WHY IS IT SO HARD TO MOVE ON?

The impact of trauma on transition aged youth

“The world breaks everyone, and afterward, some are strong in broken places.”

-Ernest Hemingway

Allison Elias, L.C.S.W., Thresholds, Chicago, ILCindy Berry, Psy.D., University of Illinois

Chicago, Chicago, IL

Trauma versus Complex Trauma

“Complex trauma” describes the experience of multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (eg. sexual or physical abuse, war, community violence) and early life onset.

–Bessel A. van der Kolk

The Impact of Trauma in Childhood

Research has shown that trauma in childhood is correlated with:

*depression *suicide attempts *alcoholism *drug abuse *sexual promiscuity *domestic violence *cigarette smoking *obesity*sexually transmitted disease [Felitti, Nordenberg et al.,

1998]

Physical abuse and neglect are associated with very high rates of violent offenses

75% of perpetrators of child sexual abuse report to have been sexually abused as children

[van der Kolk, 2003]

Complex Developmental Trauma:

Difficulty regulating (controlling) emotions Impulsive decision making/engaging in risk taking

behaviors Intense feelings of guilt, shame and low self-worth Problems with interpersonal boundaries and

relationships Struggle with trusting others Difficulties seeing another person’s point of view More likely to report physical ailments May engage in emotional numbing and social

withdrawal Sense of hopelessness about the future Increased feelings of anxiety

The Impact of Chronic Trauma on Functioning

Interferes with neurobiological development

Compromises the capacity to integrate information sensory information emotional information cognitive information

Difficulty with Affect Regulation

Impairs the ability to control emotions

Vacillates between: emotional flooding

(hypervigilance/arousal) numbing (dissociation)

Switches tend to be drastic in intensity and frequent in nature

Conditions that Impact Affect Regulation

Five Senses: Smell Touch Taste Sight Sound

Difficulty with Cognitive Functioning

Attention Decision making Working memory

Sensory/Non-verbal memories vs. Autobiographical Memories

Treatment: Four Central Goals

Safety environmentPersonal

Skills Development emotion regulation and interpersonal functioning

Treatment: Four Central Goals

Meaning-makingAbout past traumatic events in order to

consider more positive, adaptive views of themselves in the present

To help experience hope about their future

Enhance resiliency and integrate into a social network

[From Complex Trauma in Children and Adolescents, National Child Traumatic Stress Network, 2003]

Research Findings*Area of Concern With

Depression/Anxiety

Without Depression/Anxiety

Sex by age 16 62% 50%

Marijuana use by age 16

46% 34%

Other drug use 39% 26%

Attacked someone 41% 27%

Ever ran away 30% 17%

Charged with an adult crime by age 24

27% 16%

Has a biological child at age 18 (females)

24% 9%

*From US Department of Health and Human Services, 7/2009

Research Findings (con’t)

Area of Concern With Depression/Anxiety

Without Depression/Anxiety

Do not earn HS diploma

35% 15%

Employed on 24th Birthday

66% 79%

Consistently connected to school or work, ages 18-24

43% 61%

Median Annual Earnings at age 23

$15,506 $22,875

Research Findings

Sexual, Physical , & Emotional Maltreatment group significantly elevated from low maltreatment group on Youth Self Report

Withdrawn

Somatic Complaints

Anxious/depressed

Social Problems

Thought Problems

Attention Problems

Delinquent Behavior

Aggressive Behavior

MOVING ON…

“Independence is not linked to the physical or intellectual capacity to care for oneself without assistance; independence is created by having assistance when and how one requires it”

-Brisenden, 1989

The Transition in Crisis Youth may start to decompensate

become aggressive run away engage in self injurious behavior

Youth may blame others for their difficulties foster parents, staff, the program, case

workers, the system, push others away: It’s easier to “burn bridges”

than to feel sad or loss May lose a job or do worse in school

if employment or diploma is required for transition.

Why Do These Youth Seem To Undermine Their Success?

TRANSITIONS ARE SCARY! Fear of the unknown Fear of failure Fear of success Out of comfort zone

Complex trauma exacerbates all this May be a resurgence of past symptoms Current symptoms may be magnified by

transition

Trauma Symptoms through a Transitional Lens:

Trust Issues Distrust of people, system, etc. Suspicious of others motives Uncertain of the predictability/reliability of the

world Social Issues

Tendency towards social isolation Difficulty taking another’s perspective Trouble understanding one’s own contribution

to what happens to them

Trauma Symptoms through a Transitional Lens:

Executive Skills (ability to perform tasks) Problems with focus and attention Problems processing new information Difficulty problem solving Difficulty with planning and anticipating Problems with working memory Failures to make wise judgments Cognitive inflexibility Difficulty inhibiting inappropriate responses

Why Can’t They Just Tell Us?

These youth don’t always say what they mean

Don’t want to show fear Afraid to need help or support May not always be aware of

feelings

Look at the feelings under the words!!!!

Common Ways We Try To Help

“Dangle a Carrot” approach Use an apartment, job, etc. as an incentive for

youth to do well. May just be reinforcing that the youth has to

leave. Youth may only focus on the leaving (poor sense of time).

“I’m not worthy of this”

Contracts If ____, then ____. “If you have zero incidents of

aggression for 30 days, then you’ll be able to leave.”

Unfortunately, youth may only hear, “You’re leaving.”

OVERWHELMING!

“Stuck” at Transition:

Youth are at an early stage of their development

Being on their own is overwhelming Often raised in foster care/residential care

Decisions are made for them Multiple transitions—no lasting relationships May lack experiences with unconditional love

Poor affect regulation and arousal Staff may mention “when you’re on your own”

in passing and the anticipation becomes a trigger

“Stuck” at Transition:

Youth are present focused: can’t always remember periods of success very difficult to imagine the future

Youth grieve the loss of their childhood: never experienced a “true” childhood fear of being an adult

Lack of social supports: may live away from family with no contact in

years don’t know how to reconnect family or

community

How can we help them move on?

Creating a Smooth Transition for Traumatized Youth

Talk about the “elephant in the room”

Validate stress & anxiety about transitioning

Identify potential fears Generate discussion around peer’s

transitions- successful & unsuccessful Help them grieve loss of childhood

Independence is not always the “carrot”

When achievement parameters back fire: “Have a little faith in me” “Just do it”

High support still needed

The team must examine its own anxiety

Build Competencies

Focus on Skill Building independent living skills coping/affect regulation skills social skillsBE REPETITIVE! *The ‘Dora’ method

Focus on Mastery & Strengths identify strengths/interests provide opportunities for success/redefine

success help them recognize previous success build forums to celebrate accomplishmentsBE CREATIVE & DON’T GIVE UP!

Seek Appropriate Treatment Refer to trauma informed therapy

Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)

Trauma Focused- Cognitive Behavioral Treatment

Skills Training in Affect and Interpersonal Regulation (STAIR)

Dialectical Behavior Therapy (DBT) Trauma Systems Therapy Attachment, Self-regulation & Competence

(ARC)

For more information: National Child Traumatic Stress Network

http://www.nctsnet.org

Build Social Support Networks

Build a sense of community

Reconnect to the past: BE DETECTIVES!

Support elements of healthy relationships

Help them have different endings

Role model healthy termination

Combat ‘the burning of the bridge’

In Time Perhaps 

In timeperhaps

My wounds will healAnd my pain will no longer be numb.

It will disappear.The smile that I wear upon my face

will be real.My locked up dreams

will slowlycut themselves free

from helplessness and disappointment.-Anonymous