BY: JEAN WEST MSW LCSW CTS

Interventions with Traumatized Children: TLC’s

SITCAP Model

Today’s Presentation

What is trauma?How is trauma related to homelessness?How does trauma affect behavior and

learning?The SITCAP modelHow is our school district using this model?Hands on activities

What is trauma?

Trauma is an overwhelming sense of terror, powerlessness, and the absence of a sense of safety.

Following exposure to a potentially trauma inducing incident, survivors may become frozen in an activated state of arousal.

Arousal refers to a heightened state of alert and fear for one’s safety. (wreck)

Experiences which can cause trauma

Physical and/or sexual abuseDomestic violenceLiving with substance abusing parentsWitnessing parental homicideHomelessnessBurns/other serious accidentsCar fatalitiesDivorceNatural disasters

The Role of the Brain and the Nervous System

The Autonomic Nervous System

Part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness. It helps people adapt to changes in their environment.

Typically function in opposition to create homeostasis.

Parasympathetic: rest and digest (brake)Sympathetic: flight, fright, or freeze (gas)

The Autonomic Nervous System

Midbrain

Our midbrain is the central relay system for the senses.

Our senses travel through the brain stem and quickly go to the hypothalamus.

The hypothalamus links the nervous system to the endocrine system via the pituitary gland.

The hypothalamus either sends the message to the cortex and it says everything is o.k. or it sends to the pituitary gland to start the fight/ flight /freeze process

Neurotransmitters are released to respond to crisis.Freeze is when the cascade of neurotransmitters

are frozen.

Midbrain cont…

Hypothalamus codes memories.Amygdala: It’s primary role is to process and

remember emotional reactions, state dependent recall (test, room, anniversary dates)

Hippocampus: extremely vulnerable to traumatic stress, slow growing part of the brain grows even slower with extreme stress can result in profound difficulties in recalling their childhood.

“Children won’t remember what you said or did but how you made them feel”

Implicit Memory

Right hemisphere/reptilian/limbic/brain stem How an event is remembered by the body and

central nervous systemSensory memories-sight, sound, touch, smell,

tasteIconic symbolizationTrauma experience is stored via images and

sensationsNo language-no words to describe (apple pie, petting dog)

The body has a memory (suffocation)

Explicit Memory

Left hemisphere /neocortexContains cognitive processesThe ability to take in information and make

sense of itLanguage-words to describeAbility to reorder this changed, therefore…

Trauma and Homelessness

“Trauma- physical, sexual, and emotional –is both a cause and a consequence of homelessness.” HCH 1999

Trauma and Homelessness cont…

“The experience of homelessness can be best understood as highly stressful, and, in some instances, traumatic. While homelessness is enormously stressful to individuals of any age, children’s experiences are unique in that it involves multiple losses during critical developmental periods. Children who are homeless are likely to be forced to leave behind valued possessions, experience disruptions in friendships and other significant relationships, and both change and infrequently attend school. Additional emotional strains are tied to enduring the social stigma of homelessness .” Cowan 2007

Trauma and Homelessness Cont…

Homelessness results in a loss of community, routines, possessions, privacy, and security.

According to The National Traumatic Stress Network, more than 90% of sheltered and low-income mothers have experienced physical and sexual assault over their lifespan.

The experience of homelessness puts families in situations where they are at greater risk of additional traumatic experiences such as assault, witnessing violence, or abrupt separation.

The stresses associated with homelessness can exacerbate other trauma-related difficulties and interfere with recovery due to ongoing traumatic reminders and challenges. NCTSN 2005

Homelessness results in a loss of community, routines, possessions, privacy, and security.

According to The National Traumatic Stress Network, more than 90% of sheltered and low-income mothers have experienced physical and sexual assault over their lifespan.

The experience of homelessness puts families in situations where they are at greater risk of additional traumatic experiences such as assault, witnessing violence, or abrupt separation.

The stresses associated with homelessness can exacerbate other trauma-related difficulties and interfere with recovery due to ongoing traumatic reminders and challenges. NCTSN 2005

The Emotional Impact

More then one-fifth of homeless preschoolers have emotional problems serious enough to require professional care, but less then one-third receive any treatment.

Homeless children have twice the rate of learning disabilities and three times the rate of emotional and behavioral problems as nonhomeless children.

Half of school-age homeless children experience anxiety, depression, or withdrawal compared to 18% of nonhomeless children.

By the time homeless children are eight years old, one in three has a major mental disorder. NCTSN 2005

Trauma and Homelessness Cont…

Trauma is THE predominant mental health issue for homeless mothers.

Research confirms that the strongest predictor of emotional and behavioral problems in poor and homeless children is their mother’s level of emotional distress. HCH

2003

Emotional help is needed for both the parents and their children in order to be most effective.

What does trauma do to the developing brain?

Sympathetic nervous system takes over.Cortisol and adrenaline goes up and stays up

and acts like an acid rain on the rest of the nervous system.

Suppressed serotonin levelsAffect dysregulationDepressed executive function organization,

planning,

Traumas Effect on Learning

In the arousal (anxious) state it becomes difficult to process information, follow directions, recall information, and focus (Doctor’s

office)

Poor problem solving, attention, disorganizedOften only hear half of the words spoken by

their teachersCognitively will generally be far behind their

peers, children can often learn at three times the rate compared to when engulfed in trying to survive

Traumas Effect on Behavior

HypervigilanceDifficulty sleepingEasily startledClingingNightmaresDisobedienceImpaired social skillsAnger /rageCan’t self sooth or

modulate emotions

DepressionAttention problemsImpulsivityAggressionFearfulRisk takingPanic attacksHypersensitive to

touch, movement, some sounds and smells

Assessment Tool from TLC

ReexperiencingFlashbacksIntrusive thoughts, imagesTraumatic dreamsPhysiological reactions

Assessment Tool Cont…

ArousalCognitive dysfunction/ focus, retain etc…HypervigilanceAttachment reactionStartle responsesSleep difficultyIrritability, aggressiveness, assaultiveConstant state of readiness (sleeping on the

floor)

Assessment Tool Cont…

AvoidanceDissociative behaviorDetachment, numbingNot wanting to talk about itDiminished interestOCD like behaviorPhobic-like behavior

Secondary Victimization or Wounding

Secondary victimization or wounding occurs when the people and organizations you turn to for help respond in subtle ways that cause you additional pain.

Denial and disbeliefDiscounting and minimizingBlaming youTreating you as defective

SITCAP Research

2005 / Georgia/ 85 at-risk adjudicated adolescents

100 % reported reduction of trauma symptoms90 % indicated they definitely felt better using

9 and 10 (out of ten) to rate the differenceOne year following the field test, 85 % HAD NO

ADDITIONAL CONTACT WITH THE COURT

SITCAP Research Cont…

2007-2008/four elementary schools grades 2-5

Most children demonstrated outstanding reductions in most trauma symptoms and problem behaviors as a result of their participation

Confirms findings of 1996-1997 study of 168 children in which statistically significant reductions of PTSD symptoms was demonstrated

SITCAP: Primary Issues with Trauma

Fear / TerrorWorryHurtAngerRevengeAccountabilityPowerSafetySurvivor vs. Victim

Symptoms Versus Behaviors

Reduction of PTSD symptoms can be experienced without focusing on symptoms. Begin to restore a sense of safety and power in the child and symptoms will diminish.

Sessions

Eight sessions1st and 7th session the parents are encouraged to attendIt is a critical component of the model to educate the

parents or caregivers on traumaSession2 Addresses fear and worrySession 3 Addresses physical and emotional hurtSession 4 Addresses anger, revenge, and accountabilitySession 5 Addresses future orientationSession 6 Prepares child for meeting with parentSession 7 the child shares his story with the parentSession 8 review, reassessment of where child is at

Drawing

Draw me a picture of what happened that you can tell me a story about

Psychomotor activity that helps to trigger the sensory memories when it is trauma focused

Engages the child in active involvement in their healing

Helps us to see what the child seesHelps the child externalize the experience

and move it to a safe place (the paper) outside himself which he has control over

Drawing cont…

Provides visual representationTo communicate visually what we do not

always have words to describeSafe vehicle to communicate detailsRecreates a renewed sense of power and

safety which gives them hope for the future

17 year old male

10 year old female

8 year old female

8 year old female

8 year old female

11 year old female

19 year old female

13 year old male

The Child Must Feel Safe

Begin and end each session in a safe placeIt’s not about how skilled you are but how

safe you are!

Questions to Elicit Details

After the child has drawn their experience, begin to ask trauma-specific questions about the story

What do you remember seeing or hearing?Do you sometimes think about what happened

even when you don’t want to?Do certain sounds, smells, etc… suddenly remind

you of what happened?What would you like to see happen to the person

or thing that caused this to happen?Do you sometimes think it should have been you

instead?

How do we Discuss trauma with our clients?

SafetyStructureBecoming a witnessWe must be aware of how our own

experiences effect our ability to help

SJSD McKinney-Vento Initiatives

Priority Level 1 building Staff trainingParent trainingScreening of studentsGroups of 6-8 students, highest need using

SITCAP modelSchool Counselor and Social Workers trainingTrauma questions on local mental health centers

assessment /intake formsCommunity training for clinicians which included

key shelter staff

Hands on Activities

How big is your worry?Grounding exerciseSafety

Judith Herman Quote

“Atrocities refuse to be buried…..Remembering and telling the truth about terrible events are prerequisites both for restoration of the social order and for the healing of individual victims.”

Resources

Information in presentation obtained from The National Institute for Trauma and Loss in Children

www.starrtraining.org/tlc

Cowan, Beryl Ann, "Trauma exposure and behavioral outcomes in sheltered homeless children: The moderating role of perceived social support" (2007). Psychology Dissertations. Paper 39. http://digitalarchive.gsu.edu/psych_diss/39

HCH Health Care for the homeless Clinician’s network. Trauma and Homelessness.(1999) Vol.3, No.3

HCH Health Care for the homeless clinician’s network. Homelessness and family trauma: The Case for early intervention. (2003) Vol. 7, No. 2

NCTSN The National Child Traumatic Stress Network. Facts on Trauma and homeless children. (2005) www.NCTSNet.org

jean.west@sjsd.k12.mo.us