Please enable JavaScript.

Coggle requires JavaScript to display documents.

M4U4A2: Responding to Traumatic Stress, The Impact of Trauma, Effects, How…

- - - - Avoidance
        • Avoiding thinking or talking about the illness, injury, or hospital experience, or things associated with it • Displaying less interest in usual activities • Feeling emotionally numb or detached from others
      - Hyper-arousal
        • Increased irritability • Trouble concentrating or sleeping • Exaggerated startle response • “Hyper-vigilance”— always expecting danger
      - Re-experiencing
        • Thinking a lot (unwanted, intrusive thoughts) about the illness, injury, or procedure • Feeling distressed at thoughts or reminders of it • Having nightmares and “flashbacks”
      - Others
        • New fears related to the medical event • New somatic complaints (bellyaches, headaches) not explained by medical condition • Feeling in a daze or “spacey
    - - Encourage parent presence.
        
        Encourage parents to be with their child as much
        
        as possible during hospital stay.
        
        • Encourage parents to talk with their child about
        
        worries, hopes, etc.
        
        • Parents know their child better than anyone,
        
        and can help staff understand their child’s needs
        
        and coping strengths.
        
        Encourage social support & involvement
        in “normal” activities.
        
        • Suggest age-appropriate positive activities that fit
        
        the child’s medical status (play, family time, videos.)
        
        • Promote the child’s appropriate contact
        
        with friends, classmates, teachers (letters,
        
        calls, email.)
        
        Empower parents to comfort and help their child.
        
        Help parents understand the illness or injury
        
        and treatment plan — so that they can give
        
        age-appropriate explanations to their child.
        
        • Encourage parents to use the ways they have
        
        learned to soothe and calm their child at home.
        
        • Parents may welcome specific suggestions from
        
        staff about how to help their child during
        
        procedures — e.g., “You can hold his hand and
        
        talk to him while we do this.”
      - Remember family members’ emotional needs.
        
        Help them to enlist support systems (friends,
        
        family, faith community)
        
        • If parents or other family members are having
        
        difficulty coping,
        
        – use hospital services (chaplain, family
        
        support services)
        
        – consider referral of parent to mental
        
        health professional.
        
        Be sensitive to resource needs of the family
        
        These issues can significantly interfere with
        
        the child’s recovery. If problems are identified,
        
        utilize psychosocial resources (e.g., social work
        
        services) to address them.
        
        • Housing
        
        • Finances
        
        • Insurance
        
        • Language/Translation
        
        • Immigration
        
        • Care of other children
        
        Encourage parents’ basic self-care
        
        Encourage parents to take care of themselves.
        
        They need sleep, nutrition, and breaks from
        
        the hospital.
      - Provide the child with as much control as possible
        over the clinical encounter. The child should:
        
        • understand what is about to happen
        
        • have a say in what is about to happen
        
        • have some control over pain management
        
        Listen carefully to hear how the child understands
        what is happening.
        
        • After explaining diagnosis or procedure,
        
        ask the child to say it back to you.
        
        • Remember that the child’s understanding may be
        
        incomplete or in error.
        
        • Provide accurate information.
        
        • Use words and ideas the child can understand.
        
        Provide reassurance and realistic hope.
        
        Describe what is being done to help the child
        
        get better.
        
        • State that there are many people working together
        
        to help the child
  - - - VIDEO Pediatric Medical Trauma: Module 1
- - - - Bruises (especially suggestive of abuse is seen in infants and immobile children)
      - Fractured or broken bones, or signs of old fractures
      - Burns or blisters, especially on the feet or the bottom
      - Lacerations to the body or mouth
      - Bite marks
      - Scarring
      - The effects of poisoning, such as vomiting, drowsiness, seizures
      - Breathing problems from drowning, suffocation, or poisoning
      - The following symptoms may signal head injuries in babies and toddlers: swelling, bruising, fractures, being extremely sleepy, breathing problems, vomiting, seizures, being irritable, or not feeding properly.
      - Looking terrified of parents, hesitant to go back home after school
      - Displays frozen watchfulness
      - Asking questions either in words/actions what will happen next constantly
      - Shrinks away at the approach of adults
      - References:
        Brighton & Hove Safeguarding Children Partnership. (n.d.). Signs of physical abuse. https://www.bhscp.org.uk/preventing-abuse-and-neglect/spotting-the-signs/signs-of-physical-abuse/
  - - - https://youtu.be/95ovIJ3dsNk
      - Response Strategies
        
        Responding to a suspected or confirmed case of child abuse and neglect can affect whether or not a child gets the necessary support. It can also influence how an abused child will recuperate from their traumatic and painful experience. Therefore, to better increase the possibility of a positive outcome, here are response strategies for child abuse and neglect:
        
        Report suspected child abuse immediately. As long as you have sufficient reason to make a report, you are legally protected and cannot be sued. Be sure to give the person or agency you make the report as much information as possible.
        
        Do not act shocked or disgusted if a child reveals something about their abuse to you. Children are inclined to think that you are responding that way because of them, which can significantly impact their healing and recovery.
        
        Be supportive in your response and let the child know it is not their fault. Also, remember that you cannot promise not to tell since you are legally required to report any suspicion. The Crisis Manual for Early Childhood Teachers suggests the following response: 'I'm glad you told me. You did the right thing. I'm sorry this happened to you.'
        
        Make sure children who are abused have plenty of ways to express themselves. Drawing, painting, and writing are excellent creative outlets for children to express their thoughts and feelings about what happened to them.
        
        Treat all children with kindness, respect, and empathy. Building positive relationships with children will also give abused children the opportunity to use violence or humiliation in their social interactions with others.
        
        Reference:
        Kaplan Early Learning Company. (n.d.). Responding to child abuse and neglect. https://www.kaplanco.com/ii/child-abuse-neglect
- - - - Low self-confidence (NCTSN, n.d.)
      - Verbally abusive (NCTSN, n.d.)
      - Difficulty making new friends and connections (NCTSN, n.d.)
      - Trouble focusing in classroom sessions, and decreased skill development (NCTSN, n.d.)
      - May have stomach aches or head aches throughout the day (NCTSN, n.d.)
    - - Build a strong relationship over time, based on what they are willing to share (Resilient Educator, n.d.)
      - Approach a students behavior with "openness and curiosity" to move past the classroom behavior (Resilient Educator, n.d.).
      - Provide specific accommodations that address a student's need (Resilient Educator, n.d.)
      - Create a safe environment through routines, norms, and physical layout (Resilient Educator, n.d.)
      - https://www.youtube.com/watch?v=8NkZO3_h7vI
      - https://www.youtube.com/watch?v=PTsPdMqVwBg
    - - A student is unwilling to enter the classroom until all of their peers are seated.
        
        Response: The student could perform a morning work task in the hallway, while students are arriving. After a few weeks, the teacher can ask the student to come into the back of the room and start the day, or come to the "teacher desk" and start their morning work from there.
      - A student is having trouble making new friendships and is verbally abusing other students they are trying to befriend.
        
        Response: The teacher can use SEL to help the student unpack their feelings is a specific moment, and ask them how they feel the interaction went. After the quick discussion, the teacher and student can partner together to practice specific phrases and sentences to help start a friendship conversation the next day.
- - - - RESPONSE: Check in with the student. Offer them the chance to talk. If you have a PLC, check in with the other teachers. Refer the student to the school counselor's office. Offer the student a "free journal" assignment and let them know that anything they share will remain confidential between the student and the school. And bear in mind the 3 resources from above: Avoid judgement, check in, and know your resources.
    - - Again the behavior is unacceptable and must be shut down. However try not to shame the student. Inquire WHY they are behaving in this specific way? As above, check in with your PLC, refer to the school counselor, and avoid judgement, check in, and know your resources.
    - - RESPONSE: You must shut down the behavior as it's completely unacceptable, however you should deal gently with the person. Offer a safe place to discuss what might be going on in their world. If they prefer, refer them to the school counselor. In any case, remember these three things:
        
        Avoid judgment. It can be difficult to watch a survivor struggle with the effects of sexual assault for an extended period of time. Avoid phrases that suggest they’re taking too long to recover such as, “You’ve been acting like this for a while now,” or “How much longer will you feel this way?”
        
        Check in periodically. The event may have happened a long time ago, but that doesn’t mean the pain is gone. Check in with the survivor to remind them you still care about their well-being and believe their story.
        
        Know your resources. You’re a strong supporter, but that doesn’t mean you’re equipped to manage someone else’s health. Become familiar with resources you can recommend to a survivor, such as the National Sexual Assault Hotline 800.656.HOPE (4673) and online.rainn.org, y en español a rainn.org/es.
  - - - “I believe you. / It took a lot of courage to tell me about this.” It can be extremely difficult for survivors to come forward and share their story. They may feel ashamed, concerned that they won’t be believed, or worried they’ll be blamed. Leave any “why” questions or investigations to the experts—your job is to support this person. Be careful not to interpret calmness as a sign that the event did not occur—everyone responds to traumatic events differently. The best thing you can do is to believe them.
      - “It’s not your fault. / You didn’t do anything to deserve this.” Survivors may blame themselves, especially if they know the perpetrator personally. Remind the survivor, maybe even more than once, that they are not to blame.
      - “You are not alone. / I care about you and am here to listen or help in any way I can.” Let the survivor know that you are there for them and willing to listen to their story if they are comfortable sharing it. Assess if there are people in their life they feel comfortable going to, and remind them that there are service providers who will be able to support them as they heal from the experience.
      - “I’m sorry this happened. / This shouldn’t have happened to you.” Acknowledge that the experience has affected their life. Phrases like “This must be really tough for you,” and, “I’m so glad you are sharing this with me,” help to communicate empathy.
      - Using SEL strategies to help the student understand their own emotional responses, what they're feeling, why, how to best express it, and how their actions impact others.
- - - - Do not use physical force
        
        Talk about the problem
        
        Therapy for the bullied
  - - - unexplainable injuries
- - - - Help Kids Cope Mobile App: https://www.nctsn.org/sites/default/files/resources/flyer/help_kids_cope_flyer_0.pdf An app that teaches users what to do before, during, and after ten different disasters. Also contains activities, children's books resources, and tip sheets.
      - Teacher guidelines for helping students after an earthquake: https://www.nctsn.org/sites/default/files/resources//teachers_guidelines_talking_students_after_earthquake.pdf
      - Trauma Informed Schools and Practices Video
    - - Help students cope with distress. Provide strategies: talking with trusted adult, doing enjoyable activities, calming spaces...
      - Provide structure, order, discipline with clear set rules and boundaries. Regularity and predictability enables a feeling of safety.
      - Create a culture of tolerance in the classroom. Include students in group activities, curb bullying/teasing, model empathy and tolerance.
      - Modify lesson plans (slower pace, reduce workload)
      - Using Professional Learning Communities to help connect students to proper channels for coping with trauma (e.g. counselors) and for discussing best practices for managing trauma on a schoolwide level. Intervention groups could also be formed and/or designated to select students.
      - Use SEL to help students develop self-awareness (how their thoughts/values impact behavior). Nurture and encourage a growth mindset. Provide students opportunities to talk through thoughts, feelings, and emotions to help students process feelings in a constructive way. https://apertureed.com/3-ways-sel-can-support-trauma-informed-practices-2/
    - - An early elementary student experiences the trauma of a hurricane that devastated his family's home and resources. Back at school, this student has difficulty settling down for class. He is jumpy and restless during lessons. He has begun acting out aggressively, hitting and pushing his classmates. He throws screaming tantrums when he doesn't get his way.
        
        Response: Set clear expectations and boundaries for behavior with consequences following misbehavior. Consequences should always be consistent and logical. Make lessons more dynamic by adding physical activity or brain breaks after every half hour or so to maintain student concentration and to curb restlessness. Keep a consistent routine to provide a sense of structure and safety. https://schools.aidr.org.au/media/4605/conrod_childhood-trauma-reactions.pdf
      - A high school student experiences the trauma of a wildfire that devastated his entire county. He lost some close neighbors to the fires, and his family, though safe, lost their property. The student's family had to stay in a camp until the family was able to get resituated. To cope, the student partakes in doing drugs and drinking alcohol. His grades have noticeably slipped and he talks back to his teachers and gets into fights with his classmates.
        
        Response: Help students to build a strong support network. A natural disaster such as a wildfire could impact one's community system, making one feel alone, lost, and afraid. Teachers can help students connect with the right people, such as the grief/trauma counselor, a student welfare agent, etc. Connecting students to the right people could help them on the right path towards appropriate coping and healing from trauma. https://schools.aidr.org.au/media/4605/conrod_childhood-trauma-reactions.pdf
      - A middle school student experiences the trauma of a deadly earthquake that toppled her city, killing countless people and causing lots of structural damage to buildings. Several of her family members got injured, though they all recovered. This student is always fearful of the next earthquake. After hearing of survivors who were trapped in rubble for days (and even weeks in some cases), she has become profoundly fearful and carries around a stash of emergency supplies wherever she goes. She gets into an extremely agitated state whenever something happens suddenly, such as a loud noise.
        
        Response: Give students a heads-up about things that may be triggering, especially things that are out of the norm or not part of a daily routine (for example, a fire alarm drill). Teachers can create a calming space in the class for students to go to for regaining composure and calmness. A quiet area of the classroom stocked with books, cushions, and ambient lights could help enhance the feeling of calmness. https://schools.aidr.org.au/media/4605/conrod_childhood-trauma-reactions.pdf
      - A fifth grade student experiences the trauma of a flood that devastated not only her family's home, but almost her entire district. Once outgoing and sociable, she has recently withdrawn from her friends. In class, she seems to be zoned out, staring off into the distance. She becomes agitated whenever the flood is brought up at school, leading to full blown panic attacks.
        
        Response: Set aside time to talk about the natural disaster with firm boundaries set when doing so. Set a time limit for discussion and obtain extra support, such as from a grief or trauma counselor, to aid in the discussion. Keep the discussion on a positive note and discourage any conversations that may lead to fear. Have students share positive coping strategies and impacts of the flood. Teachers should model a calm disposition and appropriate coping behaviors. https://schools.aidr.org.au/media/4605/conrod_childhood-trauma-reactions.pdf
    - - Decreased concentration and attention
        
        Increased irritability
        
        Withdrawal
        
        emotional outbursts
        
        Behavior Changes: (NCTSN)
      - Increased sensitivity to sounds (sirens, loud noises, things falling or crashing) (NCTSN)
      - Feelings of anxiety, fear, and worry about the safety of self and others (NCTSN)
      - Lack of interest in usual activities, including playing with friends (NCTSN)
      - Increased high-risk behaviors in adolescents (drinking, substance abuse, self-injurious
        behaviors) (NCTSN)
- - - - The student has recently had to endure a fatal car crash involving a sibling. The student is experiencing some anxiety and fear during class.
        
        RESPONSE: The teacher sets up some discrete signals with the teacher to signify when the student is experiencing emotional distress or anxiety during class. The teacher can set up relaxation exercises that the student can perform when this occurs. When given the signal the teacher will move over to the student's desk and lead the student through guided meditation and/or breathing exercises.
      - The student lost a parent due to illnesses and periodically has outburst of anger and heightened irritability.
        
        RESPONSE: The class goldfish died and the teacher used this as a chance to discuss death in class to help to manage the narrative on death to a more emotionally manageable level. Normalize the student's feelings about death by having students use words to describe the feelings they experience concerning the problem. It also can build a level of comfortability around expressing feelings in a healthier way.
    - - Provide cognitive assistance through helping to reduce emotional stress in the classroom (Cohen and Mannarino)
      - Remove reminders of traumatic events in the classroom setting (Cohen and Mannarino)
      - Alleviate emotional weightiness by encouraging creative expression (Cohen and Mannarino)
      - Help the student to develop an emotionally manageable narrative concerning death
    - - Haunting and intrusive memories concerning manner of death (NCTSN, n.d.)
      - Avoidance and withdrawal from things that can serve as reminders (NCTSN, n.d.)
      - Physical or emotional symptoms such as: increased irritability, anger, and fear (NCTSN, n.d.)
- - - - Response:
        
        Grounding exercises
        
        Have students practice identifying:
        
        5 things you see
        
        4 things you hear
        
        3 things you smell
        
        2 things you can touch
        
        1 thing you taste
        
        https://www.counselorkeri.com/2019/04/02/help-kids-manage-worry/
        
        Reorientation - To re-orient to the moment, just have students name facts about the moment. You can give them a card to keep with them to remind them of facts they can state and practice practice practice! It might sound like:
        
        My name is…
        
        I am in…
        
        Today is…
        
        The season is…
        
        The weather is…
        
        I am wearing…
        
        https://www.counselorkeri.com/2019/04/02/help-kids-manage-worry/
        
        First and foremost, remind the student that they are safe and nobody can hurt them at school. Depending on the fluency in English, help students with grounding or reorientation exercises. Additionally, have a meeting with the parents including a translator present that can express how schools operate, what safeguarding is and the need to have a conversation with their child about how they are safe and welcome.
        
        Provide students with information on any school drills. construction or bells that may occur in advance to minimize any triggering C-PTSD. The school can also provide a solo session of orienting the student to the sound that may occur in an emergency. such as the school fire drill..
        
        Anticipate difficult times and find preventative methods to keep the student from feeling triggered. A common reality of displacement is the fear of being alone, therefore finding a partner for the year for the particular student can be helpful, or even a buddy to walk them to the restroom and back. (https://www.nctsn.org/sites/default/files/resources//child_trauma_toolkit_educators.pdf)
        
        Accommodations and modifications can also be made to academic requirements and expectations. The following can also be included in a 504 plan:
        
        • Shorten assignments
        
        • Allow additional time to complete assignments
        
        • Provide additional support for organizing and remembering assignments. Provide ample check-ins and let the student know that they are seen, valued, welcome and safe.
        
        If the student feels overwhelmed in class, allow them to go to the school nurse for a break or the guidance counsellor for additional assistance and space.
        
        When discussing potentially triggering matters such as home, displacement, community and war, it is helpful to remind students that the threat/danger is over if included in the example in class, and that after an incident is over, there is an opportunity to rebuild and recreate our lives and our communities.
        
        Create ample opportunities for students to share their experiences in a non-intrusive manner. Encouraging the expression of emotions around topics of land, countries, identity, safety, etc. through art and journaling can help prompt the process of acknowledgment and healing.
  - - - Stomach aches, headaches
      - Crying a lot
      - Fear or anxiety
      - Sadness or irritability
      - Thoughts about the traumatic event that won't go away
      - Avoiding thinking or talking about anything that reminds him or her of the traumatic event
      - Acting as if the event is happening right now (when it is something that occurred in the past)
      - Trouble managing behavior or emotions
      - Lack of desire to play with others or take part in activities that he/she used to enjoy
        
        Getting upset when things happen that remind him or her of the traumatic event
        
        Trouble falling asleep, or sleeping too much (at home and in-school)
        
        Trouble paying attention