regulation.

ETTING
WCWC VI Conference
Trauma Informed Care: A Lifelong Perspective For Living Well
September 18, 2015
Lily Cosico-Berge, PsyD, ATR-BC, RPT, I-F ECMH RPM
Neighborhood House Association Head Start
Learning Objectives
 Demonstrate a basic
understanding of how trauma
affects self-regulation and coregulation.
 Identify a respectful and traumainformed, relationship-based
approach to early care and
education.
 Practice strategies that promote
self-regulation and co-regulation,
as well as foster feelings of mutual
respect and connectedness.
 Review a mental health screening
tool (MHST 0-5) that can be used
by teachers and home-visitors to
assist in further referrals for
mental health consultation and
services.
“It’s all about the
relationship and selfregulation…”
What can I do?
Island of
Competence
(Robert Brookes, PhD)
“If we can find and reinforce these
areas of strength, we can create a
powerful "ripple effect" in which
children and adults may be more
willing to venture forth and
confront situations that have been
problematic.”
Symbol of hope and respect, a
reminder that all individuals
have unique strengths and
courage.
 How might we strengthen these
islands and display them for
others to see?
 Alter the mindset from "fixing
deficits" to "identifying and
reinforcing strengths."
Core Components
for Trauma
Intervention
 Strong therapeutic relationships
 Psychoeducation about normal
response to trauma
 Parental support/parent training
 Emotion expression and
regulation skills
 Anxiety management and
relaxation skills
 Trauma processing and
integration
 Personal safety training
 Resilience and closure
Toxic Stress and Trauma
How Much Stress Is Too Much?
Positive Stress
• Moderate, short live
responses
• Brief increases in
heart rate
• Mild changes in
hormone levels
• Important part of
development and
coping
Tolerable Stress
• Stress responses that
could disrupt brain
wiring
• Generally timelimited period (vs.
on-going)
• Buffered by
supportive
relationships
Co-regulation helps with Gives brain the
adaptive behaviors
opportunity to recover
from potentially
damaging effects
Toxic Stress
• Prolonged activation
of the body’s stress
management
systems
• Stress responses that
disrupt brain wiringleads to low
threshold
• Absence of
relationship buffer
Increases risk of stress
related physical and
mental illness
Tolerable and Toxic Stress
Alarm
Relaxation
Alarm, Alarm
How Stress Harms
• Higher risk for
developing learning
disabilities, emotional
and behavioral
problems, as well as
asthma, immune-system
dysfunction and heart
disease
• Early, frequent, and
intense stress tunes the
brain to set “stress
regulation” at high levels.
What is Trauma?
• An exceptional and dangerous experience
which overwhelm the capacity to regulate
emotions.
• Children’s reactions to trauma vary at
different ages. Early intervention can be
very helpful to allow them to get back on
a normal developmental path
MHST 0-5
• Recognizing red-flags
• Sharing observations
• Role of ECMH
Staff/Consultant
What does
this mean to
us?
• We need to have a new lens
through which to see and
understand where are
families have been and what
they have experienced
• Recognize that parents are
the most important people
in children’s lives
• Relationships and structure
help reframe the world as a
safe place
Parallel Process
“Do unto others as you would have others do unto others.”
Jeree Pawl
Children
• Young children develop in
relationships.
• Young children use
relationships with caregivers
to:
• Regulate physiological response
• Form internal working
• Provide secure base for
exploration and learning
• Model coping behaviors
Parents
 Engagement starts with rapport.
 Relationships with parents have
the potential to:
 Regulate physiological response
 Create new meaning to “positive
relationships”
 Provide a safe environment to ask
questions & express concerns
 Model coping behaviors
What gives you
strength to keep
going?
There is power and meaning in every
story….what’s your story?
What affects the way we respond to the child’s
cues for attention and nurturance?
What we believe about
attention and nurturance
What we are told, what we
have heard and read in the
media
External demands of your
job
Your current emotional
state…how you are feeling
at the time…
What affects the way we respond to the cues parents
show us when they need attention and nurturance?
What we believe about
adults’ need for attention
and nurturance
What we are told, what we
have heard and read in the
media
External demands of your
job
Our feeling at the time…
RESPECTFUL STRATEGIES & WAYS OF BEING:
A COMMUNICATION FRAMEWORK
(MARY CLAIRE HEFFRON & LUCIA MILBURN)
• How to be
• How to understand
• How to influence




Foundation of trust
Strong attunement
Careful listening
Ability to monitor your
feelings and perception
 Observe the relationship
going on around you
Group Activity
Respectful Strategies
That Build Relationship
RESPECTFUL STRATEGIES & WAYS OF BEING:
A COMMUNICATION FRAMEWORK
(MARY CLAIRE HEFFRON & LUCIA MILBURN)
 HOW TO BE…..
 Be aware of your own
feelings, how you are
reacting….
 Are you reading cues? Are
you adjusting to respond to
cues?
 Normalize
 Attribute positive meaning
 Find the island of
competence
RESPECTFUL STRATEGIES & WAYS OF BEING:
A COMMUNICATION FRAMEWORK
(MARY CLAIRE HEFFRON & LUCIA MILBURN)
How to understand
Use MHST/ASQs- giving
feedback, asking
questions




Ask open-ended questions
Be curious
Restate and rephrase (SSTs)
Be tentative when
appropriate (HV/T/SS)
 Tease out concerns- don’t
rush to solve problems
 Voice something you have
noticed and ask to expand
(HV/Teachers)
RESPECTFUL STRATEGIES & WAYS OF BEING:
A COMMUNICATION FRAMEWORK
(MARY CLAIRE HEFFRON & LUCIA MILBURN)
• How to influence
“But I have sooo much to give you and
help you with, if you would only take
it….”
Our Little Brown Cousin
 Give specific feedback to
shape behavior
 Be tentative when making
observations or giving
suggestions
 Encourage an experimental
attitude
Strategies For Teachers
Schedules & Routines
lcosico-berge2014
More Ways to Support Parents
 Recognize that parents and caregivers are the most
important people in children’s lives
 Support parents as their children’s first teachers
 Help parents see the power of their relationships w/
their children
 Give parents information and community resources
 Help with follow-through with referrals and
appointments
lcosico-berge2014
Time to Reflect…
 What does this work mean to you
personally?
 What are you bringing to your
particular role from your life
experiences?
 How do these things help you or
hinder you in your work?
• I WILL IMPLEMENT THIS STRATEGY
RIGHT
WAY________________________
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• I pledge to assist families to
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