10/2/2016 Ste e ring Yo ur Co urt to Suc c e ssful Outc o me s: Unde rsta nding Yo ur L itig a nts PRE SE NT E D BY: K RI ST YN S. CARVE R, PH.D., L PC-S 70% o f a dults in the US ha ve e xpe rie nc e d a tra uma tic e ve nt a t le a st o nc e in the ir live s. At le a st 75% o f yo uth invo lve d in the juve nile de linq ue nc y syste m ha ve e xpe rie nc e d tra uma tic vic timiza tio n (Na tio na l Child T ra uma tic Stre ss Ne two rk) Pre se nta tio n Ove rvie w T ra uma T ra uma & T he Bra in Adve rse Childho o d E xpe rie nc e s Study Applic a tio n fo r Suc c e ssful Outc o me s 1
10/2/2016 Wha t is a tra uma info rme d a ppro a c h? Ac kno wle dg ing the pre va le nc e a nd impa c t o f tra uma a nd a tte mpting to c re a te a se nse o f sa fe ty fo r a ll pa rtic ipa nts, whe thr o r no t the y ha ve a tra uma -re la te d dia g no sis. T ra uma a wa re ne ss is a n o ppo rtunity to ma ke sma ll a djustme nts tha t impro ve judic ia l o utc o me s while minimizing a vo ida b le c ha lle ng e s a nd c o nflic t during a nd a fte r he a ring s. Re q uire s re -e xa mining po lic ie s a nd pro c e dure s tha t ma y re sult in pa rtic ipa nts fe e ling lo ss o f c o ntro l, tra ining sta ff to b e we lc o ming . Minimizing pe rc e ive d thre a ts, a vo iding re -tra uma tiza tio n, a nd suppo rting re c o ve ry. T ra uma & T he Bra in T he Huma n Bra in Bo rn with o ve r 100 b illio n ne uro ns in o ur b ra in Unde r o ptima l c o nditio ns whe n o ur ne e ds a re c o nsiste ntly me t b y lo ving c a re g ive rs o ur b ra ins thrive . T he se ne uro ns c o nne c t in c o mple x a nd va st ne two rks. Ba b ie s a re b o rn with a ll this wiring , b ut it is huma n inte ra c tio ns tha t ma ke the b ra in de ve lo p. 2
10/2/2016 Huma n I nte ra c tio n… E ve ry e xpe rie nc e a nd inte ra c tio n sc ulpts the b ra in. T he huma n b ra in flo urishe s whe n e xpo se d to po sitive o r nurturing e xpe rie nc e s. E a rly c hildho o d e xpe rie nc e s impa c t the de ve lo pme nt a nd wiring o f the b ra in I nfa nts who a re nurture d a nd c o nsiste ntly c a re d fo r b y a n a ttune d c a re g ive r will de ve lo p a fo unda tio n o f trust. Do wnsta irs Bra in Hig hly de ve lo pe d a t b irth. Allo ws b a b ie s to e a t, sle e p, b re a the , he a r… Surviva l func tio ns a re ro o te d he re Primitive , re a c tive , re spo nsib le fo r ke e ping us a live Upsta irs Bra in Mo re so phistic a te d re g io ns o f the b ra in Go ve rns hig he r func tio ns c o mple x tho ug ht re a so ning e mo tio na l re g ula tio n info rma tio n pro c e ssing As this pa rt de ve lo ps it a llo ws us to re g ula te spe e c h, e mo tio ns, c a lm o ur o wn b o die s, unde rsta nd o urse lve s a nd o the rs, ma ke g o o d c ho ic e s, se lf-re g ula tio n b e fle xib le a nd a da ptive . 3
10/2/2016 Wha t we kno w… A de ve lo ping b ra in is ne g a tive ly impa c te d b y e xpo sure to stre ss, fe a r, a nd tra uma . E xpo sure to the se e xpe rie nc e s unde rmine s the struc ture , wiring , a nd c he mistry o f the b ra in. T his puts a c hild a t risk fo r a life time o f diffic ulty with so c ia l, le a rning , a nd b e ha vio ra l pro b le ms. E a rly T ra uma & Stre ss Sig nific a ntly a lte r b ra in de ve lo pme nt a nd c he mistry Ca use de la ys in so c ia l c o mpe te nc e L e a d to de ve lo pme nt o f dysfunc tio na l c o ping me c ha nisms Cre a te b a rrie rs to de ve lo ping he a lthy re la tio nships in a ne w e nviro nme nt Witho ut inte rve ntio n – the se will pe rsist a nd inte nsify Chro nic Stre ss Whe n a c hild sta ys in a c hro nic sta te o f stre ss, the b ra in is b a the d in c o rtiso l. T o xic stre ss in c hildho o d is a sso c ia te d with a dult o b e sity, dia b e te s, c a rdio va sc ula r dise a se , a ddic tio n, a nd de pre ssio n E xc e ssive le ve ls o f c o rtiso l ta ke s a to ll o n pre fro nta l c o rte x whic h c o ntro ls: I mpulsivity a g g re ssio n Mo o d Se lf-re g ula tio n 4
10/2/2016 Be ha vio r is the o utwa rd sig n o f inne r turmo il – the re sult o f a dysre g ula te d b ra in c a use d b y e a rly tra uma – ta ke time to try a nd unde rsta nd wha t is b e hind the b e ha vio r . Atta c hme nt & T ra uma Wha t is Atta c hme nt? Jo hn Bo wlb y – I de a tha t infa nts c re a te a spe c ia l b o nd with the ir c a re g ive rs. I n a n ide a l situa tio n, infa nts use c a re g ive rs a s a secur e base fro m whic h to e xplo re the ir physic a l a nd so c ia l wo rlds. I nfa nts ne e d to fe e l safe a nd kno w the ir c a re g ive r will me e t the ir needs 5
10/2/2016 I nfa nts use a tta c hme nts with c a re g ive rs a s models fo r future re la tio nships. Histo rie s with c a re g ive rs influe nc e pa tte rns o f a tta c hme nt a nd ho w infa nts re spo nd whe n the y a re upse t. Atta c hme nt style s pe rsist into a dultho o d Atta c hme nt Style s & Outc o me s Adult Attac hme nt Style Assoc iate d Be havior s Se c ure Atta c hme nt • Ab le to g ive & re c e ive c a re (nurture ) • Ab le to ne g o tia te ne e ds • Ab le to b e a uto no mo us • Co mpe te nt le a de r • Ab le to se lf-re g ula te Dismissive Atta c hme nt • Clo se d o ff e mo tio na lly • Diffic ulty with a ffe c tio n & e mo tio n • I nve sts e ne rg y in thing s ra the r tha n pe o ple E nta ng le d Atta c hme nt • I ntrusive in re la tio nships • L ike ly c o ntro lling • Ma y strug g le with a ng e r & re se ntme nt • Po o r b o unda rie s Unre so lve d Atta c hme nt • Ma y e ng a g e in “c he c king o ut” b e ha vio rs • Be ha vio ra l & e mo tio na l diso rde rs like ly • Cha o tic / c o nfusing re la tio nships T ra uma & Atta c hme nt in the Bra in Bra in c he mistry pre dic ts me nta l he a lth / me nta l illne ss K ids fro m ha rd pla c e s o fte n do no t ha ve b a la nc e b e twe e n e xc ita to ry a nd inhib ito ry ne uro tra nsmitte rs b e c a use whe n the y c rie d, no o ne c a me . T he se kids g ro w into a do le sc e nts a nd a dults who displa y e ffe c ts o f inse c ure a tta c hme nt a nd tra uma . 6
10/2/2016 F e a r, stre ss, a nd tra uma c a use the do wnsta irs b ra in to o ve r de ve lo p while the upsta irs b ra in unde r de ve lo ps. T he Bra ins Surviva l Re spo nse Whe n c hildre n fe e l thre a te d o r o ve rwhe lme d with fe a r – b ra in trig g e rs fig ht, flig ht, o r fre e ze re spo nse . I f the b ra in sta ys he re to o lo ng it re o rg a nize s a ro und surviving the tra uma a t the e xpe nse o f de ve lo pme nt o f o the r pa rts o f the b ra in. Re pe a te d fe a rful e xpe rie nc e s De trime nta l whe n c hild is le ft to ma na g e fe a r a lo ne o r whe n the c a re g ive r is frig hte ning . Re pe a te d e xpo sure a c tiva te s g ro wth a nd c o nne c tio n in the do wnsta irs b ra in Child ha s lo ts o f e xpe rie nc e s whe re do wnsta irs b ra in is a c tive a nd o ve rde ve lo pe d – b ut ve ry fe w e xpe rie nc e s to de ve lo p se lf so o thing skills in upsta irs b ra in. 7
10/2/2016 I mpa c t o f tra uma g o e s b e yo nd upsta irs a nd do wnsta irs b ra in – F e a r a lso impa c ts the he misphe re s Whe n ne e ds a nd e mo tio ns a re no t re spo nde d to c o nsiste ntly a nd in a n a ttune d wa y, the rig ht he misphe re do e s no t de ve lo p o ptima lly. Whe n o ne he misphe re o ve r de ve lo ps, the c hild e ithe r b e c o me s c ut o ff fro m his e mo tio ns, o r flo o de d b y the m. Re pe a te d e xpo sure sha pe s the b ra in. Bra ins c ha ng e d b y fe a r a nd unme t ne e ds c a n b e re sha pe d thro ug h re pe a te d, nurturing , po sitive e xpe rie nc e s. 8
10/2/2016 Adve rse Childho o d E xpe rie nc e s Study Ong o ing c o lla b o ra tive re se a rc h b e twe e n the Ce nte rs fo r Dise a se Co ntro l a nd Pre ve ntio n a nd K a ise r Pe rma ne nte Ove r 17,000 pa rtic ipa nts – ma jo rity white , o ve r a g e o f 50, e duc a te d, e mplo ye d, g o o d he a lth insura nc e De sig ne d to a sse ss a sso c ia tio ns b e twe e n c hildho o d ma ltre a tme nt a nd la te r he a lth a nd we ll-b e ing “ Child a b use is the g ra ve st a nd mo st c o stly pub lic he a lth issue in the Unite d Sta te s ” R OBE RT A NDA , MD ACE S R E SE ARCHE R T he o ve ra ll c o st o f c hild a b use e xc e e ds tha t o f c a nc e r o r he a rt dise a se . E ra dic a ting c hild a b use in Ame ric a wo uld re duc e the o ve ra ll ra te o f de pre ssio n b y mo re tha n ha lf, a lc o ho lism b y 2/ 3 a nd suic ide , I V drug use , a nd do me stic vio le nc e b y 3/ 4. I t wo uld ha ve a dra ma tic e ffe c t o n wo rkpla c e pe rfo rma nc e a nd va stly de c re a se the ne e d fo r inc a rc e ra tio n 9
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