Trauma-Informed Care for People with Intellectual Disabilities Karyn Harvey, Ph.D. Objectives Following this webinar, participants will… 1. Recognize the sources of trauma in the lives of people with intellectual/ developmental disabilities 2. Identify the effects of trauma 3. Identify key components of healing Sources of Trauma for People with IDD Statistics on Sources of Trauma • Over 70% of people with Disabilities report being victims of abuse • 90% of them said it was on multiple occasions • Only 37% reported the abuse to the authorities • People with IDD are 7 times more likely to be sexually abuse than those without disabilities – NPR • People with disabilities are 2.5 times more likely to be victims of violent crime and 40% more likely to have the perpetrators be someone they know (BJS statistics) “Big T and “Little t” Traumas MajorEventsLittle “t”Trauma Sexual Abuse Family Violence Physical Abuse Neighborhood Violence Neglect Social Exclusion Negative Events Exclusion from Family Frequent foster care or group Grief and Loss home placements and lack of stability Effects of Trauma on the Brain Bucharest Early Intervention Orphan Study – Effects of Neglect • 138 children between 6 and 31 months who were in an orphanage in Bucharest were studied • 68 kept in institution • 68 placed in a new foster care system – full time paid parenting • Results: After 54 months ( 4 1/2 years): Compared to 138 children raised in birth families http://www.unicef.bg/public/images/tinybrowser/uplo ad/PPT%20BEIP%20Group%20for%20website.pdf Bucharest Early Intervention Orphan Study Issues: Institution Foster Care Biological Axis 1 Disorders 55% 35% 13% Emotional Disorders 49% 29% 8% Behavioral Disorders 32% 25% 6.8% Intellectual Disability Average IQ Score 73 85 110 Children Who Stayed in Institutions –Nathan Fox • Gray matter in brain actually shrunk • Lower brain activity measured by EEG • Impairments in Executive Functioning • Increased Adrenaline levels after 1 year – affects heart, behavior, ability to focus ( looks like ADHD) • Often abnormally small physically • At higher risk for premature deaths Psychological Trauma – Past is Present Neocortex – the rational intellectual tasks Limbic – the intermediate brain: emotions Reptilian – the primitive preservation and aggression How did the brain react? Trauma Responses Due to “Buttons Pushed” Trigger Response – Something happens in the present that reminds the person of the negative past -person goes into fight, flight or freeze mode: Thinking he or she is in danger! Chemistry When Sympathetic Nervous System Is Triggered • Cortisol goes from Amygdala to Frontal lobe • Adrenaline is released and floods the system • Regions of brain do not communicate and integrate The Behavioral Pyramid BEHAVIOREMOTIONTRAUMABehavioral Issues: Emotions Expressed Often Rooted in Trauma When we only address the behavior, we miss the true cause and root of difficulties Trauma Response vs. Behavior Response • Trauma • Triggered in an irrational manner • Overreaction to small event • Very emotion based • Does not serve the person well • Does not move them forward • Behavior • Has a purpose and intent • Deliberate-acting on environment to get response • Intent is important in identifying the response • Goal is to get something they want, can move them forward • You can typically identify the antecedent 4 Areas of Symptoms of PTSD 1. Re-experiencing ( interfering with present to different degrees) • Intrusive Memories • Nightmares • Flashbacks-Person can disconnect from reality and be convinced he or she is being attacked, hurt or threatened due to a memory that becomes present 2. Avoidance • Blunted emotions • Shut down responses • Person can become obsessive about details concerning self and safety • Disconnection and withdrawal 4 Areas of Symptoms of PTSD (2) 3. Negative Alterations in Cognition and Mood • Persistent negative-trauma related emotions i.e. fear, horror, anger, guilt and shame • Constricted emotion – inability to express positive emotion • Alienation and withdrawal from others 4. Arousal • Easy to startle • Agitated – can lead to property destruction • Periodically Combative • Impulsive • Also associated with reckless or self-destructive behavior PTSD is a Spectrum Addressing Trauma for People with IDD The Profile of Trauma in People with I/DD has Changed The brain chemistry of people with I/DD has changed. • Less genetics-related disability, more disability caused by other external factors • Changes brain chemistry, which changes how their brain responds to trauma and healing services Ingredients Necessary for Post Traumatic Recovery What People Need Most Sense of Safety Understanding Support for Next Steps Kindness Empathy The Body Stores Trauma • Gastro-Intestinal Issues • Phantom Pain • Exaggerated Pain Response • Treatment : • Being Present In Body – • Yoga • Dance • Massage The Iraq PTSD Study EMDR Study • 8 Individuals Diagnosed With PTSD • EMDR For 1 Year • All Individuals No Longer Diagnosed With PTSD – Symptoms Gone! Behavioral Results 2012 -2013: Individual 1 – “manifestations of trauma” – from 6 to 0 Individual 2 – “excessive crying” – 58 to 13 Individual 3 – “aggression” -16 to 0 Expressive Therapies The Healing Center Grief Work: Goodbye Book and Memory Box Who Am I? Positive Identity Development Negative Identity Positive Identity • NOT the person who gets the • Who I am job • What I do well • NOT the person who gets • Who my friends are married • What my preferences are • NOT the person who drives • Where I make a difference • NOT the person who plays on a high school sport team • What I am proud of • NOT the person who is popular or liked • Not the cool one What matters most is how YOU see yourself ! From Recovery to Happiness Five levels of Happiness: 1. Pleasure 2. Engagement 3. Positive Relationships 4. Achievement 5. Meaning *Happiness Assessment The Connections Cruises Supporting Staff • Secondary trauma • Staff’s own trauma history • Need for de-briefing • Need for trauma-informed management Supporting Families and Family Trauma • Family system trauma • Stressors on families – high incidents of divorce • Stress on siblings • Stress from the system • Stress from transition • Stress from mortality Questions? karynharvey911@gmail.com Materials at: Pid.thenadd.org Books at Amazon.com References Bennett, DS, Bendersky, M, and Lewis, M. (2008). Children’s cognitive ability from 4 to 9 years old as a function of prenatal cocaine exposure, environmental risk and maternal verbal intelligence. Developmental Psychology, 44,(4) 919-28. Chasnoff, IS, Griffith, DR, Freier, C, and Murray, J. Pediatrics 89. Cocaine/Polydrug Use Pregnancy: Two Year Follow-up. (2) 284-9. 1992 Frank, DA, Augustyn, M, Knight, WG, Pell, T and Zukerman, B.( 2001). Growth, development, and behavior in early childhood following prenatal cocaine exposure: a systematic review. Journal of American Medical Association, 285, (12) 1613 Chiriboga, CA. ( 1998) Neurobiological Correlates of Fetal Cocaine Exposure Annals of NewYork Acadamy of Sciences ,846, 109-125. Eisenberger, N, Lieberman, M., Williams, K. Does Rejection Hurt? An fMRI Study of Social Exclusion in Science Vol 302, no 5643. Pp290-292. October 2003. References (2) Harvey, K. Trauma – Informed Behavioral Interventions ( 2012) AAIDD Press, Washington. Harvey, K. Positive Identity Development ( 2009) NADD Press, Kingston. Herman, J. (1997).Trauma and Recovery. New York: Basic Books. LeDoux, J. (1996). The Emotional Brain. New York: Simon And Schuster. Chapter 8. Mercier F1, Kwon YC, Douet V Hippocampus/amygdala alterations, loss of heparan sulfates, fractones and ventricle wall reduction in adult BTBR T+ tf/J mice, animal model for autism. 2012 Neuroscience 2 p 208-13. Seigel, D. (2009). The Mindful Therapist.New York: W.W. Norton and Company. Chapter 10. Seligman, M. Authentic Happiness. New York: Vintage Books. 2006. Thank you! Thank you for attending our webinar. A record of attendance and a PDF of the PowerPoint are available for download in the Downloads Pod. Please take a moment to complete a brief survey about this webinar.