Download Villages Foster Parent Support Group

Trauma in the Lives of
Foster Children
Amanda Briles, MSSW, LSW
March 3, 2017
Heavily based on a presentation by John Polstra, MSW, LCSW, CSAYC
TRAUMA: noun. A very
difficult or unpleasant
experience that causes
someone to have mental or
emotional problems usually
for a long time.
 --Merriam-Webster Dictionary
Trauma Defined
The person was exposed to: death, threatened death, actual or
threatened serious injury, or actual or threatened sexual
violence, as follows: (one required)
1.
Direct exposure.
2.
Witnessing, in person.
3.
Indirectly, by learning that a close relative or close friend
was exposed to trauma. If the event involved actual or
threatened death, it must have been violent or accidental.
4.
Repeated or extreme indirect exposure to aversive details
of the event(s), usually in the course of professional duties
(e.g., first responders, collecting body parts; professionals
repeatedly exposed to details of child abuse). This does not
include indirect non-professional exposure through
electronic media, television, movies, or pictures.
--Diagnostic and Statistical Manual of Mental Disorders—5th ed.
As defined by the DSM-V …
1.
2.
3.
4.
5.
6.
7.
8.
Emotional Neglect
Child Sexual Abuse
Child Emotional Abuse
Child Physical Abuse
Physical Neglect
Drug Addicted or Alcoholic Family Member
Incarceration of a Family Member
Mentally Ill, Depressed or Suicidal Family
Member
9. Loss of a Parent to Death or Abandonment
10. Witnessing Domestic Violence Against Mother
Adverse Childhood Events (ACEs)
Of the 17,000+ respondents…

More than 25% grew up in a household with an alcoholic
or drug user

25% had been beaten as children

Two-thirds had 1 adverse childhood event

1 in 6 people had four or more ACES

Found correlation between ACEs and increased smoking,
obesity, drug/alcohol use, suicide, diabetes, heart
disease, cancer and stroke over a person’s lifetime.
ACEs Study Findings
Drug use Over Lifetime
30
25
% of Total
20
Considers Self Alcoholic
15
Ever used illicit drugs
Ever injected drugs
10
5
0
0
1
2
3
4 or more
No. of ACEs
Felitti, V. J. et. al., Relationship of Childhood Abuse and Household Dysfunction to Many Leading Causes of Death in Adults:
The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998; 14(4). Pp 245-258.
Ever Attempted Suicide
20
18.3
18
16
% of Total
14
12
9.5
10
% Attempted Suicide
8
6
4.3
4
2
2.4
1.2
0
0
1
2
3
4 or more
No. of ACEs
Felitti, V. J. et. al., Relationship of Childhood Abuse and Household Dysfunction to Many Leading Causes of Death in Adults:
The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998; 14(4). Pp 245-258.
Impact on Lifetime Sexual Behavior
18
16
14
% of Total
12
10
50 or more lifetime Sexual Partners
8
Ever had a STD
6
4
2
0
0
1
2
3
4 or more
No. of ACEs
Felitti, V. J. et. al., Relationship of Childhood Abuse and Household Dysfunction to Many Leading Causes of Death in Adults:
The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998; 14(4). Pp 245-258.
The Brain and its
Response to Trauma
How is the brain designed?
Stress Responsefight/flight/freeze
Increase in adrenaline.
 Digestion initiated.
◦ Increase in digestive fluids in the stomach
◦ Bowel activity—retention or evacuation
◦ Somatic complaints
 Perspiration starts.
◦ Clammy hands
 Heart rate increases.
 Respiration increases.

Physiology of the Stress response
“Some studies on adolescents and adults who were severely
neglected as children indicate they have a smaller prefrontal
cortex, which is critical to behavior, cognition, and emotion
regulation … but other studies show no differences… . Physically
abused children also may have reduced volume in the
orbitofrontal cortex, a part of the prefrontal cortex that is
central to emotion and social regulation. … Children who
experienced severe neglect early in life while in institutional
settings often have decreased electrical activity in their
brains, decreased brain metabolism, and poorer
connections between areas of the brain that are key to
integrating complex information … These children also may
continue to have abnormal patterns of adrenaline activity
years after being adopted from institutional settings.”
--Children’s Bureau (April, 2015)
Neurobiological Impact of Trauma
Trauma and Children in
Foster Care
What strengths or
resiliencies do your
foster children have?
What has happened
to them?
 Sleep disturbances such as nightmares, night
terrors, difficulty falling asleep, difficult staying
asleep or anxiety about going to bed alone.
 Jumpiness, chronic anxiety, frequent worry,
and/or hyper-vigilance.
 Irritability, aggression, disproportionate
emotional reaction to provocation.
 Intrusive thoughts or memories that are
upsetting to the trauma victim.
 Isolation from others and restricted play or social
skills.
Symptoms of Traumatic Stress
 Going out of one’s way to avoid certain things that
others find harmless.
 Needing excessive reassurance to engage in
“normal” activities.
 Engaging in sexual behaviors that are not ageappropriate.
 Engaging in other unusual coping behaviors such
as hoarding food, practicing rituals to feel safe,
engaging in self-harm or suicidal behavior.
 Recent onset of inattention at school,
uncharacteristic distractibility, excessive daydreaming or other dissociative-type experiences.
More symptoms …






Often victims of complex, chronic trauma (no normal
baseline of healthy functioning).
Have fewer resiliencies and resources to mitigate traumatic
events than children who have not been in care.
Experience multiple traumatic events in their lives prior to
removal and placement.
The process of removal is traumatic in and of itself.
◦ Being removed from their biological parents,
◦ Extended families
◦ Familiar neighborhoods and friends
◦ Neighborhood institutions—church & schools.
Often have had multiple foster placements.
Have higher rates of trauma symptoms than the general
public (Dorsey & Deblinger, 2012)
Foster children …
Trauma-focused Cognitive
behavioral therapy
(TF-CBT)
Screenings
◦ UCLA PTSD Screening
◦ Childhood Traumatic Events Survey (CTES)
 Clinical Interviews
◦ Mental health professionals
◦ Psychologists/Psychiatrists
◦ Social Workers trained in TF-CBT or trauma work.
 Observations of the child
◦ Foster parents
◦ Biological parents
◦ Schools
◦ Other professionals

Assessment
Thoughts
Consequences
Behaviors
Feelings
Cognitive Triangle

Identification of trauma triggers.

Changing distorted thinking.

Emotional Regulation—Learning to calm down.

Sharing the Trauma Narrative—What happened.

Effective parenting strategies—”Keep calm and carry
on”

Learning to cope daily in your home and with your
family.
Outcomes for TF-CBT:
What caregiver and kids will get out of this
Identifying Trauma Triggers--
“It’s just stuff” from the movie Martian Child
My foster mother
loves me even
when she puts me
in time-out
My foster mother
put me in time-out
because she does
not love me
Refuses to listen.
Hits foster brother.
Angry, Sad,
Worried
Use breathing
slowly to calm
myself.
Angry, worried,
frustrated
Restructuring distorted thinking.



Telling the story of what happened over and over so that it
loses it’s “sting.” (systematic de-sensitization)
Happens in the time, pacing, and media that child chooses.
To be shared with someone safe and supportive when
ready – after has a handle on coping techniques
“What happened to you?”—The
Trauma Narrative
Through years of responsive parenting, children
can learn valuable strategies to regulate
emotions, including distraction, soothing,
cognitive reappraisal, and problem-solving. They
also learn important lessons about negative
emotional states: that their emotions matter to
other people, that their emotional reactions
make sense, that they can tolerate their
negative emotional states, and that their
emotional states may not last long.
(McMillen, Katz and Claypool, 2014).
The Importance of Responsive
Parenting

Ignore unwanted behavior.

Practice positive behavior.

Praise positive behavior.

Reward the opposite, positive behavior.

Stay calm and model calm behavior.

Be creative in a fun and positive way.
Positive Parenting

Controlled breathing

Monitor heart rates

Progressive muscle relaxation

Guided imagery/safe place
Exercises
Bibliography
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders:
DSM-5. Washington, D.C: American Psychiatric Association.
Children’s Bureau. April, 2015. Understanding the Effects of Maltreatment on Brain Development.
Child Welfare Information Gateway. Retrieved from
https://www.childwelfare.gov/pubPDFs/brain_development.pdf
Dorsey, S & E. Deblinger, (2012). Children in Foster Care. In J. Cohen, A. Mannarino & E.
Deblinger, Trauma-Focused CBT for Children and Adolescents: Treatment
Applications. (pp 49-72). New York, NY: Guilford Press.
Felitti, V. J. et. al., Relationship of Childhood Abuse and Household Dysfunction to Many
Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study.
American Journal of Preventive Medicine. 1998; 14(4). Pp 245-258.
McMillen, J. C. Katz, and E. Claypool. (September 2014). An Emotion Regulation Framework for
Child Welfare Intervention and Programming. In Social Service Review, Vol. 88, No. 3.
The University of Chicago Press. Pp 443-468.
Trauma. ( n.d.) In Merriam-Webster Dictionary on-line. Retrieved from http://www.merriamwebster.com/trauma.