Helping Children Deal with Trauma and Disasters

With so many disasters, natural and man made, taking place this year, sharing this pamphlet from National Institute of Mental Health is appropriate.  The first thing that is clear from the pamphlet is that different ages react differently to trauma,  I really like the dos and don'ts.

Elizabeth Smart and Resiliency

If anyone can teach and explain how to overcome overwhelming trauma it is Elizabeth Smart, who was kidnapped, and held hostage for nine months.  During that time she experienced tremendous trauma, including almost daily rape.  Elizabeth provides some insight of how she has been able to overcome such horrendous trauma.
She says, The human spirit is resilient.  God made us so.  He gave us the ability to forgive.  To leave the past behind.  To look forward instead of back.  I'm not the first on who has ever done this.  People have been doing it for generations.  Since the beginning of time, men have found ways to heal.
She talks about the history of strong Mormon women in her family, especially her mother.  After her ordeal, these are the words her mother told her:

Elizabeth, what this man has done is terrible.  there aren't any words that are strong enough to describe how wicked and evil he is!  He has taken nine months of your life that you will never get back again.  But the best punishment you could ever give him is to be happy.  To move forward with your life.  To do exactly what you want.  Because, yes, this will probably go to trial and some kind of sentencing will be given to him and that wicked woman.  But even if that's true, you may never feel like justice has been served or that true restitution has been made.  But you don't need to worry about that.  At the end of the day, God is our ultimate judge.  He will make up to you every pain and loss that you have suffered.  And if it turns out that these wicked people are not punished her on Earth, it doesn't matter.  His punishments are just.  You don't ever have to worry.  You don't ever have to even think about them again.  You be happy, Elizabeth.  Just be happy.  If you go and feel sorry for yourself, or if you dwell on what has happened, if you hold on to your pain, that is allowing him to steal more of your life away.  So don't you do that!  Don't you let him!  There is no way he deserves that.  Not one more second of your life.  You keep every second for yourself.  You keep them and be happy.  God will take care of the rest.

Elizabeth put this advise into practice.  She also employed some specific activities to help herself heal.  On of these included horse back riding with her grandfather.  Horses provided her a place to heal, as she experienced nature on the back of a horse.
Elizabeth also turned to her music.  She plays the harp.  She studied music performance at BYU.
She also embraced an attitude of gratitude, focusing on her many months of good experience, rather than her terrible nine months.
She concludes with this statement, "All of these things have helped me.  But ultimately, to get better, I simply made a choice.  Life is a journey for us all.  We all face trials.  We all have ups and down.  All of us are human.  But we are also the masters of our fate.  We are the ones who decide how we are going to react to life.

Resilience is a special gift.  It is such a factor in our reaction to trauma.  It is often a determining factor on our response and outcome.  Those people with more resiliency are able to move past trauma.  However less is known about where resiliency comes form.  Is it something that can be taught, because if it can, this could be a major focus of mental health treatment.


Wikipedia gives a definition of psychological resilience, which is a new area of focus in mental health:
Psychological resilience is defined as an individual's ability to successfully adapt to life tasks in the face of social disadvantage or highly adverse conditions.^[1] Adversity and stress can come in the shape of family or relationship problems, health problems, or workplace and financial worries, among others.^[2] Resilience is the ability to bounce back from a negative experience with "competent functioning". Resilience is not a rare ability; in reality, it is found in the average individual and it can be learned and developed by virtually anyone. Resilience should be considered a process, rather than a trait to be had. It is a process of individuation through a structured system with gradual discovery of personal and unique abilities.

Documentary Review: Paper Tigers: Trauma

It been some time since I watched this, but I meant to write about it.  Paper Tigers is a movie about Lincoln High School in Walla Walla, Washington.  This is the school for those who are not making it in regular school, either due to legal or behavioral or emotional issues.
The basic philosophy of the film are that children have been subjected to complex trauma.  toxic stress or trauma can threaten brain development.  This can harm health, lead to erratic behavior.  The behavior is not the kid, but a symptom of what is going on in their life.  You have to unconditionally love them, and believe that their behavior might be out of their control.
Sant Clara County has used this movie as an introduction to their efforts to take on trauma and make a difference in the lives of others.  I must admit, as I watched I was amazed at some of the worker the teachers and counsellors were doing.  How could they stay focus and not become reactive to some of the stuff the kids were dong.

Magazine Article: Self-regulation and Stress Coping at the Foundation of Resilient Recovery

Self-regulation and Stress Coping at the Foundation of Resilient Recovery by Stephen Sideroff, Phd, Counselor: the Magazine for Addiction and Behavioral Health Professionals, October 2016.
I found this article very fascinating.  It is presented in two parts really.  The first is how childhood effects someone's vulnerability to addiction and relapse.  "High levels of early childhood stress alter and impair neural mechanisms of self-regulation and functioning."  He is mostly talking about attachment issues, and how impairment in attachment "impairs endorphin brain circuitry" which in turn makes it more difficult to self-soothe.  It is also partially why stress can lead to relapse in adults.  Substances become a substitute for self soothing.
The second part of the article deals with the model for self regulation as a way to teach individuals how to self-regulate rather than turning to drugs.  This is a nine-step process.  It focuses on three areas, relationships, balance and mastery and engagement with the world.  This concepts are presented as things to learn:
1. Relationship with Self.  Being able to have positive and loving self-talk is essential.  Much of the author's work involves relearning this internal script.
2. Relationship with Others.  Healthy relationships should have a ratio of at least twenty positives to one negative.  He suggests relationship with less than a five to one ratio may need to be discarded.
3. Relationship with Something Greater.  This of course is the core of 12-step programs.
4. Physical Balance and mastery.  Relaxation techniques should be a part of any recovery program.  Being able to be at peace with yourself is essential.
5. Mental or Cognitive Balance and Mastery.  The perspective of an addict is frequently flawed.  Maintaining a positive attitude is essential to recovery.
6. Emotional Balance and recovery. Emotional reactivity negatively impacts resilience.  A brain is easily high jacked by reactivity.  A four step guide: 1) Become aware of emotions and accept them. 2.)Sit with emotions and recognize what they are about and whom they involve. 3) Expressing emotions in the contest of acceptance.  It is ok to be sad or angry about past events.  however it is not always possible to change the past.  Sometime accepting reality is needed.  4) Let go.  Once a feeling has been expressed, it is important to let go, and not continue to expect the impossible.
7. Presence.  This is about our ability to be in the moment.  This also deals with how you project into the world, which is charisma.  This can involve a change of posture.
8. Flexibility.  Flexibility is the ability to adapt.  Awareness of patterns is essential to being able to confront them, and adapt other ways of coping.
9. Power: The Ability to Get Things Done.  This is having realistic expectations, and setting goals, but understanding new learning is a growth process.  Having more power leads to more freedom, and less dependence, and then increased confidence in one's self.

Train Safety: No Selfies Please

This is a tragic story from U.P. Inside track about a train accident involving three teenage girls taking a selfie.  It does not end well.  In this case the accident had long-last effect on the engineer and the conductor and the families of the girls, and the first responders.  I think of my own son, who took a picture with his band on what they thought was an abandoned rail bridge.  However it isn't.  Luckily there was no tragedy.  Train bridges and tracks are cool, but pictures should not be taken from close on the tracks.  I previously made a personal video sharing my thoughts on train safety.  Be safe please.

Trauma: Signs of and Tips for from Mental Health First Aid

 The things to watch for are that some one has passed through a traumatic event, anger, sadness, hopelessness, withdrawal fatigue etc.

I thinks asking how you can help is important, talk as an equal is important, don't interrupt, don't trivialize, connect with resources if the person wants help, get help for suicidal or other risk behaviors.

National Trauma Awareness

This is taken from internal email at work.
Its National Trauma Awareness Month

National Trauma Awareness Month celebrates its 27th anniversary with the campaign slogan, “3D

Trauma Prevention” and a focus on contributors to motor vehicle crashes: Drugs/Drinking,

Distraction and Drowsiness. This is an all too familiar list that makes driving in the United States a

risky endeavor.  Here are some important statistics:

• In 2013, the US saw over 32,000 fatalities and over 2.3 million injuries from motor vehicle

crashes.  Of those, 31% involved an alcohol-impaired driver and 18% involved a distracted driver.  

• 2.5 million Americans went to the emergency department (ED)—and nearly 200,000 were

then hospitalized.

• Crash injuries in 2012 totaled $18 billion in lifetime medical costs. More than 75% of

costs occur during the first 18 months following the crash injury.

By reducing and ending these causes of injuries, we are helping people live longer and healthier lives.

**Pamplet Review: Helping Children and Adolescents Cope with Violence and Disasters

Helping Children and Adolescents Cope with Violence and Disasters: What Community Members Can Do
This pamphlet is available through the National Institute of Mental Health.  Trauma is an emotionally painful, shocking, stressful and sometimes life-theatening experience that may involve physical injuries but also can happen without physical injury.  (It includes witnessing events.)  This pamphlet lists the most common responses to trauma by age:
Children 5 and under: Facial expressions of fear, Clinging to parent or caregiver, crying or screaming, moving aimlessly, whimpering or trembling, returning to behaviors common to being younger, bedwetting, being afraid of the dark.
Children 6 to 11: isolating themselves, becoming quiet around friends, family and teachers, having nightmares or other sleep problems, refusing to go to bed, having outburst of anger, becoming irritable, starting fights, being unable to concentrate, refusing to go to school, complaining of physical problems, becoming depressed, feeling numb, doing poorly with school and homework, loss of interest.
Adolescents 12 to 17: Having flashbacks to the event, having nightmares or other slep problems, avoiding reminders of the event, using or abusing drugs, being disruptive, disrespectful or behaving destructively, being depressed, being angry, loss of interest in previously enjoyable activity, having suicidal thoughts.
In then provides ideas of what community members can do to help children following trauma:
Allow child to express their feelings and the event, but not forcing.  Listen to them, accept and do not argue with their feelings, help them cope with the reality of the experience.
Love and support your children, and be with them if possible.
Community members should identify and address their own feelings.
Use their buildings as gathering places.
Help identify resources and emphasize community strengths and resources that sustain hope. 
Reduce other stressors, avoid frequent moving, school pressures, transportation problems, being hungry.
Community members should help children that continue to show problematic behaviors find appropriate help.  Behaviors which should alert to finding help include: refusing to go places that remind them of the event, emotional numbness, behaving dangerously, unexplained anger/rage, sleep problems, thoughts of suicide. 
Important does: get food and water, get a safe place to stay, gel help from doctor if needed, contact loved ones, keep children with family, understand what happened and what is being done, know where to get help, meet your family’s needs.
Important don’ts: force people to tell their stories, probe for person details, say things like “It will be OK.” Say people deserved to suffer, tell others how others should feel or act, be negative
I was able to go to Los Angeles after the Northridge Earthquake and was located in a FEMA Center.  Mostly what we did was make sure people had water.  Coors had supplied water bottles for people to take.  We did anything to help people feel like they had a sense of control.  During this time I was also on the phone, and supported some of the people had experienced this trauma with phone support, the same for Katrina and other disasters.  Sometimes just a listening ear, and anything supportive statement so help the individual feel they have some control, when things don’t always make sense.
Remember, if you are worried, voice your worry.  It is OK to ask someone if they are contemplating suicide. 
Santa Clara County Suicide and Crisis line: 1-855-278-4204
National Suicide prevention line 1-800-273-talk (8255)

**Book Review: Youth Mental Health First Aid USA for Adults Assisting Young People

C 2012 Maryland Department of Health and Mental Hygiene, Missouri Department of Mental Health and National Council for Community Behavioral Healthcare.
This book was given to me as part of a training presentation by the same name.  This training is geared towards nonprofessional people, and provides assistance so they can offer help to their family members, friends, community members or others.  It compares this program to first Aid for a physical problem.  First Aid aims to preserve life, prevent further harm, promote recovery and resiliency and provide comfort.  Mental Health First Aid is geared to promote life when a person may be a danger to themselves or others, prevent the problem from becoming worse, promote recovery, provide comfort and support and help to identify or guide a person to appropriate resources and supports.  It does this through the “Youth Mental Health first Aid Action Plan.”  This plan includes five steps which spell out ALGEE.  1) Assess for risk of suicide or harm; 2) Listen nonjudgmentally; 3) Give reassurance and information; 4) Encourage appropriate professional help; 5) Encourage self-help and other support strategies. 
It includes a section on adolescence and young adulthood, and distinguishing these transitional steps which are part of normal development from mental health issues.  It then has a very large section on different mental health issues, and how to apply this model.  These include: depression, anxiety, eating disorders, psychosis, substance use and attention and disruptive behavior problems. 
It concludes with a how-to handle certain situations.  This includes suicidal thoughts, self injury, panic attacks, trauma, acute psychosis, aggressive behavior and emergencies from alcohol or drug abuse.
This workbook is a tremendous resource.  However, I would advise taking the course so as to have some practice in the techniques before trying them.