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Youth, Trauma, & Restorative Relationships

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Dr. Meagan McBride, LPCC-S, CTRP, EMDRt

Director & Professor MAC

Heidelberg University

Certified Trauma & Resiliency Practitioner
K-12 Special Ed teacher
Owner Private Practice
17 years experience working with children
In patient and outpatient settings

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Plan for Today

Childhood Trauma

Restorative Relationships

Q & A

Neurosequential Model

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How this journey was developed

Trauma

Paradigm Shift

Countering ACEs

We have a broader understanding of ACEs.

Neurosequential Model

Resilience through restorative relationships

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So, by nature by the set of classes, the work we do, the trainings- counseling, social work, education, school counseling ---- much of this is trauma informed, trauma sensitive, trauma aware at a minimum.

As a previous K-12 educator, this was something I saw regularly in my kids in the classroom right? Jane isn’t flipping her desk because she hates math that much, there’s something under that behavior. So...I became a MH counselor--focusing on youth and adolescents with trauma. I worked in patient and outpatient, suicidal, homicidal, fire setters...and I worked my journey to learn more and understand better. I became a certified trauma practitioner, and had the debates around do they have to tell their stories or not tell their stories- the whole thing right?

And I kept wondering...what is it, we see with ACES there is a CHANGE that happens, we see it in health outcomes, ed outcomes, all the outcomes yeah? But what...mentally...is the change. And through those questions I found Dr. Bruce Perry. Dr perry. Bruce D. Perry is an American psychiatrist, currently the Senior Fellow of the Child Trauma Academy in Houston, Texas and an Adjunct Professor of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine in Chicago, Illinois. A clinician and researcher in children's mental health and the neurosciences, from 1993 to 2001 he was the Thomas S. Trammell Research Professor of Psychiatry at Baylor College of Medicine and Chief of Psychiatry at Texas Children's Hospital. He also serves as Senior Consultant to the Alberta Minister of Children and Youth Services in Alberta, Canada. Dr. Perry is also a Senior Fellow at the Berry Street Childhood Institute in Melbourne, Australia.

So I was like this guy! This guy is a psychiatrist and works in neurosciences? Maybe he knows. Turns out, he does. If y’all have read the Book The Boy Who was raised as a Dog- that’s him. He developed the Neurosequential Model of Therapeutics...So, he has about 200 articles, a number of books, and is one of the forerunners taking us from ACES and these the impacts of trauma---to here is why they have these impacts, how they look in the brain, and how to help.

So..when I came to Heidelberg and was teaching and we were discussing crisis and trauma I told my boss--I think we should look to bringing this model in more. Incorporating it more. And she looked at me and said...ok. Do it.

So I searched for trainings, and of note this was back when we could travel! Ronee and I attended a 2 day seminar with him in Santa Fe, New Mexico.

So throughout this presentation, we will be pulling from his works, both his publications, and some small clips from videos he recently made public.

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Neurosequential

Model

Dr. Bruce Perry

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Overview of the Impact of Trauma

Using the neurosequential model

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Neurosequential Model

Not a specific theory or technique

“A developmentally sensitive, neurobiologically informed approach to clinical work” (Perry, 2019)

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One of the things you’ll see in the neurosequential model is this simple visual representation of the makeup of the brain. This helps us understand the concept that there is a hierarchical organization to the brain. You can see that the more lower parts monitor more regulatory functions (the ones that keep us alive) and as you go up to the highest level it starts to get into more complex functions. The neurosequential model utilizes this representation to help us understand how the brain regulates the stress response. This model helps serve as a map of the brain, and the way that Dr. Perry uses it to explain the impact of trauma in childhood. If traumatic experiences or (stress responses) occur during childhood development it can hinder the development of the brain.

The human brain is constantly reacting to information collected from the environment.

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Whoa

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Did you hear that?

We hear “trauma” and “triggered” and ACES impact health outcomes, and ACEs impact mental health...and it has almost become commonplace.

But, when we view it through the neurosequential model, we get a fuller understanding of how the brain functions when a threat is perceived (remember, we say perceived because our bodies and senses are constantly taking in our surroundings, everything from the sights, and sounds, to the smells and textures, dates, seasons, and behavioral patterns of our surroundings)....when one of these is picked up and enters that lower core regulatory network and threat is perceived

The higher order functioning- REFLECTING, PROCESSING, CONCRETE THOUGHT, ABSTRACT THOUGHT, REWARD--- that is gone.

Thus, the really great behavioral plan you have in place, fails. And everyone is frustrated with that kid.

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Childhood Trauma

Development of child is a series of complex processes

Internal: release of neurotransmitters at the synapse

External: Interactions with caregivers & family

Adverse childhood experiences can cause serious emotional, behavioral, cognitive, & physiological issues

Children who have been traumatized develop a sensitized hyperarousal or dissociative pattern when they feel anxious

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So remember that the brain is composed of billions of neurons and interact and organize into a hierarchical group of functional structures. So we know that the brain develops from bottom to top. The lower parts of the brain control the simple functions that exist to keep someone alive and the higher parts mediate more complex functioning such as language or abstract thinking. The human brain is constantly sensing, processing, and acting in response to stimuli from their environment. These internal and external processes work together to influence and shape the individual, a person with unique strengths and also vulnerabilities.

The majority of brain development begins in the first 4 years of life. A child who experienced chronic threats will result in having a brain that constantly is in a state of fear.

We know that from the ACEs study that adverse childhood experiences can cause serious long-lasting emotional, behavioral, cognitive, and physiological issues that can be carried long into adulthood.

Children who have experienced chronic threats and exposed to trauma can cause the child stress response to be oversensitive, overreactive, and dysfunction. One of the ways might include the development a sensitized hyperarousal or dissociative pattern when they feel anxious.

Dissociation is described simply as disengaging from stimuli-- it is a human superpower--- this is how people can become injured and still fight and only once the battle is over realize they are injured.

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Patterns of Stress

Unpredictable

Severe

Prolonged

Creates Vulnerability

Sensitization

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Stress is not a scary word, or a bad word. We also cannot just simply avoid stressful situations. Our body has appropriate ways to deal with stress and stress is essential to healthy development. For instance, when we have a project due for work, stress can help us accomplish tasks and helps us create the capacity to accomplish tasks and complete the project. Stress is good for you if it presents itself in the right way and in healthy doses. We learn to anticipate how we will respond, how to adapt, and how to recover from these stressful times. This builds resilience and is a healthy pattern of stress.

Children exposed to consistent, predictable, nurturing, and enriched experiences develop neurobiological capabilities that increase their chance for health, happiness, productivity, and creativity.

On the flip side--- children exposed to neglectful, chaotic, and terrorizing environments have an increased risk of significant problems in all domains of functioning. Dysfunctional symptoms and functional assets in children are both related to the nature, timing, pattern, and duration of their developmental experiences. In a child who has experienced chronic threats, the result is a brain that exists in a persisting state of fear. These trauma-invoked, repetitive alterations have made the child's stress response oversensitive, overreactive, and dysfunctional because of overutilization of brainstemdriven reactions.

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Why am I going over this?

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Alright, now, let’s flip this a bit.

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Restorative Relationships

Counselors

Who else?

Educators

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Sequence of Engagement

Regulate

Relate

Reason

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These come back to the organization of the brain and helps us understand why it is tough to reason with someone who is dysregulated, stressed, etc. We know that within relationships it is easier to reason with a person who feels safe with that specific person. You cannot just jump right into trying to reason with an individual who is dysregulated. So the first step needs to be working on regulation and move up as improvements are seen. This looks like providing repeated interventions that are positive, nurturing interactions with peers, other providers, teachers, and also caregivers especially for kiddos that have been neglected and not had enough bonding experiences.

Children with relational stability and multiple positive, healthy adults invested in their lives improve; children with multiple transitions, chaotic and unpredictable family relationships, and relational poverty do not improve even when provided with the best "evidence-based" therapies.

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Relational Monitoring

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Do I belong?

Am I accepted?

Are you safe?

Before you can even begin to relate, perhaps before you have said anything, the child you are working with is bringing these pieces in through that core regulatory network.

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A few ways to do so...

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Tone of Voice

(not what you say, but how you say it)

Power Differential

(Stance/height, get lower)

Inclusive Spaces

(this is perpetually being perceived by folks. If they are unable to regulate with you due to threat, they will not be able to get to the level of reasoning)

Rhythm

(there is a cadence to self regulation)

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To Review

Childhood Trauma

Restorative Relationships

Impacts how an individual perceives and responds to the world around them, especially when there is a perception of fear or threat.

No higher order processing can happen, and relating cannot happen until *both* parties are regulated. Regulate- Relate-Reason. Through this comes resilience.

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NO Idea why, but I love this picture.

Here is some more info..if we have time..

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Some quick things you can do

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Focus on Arousal not Behaviors

See behaviors through the lens of the

….arousal continuum and stress response.

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Stop Focusing On Behaviors

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So, you’ve noticed you (or your student) is dysregulated!

You take note of the arousal continuum- you view the behaviors through this lens!

Bam! Step 1 Done! (you’ll revisit this, LOTS)

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“

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Then What?

Take a drink (non alcoholic), eat a snack-- do something that gets our body moving or in a different state.

(for kids this is not a reward for “poor” behavior, remember- we are viewing behaviors through the arousal continuum)

You aren’t focusing on behaviors, you are focusing on supporting regulation- safety.

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Try to Incorporate Body Movement

Kids-

A thumb war

A dance party

Crashing into a bean bag chair or couch

A fidget, play-doh

Adults-

A walk

Dance!

Heavy lifting or punching (appropriate spaces)

Cooking, or baking

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Be sure to have conversations with individuals who are chronically in a fear based state of arousal to be extremely consistent with food, drink, and movement. Prioritize these things over almost anything else.

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Food

Water

Movement

Support Regulation

Structure

Routine

Predictability

Stick Close-

Co-Regulate

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No Learning or Reasoning Will Happen

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What Questions Do You Have?

Relax muscle body → perceived versus actual threat → tell me in this room what could hurt you → Difference perceived and actual threat → notice your body → use video - take a deep breath your safe, give those cues, the reason you give those cues is to bring their awareness to it and then dont skip a beat and keep going into what you were talking about and then youre reprocessing what was causing them so much anxiety.

***ACES - level of trauma

Explain whatyour body is doing in fight or flight → Relax muslce body, regulated breathing, safe place, understanding subjective units of distress (stage 1)

Tracking symptoms -

Space

Safe spa

Subjective units of distress → think of a difficult experience in your life that was resolved, what were some of the changes in my life, what were the things that came out of it,

Our goal with these moadlitis is to help our clients work on Externalization, sensory processing, arousal reduction, attachment

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Thank You

mmcbride@heidelberg.edu

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