Module 2 – developing and implementing strategies for working with young children with - PowerPoint Presentation

1. Module 2 – developing and implementing strategies for working with young children with trauma

2. Module contentThe impact of trauma on young childrenEstablishing safe, secure environments for young children with traumaDeveloping strategies for working with young children with trauma

3. Trauma and young childrenUp to one-in-four children experience traumatic events in their childhoodSome children experience a number of traumas and the effect may be cumulative making these children more vulnerable to stress reactions such as difficulty in concentrating, loss of social skills, poor academic outcomes Source: Australian Child and Adolescent Trauma, Loss and Grief Network, 2010, How children and young people experience and react to traumatic events, ANU College of Medicine, Biology and Environment.

4. Types of behaviours 0-12 monthsIncreased tension, irritability, reactivity and inability to relaxIncreased startle responseLack of eye contactSleep and eating disruptionLoss of eating skills

5. Types of behaviours 0-12 months (cont.)Loss of acquired motor skillsAvoidance of eye contactArching back/inability to be soothedUncharacteristic aggressionAvoids touching new surfaces e.g. grass, sand, other tactile experiences

6. Types of behaviours 0-12 months (cont.)Avoids, or is alarmed by, trauma related reminders, e.g. sights, sounds, smells, tastes, textures and physical triggersFight, flight, freeze responseUncharacteristic, inconsolable or rageful crying and needinessWithdrawal/lack of usual responsiveness

7. Types of behaviours 0-12 months (cont.)Limp, displays no interestUnusually high anxiety when separated from primary caregiversHeightened indiscriminate attachment behaviourReduced capacity to feel emotions – can appear numb

8. Types of behaviours 0-12 months (cont.)Loss of acquired language skillsGenital pain: including signs of inflammation, bruising, bleeding or diagnosis of sexually transmitted disease

9. Types of behaviours 12mths-3yrsBehavioural changes, regression to behaviour of a younger childIncreased tension, irritability, reactivity and inability to relaxIncreased startle responseSleep and eating disruptionLoss of eating skills

10. Types of behaviours 12mths-3yrs (cont.)Loss of recently acquired motor skillsAvoidance of eye contactInability to be soothedUncharacteristic aggressionAvoids touching new surfaces e.g. grass, sand and other tactile experiences

11. Types of behaviours 12mths-3yrs (cont.)Avoids, or is alarmed by, trauma related reminders e.g. sights, sounds, smells, textures, tastes and physical triggersFight, flight, freeze responseUncharacteristic, inconsolable, or rageful crying and needinessFussiness, separation fears and clinginess

12. Types of behaviours 12mths-3yrs (cont.)Withdrawal/lack of usual responsivenessLoss of self-confidenceUnusually anxious when separated from primary caregiversHeightened indiscriminate attachment behaviourReduced capacity to feel emotions − can appear numb, apathetic or limp

13. Types of behaviours 12mths-3yrs (cont.)Loss of acquired language skillsInappropriate sexualised behaviour/touchingSexualised play with toysGenital pain, inflammation, bruising, bleeding or diagnosis of sexually transmitted disease

14. Types of behaviours 3-5yrsBehaviour changeIncreased tension, irritability, reactivity and inability to relaxRegression to behaviour of younger childUncharacteristic aggressionReduced eye contact

15. Types of behaviours 3-5yrs (cont.)Loss of focus, lack of concentration and inattentivenessComplains of bodily aches, pains or illness with no explanationLoss of recently acquired skills (toileting, eating, self-care)Enuresis, encopresis

16. Types of behaviours 3-5yrs (cont.)Sleep disturbances, nightmares, night terrors, sleepwalkingFearfulness of going to sleep and being alone at nightInability to seek comfort or to be comfortedMood and personality changes

17. Types of behaviours 3-5yrs (cont.)Obvious anxiety and fearfulnessWithdrawal and quietingSpecific trauma-related fears, general fearfulnessIntense repetitive playInvolvement of playmates in trauma-related play

18. Types of behaviours 3-5yrs (cont.)Separation anxiety with parents/othersLoss of self-esteem and self-confidenceReduced capacity to feel emotions − may appear numb, limp, apatheticRepeated retelling of traumatic eventLoss of recently acquired language and vocabulary

19. Types of behaviours 3-5yrs (cont.)Loss of interest in activitiesLoss of energy and concentration at schoolSudden intense masturbationDemonstration of adult sexual knowledge through inappropriate sexualised behaviourSexualised play with toys

20. Types of behaviours 3-5yrs (cont.)Genital pain, inflammation, bruising, bleeding or diagnosis of sexually transmitted diseaseMay verbally describe sexual abuse, pointing to body parts and telling about the ‘game’ they playedSexualised drawing

21. Types of behaviours 5-8yrs (cont.)Changes in behaviourHyperarousal, hypervigilance, hyperactivityRegression in recently acquired developmental gainsSleep disturbances due to intrusive imageryEnuresis and encopresis

22. Types of behaviours 5-8yrs (cont.)Trauma drive, acting out risk-taking behaviourEating disturbancesLoss of concentration and memoryFlight into driven activity or retreat from others to manage inner turmoilPost-traumatic re-enactments of traumatic event that may occur secretly and involve siblings or playmates

23. Types of behaviours 5-8yrsLoss of interest in previously pleasurable activitiesFear of trauma occurringMood or personality changeLoss of, or reduced capacity to manage emotional states or self-sootheIncreased self-focusing and withdrawal

24. Types of behaviours 5-8yrs (cont.)Concern about personal responsibility for traumaWish for revenge and action-oriented responses to traumaMay experience acute distress on encountering any reminder of traumaLowering of self-esteem

25. Types of behaviours 5-8yrs (cont.)Increased anxiety or depressionFear of closeness and loveLikely to have detailed, long-term and sensory memory of the traumatic eventFactual, accurate memory may be embellished by elements of fear or wish, perception of duration may be distorted

26. Types of behaviours 5-8yrs (cont.)Intrusion of unwanted visual images and traumatic reactions disrupt concentration and create anxiety often without parent awarenessVulnerable to flashbacks of recall and anniversary reactions to reminders of traumaSpeech and cognitive delays

27. Impact of trauma on academic performance and social functioningSource: Calmer Classrooms, p.11.

28. EnvironmentSafe e.g. no surprises or punitive punishmentStructured e.g. rulesPredictable e.g. routines and proceduresConsistent e.g. consequences

29. Establishing an environment - rules Involve children in developing rules (preferably five or less)Use clear, concise language e.g. act safelyProvide examples e.g. role-playingShare rules with parents/carersRemind about rules at key times e.g. transitions

30. Establishing an environment – rules (cont.)

31. Establishing an environment – rules (cont.) Any more strategies for developing rules?

32. Establishing an environment –behaviour Reinforce positive behaviourSelect a good reinforcer i.e. one that requires little planning or effort to deliverWhere appropriate, involve the child in selecting the reinforcer e.g. chooses the story to be readConsistently provide immediate, frequent and positive feedback e.g. praise, nods, smiles, eye contact, hugs, handshakes

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34. Establishing an environment – calm, controlled behaviour Any more strategies for safety and positive discipline?

35. Establishing an environment - routinesExplain – the routine, why it is used, use short sentences, repeat key messagesDemonstrate and model – break into steps, visual charts, demonstrate, repeat, adapt as independence increasesRehearse/guide practice – provide corrective feedback, arrange practice in different locationsPerform independently – give cues when to use the routine, praise and encouragementReview/teach – review, adapt and reteach

36. Establishing an environment - routines Any more strategies for developing routines?

37. Establishing an environment – communicating with parents and carersMaintaining close contact can prevent misunderstandingsInvolve key people (other staff) and the child, in the processUse a Communication book

38. Establishing an environment – Communication booksKeep comments as positive as possibleKeep communication short and to the pointRespond promptly to questions and concernsAsk for ideas and suggestionsAsk the child to contribute where appropriateCan create challenges for you and the parents or carers:transporting the book to and fromaintaining positive communicationensuring the book is used

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40. Child specific strategies – easing frustration when giving directionsUse concrete languageKeep directions short and to the pointProvide instructions in small stepsUse visual cuesUse pictures to illustrate a processUse sign prompts e.g. red traffic light or stop sign

41. Child specific strategies – reducing stimulationUse preferential seating or create a low-distraction seating areaKeep children’s work/play areas unclutteredDesignate a quiet spaceProvide relaxing music e.g. use iPod with ear phones

42. Child specific strategies – reinforcing routine and structureTell children about the timetable of eventsMake a poster of daily eventsPrepare children for transitionsMake special arrangements for morning tea/lunchtimeEstablish rules that are easy to followEstablish a routine for everything

43. child specific strategies – addressing over-activityProvide squeeze balls or sensory soft toysMake time for physical activityUse a rocking chair or floor cushionsPrecede focused activity with physical movementBuild breaks in longer-time activitiesUse a signal to let children know it is time to return to task

44. Child specific strategies – creating smooth transitionsUse visual, colour-coded or written plansUse stories relevant to the transitionPre-advise children about transitionsUse consistent rules and consequences between educators and specialistsEnsure ongoing communication between team members

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46. Child specific strategies – handling outburstsAnticipate and identify warning signsRemove child from other children if possibleDebrief the child after the incidentTeach the correct behaviourInvite the child to solve future problemsAvoid power struggles and put-downsDetermine the cause of the outburst

47. Child specific strategies – addressing playground challengesStructure activitiesConsider alternatives e.g. use of computer Provide a limited number of clear choicesInvolve the child in helping younger childrenPrepare by reviewing expectations and proceduresDevelop a plan for handling emergencies in the playground

48. Resolving behavioural incidentsReview the incident as soon as possible i.e. when the child has calmedListen activelyParaphraseUse eye contactUse physical activity e.g. walk around to help the child to relax and begin talkingUse art e.g. drawingUse music

49. Resolving behavioural incidents (cont.)Use non-threatening questions Focus on how and what rather than whyUse open-ended questionsUse calm, quiet voiceUse short, concise sentencesUse a graphic or picture problem solving procedure

50. Resolving behavioural incidents (cont.)Don’t blameFocus on teaching the correct behaviour or a replacement behaviour e.g. What would have worked better than hitting?Use role modelling, role-play and rehearsal to teach the correct/replacement behaviourPresent new ideas in a concrete way, one at a timeReinforce and re-teach as often as requiredFinish with a positive comment

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53. References and resourcesAustralian Child and Adolescent Trauma, Loss and Grief Network, 2012, How children and young people experience and react to traumatic events, ANU College of Medicine, Biology and Environment.Child Welfare Information Gateway, 2009, Understanding the Effects of Maltreatment on Brain Development, US Department of Health and Human Services.Department of Education, Manitoba, Classroom Behavioural Strategies and Interventions, <www.edu.gov.mb.ca>.Department of Human Services Victoria, Child development and trauma specialist practice resource.The Help Guide, August 2012, Healing Emotional and Psychological Trauma, <www.helpguide.org>.

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