INTRO TO TRAUMA INFORMED CARE IN ADAPTIVE SPORTS

CHRISTINE COWART

COWART TRAUMA INFORMED PARTNERSHIP

(732) 423-5709

WWW.COTIPUSA.COM

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TRAUMA INFORMED CARE

ADVERSE CHILDHOOD EXPERIENCES

ADVERSE CHILDHOOD EXPERIENCES (ACES)

In 1998, Kaiser Permanente released a study, based on the results of a

confidential survey of adult patients from their medical practice asking about

childhood maltreatment and family dysfunction, as well as items detailing their

current health status and behaviors. This information was combined with the

results of their physical examination to form the baseline data for the study.

The study resulted in the identification of Adverse Childhood Experiences.

ADVERSE CHILDHOOD EXPERIENCES (ACES)

Adverse Childhood Experiences are

potentially traumatic events that can

have negative, lasting effects on

health and well-being, which occur in

a person's life before the age of 18,

and may have lasting impact as an

adult.

WHY DO ACES MATTER?

WHY DO ACES MATTER?

Studies have shown that higher ACE scores are directly correlated to increased

health risks. According to the original study, as the number of ACES increases, so does

the risk of:

Alcoholism and alcohol abuse Chronic obstructive pulmonary disease Depression

Fetal death Health-related quality of life Illicit drug use

Ischemic heart disease Risk for intimate partner violence Liver Disease

Financial Stress Unintended pregnancies Poor work performance

Sexually transmitted diseases Early initiation of smoking Smoking

Suicide Attempt Early initiation of sexual activity Multiple sexual partners

Risk for sexual violence Poor academic achievement Adolescent pregnancy

WHY DO ACES MATTER?

• Data from the original ACE study showed that people with high ACE scores

are more likely to have more broken bones, drug prescriptions, auto-immune

diseases, and work absences

• People with six or more ACEs died nearly 20 years earlier on average than

those without ACEs.

• People with four or more ACEs were:

• 390% more likely to have COPD

• At a 240% greater risk of hepatitis or

sexually transmitted disease

• 7 times more likely to be an alcoholic

HOW PREVALENT ARE ACES?

ACE ScoreOriginal ACE Study

Prevalence (1998)

BRFSS Data

(2011-2014)

0 36% 39%

1 26% 24%

2 16% 13%

3 9% 9%

4 or more 12% 16%

Source: CDC ACE Study & Behavioral Risk Factor Surveillance System Data

BEYOND ACES

TRAUMA

According to the Substance Abuse and Mental Health Services Administration

(SAHMSA) individual trauma results from an event, series of events, or set of

circumstances experienced by an individual as physically or emotionally harmful

or life-threatening with lasting adverse effects on the individual’s functioning

and mental, physical, social, emotional, or spiritual well-being.

Toxic

Stress

STRESSTolerable

Stress

Positive

Stress

Comfort

Zone

TOXIC STRESS

Toxic stress is a term used to describe the kinds of experiences, particularly in

childhood, that can affect brain architecture and brain chemistry

• ACEs can be toxic stressors, if the adversity is not

buffered or counterbalanced with supportive

relationships and the types of experiences and

emotions that comprise resilience

• Possible causes can also include chronic health

issues or neglect and prolonged legal or

emotional battles

EFFECTS OF TRAUMA

EFFECTS OF TOXIC STRESS ON THE BRAIN

Traumatic stress can be associated with lasting changes in the brain

• Traumatic stress is associated with the release of increased levels of norepinephrine

and the “stress hormone” cortisol

• Stress results in acute and chronic changes in neurochemical systems and specific

brain regions, which result in long-term changes in brain “circuits,” involved in the

stress response

• Trauma can result in changes in how the amygdala and Prefrontal Cortex (PFC) work

EFFECTS OF TOXIC STRESS ON THE LIMBIC SYSTEM

When a person experiences stress, cortisol is released. Levels of cortisol can become too high in

a person experiencing toxic stress, resulting in:

• Increased blood sugar levels;

• Weight gain, resulting from false hunger signals;

• A suppressed immune system;

• Digestive problems; and

• Heart disease

EPIGENETICS AND EXPOSURE TO TOXIC STRESS

Epigenetics is the study of biological mechanisms that switch genes “on” and

“off.”

• Research indicates that exposure to traumatic events may result in changes to

genetic markers

• New evidence suggests these markers may be passed down from generation

to generation

HOW TRAUMA PRESENTS

TYPES OF TRAUMA SYMPTOMS

Cognitive

Behavioral

Physical

Psychological

SYMPTOMS OF TRAUMA

Nightmares or insomnia Mood swings, edginess, and agitation

Tremendous fatigue and exhaustion Tachycardia or racing heartbeat

Loss of memory and concentration Chronic muscle patterns or tension

Confusion and disorientation Aches and pains throughout body

Social isolation and withdrawal Avoidance of direct eye contact

SYMPTOMS OF TRAUMA

Intrusive thoughts of the event that may occur out of the blue

Easily startled; extreme alertness against danger

Avoidance of activities or places that trigger memories of the event

Lack of interest in previously-enjoyable activities

SYMPTOMS OF TRAUMA

Emotional numbing, feeling disconnected Obsessive and compulsive behaviors

Detachment from people and emotions Depression

Shame, self-blame Guilt (especially survivor’s guilt)

Anger Emotional shock, denial, or disbelief

Changes in eating patterns Anxiety, fear, or panic attacks

TRAUMA TRIGGERS

Activate the “survival brain,” causing the individual to react as though a

previous traumatic event is happening “here and now,” in the current reality.

Common triggers include:

• Unpredictability

• Sensory overload

• Feeling vulnerable or frustrated

• Confrontation

• Experiencing something that reminds the person, even at a subconscious level,

of traumatic things that have happened to them

TRAUMA INFORMED CARE: MEETING OUR CLIENTS WHERE THEY ARE

CHANGING OUR MINDSET

HOW DO YOU KNOW IF SOMEONE HAS EXPERIENCED TRAUMA?

Short of witnessing it or a

person telling you, there is no

way to know if a person has

experienced trauma. As a

result, we should always assume

each person we meet may have

trauma in their background.

CHANGING OUR MINDSET CHANGES OUR APPROACH

“What’s wrong with you?”

“What happened to

you?”

“What’s right with

you?”

RESILIENCE

Resilience is the ability to overcome serious hardship

ADAPTIVE SPORTS HAVE UNIQUE BENEFITS TO PEOPLE WHO HAVE EXPERIENCED TRAUMA

APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION

Use CLEAR communication:

• Calming voice and tone;

• Listen deeply;

• Explain the how and why of what you are doing;

• Ask engaging questions; and

• Reduce distractions

APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION

• Set up the space and session in a consistent way, so athletes know what to expect

• Check-in with athletes about how they are feeling, what’s happening in their bodies

and minds, and what to expect for the day

• Share the expectations of the day and work with athletes to identify and prepare

for potential moments of bad stress

• Be consistent in all your interactions and offer routine for athletes

APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION

• Focus in on one skill at a time

• Focus on progress rather than performance

• Build competence by recognizing small accomplishments and use that

momentum

• Encourage expression of emotions – both verbal and non-verbal

APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION

• Offer choices of what to do throughout the session

• Offer opportunities for athletes to opt out and opt back in to play

• Reframe challenging situations in a positive, hopeful light that highlights the

athlete’s strengths

• Engage athletes by inviting them for input

APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION

• Check in and debrief with the athlete by reviewing and asking “looking back”

questions

• Support good stress by reminding athletes how they are positively handling the

stress, encouraging them to stay in the game, and to pay attention to how they feel

• Stop bad stress by making athletes aware of their negative reactions, helping them

articulate their feelings under pressure, and encouraging them to take a break

APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION

• No matter what happens, maintain your composure and project a sense of calm –

athletes struggling to self-regulate will read and internalize your panic

• Offer a closing activity that is always a marker for the session ending and helps

athletes leave on a high note

• Provide routine around the transition at the end of the session

• Be available for informal time before and after practice – create opportunities for

informal connection

TRAUMA INFORMED PRACTICES DURING AN ADAPTIVE SPORTS LESSON

• Always ask before touching an athlete!

• Ask the athlete what they like to be called and possibly their preferred pronouns

• When reading an athlete’s file, take note of any indications of potential past trauma

• If a client is avoiding direct eye-contact, do not force it

• No matter what happens, maintain your composure and project a sense of calm –

participants struggling to self-regulate will read and internalize your panic

THINGS NOT TO SAY TO SOMEONE WITH ANXIETY

• “It’s going to be okay. Trust me.”

• “There’s nothing to be scared of.”

• “Let me tell you all the reasons you don’t have to worry.”

• “Stop being such a worrier.”

• “I don’t understand why you’re so worried.”

THINGS TO TRY WHEN TALKING WITH SOMEONE EXPERIENCING ANXIETY

We’re on the same team. I will help you.

I can see this is hard for you.

I understand you’re overwhelmed and

that’s okay.

That was really sad/ frustrating/

disappointing.

Let’s take a break. You are safe.Would you like help/ a break/to try again?

I remember when you….

Let’s come up with a solution together.

Tell me more about that.

I can hear you are upset but I don’t know what you need. Can

you help me understand?

Maintain silence and hold space for the

person

COUNTDOWN TECHNIQUE FOR ANXIETY

5 • Things You Can SEE

4 • Things You Can FEEL

3 • Things You Can HEAR

2 • Things You Can SMELL

1 • Thing You Can TASTE

Look around and notice

ACTIVITIES THAT CAN HELP REGULATION

Listen to the sounds around

youCount to 10

Touch something (in nature/ furniture)

Push against a wall

Notice your surroundings

Go for a walk

Drink a glass of water

Feel the temperature

Focus your attention on

something you see

DE-ESCALATION TECHNIQUES

If you notice an athlete is experiencing distress:

• Try to connect with the athlete – this is when we fall back on that personal

connection we built

• Get the athlete to a place/position that feels safe to the athlete as quickly as

possible – this is not the time to try to reason with the athlete

• Redirect the athlete's behavior or focus by providing reasonable options for

alternative activities

After the athlete is calm, you can try to discuss what happened and why

REGULATE → RELATE → REASON

THINGS TO KEEP IN MIND WHEN WORKING WITH CHILDREN

Kids who have experienced trauma:

• Aren’t trying to push your buttons

• Worry about what’s going to happen next

• Need to feel they’re good at something and can influence the world

• Can really struggle with self-regulation

THINGS TO REMEMBER

• Words may not always sink in – use visual cues

• Even if the situation doesn’t seem that bad to you, it’s how the athlete feels

that matters

• There’s a direct connection between stress and learning

• It’s okay to ask athletes directly what you can do to help them make it through

the session

ONE CARING ADULT

- Josh Shipp

“Every kid is one caring adult away from being a success story”

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