Module 6: Trauma and the Child

/ Time: 4 hours, 30 minutes
Module Purpose:This module explains the short and long-term impacts of traumatic events on the child. It alsopoints to the multi-generational nature of trauma and discusses how parents who were traumatized children often become traumatizing adults. The module also highlights the importance of thoughtful professional intervention.
/ Demonstrated Skills:
  1. Own the reality of the impact of trauma (attitude)Choose to implement a trauma-informed focus through an understanding of the short- and long-term impact of trauma on a child.
There is 1 unit in this module.
Materials:
  • Trainer’s Guide
  • Participant’s Guide (participants should bring their own)
  • PowerPoint slide deck
  • Markers
  • Flip chart paper

Agenda:
Unit 6.1: Trauma and Its Impact on the Child
Materials:
Trainer’s Guide
Participant’s Guide (participants should bring their own)
PowerPoint slide deck
Markers
Flip chart paper
Trainer Instructions and Script:
Display Slide 6.0.1: Module 6 Trauma and the Child(PG:1X)

Display Slide 6.0.2: Learning Objectives (PG:1X)

Display Slide 6.0.3: Agenda (PG:1X)

Unit 6.1: Trauma and Its Impact on the Child

/ Time: 4 hours, 30 minutes
Unit Overview:This unit portrays for participants the short- and long-term impact of traumatic events on the child, highlighting the importance of careful, thoughtful professional intervention. The implications of the Adverse Childhood Experiences (ACE) study are woven into this discussion and activities are designed to produce a visceral impact in participants on the child’s experience of trauma.
/ Learning Objectives:
  1. Define “trauma”, to include persistent absence of responsive care during infancy and early brain development.
  2. Define the term “child traumatic stress. “
  3. Explain the types of experiences that constitute childhood trauma.
  4. Explain how childhood trauma can be the result of numerous experiences related to life in general.
  5. Describe how traumatic experiences affect brain development and memory.
  6. Explain how traumatic experiences affect child development.
  7. Explain the impact of trauma and subsequent changes in the child’s behavior, development and relationships in the long-term.
  8. Explain how cultural factors influence how children may identify, interpret and respond to traumatic events.
  9. Explain how childhood traumatic stress may impact people as current caregivers.
  10. Own the reality of the impact of trauma (attitude).

Trainer Instructions and Script:
Display slide 6.1.4: Unit 6.1 Trauma and Its Impact on the Child (PG:X2)

Display slide 6.1.5: Learning Objectives (PG:X2)

/ Say:We have spent much of the last two weeks looking at the family including:
  • The child.
  • The adult who is also a parent/caregiver.
  • Family systems, dynamics and culture.
  • Various types of phenomena that can negatively impact the family.
We have also looked at the kinds of things that can happen in families that result in safety and well-being concerns for the children. This module discusses the impact of trauma on the child in the short- and long-term, and even how it carries on multi-generationally.
/ Say: In this module we will:
  1. Define “trauma”, to include persistent absence of responsive care during infancy and early brain development.
  2. Define the term “child traumatic stress. “
  3. Explain the types of experiences that constitute childhood trauma.
  4. Explain how childhood trauma can be the result of numerous experiences related to life in general.
  5. Describe how traumatic experiences affect brain development and memory.
  6. Explain how traumatic experiences affect child development.
  7. Explain the impact of trauma and subsequent changes in the child’s behavior, development and relationships in the long-term.
  8. Explain how cultural factors influence how children may identify, interpret and respond to traumatic events.
  9. Explain how childhood traumatic stress may impact people as current caregivers.
  10. Own the reality of the impact of trauma (attitude).

Display slide 6.1.6: What is Trauma? (PG:3X)

/ Ask:We have talked about trauma in various ways over the course of your training. When you hear the word “trauma” what is the first thing that now comes to your mind?
Allow for a free flow of answers. Record on a flipchartor wipeboard.
/ Say: Just like everything that we have discussed to this point, we all have “our” defintion of what trauma is or isn’t based on our perceptions and experience.
It is important in your work as a child welfare professional, that we all use a common language and have common definitions that are central to child welfare practice.
Let’s start by defining “trauma.” Look in your Key Points under Slide 6.1.6, where you will find the defintion of trauma. Trauma is an emotional response to an event. There can be direct involvement in the event or indirect through witnessing the event. The emotional response is intense, distressing and/or painful and can overwhelm your ability to cope.
The stress that is caused by the trauma is called “traumatic stress.”
The National Child Traumatic Stress Network has identified 13 types of trauma. Look in your PG, page 3, as we walk through these. The thirteen types of trauma include:
•Community violence
•Early childhood trauma
•Domestic violence
•Medical trauma
•Natural disasters
•Physical abuse
•Neglect
•Refugee and war zone trauma
•School violence
•Sexual abuse
•Terrorism
•Traumatic grief
•Complex trauma
We are going to focus on the seven (7) that you will typically see in your work as a child welfare professional:
  1. Early Childhood Trauma
  2. Domestic Violence
  3. Physical Abuse
  4. Neglect
  5. Sexual Abuse
  6. Traumatic Grief
  7. Complex Trauma or Toxic Stress

Display slide 6.1.7: Childhood Trauma (PG:X4)

/ Say: Let’s start with Early Childhood Trauma.
Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6.
These traumas can be the result of intentional violence - such as child physical or sexual abuse or domestic violence - or the result of natural disaster, accidents, or war.
Young children also may experience traumatic stress in response to painful medical procedures or the sudden loss of a parent/caregiver.
/ Say: In the last module, you learned about domestic violence, sometimes called intimate partner violence, domestic abuse, or battering. This includes actual or threatened physical or sexual violence or emotional abuse between adults in an intimate relationship.
This clinical definition is broader than the legal definition, which may be restricted to acts of physical harm.
According to the National Child Traumatic Stress Network, It is estimated that anywhere from 3 to 10 million children are exposed to domestic violence in the United States every year. Studies suggest that the majority of children who are exposed to domestic violence are young - under the age of 8.
/ Say: Physical abuse means causing or attempting to cause physical pain or injury. It can result from punching, beating, kicking, burning or harming a child in other ways. Sometimes, an injury occurs when a punishment is not appropriate for a child's age or condition.
/ Ask: In your field time, you read the article on The Science of Neglect, and other information related to neglect. What is neglect and how can it occur?
Allow for brief discussion, and respond appropriately. Then move ahead with defintion below.
/ Say:Child neglect occurs when a parent or caregiver does not give a child the care he or she needs according to its age, even though that adult can afford to give that care or is offered help to give that care. Neglect can mean not giving food, clothing and shelter.
Child neglect can mean that a parent or caregiver is not providing a child with medical or mental health treatment or not giving prescribed medicines the child needs. Neglect can also mean neglecting the child's education. Keeping a child from school or from special education can be neglect.
Neglect also includes exposing a child to dangerous environments. It can mean poor supervision for a child, including putting the child in the care of someone incapable of caring for children. It can also mean abandoning a child or expelling it him or her from home. Neglect is the most common form of abuse reported to child welfare authorities.
Say:Child sexual abuse includes a wide range of sexual behaviors that take place between a child and an older person or alternatively between a child and another child/adolescent.
Behaviors that are sexually abusive often involve bodily contact, such as sexual kissing, touching, fondling of genitals, and intercourse.
However, behaviors may be sexually abusive even if they do not involve contact, such as of genital exposure ("flashing"), verbal pressure for sex, and sexual exploitation for purposes of prostitution or pornography.
Say:Childhood traumatic grief may occur following a death of someone important to the child when the child perceives the experience as traumatic. The death may have been sudden and unexpected (e.g., through violence or an accident), or anticipated (e.g., illness or other natural causes).
The distinguishing feature of childhood traumatic grief is that the trauma symptoms interfere with the child's ability to go through the typical process of bereavement. The child experiences a combination of trauma and grief symptoms so severe that any thoughts or reminders, even happy ones, about the person who died can lead to frightening thoughts, images, and/or memories of how the person died.
/ Ask: From your readings, does anyone have an idea of what ‘complex trauma’ might be?
All for brief discussion and feedback. Then respond appropriately.
/ Say: The term “complex trauma” describes the problem of children's exposure to multiple or prolonged traumatic events and the impact of this exposure on their development.
Typically, complex trauma exposure involves the simultaneous or sequential occurrence of child maltreatment - including psychological maltreatment, neglect, physical and sexual abuse, and domestic violence - that is chronic, begins in early childhood, and occurs within the primary caregiving system.
Exposure to these initial traumatic experiences - and the resulting emotional dysregulation and the loss of safety, direction and the ability to detect or respond to danger cues—often sets off a chain of events leading to subsequent or repeated trauma exposure in adolescence and adulthood.
Display slide 6.1.8: What is Child Traumatic Stress (CTS)? (PG:X5)

/ Say: So when we talk about child traumatic stress (CTS) we are talking about a psychological reaction that some children have to a traumatic experience.
Children who suffer from CTS have developed reactions to trauma that linger and affect their daily lives long after the traumatic event has ended. Not every child experiences CTS after a trauma. The reality is that all children are different, and many children are able to adapt to and overcome difficult events and situations.
If left untreated, CTS can interfere with a child’s healthy development and lead to long-term difficulties with school, relationships, jobs and the ability to participate fully in a healthy life.
It is important to note that psychological trauma in childhood can be just as damaging as trauma that has caused physical injuries.
Psychological trauma is an emotionally painful, shocking, stressful and sometimes life-threatening experience. It may or may not involve physical injuries, and can result from witnessing distressing events.
There are three levels of CTS:
  • Acute stress refers to exposure to a single event such as a car accident.
  • Chronic trauma refers to repeated events such as physical or sexual abuse or exposure to ongoing domestic violence.
  • Complex trauma as we already discussed refers to exposure to chronic, multiple types of trauma.

Display slide 6.1.9: How Trauma Impacts the Child (PG:X6)

/ Say:Experiencing trauma in childhood, especially early childhood, negatively impacts early experiences and development.
Please turn to Page XXPG: 6in your participant guide to Handout XHandout: Child Development Stages, which we discussed at great length in Module 2. The critical developmental elements that are impacted by trauma are attachment and social-emotional development, but we will also look at the other elements where relevant.
Briefly walk participants through the Handout XHandout: Child Development Stages again to remind them of the different categories and age groupings. Remind them that with trauma, we are looking specifically at evidence of attachment issues, as well as physical, cognitive, and social/ and emotional developmental issues.
Respond to any questions that might arise before moving forward.
/ Say: If you will recall, in Module 2, we looked at Jack and his child functioning at a variety of ages.
In this next activity, we are going to turn our attention back to Jack as a very young child, assessing the visible shorter term impacts Jack experienced at a young age from his maltreatment and the family’s dynamics (which included substance abuse by both parents and his father’s domestic violence). We will be looking specifically at his attachment to his parents, as well as his and his physical, cognitive and social-emotional development.
This is the first of a series of activities in this module that will culminate in your gaining a greater understanding of the long-term impact of child abuse and neglect, and what is required to help a child – and a family – heal from their traumas.
Display slide 6.1.10: Activity Jack at 0-3 Impact of Trauma (PG:X11)

The content to be used in this next activity is a set of bullet points of salient features from the narrations with father Marc, mother, Sandy, and Jack himself looking back to his early childhood days. Since particpants have been exposed once to the written narratives and worked strongly with them, the bullet points are provided for two reasons:
  • To refresh their memories without having them read through the entire three narratives again.
  • To give them practice working with bullet-pointed information in a manner similar to how they will need to work with their case notes and recall information that they will use to build their argumentation in FSFN.

/ Activity #1: Impact of Traumatic Stress on Jack Ages 0-3
Purpose: This activity carries the work on Jack in Module 2 forward, having us take a peek behind the curtain to see the what kinds of traumatic impacts Jack experienced as the result of:
  • His father, Marc, who demonstrated alcoholic behavior, as well as verbally and physically abusive domestic violent behavior, and
  • His mother, Sandy, whose implied prescription (pain) pill addiction, her own needs for external validation, and her own childhood upbrining in a home of verbal abuse, led her to be neglectful of Jack and minimize the impact of Marc’s behavior on Jack.
Participant GuidePG: 12X
Materials:
  • Handout XHandout: Child Development Stages
  • Handout XHandout: Jack at Ages 0-3 (once final approvals are achieved, Andersen bullet point information will replace current information based on the previously-read narratives from Module 2)
Trainer Instructions:
In this activity, particpiants will work together in their groups.
  • Have them as a group silently read through each of the three bullet-point narratives.
  • After reading each, ask them to use their Handout XHandout: Child Development Stages to assess Jack’s reported behaviors and determine where his childhood physical, cognitive, and social-emotional development and attachment may have been compromised through the abuse and neglect her experienced.
  • Ask them to make notes in the right side on what they see as the behaviors that contributed to his abuse and neglect and the short-term impacts they had on Jack in terms of his attachment, as well as andhis physical, cognitive and social-emotional development.
  • Debrief as a class.

Trainer Notes:
  • Insert key content that trainer should know related to this activity. Cannot complete until Andersen case receives final approvals.

Trainer Notes:
Prompt participants to think about brain development, trust vs mistrust, autonomy/independence vs self-doubt. Allow ample time for exchange of information. Point to Jack and the evidence of his developmental delays and regression.
/ Activity STOP
Display slide 6.1.11: Impact of Trauma on the Child’s Brain (PG:16X)

/ Ask: During your field weeks, you read a good deal of information regarding the impact of abuse and neglect – and the related trauma – on the child, both short-term and long-term. Who can share with the class what you’ve learned about the impact of trauma on a child’s brain?
All for brief discussion, and provide appropriate feedback pointing to the following information.
/ Say: Research shows that the brains of children who are exposed to chronic trauma and stress are wired differently than children whose experiences have been more secure.
When experiencing stress or threat, the brain’s “fight or flight” response is activated through increased production of the powerful hormone cortisol. While cortisol production can be protective in emergencies, in situations of chronic stress its level is toxic and can damage or kill neurons in critical regions of the brain.