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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. 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 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