion Questions
Why are some children who experience poverty, abuse, neglect, violence, or other tragedies less affected as they grow up, while some have a more difficult time?
What makes a difference in helping children to cope with life adversity?
7
_______________________________________________________________________
Determining Factors?
Genetic Predisposition
Age and Gender
Exposure Type and History
Relationship with Parents & Caregivers
Social Support
Resilience
8
_______________________________________________________________________
Resilience Defined
An ability to recover from or adjust to misfortune or change.
Working Definition:
The ability to not become or stay traumatized in difficult environments or situations.
And to grow…
9
_______________________________________________________________________
Two Sides: Trauma Self and Resilient Self
Trauma Self
Feels unsafe
Reactive to triggers
Withdraws or fights back
Regressive
Appears stupid and immature
Harsh and judgmental
Resilient Self
Feels confident
Responsive
Engaging and communicative
Forward thinking
Knows their strengths and weaknesses
Caring and understanding
10
_______________________________________________________________________
Resilience Provides Multiple Tools to Self Regulate
Cognitive: Positive view of self and confidence in their strengths and abilities.
Relational: Effective communication and problem solving.
Affective: Capacity to manage strong feelings and impulses.
Behavioral: Ability to make realistic plans and carry them out.(Source: American Psychological Association)
11
_______________________________________________________________________
Core Competence: Contact Regulation
Adjusting between contact and withdrawal.
Receptivity to nurturance.
Managing stress of separations and loneliness.
Development of inner values that support healthy relationships
12
_______________________________________________________________________
Core Competence: Emotion Regulation
Development of body awareness.
Ability to label emotions.
Ability to use emotions as a guide to respond to situations (not react).
Ability to accept and contact full range of emotions.
13
_______________________________________________________________________
Core Competence: Mental Regulation
Focusing and sustaining attention.
Choose what to remember and what to let go in the moment.
Ability to reflect and observe different perspectives
Ability to create a personal life story.
14
_______________________________________________________________________
Source of Resilience: Caring Relationships
Resilience is not just an inborn trait, it is a capacity that can be promoted and enhanced through caring relationships.
Master & Reed (2002): The best documented source of developing resilience is a strong bond to a competent adult.
15
_______________________________________________________________________
Foundation of Resilience: Early Relationships
Minnesota Longitudinal Study of Parents and Children (1999): A 25-year study of impoverished mother and their first born.
Result: Early secure attachment in the first two years provided a group of high risk children with an increased ability to rebound and show competence in adolescence.
16
_______________________________________________________________________
Impact of Insecure Attachment
Bowlby (1944): Disruptions in early relationships often lead to significant disturbances in a person’s sense of self, sense of others, and their capacity to regulate, contain, and modulate their affective experience.
Result of insecure attachment: Avoidant, resistant and disorganized behaviors that can cause lifelong maladjustment.
17
_______________________________________________________________________
What Holds Back the Development of Resilience?
Many instances of childhood traumas occur within a youth’s immediate environment (home, school, neighborhood) and are most often perpetrated by someone the child knows. (Finkelhor et al., 2005; Garbarina et al., 1992)
Perpetrators are often themselves victims of childhood abuse and neglect and did not receive the support and help they needed.
18
_______________________________________________________________________
What Holds Back the Development of Resilience?
Past and present trauma exhausts the coping resources of the child and the caregivers.
Persistent survival coping interferes with the development of self regulatory competencies for both caregivers and the child, resulting in poor attachment.
The absence of a “good enough” connection becomes the source of more stress (and trauma) for both the child and the caregiver.
19
_______________________________________________________________________
Important Facts About the Children We Help
By the time they have entered into treatment programs, they have frequently experienced chronic and repeated traumas over an extend period of time rather than a singular trauma.
The negative impact of these traumas has become cumulative and impacted brain development.
It takes a lot of time, persistence, and resources (e.g. teamwork and community support) to understand and address the child’s (and the caregiver’s) challenges.
20
_______________________________________________________________________
What Should We Do to Help?
The first step in helping traumatized children is to create an environment, that is truly safe for for the child, where the child has consistent supportive relationships and is not threatened with physical or emotional harm.
Interventions sometimes involve removal of the children from their biological homes and immediate environment.
21
_______________________________________________________________________
What Should We Do to Help?
The second step involves supporting all possible activities that enable the child to have positive experiences about self, and empower the child to develop practical skills to achieve success in life.
These abilities may include academic, vocational, social, athletic, and artistic skills.
22
_______________________________________________________________________
Resilience Based Programs: The California Experience
California’s Mental Health Service Act passed in 2004 provides significant funding for resilience-based programs for high risk children who are exposed to multiple traumas.
Approximately $5 Billion (USD) in funding have accrued as of June, 2009. Another $5 Billion has been committed to fund services through fiscal year 2011-12.
23
_______________________________________________________________________
Resilience Based Programs: The California Experience – Four Guiding Principles
Early Intervention: How to reach out to children at risk of multiple traumas?
System of Care: How to facilitate collaboration between different systems (family, child welfare, school, health…)?
Intensive Teamwork: How to support staff to provide a consistent and caring environment?
Wrap around services: How to provide positive experiences for our children?
24
_______________________________________________________________________
Resilience Based Programs: The California Experience – Positive Outcomes
My service experience: 23 high risk children were served in my team between 2005 July - 2006 October. 20 children were able to stabilize and function well in the community. Only 3 children were re-hospitalized or re-institutionalized.
Result of California Mental Health Service Act’s three year study (2009): Significant lower arrest rates since enrollment of program, especially in second and third year of participation.
25
_______________________________________________________________________
Resilience Based Programs: The California Experience – Positive Outcomes
Graph
Average Number of Arrests Per Month
for Individuals Participating in FSP Programs
by Year of Participation.
Download Presentation and see slide 26 to view graph
Child, Transitional Age Youth, Adult, Older Adult
26
_______________________________________________________________________
The Ultimate Goal: Rebuilding Connection
“Rebuilding attachment means mustering the courage and the allies to cope with a “succession of trials” over time. With each test, caring adults, practitioners and children challenge the power of old trauma and strive to learn from the wisdom of each other’s past experiences and old heroes, in order to reduce the power of their nightmares”.
(Source: Richard Kagan (2009) “Transforming troubled children into tomorrow’s heroes”)
27
_______________________________________________________________________
Attitudes and Roles of Child Care Workers
- Committed to be present.
- Tolerant of intense feelings especially anger and frustration.
- Sticking with the child despite breakdowns in the relationship.
- Able to seek solutions together.
- Do not give up.
28
_______________________________________________________________________
3 Languages of Integration: Trauma and Resilient Self
Bad things did happen, BUT…
I Have: I now have a safe place to live, I have people who love me, I have friends to have fun with”.
I Am: “I am a survivor, I am okay, I am lovable, I am powerful”.
I Can: “I can learn, I can make things, I can control myself, I can succeed”.
(Source: The International Resilience Project, Bernard Van Leer Foundation)
29
_______________________________________________________________________
Societal Benefits for Investing in Resilience Based Programs
Increase independent living skills; reduced cost of hospitalization and adult institutionalization.
Increase productivity; help children reach their full potential despite life's adversities.
Build a caring community; mobilize community support and resources for children, parents, caregivers, children care workers.
30
_______________________________________________________________________
Highlights and Recommendation
Most children do not heal alone. They heal by reconnecting with committed caring adults who will nurture, guide, and protect the child into maturity.
Treatment staff cannot do this alone. Political and public support is essential.
Families of children also need support and help in this process.
Programs for early interventions (0-5) and transitional age youths (17-26) need to be in place to increase sustainability of success.
31
_______________________________________________________________________
Conclusion: Developing Resilience in Adversity
It is the commitment “to be there” for our children and their caregivers, that ultimately recreates the connection and helps them become more resilient toward traumas.
32
_______________________________________________________________________
- End -
_______________________________________________________________________
A Team Approach to Develop Resilience in Traumatized Children and Youth
Expert Conference
The Therapeutic Communities
Ebenfurth, Austria September 18, 2009
1
_______________________________________________________________________
Presenter: Sharon Law, M.A. Marriage and Family Therapist
www.SharonLawMFT.com
Los Angeles, California, USA
2
_______________________________________________________________________
Trauma Defined
Threats to your basic well-being (danger to life
and body integrity, sudden loss, exposure to
horror, etc).
It violates your basic trust in yourself, people,
and the world.
Trauma is a part of life for many people, and
children are not excluded from it.
3
_______________________________________________________________________
Post-Traumatic
Stress Disorder (PTSD)
This “new” diagnosis was first introduced in 1980 in Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
It came to recognize the possible impact of traumatic experience on a person’s well-being.
Diagnostic features include hyperarousal, intrusive memories, numbing of feelings, avoidance of stimuli.
4
_______________________________________________________________________
PTSD in Children
It was not until 1987 that features of PTSD specific to children were added when DSM-III-R was published.
Children may not have actual memories but may enact traumatic experiences repetitively through play and artwork.
They may show regressive behaviors, especially in reaction to reminders of past traumatic experiences.
5
_______________________________________________________________________
Trauma Is More Than a Diagnosis
Trauma is a profound experience that produces cognitions, emotions, and behaviors that were not present before the trauma.
Trauma cannot be precisely measured, and the same external event will not produce the same result (symptoms) with different individuals.
How trauma affects a person’s well-being involves a complex process.
6
_______________________________________________________________________
Discussion Questions
Why are some children who experience poverty, abuse, neglect, violence, or other tragedies less affected as they grow up, while some have a more difficult time?
What makes a difference in helping children to cope with life adversity?
7
_______________________________________________________________________
Determining Factors?
Genetic Predisposition
Age and Gender
Exposure Type and History
Relationship with Parents & Caregivers
Social Support
Resilience
8
_______________________________________________________________________
Resilience Defined
An ability to recover from or adjust to misfortune or change.
Working Definition:
The ability to not become or stay traumatized in difficult environments or situations.
And to grow…
9
_______________________________________________________________________
Two Sides: Trauma Self and Resilient Self
Trauma Self
Feels unsafe
Reactive to triggers
Withdraws or fights back
Regressive
Appears stupid and immature
Harsh and judgmental
Resilient Self
Feels confident
Responsive
Engaging and communicative
Forward thinking
Knows their strengths and weaknesses
Caring and understanding
10
_______________________________________________________________________
Resilience Provides Multiple Tools to Self Regulate
Cognitive: Positive view of self and confidence in their strengths and abilities.
Relational: Effective communication and problem solving.
Affective: Capacity to manage strong feelings and impulses.
Behavioral: Ability to make realistic plans and carry them out.(Source: American Psychological Association)
11
_______________________________________________________________________
Core Competence: Contact Regulation
Adjusting between contact and withdrawal.
Receptivity to nurturance.
Managing stress of separations and loneliness.
Development of inner values that support healthy relationships
12
_______________________________________________________________________
Core Competence: Emotion Regulation
Development of body awareness.
Ability to label emotions.
Ability to use emotions as a guide to respond to situations (not react).
Ability to accept and contact full range of emotions.
13
_______________________________________________________________________
Core Competence: Mental Regulation
Focusing and sustaining attention.
Choose what to remember and what to let go in the moment.
Ability to reflect and observe different perspectives
Ability to create a personal life story.
14
_______________________________________________________________________
Source of Resilience: Caring Relationships
Resilience is not just an inborn trait, it is a capacity that can be promoted and enhanced through caring relationships.
Master & Reed (2002): The best documented source of developing resilience is a strong bond to a competent adult.
15
_______________________________________________________________________
Foundation of Resilience: Early Relationships
Minnesota Longitudinal Study of Parents and Children (1999): A 25-year study of impoverished mother and their first born.
Result: Early secure attachment in the first two years provided a group of high risk children with an increased ability to rebound and show competence in adolescence.
16
_______________________________________________________________________
Impact of Insecure Attachment
Bowlby (1944): Disruptions in early relationships often lead to significant disturbances in a person’s sense of self, sense of others, and their capacity to regulate, contain, and modulate their affective experience.
Result of insecure attachment: Avoidant, resistant and disorganized behaviors that can cause lifelong maladjustment.
17
_______________________________________________________________________
What Holds Back the Development of Resilience?
Many instances of childhood traumas occur within a youth’s immediate environment (home, school, neighborhood) and are most often perpetrated by someone the child knows. (Finkelhor et al., 2005; Garbarina et al., 1992)
Perpetrators are often themselves victims of childhood abuse and neglect and did not receive the support and help they needed.
18
_______________________________________________________________________
What Holds Back the Development of Resilience?
Past and present trauma exhausts the coping resources of the child and the caregivers.
Persistent survival coping interferes with the development of self regulatory competencies for both caregivers and the child, resulting in poor attachment.
The absence of a “good enough” connection becomes the source of more stress (and trauma) for both the child and the caregiver.
19
_______________________________________________________________________
Important Facts About the Children We Help
By the time they have entered into treatment programs, they have frequently experienced chronic and repeated traumas over an extend period of time rather than a singular trauma.
The negative impact of these traumas has become cumulative and impacted brain development.
It takes a lot of time, persistence, and resources (e.g. teamwork and community support) to understand and address the child’s (and the caregiver’s) challenges.
20
_______________________________________________________________________
What Should We Do to Help?
The first step in helping traumatized children is to create an environment, that is truly safe for for the child, where the child has consistent supportive relationships and is not threatened with physical or emotional harm.
Interventions sometimes involve removal of the children from their biological homes and immediate environment.
21
_______________________________________________________________________
What Should We Do to Help?
The second step involves supporting all possible activities that enable the child to have positive experiences about self, and empower the child to develop practical skills to achieve success in life.
These abilities may include academic, vocational, social, athletic, and artistic skills.
22
_______________________________________________________________________
Resilience Based Programs: The California Experience
California’s Mental Health Service Act passed in 2004 provides significant funding for resilience-based programs for high risk children who are exposed to multiple traumas.
Approximately $5 Billion (USD) in funding have accrued as of June, 2009. Another $5 Billion has been committed to fund services through fiscal year 2011-12.
23
_______________________________________________________________________
Resilience Based Programs: The California Experience – Four Guiding Principles
Early Intervention: How to reach out to children at risk of multiple traumas?
System of Care: How to facilitate collaboration between different systems (family, child welfare, school, health…)?
Intensive Teamwork: How to support staff to provide a consistent and caring environment?
Wrap around services: How to provide positive experiences for our children?
24
_______________________________________________________________________
Resilience Based Programs: The California Experience – Positive Outcomes
My service experience: 23 high risk children were served in my team between 2005 July - 2006 October. 20 children were able to stabilize and function well in the community. Only 3 children were re-hospitalized or re-institutionalized.
Result of California Mental Health Service Act’s three year study (2009): Significant lower arrest rates since enrollment of program, especially in second and third year of participation.
25
_______________________________________________________________________
Resilience Based Programs: The California Experience – Positive Outcomes
Graph
Average Number of Arrests Per Month
for Individuals Participating in FSP Programs
by Year of Participation.
Download Presentation and see slide 26 to view graph
Child, Transitional Age Youth, Adult, Older Adult
26
_______________________________________________________________________
The Ultimate Goal: Rebuilding Connection
“Rebuilding attachment means mustering the courage and the allies to cope with a “succession of trials” over time. With each test, caring adults, practitioners and children challenge the power of old trauma and strive to learn from the wisdom of each other’s past experiences and old heroes, in order to reduce the power of their nightmares”.
(Source: Richard Kagan (2009) “Transforming troubled children into tomorrow’s heroes”)
27
_______________________________________________________________________
Attitudes and Roles of Child Care Workers
- Committed to be present.
- Tolerant of intense feelings especially anger and frustration.
- Sticking with the child despite breakdowns in the relationship.
- Able to seek solutions together.
- Do not give up.
28
_______________________________________________________________________
3 Languages of Integration: Trauma and Resilient Self
Bad things did happen, BUT…
I Have: I now have a safe place to live, I have people who love me, I have friends to have fun with”.
I Am: “I am a survivor, I am okay, I am lovable, I am powerful”.
I Can: “I can learn, I can make things, I can control myself, I can succeed”.
(Source: The International Resilience Project, Bernard Van Leer Foundation)
29
_______________________________________________________________________
Societal Benefits for Investing in Resilience Based Programs
Increase independent living skills; reduced cost of hospitalization and adult institutionalization.
Increase productivity; help children reach their full potential despite life's adversities.
Build a caring community; mobilize community support and resources for children, parents, caregivers, children care workers.
30
_______________________________________________________________________
Highlights and Recommendation
Most children do not heal alone. They heal by reconnecting with committed caring adults who will nurture, guide, and protect the child into maturity.
Treatment staff cannot do this alone. Political and public support is essential.
Families of children also need support and help in this process.
Programs for early interventions (0-5) and transitional age youths (17-26) need to be in place to increase sustainability of success.
31
_______________________________________________________________________
Conclusion: Developing Resilience in Adversity
It is the commitment “to be there” for our children and their caregivers, that ultimately recreates the connection and helps them become more resilient toward traumas.
32
_______________________________________________________________________
- End -