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Trauma Informed Strategies in

Early Childhood Settings

Carol Meade, MSW, LISW

Director of Behavioral Health Services

Craig Meskimen, MSW, LISW

Manager of Children’s Specialty Services
UnityPoint St. Luke’s Hospital
● Develop a shared understanding of the definition of trauma
and the impact of trauma on the development of young children

• Recognize and identify the role of educator’s bias and

perception in supporting at-risk children and their families

• Identify strategies when working with children who have

experienced trauma. (Extra bonus – these strategies work with
kids who have not experienced trauma too!)
What is Trauma?

● Trauma is an exceptional experience in which powerful and

dangerous events overwhelm a person’s capacity to cope.
(Rice & Groves, 2005, p.3)

● Complex trauma exposure refers to the simultaneous or

sequential occurrences of child maltreatment – including
emotional abuse and neglect, sexual abuse, physical abuse,
and witnessing domestic violence – that are chronic and begin
in early childhood . . . Complex trauma outcomes refer to the
range of clinical symptomatology that appears after such
exposures. *

● Adverse Childhood Experiences

● *National Child Traumatic Stress Network’s Complex Trauma Task Force, White Paper: Complex Trauma in
Children and Adolescents
The study

• Examined health and social effects of adverse

childhood experiences throughout lifespan

• Conducted by Dr. Robert Anda, CDC and Dr.

Vincent Felitti, Kaiser Permanente

• Decade-long study involving 17,000 people

– Demographics: primary care setting, educated, middle
class, predominantly white

• Largest study ever done on the subject

The study
Adverse Childhood Experiences (ACE):
– Abuse:
• Physical
• Sexual
• Emotional
– Neglect:
• Emotional
• Physical
– Other traumatic stressors:
• Substance abuse
• Divorce
• Mental illness
• Domestic Violence
• Criminal behavior
Aces Are Common
Of those surveyed:

• 1 in 4 exposed to 2 categories of ACEs

• 1 in 5 experienced 3 or more.

• 22% were sexually abused as children.

• 66% of the women experienced abuse,

violence or family strife in childhood.
What it found

Childhood experiences are

powerful determinants of
who we become as adults.
Effect of ACEs on Children

● Disruption in brain
● Harm to the nervous and
immune system
● Learning issues
● Behavior issues
● Psychological issues
● Impaired daily functioning
Impact of ACEs on Early Brain Development
What it found
ACEs are commonly linked to:
• Developmental impairment in • Liver disease
children • Heart disease
• Chronic depression • Victim of domestic violence
• Attempted suicide • Impaired worker performance
• Alcohol use • Health-related quality of life
• Smoking • Early mortality
• Illicit drug use
• Risky sexual behaviors
Toxic Stress in Children

● Caused by long-lasting
and/or severe stressors
● Stress response system on
“high alert” for extended
periods of time
● Caused when child has very
little control over their
environment and what
happens to them
● Occurs in the absence of a
healthy supportive
relationship with a caregiver
Flight, Fight, or Freeze

Flight Fight Freeze

• Withdrawing • Acting out • Exhibiting numbness
• Fleeing the classroom • Behaving aggressively • Refusing to answer
• Daydreaming • Acting silly • Refusing to get needs met
• Seeming to sleep • Exhibiting defiance • Giving a blank look
• Avoiding others • Being hyperactive • Feeling unable to move or
• Hiding or wandering • Arguing act
• Becoming disengaged • Screaming/yelling
Resilient Children
Learn to be:

● Leaders ● Hopeful
● Self-starters ● Creative
● Comfort seekers ● Autonomous
● Problem solvers ● Adventurous
● Optimistic ● Confident
Educator’s Biases and
“The way we interpret the events, people,
and situations in our lives determines our
reality. These interpretations are driven by
our belief system. Our beliefs are the most
powerful influence on the way we live, the
choices we make, the relationships we
have, the things we do, the places we go,
and the dreams we keep.”
●(excerpt from Fostering Resilient Learners, 2016)
Examining Educator’s Biases
and Perceptions by Reframing
Belief Reframed Statement
●His parents don’t value ●Both parents work full
education. time jobs to support the
●They are uninvolved in family and are not able
his education.
to attend in person
meetings at the school.

● ACEs are often intergenerational but

you have the power to impact your
students. Sometimes all it takes is a
Who said this?
● “Our youth now love luxury. They have bad manners,
contempt for authority; they show disrespect for their
elders and love chatter in place of exercise; they no longer
rise when elders enter the room; they contradict their
parents, chatter before company; gobble up their food and
tyrannize their teachers.”

470 BC – 399 BC
Unity Point – St. Luke’s

● Child Services start at 18 months.

– Teaching Interventions to Empower and
Strengthen Families (TIES Program): 18
months – 5 years
– Parent-Child Interaction Therapy (PCIT): 2
– 7 years
– LIFE Program: school age
* St. Luke’s provides mental health services 18 months – death ☺
● In this age group (18
months-7ish) an
underlying factor in
the majority of the
kids’ behaviors is
– Negative over none,
any day of the week!
● http://www.bing.com/videos/search?
Operant Conditioning
● Reinforcement – we condition responses to
children by the way we give attention
Operant Conditioning
● Don’t forget the lovely “Extinction Burst”!
– Often times, when children are faced with
significant change to their pattern, things get
worse before they get better.
How do we help these kids?

● We have to be what they are missing

● Build a Culture using:
– Compassion
– Positivity
– Consistency
Build a Culture - Compassion
● If we do the same thing we have always
done, we will get the same results we’ve
always gotten
– Are we reinforcing the wrong stuff!
• Pattern development takes time
• Keep in mind their history (extinction burst)
Build a Culture - Positivity
● Less punishment, more PRAISE
– Remember their history!
• What‘s safe and normal to these kids isn't
necessarily healthy
Build a System - Consistency
● Consistency
– Be “the One” that Carol is talking about
8 Strategies That Help!
● Strategy 1: Give Clear Instructions (every
– On their level
– Short and sweet
– Stated in a positive
8 Strategies That Help!
● Strategy 2: Give “Quality Attention” early
and often!
– Specific Positive Attention (SPA)
– Reflection
– Descriptions
8 Strategies That Help!
● Quality Attention – SPA
– Tells the child, in a clear concise manner, what
exactly we like about what they are doing
• increases the recurrence of the praised behavior
• Increases self-esteem

8 Strategies That Help!
● Quality Attention – Reflection
– Literally repeating or paraphrasing what the
child is saying
• Lets the child lead
• Shows that you are present with them
• Gives clarity…they will correct you

8 Strategies That Help!
● Quality Attention – Description
– Describing what the child is doing physically
with their hands/body (observable behavior)
• Builds the attention span “muscle” by helping them
hold attention on a task
• Helps gain clarity without asking questions
• Takes away assumptions

(sorry, no cool picture)

8 Strategies That Help!
● A little bit about questions…
– Many of us ask WAY to many questions in
working with kids
– With our age range, questions aren’t as
beneficial as one would think.
● SPA + Reflection + Description – Questions
= good communication
– 4/1 ratio for TIES families
– 30/1 for PCIT!
8 Strategies That Help!
● Example of a PCIT CDI session using the
– http://www.bing.com/videos/search?q=pcit+sess
● Grab a partner, and give one of each
– Reflection
– Description
8 Strategies That Help!
● Benefits of Consistent “QA”
– Builds self-esteem
– Increases the recurrence of the praised
– Plus, it’s just the right way to talk to people!
8 Strategies That Help!
● Strategy 3: Limited Reasonable Choices
– Help kids make decisions by limiting their
– Overwhelmed kids are usually upset kids.
• Limit chaotic overload as much as possible
8 Strategies That Help!
● Strategy 4: When…Then… statements
– Cause and effect communication
• “When you finish your assignment, then you can play
the game”
• “When you throw the cars, then they get put away”
– Keeps us from monologueing! (remember, swift and
– The less we talk, the
more they listen.
8 Strategies That Help!
● Strategy 5: Plan Ahead
– Set your child up for success
– “Fool me once, your fault. Fool me twice, my
• Environment
• Distractions
• Remember their
8 Strategies That Help!
● Strategy 6: Know What is Reasonable
– Just because they did it once, doesn’t mean
they have it mastered.
• Kids need time and repetition
– Especially when trauma is involved

– Expect inconsistency!
• It may feel like at times you’re starting over
– Holidays
– Breaks
8 Strategies That Help!
● Strategy 7: Stay Calm
– Kids can sense our emotions!
– Integrated Experience (behavior influences
8 Strategies That Help!
● Strategy 7: Stay Calm
– Model appropriate behavior for our kids
8 Strategies That Help!
● Strategy 8: Neutral Talk
– Avoid finger pointing
– Own it!
8 Strategies That Help!

● I believe that consistent implementation of the

8 strategies can eliminate, or at least
dramatically reduce, the majority of behaviors
within our age group.
– However, there are exceptions
• Mental Heath
– Parent or Child
• Family Barriers
– Poverty
– Abuse
Implementation Takes Time
● Extinction Burst
● Stay with it
● Trust the data
– “This won’t work with our
Additional Resources
● http://www.pcit.org/
● https://www.unitypoint.org/cedarrapids/services-
● http://www.ripnetwork.org/
● https://www.ricklavoie.com/