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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