intro to trauma informed care in adaptive sports€¦ · intro to trauma informed care in adaptive...
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INTRO TO TRAUMA INFORMED CARE IN ADAPTIVE SPORTS
CHRISTINE COWART
COWART TRAUMA INFORMED PARTNERSHIP
(732) 423-5709
WWW.COTIPUSA.COM
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TRAUMA INFORMED CARE
ADVERSE CHILDHOOD EXPERIENCES
ADVERSE CHILDHOOD EXPERIENCES (ACES)
In 1998, Kaiser Permanente released a study, based on the results of a
confidential survey of adult patients from their medical practice asking about
childhood maltreatment and family dysfunction, as well as items detailing their
current health status and behaviors. This information was combined with the
results of their physical examination to form the baseline data for the study.
The study resulted in the identification of Adverse Childhood Experiences.
ADVERSE CHILDHOOD EXPERIENCES (ACES)
Adverse Childhood Experiences are
potentially traumatic events that can
have negative, lasting effects on
health and well-being, which occur in
a person's life before the age of 18,
and may have lasting impact as an
adult.
WHY DO ACES MATTER?
WHY DO ACES MATTER?
Studies have shown that higher ACE scores are directly correlated to increased
health risks. According to the original study, as the number of ACES increases, so does
the risk of:
Alcoholism and alcohol abuse Chronic obstructive pulmonary disease Depression
Fetal death Health-related quality of life Illicit drug use
Ischemic heart disease Risk for intimate partner violence Liver Disease
Financial Stress Unintended pregnancies Poor work performance
Sexually transmitted diseases Early initiation of smoking Smoking
Suicide Attempt Early initiation of sexual activity Multiple sexual partners
Risk for sexual violence Poor academic achievement Adolescent pregnancy
WHY DO ACES MATTER?
• Data from the original ACE study showed that people with high ACE scores
are more likely to have more broken bones, drug prescriptions, auto-immune
diseases, and work absences
• People with six or more ACEs died nearly 20 years earlier on average than
those without ACEs.
• People with four or more ACEs were:
• 390% more likely to have COPD
• At a 240% greater risk of hepatitis or
sexually transmitted disease
• 7 times more likely to be an alcoholic
HOW PREVALENT ARE ACES?
ACE ScoreOriginal ACE Study
Prevalence (1998)
BRFSS Data
(2011-2014)
0 36% 39%
1 26% 24%
2 16% 13%
3 9% 9%
4 or more 12% 16%
Source: CDC ACE Study & Behavioral Risk Factor Surveillance System Data
BEYOND ACES
TRAUMA
According to the Substance Abuse and Mental Health Services Administration
(SAHMSA) individual trauma results from an event, series of events, or set of
circumstances experienced by an individual as physically or emotionally harmful
or life-threatening with lasting adverse effects on the individual’s functioning
and mental, physical, social, emotional, or spiritual well-being.
Toxic
Stress
STRESSTolerable
Stress
Positive
Stress
Comfort
Zone
TOXIC STRESS
Toxic stress is a term used to describe the kinds of experiences, particularly in
childhood, that can affect brain architecture and brain chemistry
• ACEs can be toxic stressors, if the adversity is not
buffered or counterbalanced with supportive
relationships and the types of experiences and
emotions that comprise resilience
• Possible causes can also include chronic health
issues or neglect and prolonged legal or
emotional battles
EFFECTS OF TRAUMA
EFFECTS OF TOXIC STRESS ON THE BRAIN
Traumatic stress can be associated with lasting changes in the brain
• Traumatic stress is associated with the release of increased levels of norepinephrine
and the “stress hormone” cortisol
• Stress results in acute and chronic changes in neurochemical systems and specific
brain regions, which result in long-term changes in brain “circuits,” involved in the
stress response
• Trauma can result in changes in how the amygdala and Prefrontal Cortex (PFC) work
EFFECTS OF TOXIC STRESS ON THE LIMBIC SYSTEM
When a person experiences stress, cortisol is released. Levels of cortisol can become too high in
a person experiencing toxic stress, resulting in:
• Increased blood sugar levels;
• Weight gain, resulting from false hunger signals;
• A suppressed immune system;
• Digestive problems; and
• Heart disease
EPIGENETICS AND EXPOSURE TO TOXIC STRESS
Epigenetics is the study of biological mechanisms that switch genes “on” and
“off.”
• Research indicates that exposure to traumatic events may result in changes to
genetic markers
• New evidence suggests these markers may be passed down from generation
to generation
HOW TRAUMA PRESENTS
TYPES OF TRAUMA SYMPTOMS
Cognitive
Behavioral
Physical
Psychological
SYMPTOMS OF TRAUMA
Nightmares or insomnia Mood swings, edginess, and agitation
Tremendous fatigue and exhaustion Tachycardia or racing heartbeat
Loss of memory and concentration Chronic muscle patterns or tension
Confusion and disorientation Aches and pains throughout body
Social isolation and withdrawal Avoidance of direct eye contact
SYMPTOMS OF TRAUMA
Intrusive thoughts of the event that may occur out of the blue
Easily startled; extreme alertness against danger
Avoidance of activities or places that trigger memories of the event
Lack of interest in previously-enjoyable activities
SYMPTOMS OF TRAUMA
Emotional numbing, feeling disconnected Obsessive and compulsive behaviors
Detachment from people and emotions Depression
Shame, self-blame Guilt (especially survivor’s guilt)
Anger Emotional shock, denial, or disbelief
Changes in eating patterns Anxiety, fear, or panic attacks
TRAUMA TRIGGERS
Activate the “survival brain,” causing the individual to react as though a
previous traumatic event is happening “here and now,” in the current reality.
Common triggers include:
• Unpredictability
• Sensory overload
• Feeling vulnerable or frustrated
• Confrontation
• Experiencing something that reminds the person, even at a subconscious level,
of traumatic things that have happened to them
TRAUMA INFORMED CARE: MEETING OUR CLIENTS WHERE THEY ARE
CHANGING OUR MINDSET
HOW DO YOU KNOW IF SOMEONE HAS EXPERIENCED TRAUMA?
Short of witnessing it or a
person telling you, there is no
way to know if a person has
experienced trauma. As a
result, we should always assume
each person we meet may have
trauma in their background.
CHANGING OUR MINDSET CHANGES OUR APPROACH
“What’s wrong with you?”
“What happened to
you?”
“What’s right with
you?”
RESILIENCE
Resilience is the ability to overcome serious hardship
ADAPTIVE SPORTS HAVE UNIQUE BENEFITS TO PEOPLE WHO HAVE EXPERIENCED TRAUMA
APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION
Use CLEAR communication:
• Calming voice and tone;
• Listen deeply;
• Explain the how and why of what you are doing;
• Ask engaging questions; and
• Reduce distractions
APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION
• Set up the space and session in a consistent way, so athletes know what to expect
• Check-in with athletes about how they are feeling, what’s happening in their bodies
and minds, and what to expect for the day
• Share the expectations of the day and work with athletes to identify and prepare
for potential moments of bad stress
• Be consistent in all your interactions and offer routine for athletes
APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION
• Focus in on one skill at a time
• Focus on progress rather than performance
• Build competence by recognizing small accomplishments and use that
momentum
• Encourage expression of emotions – both verbal and non-verbal
APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION
• Offer choices of what to do throughout the session
• Offer opportunities for athletes to opt out and opt back in to play
• Reframe challenging situations in a positive, hopeful light that highlights the
athlete’s strengths
• Engage athletes by inviting them for input
APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION
• Check in and debrief with the athlete by reviewing and asking “looking back”
questions
• Support good stress by reminding athletes how they are positively handling the
stress, encouraging them to stay in the game, and to pay attention to how they feel
• Stop bad stress by making athletes aware of their negative reactions, helping them
articulate their feelings under pressure, and encouraging them to take a break
APPLYING TRAUMA INFORMED CARE TO ADAPTIVE SPORTS INSTRUCTION
• No matter what happens, maintain your composure and project a sense of calm –
athletes struggling to self-regulate will read and internalize your panic
• Offer a closing activity that is always a marker for the session ending and helps
athletes leave on a high note
• Provide routine around the transition at the end of the session
• Be available for informal time before and after practice – create opportunities for
informal connection
TRAUMA INFORMED PRACTICES DURING AN ADAPTIVE SPORTS LESSON
• Always ask before touching an athlete!
• Ask the athlete what they like to be called and possibly their preferred pronouns
• When reading an athlete’s file, take note of any indications of potential past trauma
• If a client is avoiding direct eye-contact, do not force it
• No matter what happens, maintain your composure and project a sense of calm –
participants struggling to self-regulate will read and internalize your panic
THINGS NOT TO SAY TO SOMEONE WITH ANXIETY
• “It’s going to be okay. Trust me.”
• “There’s nothing to be scared of.”
• “Let me tell you all the reasons you don’t have to worry.”
• “Stop being such a worrier.”
• “I don’t understand why you’re so worried.”
THINGS TO TRY WHEN TALKING WITH SOMEONE EXPERIENCING ANXIETY
We’re on the same team. I will help you.
I can see this is hard for you.
I understand you’re overwhelmed and
that’s okay.
That was really sad/ frustrating/
disappointing.
Let’s take a break. You are safe.Would you like help/ a break/to try again?
I remember when you….
Let’s come up with a solution together.
Tell me more about that.
I can hear you are upset but I don’t know what you need. Can
you help me understand?
Maintain silence and hold space for the
person
COUNTDOWN TECHNIQUE FOR ANXIETY
5 • Things You Can SEE
4 • Things You Can FEEL
3 • Things You Can HEAR
2 • Things You Can SMELL
1 • Thing You Can TASTE
Look around and notice
ACTIVITIES THAT CAN HELP REGULATION
Listen to the sounds around
youCount to 10
Touch something (in nature/ furniture)
Push against a wall
Notice your surroundings
Go for a walk
Drink a glass of water
Feel the temperature
Focus your attention on
something you see
DE-ESCALATION TECHNIQUES
If you notice an athlete is experiencing distress:
• Try to connect with the athlete – this is when we fall back on that personal
connection we built
• Get the athlete to a place/position that feels safe to the athlete as quickly as
possible – this is not the time to try to reason with the athlete
• Redirect the athlete's behavior or focus by providing reasonable options for
alternative activities
After the athlete is calm, you can try to discuss what happened and why
REGULATE → RELATE → REASON
THINGS TO KEEP IN MIND WHEN WORKING WITH CHILDREN
Kids who have experienced trauma:
• Aren’t trying to push your buttons
• Worry about what’s going to happen next
• Need to feel they’re good at something and can influence the world
• Can really struggle with self-regulation
THINGS TO REMEMBER
• Words may not always sink in – use visual cues
• Even if the situation doesn’t seem that bad to you, it’s how the athlete feels
that matters
• There’s a direct connection between stress and learning
• It’s okay to ask athletes directly what you can do to help them make it through
the session
ONE CARING ADULT
- Josh Shipp
“Every kid is one caring adult away from being a success story”
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