Trauma-responsive Occupational Therapy in Peds

Question 1

Trauma

Answer 1

Can be a singular or cumulative experience that adversely affects an individual’s functioning and mental, physical, emotional and spiritual well-being.

Question 2

Adverse childhood experiences (ACEs)

Answer 2

traumatic physical and emotional experiences that take place during childhood (between ages of 1 and 17 years); these events can have lifelong effects.

Question 3

Impact of trauma on a child

Answer 3

ACE –> disrupted neurodevelopment–> social, emotional and cognitive impairment –> adoption of health-risk behaviors –> disease, disability and social problems –> early death

Question 4

What part of the brain is particularly vulnerable to complex trauma?

Answer 4

the prefrontal cortex (contributes to attention and executive functioning)

Question 5

Who has the greatest impact on a child’s sense of self-worth and value?

Answer 5

Caregivers

Question 6

Exposure to chronic, prolonged traumatic experiences which have the potential to alter a child’s brain, may impact areas such as:

Answer 6

1. Physical challenges: impaired sensorimotor development and coordination difficulties
2. Medical issues
3. Emotional regulation: they will often internalize or externalize stress reactions and may experience significant depression, anxiety, or anger. Their emotional responses may be unpredictable or explosive and they may become easily overwhelmed.
4. Dissociation: mentally separate themselves from the experience, which then may become a defense mechanism
5. Cognitive abilities: problems with focusing, learning, processing new information, language development, planning, reasoning, problem-solving skills etc. Distracted by reactions to trauma reminders
6. Self-concept: may have trouble feeling hopeful and have low self-esteem
7. Behavioral control: difficulty controlling impulses, oppositional behavior, aggression, disrupted sleep and eating patterns, trauma re-enactments.

Question 7

6 trauma-informed principles

Answer 7

1. Safety: to ensure those who have experienced trauma feel physically and psychologically safe during interactions with providers
2. Trustworthiness and transparency
3. Peer support and mutual self-help: having another individual to establish hope with, build trust with, and share similar circumstances promotes positive outcomes.
4. Collaboration and mutuality: focus on partnerships and working together as everyone on a trauma team has a role to play
5. Empowerment, voice, and choice: allowing clients to use their voice to share their experiences promotes positive healing and supporting clients to be a part of their recovery process allows for forward progress
6. Cultural, historical, and gender issues: move past cultural differences to treat the person

Question 8

4 R’s of trauma-informed care

Answer 8

1. Realize the impact of trauma
2. recognize the signs and symptoms of trauma
3. Respond by fully integrating knowledge about trauma into policies and procedures
4. Resist re-traumatization of children

Question 9

Role of OT

Answer 9

The role of the OTP is not to treat the trauma itself, but to provide interventions and education addressing the effects the trauma has on a child’s daily activities, school performance, and social participation.

Question 10

OT evaluation in trauma-responsive care

Answer 10

Determine the extent and impact symptoms of trauma have on occupational performance including difficulty regulating arousal, decreased cognitive function, inability to develop or maintain relationships, poor emotional regulation and agitation or aggression.

Question 11

Resilience

Answer 11

the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands

• Some children are able to overcome the negative effects of trauma using a principle called resilience. Children who are able to overcome the trauma and achieve positive life outcomes

Question 12

Common symptoms seen in survivors of childhood trauma

Answer 12

• somatic symptoms (medically unexplained)
• emotional dysregulation
• Interpersonal instability
• Avoidance
• Re-experiencing and dissociation
• Disorders of memory
• Shame

Question 13

Guidelines for OTPs in treating survivors of trauma

Answer 13

-Be supportive. The ability of an OTP to engage in a supportive relationship with a child, regardless of the treatment goals, is very important.
- Involve children in activities where they have the opportunity to feel successful, experience productive problem solving, and engage in predictable routines.
- Create consistent relationships with both the child and their family.
- Promote co-regulation between the child and family.

Question 14

School Mental Health Framework

Answer 14

promotes interdisciplinary collaboration among mental health providers, related service providers, teachers, school administrators, and families to meet the mental health needs of all students.

Question 15

OTP role in early childhood settings

Answer 15

**Early adverse experiences become integrated into the child’s body, impacting lifelong development, emotional success, and mental and physical health.

-Increase Collaboration to Promote Prevention
Promote early bonding through skin-to-skin/kangaroo care, and opportunities for parent decision-making.
- Advocate for parents to be primary caregivers and identify the barriers to involving family members in the care of their child.
- Support all infants and toddlers in reaching their full potential.

Question 16

OTPs role in school settings

Answer 16

**Exposure to trauma can result in psychological, behavioral, and academic problems.
Chronic traumatic stressors may cause developmental cognitive changes that reduce students’ ability to focus, organize, and process information. Students may also demonstrate decreased concentration, anxiety, irritability, avoidance behaviors, conduct problems, and/or substance abuse.

• Look for opportunities to teach students about mental health, what it is, and how to develop it.
• Adapt activities and/or the environment to promote enjoyable participation throughout the day (e.g., lunch, recess, classroom). Experiencing positive emotions contributes to mental health.
• Mental health prevention: informally observe all children for behaviors that might suggest mental health concerns or limitations in social-emotional development. Bring concerns to the educational team.
• Positive behavioral interventions and supports (PBIS): assist teachers and other school personnel in developing and implementing schoolwide PBIS for various contexts: classroom, hallways, lunchroom, playground, and restrooms (e.g., establish clear rules, foster a positive classroom environment).
• Provide in-service training to teachers and staff on sensory processing, social-emotional learning, and psychoeducation
  Provide tips for promoting successful functioning throughout the school day, including transitioning to classes, organizing workspaces, handling stress, and developing strategies for time management.
• Consult with teachers to help them recognize the student’s most effective learning styles. Ensure that students can meet classroom demands and create modifications, if needed.
• Provide tips for promoting successful functioning throughout the school day, including transitioning to classes, organizing workspaces, handling stress, and developing strategies for time management.