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Attachment, Self-Regulation, and
Competency: A Framework for
Working with Youth Exposed to
Complex Trauma
Natalie Turner, MS LMHC
Associate Director, Area Health Education Center
Washington State University
How we feel defines how we learn.
Neurodevelopment has to guide how we teach and how
we support children.
◦ Practical actions balance increasing sophisticated
interventions.
Recalibrating our expectations of children based on
knowledge of neurodevelopment.
Social emotional development and learning is the
smooth integration of feelings and thought.
Trauma challenges this smooth integration by disrupting
what has been learned and compromising new learning.
Copyright 2012 WSU Area Health
Education Center
Effective social emotional learning aligns with
effective classroom management
Clear and effective rules and procedures
Effective discipline and accountability practices support learning
Role appropriate high quality teacher-student relationships
Teachers‟ „Mindfulness‟ in assessing, anticipating, and acting to
support learning and behavior
Instruction and management practices that support student
responsibility for learning
Parent engagement and inclusion in learning supports
Intentional use of physical and social environment to support
learning.
Copyright 2012 WSU Area Health
Education Center
Iceberg Activity
Draw an iceberg on a piece of scratch paper
Think of a student
Fill in the top of the iceberg
Now think about what might
be influencing the student‟s
behavior: What is the NEED?
Fill in the bottom of the
iceberg
Copyright 2012 WSU Area Health
Education Center
The ARC Model
Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
Attachment
Self-
Regulation
Competency
Caregiver
Affect
Mgmt.
Attunement Consistent
Response
Routines
and
Rituals
Affect
Identification Modulation Affect
Expression
Developmental Tasks
Executive
Functions Self Dev’t
& Identity
Trauma
Experience
Integration
The 3-part model
What a child has come to understand is
dangerous
Will lead to a physical and/or
behavioral response that
tries to fill a need and find safety
Thus forcing the child to put energy into survival
rather than healthy development, leaving
them with developmental deficits
Copyright WSU 2012 Information may be
used with attribution
Attachment
Caregiver affect management- Keep Calm
and Carry On
Attunement- Accurately read another‟s cues
and respond appropriately
Consistent Response- If you do A, I will do B
Routines and rituals- Provide a predictable
sequence of events
Self-Regulation
Affect Identification- The ability to
identify an emotion and tell it apart from
other emotions
Modulation- The ability to maintain a
comfortable, appropriate level of arousal
Affect Expression- The ability to share
emotional experience with others and
with self in a safe and healthy way
Competency
Executive functions- Learning to act with thoughtfulness as opposed to reacting based solely on emotion and arousal
Self Development/Identity- Coming to know the intricacies of oneself in an accepting way, especially as it pertains toward personal growth
Trauma Integration- Finding ways the self is fragmented, identifying how to make a conscious choice, and processing specific events
Caregiver Affect Management
The main idea: Support staff in
understanding, managing, and coping with
their own emotional responses, so that
they are better able to support the
children in their class
Before a caregiver can help a child manage
emotional experiences, the caregiver must
manage their own emotional experiences
Foundational skill of the ARC model
Caregiver affect management directly
impacts a child‟s experience of
environment
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Triggers
Following Rules
Getting along with peers
Acting respectfully
Sitting quietly
Sharing
The ongoing issues
The core issue
Commitment
Competence
Recognition
Acceptance
Power
Respect
Love
Caring
Integrity
Trust
Control
The
Event
What just happened that you feel you must respond to
Stanley, S. et al (2008)
Copyright 2012 WSU Area Health
Education Center
Signs of Triggers
Avoiding talking about a topic or experience
Feeling like you‟re fine one minute then really upset the next
Having a reaction that is bigger than the event or the reaction of others
Feeling like no matter how much you talk about something it doesn‟t feel better
Keeping score of each time something happens
Body cues: ◦ Increased heart rate
◦ Knotted stomach
◦ Sweaty palms
Copyright 2012 WSU Area Health
Education Center
The main idea: Support staff in
learning to accurately and empathically
understand and respond to children‟s
actions, communications, needs, and
feelings
Attunement is the capacity to accurately
read the emotional, cognitive, behavioral,
and physiological cues of another that
are both verbal and non-verbal and
respond appropriately
Children who have experienced
complex trauma often lack the skills to
easily identify and communicate what
they are feeling and cope with difficult
emotions
How do we interpret the meaning
behind behavior? Look past the top of
the iceberg and respond to what is
underneath
Identifying student‟s triggers and danger
response
Reflective listening skills
Attunement
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Some myths about attuning
It takes a long time
You need to know someone‟s history to be able to
attune
It‟s just „touchy feely‟
You can‟t attune to a stranger
If you attune, you haven‟t addressed anything
Attuning to behavior means condoning the behavior
Attuning to one person means not being available
to meet the needs of others
Copyright 2012 WSU Area Health
Education Center
“Nothing other people do is because of you. It
is because of themselves… When we take
something personally, we make the assumption
that they know what is in our world, and we try
to impose our world on their world.”
-Don Miguel Ruiz
Copyright 2012 WSU Area Health
Education Center
How Can Trauma Impact
Attunement?
Children who have experienced trauma or extreme
stress may:
Develop an expectation that bad things will happen to
them
Have a hard time forming relationships with other
people
Have difficulty managing or regulating feelings and
behavior
Have difficulty developing a positive sense of
themselves
Copyright 2012 WSU Area Health
Education Center Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
How to attune
Accept what the other person is saying and feeling
Demonstrate that you‟re listening
Paraphrase (restate in your own words what you
hear the other person saying)
Identify out loud what you hear the other person
feels
Wait to offer suggestions, criticisms, reassurances,
etc. until you‟ve validated what the other person is
experiencing
Copyright 2012 WSU Area Health
Education Center Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Consistent Caregiver Response
The main idea: Support staff in building
predictable, safe, and appropriate responses to
children‟s behavior in a manner that acknowledges
and is sensitive to the role of past experiences in
current behavior
Predictability builds sense of safety in environment
Limit setting as potential trigger for feeling
powerless
Predictability over time allows children to relax
vigilance and control and put their energy into
normal development Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Consistent response in the
classroom There is a struggle in classrooms between „consistent‟
and „consistent for this child‟
How to balance the demands of teaching and tracking
individual student behavior in order to respond
appropriately?
Some kids don‟t have the skill set to handle a consistent
adult
Help kids build these skill sets by giving feedback on
both positive and negative behavior- be specific and kind
Praise EFFORT not CHARACTER
Difference between “He won‟t” and “He can‟t”
Copyright 2012 WSU Area Health
Education Center Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Routines and Rituals
The main idea: Support staff in
building routine and rhythm into
the daily lives of children and
families
Again! Predictability builds sense
of safety
Routine vs. ritual
Target building routine
particularly around areas of
vulnerability
Transitions can be especially
difficult
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Affect Identification
The main idea: Work with
children to build an awareness of
internal experience, the ability to
discriminate and name emotional
states, and an understanding of
why these states originate
Children who have experienced
poor caretaking and poor
emotional support may have
never developed healthy ways to
identify what they are feeling
Limited skill set may be easily
overwhelmed by state of arousal
Children may miscue others as a
way of protecting themselves
from emotions that feel unsafe
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
The main idea: Work with
children to develop safe and
effective strategies to manage
and regulate physiological and
emotional experience, in
service of maintaining a
comfortable state of arousal
“Children who experience
unresponsive, inconsistent, or
abusive caretaking may fail to
develop healthy age-
appropriate skills and instead
must rely on primitive
regulation strategies.”
Young children rely on their
caregivers to modulate for
them, thus helping develop
these skills
These strategies may include:
◦ Failure to regulate
◦ Over-regulating/constricting
Children who can‟t modulate
may compensate by
◦ Over-controlling or shutting off
emotional experience
◦ Manage emotional experience
with physical stimulation
◦ Turning to external methods to
alter or control physiological
experience.
Modulation
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic
Stress in Children and Adolescents
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Individual
Differences:
The Comfort
Zone
The POWER zone –
living in hyperarousal
The KEEP-IT-
COOL zone – any
arousal is scary
THE
ROLLER-
COASTER –
Comfort
zone? What
comfort
zone?
Not every child fits neatly into one of these three
categories
Think about the students you work with- which
strategy of organizing inner experience do they use?
Notice the numbers:
◦ Do you have most students in one strategy? Are
classrooms evenly split?
◦ This can inform you as to how to structure your
routines and rituals, consistent responses, where to
attune, etc.
At your tables
Affect Expression
The main idea: Help children build
the skills and tolerance for effectively
sharing emotional experience with
others.
The ability to effectively communicate
feeling is directly related to the ability
to build relationship and master
important developmental tasks.
When children‟s emotional
environment is rejecting, angry, or
indifferent, they often learn their
emotions are shameful and should be
kept hidden.
Hiding emotions may help
children who have experienced
complex trauma feel more in
control and able to navigate
feeling unsafe.
Trauma may impact affect
expression in children by:
◦ Failure to share emotions
◦ Emotions emerging in
unhealthy ways
◦ Communicating emotions
ineffectively
◦ Over-communication
Strengthen Executive Functions The main idea: Work with children
to act, instead of react, by using higher-
order cognitive processes to solve
problems and make active choices in
the service of reaching identified goals
Include impulse control, purposeful
decisions, considering consequences,
understanding outcomes, problem-
solving, etc.
Executive functions are sacrificed in
developing individuals who are trauma
affected. Instead, the danger response
is activated
The development of executive
functions can:
◦ Serve as a way to modulate intense
arousal
◦ Provide a sense of control and ability to
impact the world
◦ Bring conscious thought to actions
◦ Increase likelihood of developing high
resilience
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress
in Children and Adolescents
Self-Development and Identity
The main idea: Support children in
exploring and building an
understanding of self and personal
identity, including identification of
unique and positive qualities,
development of a sense of coherence
across time, and support in the
capacity to imagine and work toward
a range of future possibilities
“Children who are routinely rejected,
harmed, or ignored internalize an
understanding of self as unlovable,
unworthy, helpless, or damaged.”
Self development includes:
◦ understanding self as separate from
others
◦ understanding of preferences and values
◦ identifying personal traits
◦ is an on-going process throughout life
State-dependent self-concepts may
develop, where children feel their
identity changes with their experience
in the moment
Focusing on the immediate moment
limits a child‟s perception of self to
what is rather than what could be
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Trauma Experience Integration
The main idea: Work with children to actively explore, process,
and integrate historical experiences into a coherent and
comprehensive understanding of self in order to enhance their
capacity to effectively engage in present life
The ultimate goal for trauma affected individuals is to “build
[capacity] to harness internal and external resources in service of
effective and fulfilling navigation of their life, across domains of
functioning, as they define and meet self-identified personal goals.”
2 ways:
◦ Integration of themes of fragments of self and the associated early
experience
◦ Process specific events
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Implementation Science and
adoption of new practice Implementation Stages
Exploration & Sustainability
Determining „what‟
Installation
Initial implementation
Full implementation
Critical role of improvement cycles
Implementation Drivers
Leadership
◦ Adaptive and Technical
Competency
◦ Staff selection, training, and coaching
Organization
◦ Systems development
◦ Facilitative administration
◦ Data systems and decision supports
Copyright WSU AHEC 2012 Reproduction
with attribution permitted 33
How can schools adapt ARC?
Lessons learned from pilot work:
◦ Collaboration time
◦ Classroom Observation
◦ CST
◦ Supervision
◦ Reflective practice practice change
◦ Role of leadership in supporting staff and
system change
Staff Expectations (and how we
addressed them) “Tools”
Time: small group discussion,
collaboration, problem solving, sharing
information
Case studies
Multiple methods of content delivery:
Handouts, lecture, videos, activities
Copyright WSU 2012 Information may be used with attribution
Why There is Reason for Hope-
Trauma Informed Practice in Education
Social support and resources build resiliency at any age. Resiliency buffers the effects of trauma.
Creating safety and predictability creates opportunity for new learning.
Understanding trauma creates opportunities for new behaviors.
Teachers can create powerful relationships.
Managing trauma‟s effects may result in increasing success for systems.
38
Copyright WSU 2012 Information may be
used with attribution
Remember:
Trauma Does not Define Us…..
C:\Documents and Settings\naturner\My
Documents\Jessica's _Daily Affirmation_.flv
Copyright WSU 2012 Information may be
used with attribution
For more information
Natalie Turner, Associate Director
Area Health Education Center of Eastern WA
WSU Extension
509.358.7563
naturner@wsu.edu
http://extension.wsu.edu/ahec/trauma/Pages/ComplexTrauma
.aspx
Copyright WSU 2012 Information may be used with
attribution 40
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