AHS’s An Introduction Trauma & Resilience

Welcome to the Agency of Human Services Introduction to Trauma and Resilience. It’s great to have you here! My name is Auburn Watersong, I am the Director of Trauma Prevention and Resilience Development here at AHS. My position is located in the Secretary’s office and it is part of my role to assist the Agency in providing trauma-informed services to the Vermonters who come through our doors In order to do that, we must first understand what we mean when we talk about trauma and resilience at AHS. And my hope is that this training will start us off! I always want to start off trainings talking about what we ‘re hoping to learn today. In this training, we will talk about the definition of trauma and how it differs from but is related to toxic stress and adverse experiences We will also learn about resilience We’ll learn about ways we can build our own resilience, ways that we can assist others in building their resilience and ways in which we can help to build a resilient workplace and community. Before we begin – I just want to mention that talking about trauma and toxic stress can bring up uncomfortable feelings – like sadness, anger, anxiety, or stress. I want to encourage you to please take care of yourself as you need to. You may want to pause this training and find a private space that is comfortable for you. Perhaps have a glass of water with you. You may want to start by taking a few slow, deep breaths. This may help you to manage potential stressors that arise for you. Remember to take a break if you need to. Please take care of yourself. You can always come back to this another time. So, let’s begin this training talking about resilience. Have you ever noticed that sometimes it seems that certain people have a strong ability to “adapt” or “bounce back” from challenging situations? Perhaps you are that person! The truth is most of us have experienced a tough struggle at some point in our lives and we may have found it hard to bounce back in the face of adversity. Resilience is that bounce-ability; it is the ability to bounce back when faced with adversity. So, what determines resilience? Well, how resilient you are depends upon a variety of factors. The interaction between biology and environment create the conditions for developing resilience. When we think about our biology, we need to think about how our brains are built and how they have developed throughout our lives, and when we think about our environment – we have to consider outside factors and possible stressors that we have experienced over time Let’s take a moment to watch this video and learn more about what resilience is and how it is affected by our biology and our environment. low music plays Resilience is the result of a highly interactive process between individual characteristics of a person and the environment in which that individual has developed. it’s really the counterbalancing of the difficult things that may exist in a child’s life with positive things, that occur within the family but even positive things that may exist in the community. An easy way of thinking about resilience is like a scale with a fulcrum in the middle of it. And there are things on both sides of that scale. Experiences of both bad things or good things. Our genes shape where the fulcrum is positioned at the start. There are certain genes that make a child more sensitive to the effects of maltreatment. or parental neglect or witnessing violence. The fulcrum may start our kind of more towards one side or more towards the other side. and that’s going to make a big difference in terms of how much these subsequent events affect things positively or negatively. Science tells us that experiences move the fulcrum, for better or for worse. Even though we are born with genes, genes will respond differently to certain environmental situations as opposed to others. What the genes are actually doing are turning up or turning down the expression of chemicals and circuits in the brain and the circuitry in the entire body that govern our responses to stress, to anxiety, to depressive symptoms. When positive experiences accumulate, and children learn coping skills that help them to manage stress, the fulcrum can slide so the scale tilts toward positive outcomes more easily. That’s what resilience is all about. There is always an adult or more than one adult who is key to providing that relationship that helps to build resilience. Music softly fades Clearly – for children – key to building resilience is at least one supportive and engaged adult. But let’s not forget the significance of the environment surrounding that child. Did you notice how it influenced the fulcrum? The actual biology and genetic structure of the child is affected by the environment and the load of stressors in it. That level of stress has a great deal of influence over the individual’s ability to continue developing their own resilience. When we, at any age, experience toxic stress or the effects of trauma we too may find resilience building a more difficult task – it’s harder to bounce! but if the positive influences outweigh the negative, we can build resilient selves and communities. It is worth noting that the younger the resilience development the more powerful the effect is. That’s because the brain structure is much more m the brain structure is much more changeable in the younger phases of life and development. But even older kids, adults, and even elders can build resilience over time. Let’s take a moment to think about what you do to strengthen your own ability to survive, bounce and thrive in the face of adversity. How have you managed in the past? What do you do within your own environment strengthen your bounce? What do you do to build yourself up and get through the tough times? For each of us as individuals- building resilience can take practice. It includes knowing what helps build you up and keep you going when time become challenging. It might include being especially mindful of your own physical health needs: taking regular walks, eating well, staying hydrated with water, getting ample sleep. It might include maintain a daily spiritual or mindfulness practice such a prayer or meditation. It might include connecting with friends and supportive family. Maybe it means that you need to delegate tasks and ask for help. You might build your resilience by simply setting aside time that is for you alone or for you with others away from work stress – or on vacation. Perhaps it is more time with your animals or your interests that bring you joy or comfort Nurturing yourself, your connections and your interests all help to build your own resilience. By doing these things repeatedly, intentionally over time, you are building your own personal protective factors. And there are other protective factors that, when added to your own, build even more resilience. Those are factors like: a strong cultural identity, access to health care, stable housing, economic stability, social supports – meaning connections to supportive family and friends. an affiliation with a supportive religious or faith community and food security, which essentially means having enough to eat reliably over a sustainable length of time. At AHS, we know that families thrive when protective factors are robust in their lives and communities. So, when working with families, we use a protective factors framework called the Strengthening Families Approach. Research studies support the common-sense notion that when protective factors are well established in a family, the likelihood of child abuse and neglect diminishes. Research also shows that these protective factors are also called “promotive” factors. They build family strengths and a family environment that promotes ideal child and youth development. The 5 key protective factors included in the Strengthening Families approach are: Parental resilience – it’s important that parents build their own resiliency and are supported in doing so – parents need time for self-care and positive connections. Social connections are key for parents and for children, A supportive teacher or coach or caring adult can make all the difference in a child’s ability to bounce through adversity. Families also need concrete support in times of need such as safe housing, warm clothing, or food We all know that parenting is challenging – but help with parenting skills and knowledge about and child development can help to strengthen a family’s resilience. Families are also strengthened when children have the supports needed to develop positive communication skills and manage their own emotions and reactions. Building the social and emotional competence of children helps them grow positive connections with their peers and family. Even with all of these protective factors, unfortunately, there are time when we realize that it is just too tough to bounce back. We all have those times. Often these times are when we are experiencing an unmanageable load of stress over a long period of time or when we’re experiencing the effects of a traumatic event or a series of traumatic events. So, let’s talk about the different types of stress that we experience, It is important to note that some stress can be positive When it presents a challenge that is relatively short term and easily overcome this is called positive stress – for example – a child’s first day of school, or perhaps and adults first day or work at a new and exciting job. There is also a level of stress called tolerable stress these may be negative experiences that are managed with the help of community or family, or other key supports – this might be something like the death of a family member or surviving a natural disaster. As long as all the supports are in place And then there is another level of less manageable stress we refer to as “toxic stress”. Toxic stress is stress that is caused by serious adversity, faced repeatedly, over long periods of time and without the necessary supports to navigate the challenges. Toxic Stress can have deep and lasting effects on one’s over all well-being and health When a person experiences this kind of stress, it can be difficult to manage everyday tasks because of the biological response that is occurring. Note that any of us, whatever age, in whatever situation, can experience any of these levels of stress at any time. It is important when we are working with families who face repeated stress over potentially long periods of time that we understand what it is and how that type of stress effects our biology and functioning. This next 2-minute video illustrates what toxic stress might feel like to a school age child and how it could affect his or her development and behavior. I noted that when I watched this video the first time, my heart rate increased a bit. So, it is possible that this video will stir up your pulse rate when you watch it. Please be sure to take care of yourself as you need to, breathe or pause if you wish tense music The reality is that we all need a certain amount of stress, a certain a mount of anxiety to perform well. If we don’t care about that exam that we’re going to have tomorrow, we’ll probably fail. If we’re gonna cross the street and a truck is coming at us, we have release of adrenaline. We have a hormone that we call cortisol We want to jump out of there and adrenaline and cortisol are gonna help us do that. So there is that good amount of stress, but if all day long you are feeling like a truck is coming at you, day after day after day That’s going to take a toll on the body And the Amygdala obviously here has greater activation We were able to image children that had experienced trauma and compare those brain images with children that didn’t have an experience of trauma and didn’t have symptoms. Researcher: “Right, an exaggerated fear response.” With decreased activation in areas that we need to control that emotion in the frontal areas Exposure to early adversity and trauma, literally affects the structure and function of the children’s developing brains. Truck horn honks and tires screech So the kid next to them hits them, or the teacher reprimands them in a way that they’re uncomfortable with, right? Literally what they’re feeling that activation is like there was a truck coming at them. tense music You can give something that will mask symptoms, right. For example, if someone has a cough, you can give them a really strong cough serum that will suppress their cough, but if it’s because they have Tuberculosis or lung cancer, then what you’re doing is merely masking the symptoms while the disease process continues to fester We know what’s happening in children’s brains and bodies with the experience of toxic stress So the question now is, what do we do about it? So, some of what you have just seen in the video are what we sometimes refer to as ACEs or adverse child experiences these are experiences that can have negative, lasting effects on health and well-being. These experiences can include things like physical and emotional abuse, neglect, parent or caregiver mental illness, household violence or community violence, or poverty. Some ACES are also called AFEs or Adverse Family Experiences. In Vermont, we have learned that one of every seven adults have survived 4 or more adverse experiences in their childhood. In addition, one of every 8 Vermont children has experienced more than three adverse family experiences It is worth noting that since the AFEs survey includes children all the way from birth through age 17 a large number of children represented in the survey are young and so they are at risk of experiencing more adversities before their 18th birthday. The data suggests that by the time these children become adults, it is likely that their ACE scores will be similar or higher than the current generation of adults. So, what can we do about this? Well, we first need to gain a clear understanding of adversity and its effects. Adversity can come from stress, like the toxic stress we have already discussed, or it can come from an experience of trauma. So, it’s important to ask ourselves, “what is trauma?” If you recall, the video we watched on toxic stress included the word “trauma” when referring to the effects experienced by the child. Well, what do we mean when we use that word? Take a moment to write down or just consider what you think of when you hear the word “trauma”. What does trauma mean to you? Since the word “trauma” can be an overused term these days It is helpful for us, at the Agency of Human Services, to be clear about our understanding of this word. When most of us hear the word “trauma” we think of an event that caused a physical injury, like a broken bone. But trauma can also be the result of a psychological injury. “Psychological trauma” refers to extreme stress (such as toxic stress) that overwhelms an individual’s ability to cope. Individual trauma results from an event, or series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening. These events and circumstances may include the actual event or they may include the extreme threat of physical or psychological harm So it might be experiencing an actual natural disaster, or it might be experiencing the extreme threat of violence. It could also include severe, life-threatening neglect of a child that puts the child’s health in danger. Traumatic events can occur once in a person’s lifetime or repeatedly over time. The individual’s experience of these events or circumstances helps to determine whether it is a traumatic event. We know that Some people experience the same traumatic event differently and therefore that event will have a different effect for one person than another. Never the less, trauma can have lasting, negative effects on a person’s functioning. These can be effects on physical or mental health or social, emotional or spiritual well-being. So, let’s talk more about the experience of trauma, Traumatic events by their very nature set up a power differential where one entity whether it’s a person, an event, or a force of nature like a tornado, has power over another. A sense of powerlessness frequently underpins the experience of trauma. In addition to a sense of powerlessness – the experience is influenced by numerous other conditions such as – the type of event itself, its relationship to cultural oppression such as sexism, racism, homophobia, or ableism, the availability of supports, or the developmental stage of the individual. We know that the experience of events are processed differently at age 5, 15, or 50. And of course, the experience is also influenced by the circumstances surrounding the event. And depending upon what happened, feelings of fear or avoidance, can lead to deep seated emotions such as humiliation, or guilt, or shame. Some events also lead to further isolation and silencing For example: When a person experiences physical or sexual abuse, the victim may feel humiliated, they may feel shame and guilt, as though they were somehow responsible. In cases of war or natural disasters, those who survived the traumatic event may blame themselves for surviving when others did not. Children abused by a parent or caregiver may feel betrayed, their sense of trust may be shattered, leaving them feeling alone and isolated. Often, abuse of children and domestic violence are also accompanied by threats that lead to silencing and fear of reaching out for help. Traumatic events can be motivated by prejudice, racism, sexism and ableism Cultural and racial bias support conditions that create adversity in the lives of people of color, people who identify as lesbian, gay, bisexual or transgender, people with disabilities, and women. Thus, these individuals are more likely to experience toxic stress and trauma at higher rates than the others. As stated previously, the long-lasting adverse effects of the event of trauma are a critical component of trauma. So, let’s take a moment to talk further about the effects of trauma. Negative effects from trauma can eventually wear a person down, physically, mentally, and emotionally. These adverse effects may occur immediately or may have a delayed onset. The effects may be short term and easily treated or they may be longer term and take years or decades to manage or heal. In some cases, the individual may not even recognize the connection between the traumatic events and the effects they are experiencing. Biological effects from trauma may range from what we call hyper-vigilance or a constant state of arousal to numbing and avoidance. The brain function and response may be affected, making it difficult to manage cognitive processes such as memory, attention and thinking; It makes it difficult to to regulate behavior; or to control the expression of emotions. In addition to these more visible effects, there may be an altering of one’s neurobiological make-up and on-going health and well-being. Survivors of trauma have also highlighted the impact of these events on spiritual beliefs and the capacity to make meaning of these experiences. In truth, trauma can have multiple effects and some of them can be very difficult to overcome. The Agency of Human Services is committed to being a trauma-informed and trauma-responsive organization. By this we mean that we continually educate ourselves so that we realize the widespread impact of trauma and understand the potential paths to recovery We work to recognize the signs and symptoms of trauma in clients’ families, but also in staff and in others involved in the system of care. It means that we will be able to respond by making sure that this knowledge is integrated in our policies, our procedures and our practices – in writing on paper, and in our actions and communications. And in all we do we work to resist re-traumatization this means that if something we are doing reactivates that toxic stress response in either a client or a staff person with whom we are working, we will look for ways to decrease that effect or eliminate it entirely when possible. At AHS all of our services and supports must be trauma-informed and the details of our commitment to this can be found in our “Trauma Informed Services Policy”. (Link in Description) If you would like to take a look at this policy, you might want to click on this link (in description) and take a few moments to look it over. It includes a number of key terms and concepts that may help you understand the details of our commitment here at AHS. One key detail in our policy is the concept of a Universal Precautions Approach. You might have already asked yourselves: “Well how do we know who has experienced trauma – so that we can treat them in this specific way?” Well, at AHS we use a “universal precautions approach” to trauma. The term “universal precautions” is used in medical settings to describe the need to assume all individuals seeking services may have been exposed to negative conditions. In trauma informed care, “universal precautions” means assuming that all individuals presenting for services may have experienced trauma and may have symptoms from this exposure that are not immediately obvious. Some individuals may not be comfortable to disclose or able to recall their trauma. The high prevalence of trauma exposure in the general population and especially those served by AHS tells us that a universal precautions approach is the best way to ensure that we are meeting the needs of everyone who walk through our doors. As a trauma-informed agency, AHS adheres to key principles rather than a prescribed set of practices or procedures. These principles are easily remembered by using the acronym: RICH which stands for Respect, Information, Connection, and Hope These are the principles of empowering and collaborative relationships. In addition, at AHS we promote the link between recovery and resilience for those individuals and families that are impacted by trauma. We would never want to leave someone we work with without a sense of hope and support. The promise of resilience exists in every person with whom we work and Individual opportunities for building resilience is a major focus in supporting recovery for individuals with a history of trauma. At AHS we strive to create a workplace that values and supports self-care – which is a key component to building resilience in our staff. Resilient staff will in turn be better able to deliver trauma-informed services. We have talked throughout this training about ways in which we build our own resilience and ways in which we can help others build theirs. It is critical that we practice our own self-care and that we support the self-care of those around us. It is also vital that we model self-care for those we supervise, and those with whom we work. In short, a resilient staff will be equipped to build a resilient Vermont. And now in closing: lets view this short video – this video illustrates well the kind of understanding we are building here at AHS and across the state of Vermont with regard to the effects of childhood adversity and toxic stress -and the path to resilience. This video is focused primarily on the functions of the brain and healthy brain development. But while it is focused primarily on the biological effects on the developing brain, you may note the emphasis on building resilience in individuals and communities. Notice the video never uses the words trauma or resilience, but all of those concepts are embedded here. Happy music plays Science tells us that the experiences we have in the first years of our lives actually affect the physical architecture of the developing brain This means that brains aren’t just born, they’re also built over time based on our experiences. Just as a house needs a sturdy foundation to support the walls and roof, a brain needs base to support all future development. Positive interactions between young children and their caregivers, literally build the architecture of the developing brain. Building a sturdy foundation in the earliest years provides a good based for a lifetime of good mental function and better overall health. So just how is a solid brain foundation built and maintained in a developing child? One way is through what brain experts call serve and return interactions. Imagine a tennis match between a caregiver and a child, but instead of hitting a ball back and forth across a net various forms of communication pass between the two from eye contact to touch, from singing to simple games like peekaboo. These interactions repeated throughout a young person’s developing years are the bricks that build a healthy foundation for all future development, but another kind of childhood experience shapes brain development too. and that’s stress Good kinds of stress like meeting new people or studying for a test are healthy for development because they prepare kids to cope with future challenges Another kind of stress, called Toxic Stress, is bad for brain development If a child is exposed to serious ongoing hardships like abuse and neglect and he has no other caregiver in his life to provide support. The basic structure of his developing brain may be damaged. Without a sturdy foundation to properly support future development he is at risk for a lifetime of health problems, development issues, even addiction. It’s possible to fix some of the damage of toxic stress later on but it’s easier, more effective and less expensive to build solid brain architecture in the first place One of the things that sturdy brain architecture supports is the development of basic emotional and social skills An important group of skills which scientists call executive function and self regulation can be though of like air traffic control in the child’s mental airspace. Think of a young child’s brain as the control tower at a busy airport All those planes landing and taking off and all of the support systems on the ground simultaneously demand the controller’s attention to avoid a crash. It’s the same with a young child learning to pay attention, plan ahead and remember and follow lots rules. Like all of us, kids have to react to things happening in the world around them while also dealing with worries, temptations and obligations on their minds. As these demands for attention pile up air traffic control helps a child regulate the flow of information, prioritize tasks, and above all find ways to manage stress and avoid mental collisions along the way having this ability is a necessity for positive and level mental health. Developing effective air traffic control, overcoming toxic stress and building solid brain architecture, are things kids can’t do on their own. And since strong societies are made up of healthy contributing individuals, it’s up to us as a community to make sure all have the kinds of nurturing experiences they need for positive development To build better futures we need to build better brains Calming music plays So the video says it well To build better futures we need to build our resilience by caring for ourselves, for others and for our communities, and our colleagues here at AHS and those Vermonters who walk through our doors And now that we have a shared understanding of trauma and toxic stress, its effects and our pathway to hope and healing we can do just that! So let’s get started!!

Stephen Childs

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