joshua arvidson, mss., lcsw...joshua arvidson, mss., lcsw director, alaska child trauma center at...
TRANSCRIPT
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 1
The Neuroscience of Traumatic Stress in Early Childhood: implications for
intervention and systems
Joshua Arvidson, MSS., LCSWDirector, Alaska Child Trauma Center at ACMHS
Director, Child and Family Services at ACMHS
Regional Site Director, Complex Trauma Treatment Network
Steering Committee, National Child Traumatic Stress Network
Editorial Review Board, Journal of Child and Adolescent Trauma
7/31/2018
LOS ANGELES
Category I - National Center
MA
CT
NY
PA
NM
UT CO MO
OH
VA
Category II – Intervention, Development, and Evaluation CentersCategory III – Community Treatment and Service Centers
ME
FL
AL
CA
OR
WA
ILDC
NCDURHAMOK
MT
ID WIMI
SC
NJMD
TX
TN
GA
LA
MS
NYC
FY01-02 – Member Centers
SAN DIEGO
SAN FRANCISCO
AZ
SD
AK
WV
PORTLAND
EUGENE
JERSEY CITY
DE
MN
NH
2
National Child Traumatic Stress Network (NCTSN) Sites
Arvidson, 2017
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 2
National Coordination & Training Center, The Trauma Center at Justice Resource Institute (CTTN Director: Joseph Spinazzola; Co‐Director: Bessel van der Kolk; Project Coordinator, Hillary Hogden.Lead Trainers: Margaret Blaustein & Kristine Kinniburgh
Midwest Regional Training & Technical Assistance Center, La Rabida Children’s Hospital (Co‐Director: Bradley Stolbach)
Southern Regional Training & Technical Assistance Center, DePelchin Children’s Center (Co‐Director: Robert Hartman)
Northeast Regional Training & Technical Assistance Center, University of Connecticut (Co‐Director: Julian Ford)
Evaluation Center, Washington State University at Spokane (Evaluation PI: Christopher Blodgett, Natalie Turner.)
Training Faculty: Mandy Habib, Robert Abramovitz, Monique Marrow, Ibis Carrion Gonzales, Rocio Chang, Laurel Kiser, Danielle Ferrier.
Pacific Northwest Regional Training & Technical Assistance Center, Alaska Child Trauma Center(Co‐Director: Joshua Arvidson)
Complex Trauma‐Informed (CTI) Systems of Care Initiatives•Core Concepts•Trainer Training
•CTI Strategic Planning•CTI Organizational Evaluation
•Screening & Detection•EBP Adoption & Dissemination (TARGET, ARC and
SPARCS)•Contextual Adaptation of Assessment & Treatment Materials
& Resources•Sustainability Planning
Complex Trauma Treatment Network (CTTN)
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 3
Physiology of Trauma
Arvidson, 2011
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 4
Arvidson, 2011
Arvidson, 2011
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 5
Area of Scientific Advancement Physiology of the Human Stress Response
THREAT
• Activation of Threat Appraisal and Response System
• Increased Limbic System Activity
• Alarm system “flood”
• Activation of Threat Appraisal and Response System
• Increased Limbic System Activity
• Alarm system “flood”
SURVIVAL
RESPONSE
• Fight, Flight or Freeze
• Survival Oriented Behavior
• Fight, Flight or Freeze
• Survival Oriented Behavior
POST‐STRESSOR
• Continued Arousal
• Difficulty Modulating
• Continued Arousal
• Difficulty Modulating
• Physiological Changes in Brain Structure and Function, Decreased Volume of Amygdala and Hippocampus, Prioritization of Stress Pathways
Adaptation of Brain Processes and Structure
• Significant challenges to Regulatory Capacity, Dysregulation, State and Trait Characteristics.
Chronic Exposure to
Stress Hormones
• Hypervigilance, Hyper and Hypo Arousal, Survival (as opposed to developmental) based orientation. Trauma turns a learning brain into a surviving brain.
Physiological Adaptations
Arvidson, 2013
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 6
Attachment allows children to safely explore the world and provides a healthy model for self and others.
Attachment is the dance of the limbic systems of the child and parent.
‐ Allan Schore
Contextualizing Trauma within the Attachment System
Internal Representational Models
Bowlby model delineates formation of Internal Representational Models:
– Model of SELF• e.g., “I am worthy or competent”; “I am unworthy or incompetent”
– Model of OTHER• e.g., “Others are reliable or trustworthy”; “Others are unreliable or untrustworthy”
– Model of SELF IN RELATION TO OTHER• e.g., “Others will respond to my needs”; “Others will not respond to my needs”
These models form the basis (“working models”)for future relationships.
Blaustein, 2005
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 7
Areas Impacted by Complex Trauma
Physiology and brain
development
Tolerate, control and express emotions and sensations
Control impulses and concentrate
Form healthy attachments and social
relationships
Safely negotiate conflict and differentiate
safe from unsafe
Learn and engage in goal‐
directed behavior
Form a positive and cohesive sense of self
Arvidson et al, 2011, Cook et al, 2005, Kisiel et all, 2009 and Spinazzola et al, 2005
0 20 40 60 80 100
Kidnap
School Violence
Forced Dispalcement
Natural Disaster
Serious Injury/Accident
Extreme Interpersonal Violence
Illness/Medical
Community Violence
Physical Assault
Other Trauma
Sexual Assault
Sexual Maltreatment/Abuse
Physical Maltreatment/Abuse
Emotional Abuse/Psychological Maltreatment
Domestic Violence
Traumatic Loss/Bereavement
Imparied Caregiver
Neglect
Children Served at the Alaska Child Trauma Center, 2005‐2011Types of Trauma Experienced
Yes
Suspected
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 8
Trauma:
Alarm system activates
Dysregulation generalizes
Confirmation that world and experience is overwhelming
Internalization of
overwhelming experience (There is something
wrong with me)
Behavioral adaptation
increases risk for re‐exposure
The Reproductive Cycle of Trauma: How Trauma Perpetuates Itself
Arvidson, 2016
The fundamental problem of chronic exposure to traumatic experiences in childhood is that overwhelming stress turns a learning brain into a surviving brain.
But, the brain and the physiological impact of trauma, is only the beginning of the story. Development is the context in which the impact of childhood trauma is fully realized…
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 9
…The developmental necessities of childhood: formation of healthy attachments and social development, attentional capacity and cognitive development, mastery, competency, and regulation, (the ability to control one’s body, emotions and behaviors) are compromised by chronic exposure to overwhelming stress…
…Childhood trauma can be understood, fundamentally as developmental derailment. Thus, trauma‐informed care for children is about helping the child and parent “put the train of healthy development back on the tracks.”
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 10
…Trauma‐informed care is about helping children and families chart new developmental trajectories that promote healthy development, build resiliency and restore functioning.
‐ J. Arvidson
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 11
Study Conditions: Complex Trauma Treatment using ARC Framework at a clinic serving predominantly child welfare involved clients.
Attachment/
Caregiving System
Self‐Regulation
Competencies
Competency
Regulation
Attachment
Engagement
Trauma Experience Integration
Routines & Rituals
Executive Functions
Self‐Development & Identity
Psychoeducation
Caregiver Affect
Management
Effective Response
Attunement
Identification
Relational Connection
Modulation
Graphic by Jeremy Karpen; Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
ARC Framework
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 12
86
49
0
10
20
30
40
50
60
70
80
90
100
Baseline CBCL End of Trx (1‐yearaverage)
Alaska Child Trauma Center Child Trauma Clinical Outcomes Study
CBCL Score Changes with 1 – year Complex Trauma Treatment (Percentile)
Treatment Complete
CBCL (T‐Scores) at Completion of Treatment
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 13
Econometrics of Early Intervention & Prevention• Funding early
interventions provides the largest possible return on investment
Doyle et al. (2009) Investing in Early Human Development. In: Economics and Human Biology v7:pp1-6
From, M. Hirschfeld AAPP
Public Investment in Children by Age
From, M. Hirschfeld, AAPP
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 14
27
Source: 2013-2015 Alaska BRFSS, Section of Chronic Disease Prevention and Health Promotion, Alaska Division of Public Health, Graphic by Alaska Mental Health Board Staff
Population Attributable Fraction
28
Source: Child and Adolescent Health Management Initiative (2012). “2011‐2012 National Survey of Children’s Health (2012), U.S. Department of Health and Human Services, Health Resources and Services Administration. Graphics and analysis done by the Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse Staff
Population Attributable Fraction
ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 15