Building Bright Futures Council Building Bright Futures Council

March 16March 16thth, 2012, 2012

Nicole Mondejar, MHANicole Mondejar, MHA

Administrator of Early Childhood Administrator of Early Childhood ProgramsPrograms

WCMHS, Inc.WCMHS, Inc.

Brain Brain Development Development && Trauma/StressTrauma/Stress

What to Look ForWhat to Look For

Best Practices Best Practices &&Local ResourcesLocal Resources

What You Can DoWhat You Can Do

Positive Positive StressStress

Tolerable Tolerable StressStress

Toxic StressToxic Stress

All managed byAll managed bybrain circuits and brain circuits and hormones in thehormones in thebody .body .

Prolonged Prolonged exposure exposure

to stress to stress hormones = hormones =

impaired brainimpaired braindevelopment and development and functioning.functioning.

Trauma is defined as a physical or Trauma is defined as a physical or psychological threat or assault to a psychological threat or assault to a child’s physical integrity, sense of child’s physical integrity, sense of

self, safety or survival or to the self, safety or survival or to the physical safety of another person physical safety of another person

significant to the child.significant to the child.

(VT CUPS Handbook) (VT CUPS Handbook)

Children may experience trauma as a Children may experience trauma as a

result of a number of different result of a number of different

circumstances, such as:circumstances, such as:

Abuse, including sexual, physical, emotionalAbuse, including sexual, physical, emotional Abandonment or neglectAbandonment or neglect Witness to domestic violenceWitness to domestic violence Death or loss of a loved oneDeath or loss of a loved one Severe natural disastersSevere natural disasters War, terrorism, military or police actions War, terrorism, military or police actions

(including media images)(including media images) Witness to community violence Witness to community violence Personal attack by another person or an animalPersonal attack by another person or an animal KidnappingKidnapping Severe bullyingSevere bullying Medical procedure, surgery, accident or serious Medical procedure, surgery, accident or serious

illnessillness Living in chronically chaotic environments Living in chronically chaotic environments

Study Title and Authors: Richardson, HN, Zorrilla, EP, Mandyam, CD, Rivier, CL (2006). Exposure to

repetitive versus varied stress during prenatal development generates two distinct anxiogenic

and neuroendocrine profiles in adulthood. Endocrinology 147:2506-2517.

“High levels of stress during pregnancy should be categorized as potentially

“toxic”, indicating that they might have long-term consequences for human development that are similar to the

adverse impacts of significant neglect or abuse in early childhood”.

In one study, children aged 2–5, 52.5% had experienced In one study, children aged 2–5, 52.5% had experienced a severe stressor in their lifetime.a severe stressor in their lifetime.

Young children have the highest rate of abuse and Young children have the highest rate of abuse and neglect, and are more likely to die because of their neglect, and are more likely to die because of their injuries. injuries.

Children younger than 3 years of age constituted 31.9% Children younger than 3 years of age constituted 31.9% of all maltreatment victims reported to authorities in of all maltreatment victims reported to authorities in 2007.2007.

Infants are the fastest growing category of children Infants are the fastest growing category of children entering foster care in the US. entering foster care in the US.

Infants removed from their homes and placed in foster Infants removed from their homes and placed in foster care are more likely than older children to experience care are more likely than older children to experience further maltreatment. further maltreatment.

Children aged 0-2 exposed to traumatic stress may: Children aged 0-2 exposed to traumatic stress may:

Act withdrawn Demand attention through both positive and negative

behaviors Demonstrate poor verbal skills Display excessive temper tantrums Exhibit aggressive behaviors Exhibit memory problems Exhibit regressive behaviors Experience nightmares or sleep difficulties Fear adults who remind them of the traumatic event Have a poor appetite, low weight and/or digestive problems Have poor sleep habits Scream or cry excessively Show irritability, sadness and anxiety Startle easily

Children aged 3-6 exposed to traumatic stress Children aged 3-6 exposed to traumatic stress may alsomay also::

Act out in social situations Be anxious and fearful and avoidant Be unable to trust others or make friends Be verbally abusive Believe they are to blame for the traumatic experience Develop learning disabilities Experience stomachaches and headaches Fear being separated from parent/caregiver Have difficulties focusing or learning in school Imitate the abusive/traumatic event Lack self-confidence Show poor skill development Wet the bed or self after being toilet trained or exhibit

other regressive behaviors

Contrary to popular belief, young children living in highly disadvantaged environments can be

protected from serious emotional or behavioral

consequences.

VT Child Trauma Collaborative (VCTC)VT Child Trauma Collaborative (VCTC)

12 community-based mental health 12 community-based mental health treatment centers serving all regions under treatment centers serving all regions under the DMH. the DMH.

6 clinicians at each site to form local ARC 6 clinicians at each site to form local ARC community treatment community treatment && service teams service teams

Services target children ages 3-18 and their Services target children ages 3-18 and their families, who have experienced complex families, who have experienced complex trauma trauma

Train-the-trainers series for mental health Train-the-trainers series for mental health providers and community partners to provide providers and community partners to provide trauma trainings across the system of caretrauma trainings across the system of care

Attachment, Self-Regulation and Attachment, Self-Regulation and

Competencies (ARC) Competencies (ARC) Framework for intervention with youth and

families who have experienced multiple and/or prolonged traumatic stress.

Four standardized assessments administered at Four standardized assessments administered at intake, intake,

quarterly, and at discharge:quarterly, and at discharge:

Parenting Stress Index (PSI)Parenting Stress Index (PSI) for ages 0 to 12 or the Stress Stress Index for Parents of Adolescents (SIPA) Index for Parents of Adolescents (SIPA) for ages 11 to 19.

Trauma Symptom Checklist for Children (TSCC)Trauma Symptom Checklist for Children (TSCC) for ages 8

to 16 or the Trauma Symptom Checklist for Young Children Trauma Symptom Checklist for Young Children (TSCYC) (TSCYC) for ages 3 to 12.

The The UCLA PTSD Reaction Index (UCLA PTSDRI) UCLA PTSD Reaction Index (UCLA PTSDRI) to assess post-traumatic stress reactions among children and adolescents aged 7 to 12 years old.

The The Achenbach System of Empirically Based Assessment Achenbach System of Empirically Based Assessment Child Behavior Checklist (ASEBA CBCL) Child Behavior Checklist (ASEBA CBCL) for ages 1 ½ to 5 or 6 to 18.

Neurosequential Model of Therapeutics Neurosequential Model of Therapeutics

(NMT) (NMT)

Developmental Developmental && Relational History Relational History Estimate which neural networks Estimate which neural networks && functions functions

likely impacted by traumalikely impacted by trauma

Current Assessment of FunctioningCurrent Assessment of Functioning Brain MappingBrain Mapping

Recommendation for interventionsRecommendation for interventions Addressed in developmental sequence Addressed in developmental sequence

Early Childhood & Family Mental Health (ECFMH): Accessed through referrals to CIS Home Visiting Parent Training & Education Therapeutic Case Management Individual Therapy for parent and/or child Marital/Couples Therapy Coordination with Substance Abuse Services

Linking Community Supports (LINCS) Outpatient Therapy Individualized  Play Therapy

““Participation in pre-kindergartenParticipation in pre-kindergarten

dramatically reduced participation dramatically reduced participation

in juvenile and adult crime, and in juvenile and adult crime, and increased high school increased high school

graduation, employment and graduation, employment and earnings, earnings,

with a total benefit-cost ratio with a total benefit-cost ratio

of 16 to 1.26”.of 16 to 1.26”.

1.1. Healthy Adult RelationshipsHealthy Adult Relationships2.2. Promote Protective FactorsPromote Protective Factors

Nurturing and attachment Knowledge of parenting and of child and

youth development Parental resilience Social connections Concrete supports for parents

3.3. Early Identification Early Identification && Access to Access to SupportsSupports

4.4. Increase AwarenessIncrease Awareness

5.5. Call your legislatorsCall your legislators