agenda Simple Storage Service (S3)
7/21/2009
ADDRESSING THE IMPACT OF CHILDHOOD TRAUMA ON BRAIN DEVELOPMENT THROUGH A
AGENDA Introductions
TRAINING AND POLICY INITIATIVE
The Science
Leslie Lieberman, MSW Health l h Federation d off Philadelphia hl d l h
Multiplying Connections
[email protected] http://www.multiplyingconnections.org
DHS Implementation
Khary Atif, MSS, MLSP City of Philadelphia Department of Human Services
Conclusions
[email protected] http://www.dhs.phila.gov
PSYCHOLOGICAL TRAUMA ■
Trauma is not an event itself; it is a response to a stressful experience in which a person’s ability to cope is dramatically undermined.
TRAUMA INFORMED SERVICES
■
Trauma-informed services are not designed to treat symptoms or syndromes related to violence, abuse and trauma.
■
Trauma-informed services are designed to deliver health, child welfare, juvenile justice, mental health, education, etc… in a way that acknowledges the role that violence and abuse play in the lives of many children and families.
Massachusetts Advocates for Children, Children 2005 ■
Traumatic events “overwhelm the ordinary human adaptations to life . . . . They confront human beings with the extremities of helplessness and terror.” ■
Herman, 1997, p.33
Harris and Fallot, 2001
1
7/21/2009
COMMUNITY MEETING
SELF Safety
What is your name? How are you feeling today?
Future
What is your goal for the day? One success you’ve had in the last 7 days?
Emotions Loss
Sanctuary Model®
Sanctuary Model ® 2008
IMPACT OF TRAUMA ■
First Impressions: Exposure to Violence and a Child’s Developing Brain
■
California Attorney General’s Office, 2008 www.safestate.org f
2
7/21/2009
3
7/21/2009
Childhood Trauma
The Brain on Trauma
The Brain on Trauma Unremitting Stress
Lower part of brain over-wired at expense pp parts p of upper Excessive stress hormones dumped into brain Challenging behaviors associated with lower brain functions
Stressed Brain
Calm Brain
(Tennant 2007)
ACE STUDY Recurrent & severe physical abuse
11%
Recurrent & severe emotional abuse
11%
Contact sexual abuse
22% 25%
Member being imprisoned
3%
Mentally ill, chronically depressed, or institutionalized member
19%
The mother being treated violently
12%
Both biological parents NOT present
14
ACE STUDY | Scoring
system used – one point for each category of ACE before 18
| ACE’s
Growing up in a household with: Alcoholic or drug-user g
Ongoing social, emotional, cognitive difficulties
13
not only common, but effects were cumulative
| Compared
to persons with ACE score of 0, those with ACE score of 4 or more were 2 times more likely to be smokers, 12 times more likely to have attempted suicide, 2 times more likely to be alcoholic and 10 times more likely to have injected street drugs.
22%
(Felitti, 2003) Origins of Addiction
4
7/21/2009
Death
Early Death
Disease, Disability Adoption of Health-risk Behaviors
Social, Emotional, & Cognitive Impairment Birth
Adverse Childhood Experiences The Influence of Adverse Childhood Experiences Throughout Life ACE’s Major Determinant of Health & Well Being (Felitti, 2003)
FOCUS
Zero to Five
STRATEGY
Prevention
Public Service System
BUILD CAPACITY
5
7/21/2009
KEY ACTIVITIES
HOW AND WHO Steering Committee
Professional Development
Policies/ Protocols
Evaluation
Practice Leaders
CSTI
Consultants Advisors
PRODUCTS AND OUTCOMES
THE PHILA DHS EXPERIENCE: THE PLANETS ALIGNED Series of events featuring Bruce Perry, MD
Core Competencies Cross System Foundational Course Website Provider and Caregiver Materials
Readings on neurobiology and social work added to curriculum Partnered with ISF to focus on domestic violence and child trauma Came to “Creating Sanctuary” State revising mandatory training
New administrator with interest and clinical skills
Sanctuary Model®
6
7/21/2009
FOSTER CHANGE BY USING SPHERE OF INFLUENCE Develop a • Review and revise existing OJT consistent curriculum message in training materials • Revamp OJT process
Involve State
• Served as pilot site for new core curriculum
Leverage funds to promote training of DHS contractors
• Involvement of contract agencies in CSTI • Sponsored conferences • Directed contract training agencies to develop new courses on trauma • Directed contract agencies to infuse trauma informed material in existing course
THE DHS EXPERIENCE - CHALLENGES
Crisis orientation
Size
FOSTER CHANGE BY USING SPHERE OF INFLUENCE (CONT.) Involve Juvenile Justice System
• Trauma expert as keynote an national JJTA conference • Trauma workshop • New staff training
Build Trauma Informed New Staff Cohorts
• Reading groups • Incorporate TI strategies in group process • Develop shared TI language
Strengthen relationships with partner organizations
• Ongoing formal and informal meetings with MC • Continue to leverage funds with contract agencies
THE DHS EXPERIENCE – MOVING FORWARD
Case management focus
Practice S f t M d l Safety Model
What has Happened to You
Policy review
Lack of interest in neuroscience
Time
Staff
Sanctuary Model
7
7/21/2009
RESOURCES
ON THE
WEB
RESOURCES
ON THE
WEB
Trauma
Trauma
The Trauma Center at Justice Resource Institute, www.traumacenter.org/
Sidran Foundation for Traumatic Stress - www.sidran.org PTSD Alliance - www.ptsdalliance.org
30
29
Bruce Perry, MD, Child Trauma Academy, www.childtrauma.org
Adverse Childhood Experience p Study, y, www.acestudy.org y g
David Baldwin’s Trauma Pages - www.trauma-pages.com/
International Society of Traumatic Stress http://www.istss.org/
Anna Foundation - www.annafoundation.org/MDT.PDF Sandra L. Bloom, MD, Community Works www.sanctuaryweb.com
RESOURCES
ON THE
WEB
RESOURCES
Child Development The American Academy of Pediatrics - http://www.aap.org/
The National Institute of Child Health and Human Development - http://www.nichd.nih.gov/
WEB
National Center for Trauma Informed Care http://mentalhealth.samhsa.gov/nctic/
32
The National Black Child Development Institute http://www.ncbcdi.org/04/
31
The National Association for Childhood Development http://www.nacd.org/
ON THE
Trauma Informed Care Multiplying Connections Initiative http://multiplyingconnections.org
Community Connections – Roger Fallot, PhD http://www.communityconnectionsdc.org Community Works – Sandra Bloom, MD http://www.sanctuaryweb.com/
Zero to Three - http://www.zerotothree.org National Child Traumatic Stress Network http://www.nctsnet.org
8
ADDRESSING THE IMPACT OF CHILDHOOD TRAUMA ON BRAIN DEVELOPMENT THROUGH A
AGENDA Introductions
TRAINING AND POLICY INITIATIVE
The Science
Leslie Lieberman, MSW Health l h Federation d off Philadelphia hl d l h
Multiplying Connections
[email protected] http://www.multiplyingconnections.org
DHS Implementation
Khary Atif, MSS, MLSP City of Philadelphia Department of Human Services
Conclusions
[email protected] http://www.dhs.phila.gov
PSYCHOLOGICAL TRAUMA ■
Trauma is not an event itself; it is a response to a stressful experience in which a person’s ability to cope is dramatically undermined.
TRAUMA INFORMED SERVICES
■
Trauma-informed services are not designed to treat symptoms or syndromes related to violence, abuse and trauma.
■
Trauma-informed services are designed to deliver health, child welfare, juvenile justice, mental health, education, etc… in a way that acknowledges the role that violence and abuse play in the lives of many children and families.
Massachusetts Advocates for Children, Children 2005 ■
Traumatic events “overwhelm the ordinary human adaptations to life . . . . They confront human beings with the extremities of helplessness and terror.” ■
Herman, 1997, p.33
Harris and Fallot, 2001
1
7/21/2009
COMMUNITY MEETING
SELF Safety
What is your name? How are you feeling today?
Future
What is your goal for the day? One success you’ve had in the last 7 days?
Emotions Loss
Sanctuary Model®
Sanctuary Model ® 2008
IMPACT OF TRAUMA ■
First Impressions: Exposure to Violence and a Child’s Developing Brain
■
California Attorney General’s Office, 2008 www.safestate.org f
2
7/21/2009
3
7/21/2009
Childhood Trauma
The Brain on Trauma
The Brain on Trauma Unremitting Stress
Lower part of brain over-wired at expense pp parts p of upper Excessive stress hormones dumped into brain Challenging behaviors associated with lower brain functions
Stressed Brain
Calm Brain
(Tennant 2007)
ACE STUDY Recurrent & severe physical abuse
11%
Recurrent & severe emotional abuse
11%
Contact sexual abuse
22% 25%
Member being imprisoned
3%
Mentally ill, chronically depressed, or institutionalized member
19%
The mother being treated violently
12%
Both biological parents NOT present
14
ACE STUDY | Scoring
system used – one point for each category of ACE before 18
| ACE’s
Growing up in a household with: Alcoholic or drug-user g
Ongoing social, emotional, cognitive difficulties
13
not only common, but effects were cumulative
| Compared
to persons with ACE score of 0, those with ACE score of 4 or more were 2 times more likely to be smokers, 12 times more likely to have attempted suicide, 2 times more likely to be alcoholic and 10 times more likely to have injected street drugs.
22%
(Felitti, 2003) Origins of Addiction
4
7/21/2009
Death
Early Death
Disease, Disability Adoption of Health-risk Behaviors
Social, Emotional, & Cognitive Impairment Birth
Adverse Childhood Experiences The Influence of Adverse Childhood Experiences Throughout Life ACE’s Major Determinant of Health & Well Being (Felitti, 2003)
FOCUS
Zero to Five
STRATEGY
Prevention
Public Service System
BUILD CAPACITY
5
7/21/2009
KEY ACTIVITIES
HOW AND WHO Steering Committee
Professional Development
Policies/ Protocols
Evaluation
Practice Leaders
CSTI
Consultants Advisors
PRODUCTS AND OUTCOMES
THE PHILA DHS EXPERIENCE: THE PLANETS ALIGNED Series of events featuring Bruce Perry, MD
Core Competencies Cross System Foundational Course Website Provider and Caregiver Materials
Readings on neurobiology and social work added to curriculum Partnered with ISF to focus on domestic violence and child trauma Came to “Creating Sanctuary” State revising mandatory training
New administrator with interest and clinical skills
Sanctuary Model®
6
7/21/2009
FOSTER CHANGE BY USING SPHERE OF INFLUENCE Develop a • Review and revise existing OJT consistent curriculum message in training materials • Revamp OJT process
Involve State
• Served as pilot site for new core curriculum
Leverage funds to promote training of DHS contractors
• Involvement of contract agencies in CSTI • Sponsored conferences • Directed contract training agencies to develop new courses on trauma • Directed contract agencies to infuse trauma informed material in existing course
THE DHS EXPERIENCE - CHALLENGES
Crisis orientation
Size
FOSTER CHANGE BY USING SPHERE OF INFLUENCE (CONT.) Involve Juvenile Justice System
• Trauma expert as keynote an national JJTA conference • Trauma workshop • New staff training
Build Trauma Informed New Staff Cohorts
• Reading groups • Incorporate TI strategies in group process • Develop shared TI language
Strengthen relationships with partner organizations
• Ongoing formal and informal meetings with MC • Continue to leverage funds with contract agencies
THE DHS EXPERIENCE – MOVING FORWARD
Case management focus
Practice S f t M d l Safety Model
What has Happened to You
Policy review
Lack of interest in neuroscience
Time
Staff
Sanctuary Model
7
7/21/2009
RESOURCES
ON THE
WEB
RESOURCES
ON THE
WEB
Trauma
Trauma
The Trauma Center at Justice Resource Institute, www.traumacenter.org/
Sidran Foundation for Traumatic Stress - www.sidran.org PTSD Alliance - www.ptsdalliance.org
30
29
Bruce Perry, MD, Child Trauma Academy, www.childtrauma.org
Adverse Childhood Experience p Study, y, www.acestudy.org y g
David Baldwin’s Trauma Pages - www.trauma-pages.com/
International Society of Traumatic Stress http://www.istss.org/
Anna Foundation - www.annafoundation.org/MDT.PDF Sandra L. Bloom, MD, Community Works www.sanctuaryweb.com
RESOURCES
ON THE
WEB
RESOURCES
Child Development The American Academy of Pediatrics - http://www.aap.org/
The National Institute of Child Health and Human Development - http://www.nichd.nih.gov/
WEB
National Center for Trauma Informed Care http://mentalhealth.samhsa.gov/nctic/
32
The National Black Child Development Institute http://www.ncbcdi.org/04/
31
The National Association for Childhood Development http://www.nacd.org/
ON THE
Trauma Informed Care Multiplying Connections Initiative http://multiplyingconnections.org
Community Connections – Roger Fallot, PhD http://www.communityconnectionsdc.org Community Works – Sandra Bloom, MD http://www.sanctuaryweb.com/
Zero to Three - http://www.zerotothree.org National Child Traumatic Stress Network http://www.nctsnet.org
8
