Working with children affected by domestic violence: good practice and the new evidence

base.Webinar July 2013

Karen WilcoxAustralian Domestic & Family Violence

Clearinghouse

This morning’s workshop

• The ‘new’ evidence base and a lay person’s ‘neuroscience and trauma 101’

• Practice Implications• Further research, further training options• Questions and discussions

Latest Findings from the Literature• Effects • Exposure of children to dfv• Impacts on healing and resiliency

• Trauma triggers, abuser contact and shared care

• Mother/child relationship – protective cocoon• Belonging• System-created trauma

From the new evidence base• Neuroscience - 3 key points

– Sequential development– Impacts of DFV as complex trauma– Plasticity

Sequential development

• Bruce Perry– Neuro Sequential Model of Therapeutics (NMT)

• First three years – rapid development of brain synapses in healthy child

• Develops from experiences, particularly attachment experiences

• Brain develops sequentially

(c) 2012 Karen Wilcox

‘

‘reptile’(brainstem)

• Survival - ‘safe’ or ‘unsafe’

• Basic functions – heart, breathing, temp, etc

‘primate’

‘mammal’

‘reptile’(brainstem)

• cognitive• includes pre-frontal

cortex

• emotional• attachment, relational• Includes limbic

• Survival - ‘safe’ or ‘unsafe’

• Basic functions – heart, breathing, temp, etc

‘primate’

‘mammal’

‘reptile’(brainstem)

• cognitive• includes pre-frontal

cortex

• emotional• attachment, relational• Includes limbic

• Survival - ‘safe’ or ‘unsafe’

• Basic functions – heart, breathing, temp, etc

Trauma & Brain development• Three ways:1. Limit experiences for healthy brain

connections/wiring2. Over-active alarm response3. Impacts of cortisol

Trauma, impairment, brain development:1

1. Disrupted healthy growth• Effects depend on when child exposed

– which part is developing– Damage at earlier stages effects growth of later

stages – Negative/disrupted attachment experiences

(emotional regulation)

Impairment of brain development:2

Alarm response over-activated• Baseline arousal level is higher and

more easily triggered‘on the lookout’ for

danger

Trauma and the Alarm System

• Freeze • Fight or• Flight

• Fight response - ?temper tantrums• Dissociation – inner flight• Freeze – can look oppositional

More frequent activation of alarm response =

More frequent bypassing of higher brain –> child functions in lower levels

‘primate’

‘mammal’

‘reptile’(brainstem)

• cognitive• includes pre-frontal

cortex

• emotional• attachment, relational• Includes limbic

• Survival - ‘safe’ or ‘unsafe’

• Basic functions – heart, breathing, temp, etc

• Lower parts of brain activate• Repeated/constant activation in

infancy – pathways formed– –> becomes automatic – non-conscious– Window of feeling calm and ok is narrowed– adaptive – we’d all do it

‘trauma triggers’• Constant arousal of alarm system

Baseline state is already aroused

Diagram used for presentation purposes, not for publication

Adapted from Perry 2012

Impairment of brain development:3

Cortisol production•toxic to brain if too much • mechanisms for activation/ deactivation damaged by overload

As if the ‘Switch’ doesn’t work properly

Domestic Violence is complex traumaAttunement – mother’s emotional response = child’s

“even where the violence is not physical or visually witnessed” (Morgan 2011)

-> threat to the attachment figure = threat to baby -> alarm response activated

Trauma is most damaging when…“ 1. Trauma occurs at a young age and cannot be consciously remembered

2. Trauma is repetitive, not just one-off

3. Trauma is severe and terrifying

4. Trauma is unpredictable

5. No support or comfort is offered to the child afterwards”

Morgan 2011

constant and overwhelming threat

constant emotional arousal

impairs brain development

Living with DFV – children need to be:

“ - Hyper-vigilant (Alert to cues signalling threat) - Screen out other cues (not listening) - Hyperaroused (Respond quickly to threat) - Able to act quickly and impulsively - Agitated, impulsive, poor concentration”

- Morgan 2011

DV Trauma impacts -Relational issues –

• identity • Emotional ‘intelligence – identifying own and

others feelings• expressing feelings verbally - ‘act out’• attachment – relationships and friendships

-rejecting, over-attaching • empathy• responsibility/guilt – right/wrong• stress mg’t– impulsive reactions,

dissociation, numbing (drug and alcohol)

Impacts cont’d• Behaviour - externalised

– Aggression, antisocial behaviour• Internalised

– Anxiety (including separation anxiety), depression, generalised distress, sleep disturbances

– Feelings of sadness, confusion, fear, anger• Infant behaviours:

– Crying, unsettledness, irritability– Eating and sleeping problems– Developmental impairment

Impacts cont’d• Gender of child - boys more likely externalise;

girls more likely internalise (including dissociation)

• neurobiology underpins the behavioural impacts

–> need to explore underneath the behavioural presentation

• Culture - Aboriginal children – greater risk of harm– Layers of trauma – Tactics – cultural isolation, deprivation

Living with DFV• ‘Living with’; ‘affected by’; ‘witnessing’; ‘exposed’;

‘experiencing’...?• ‘co-morbidity’ of domestic violence and child

abuse• 1 in 4• 2006 – almost 823,000 women who had

experienced DFV had dependent children• 239,000 during pregnancy

Plasticity• Brain forms depending on how it is used• Changes through repetition,

– Skills, emotional responses, thought processes etc become ‘hardwired’ through use

• Higher parts more ‘plastic’, so easier to change

• Good News Story:– healing and recovery of children

- thru repetition and healthy stimulation of region affected by trauma

– Huge implications for educators, carers, services working with mums and kids• learning• behaviour management• relationships

More from the evidence base...resilience

• Attachment + belonging = resilience• ‘Sage warning’ –

‘resilience training’ is no substitute for– trauma-informed interventions, and – protection from ongoing harm

System-created victimisation• Or ‘secondary victimisation’

– For children: ‘behaviour management’ that re-traumatises or heightens fear response

– Blaming mothers/victims, not holding perpetrators accountable

– Support service gaps or ‘hoops’– Legal abuse, financial abuse – system aiding an

abetting– Service ‘silos’

Practice Implications• Screening and Risk Assessment• Training in understanding DFV - particularly

DFV and trauma; post separation exposure; abuser tactics – – attacks on mother/child bond; – parenting time; – financial abuse and impacts on children’s

wellbeing

What works...Children exposed to dv can recover when:• Their primary protective attachment is

preserved and strengthened;• Their primary attachment figure is safe and

supported;• Specialised, trauma-informed programs are

available and provided for long enough;• System supports child/family need for

protection from ongoing exposure to abuser

Further Training• Australian Childhood Foundation

www.childhood.org.au

• Berry Street (Childhood Institute)www.childhoodinstitute.org.au

• Child Trauma Academywww.childtrauma.org

• ASCA (Adult Survivors of Childhood Abuse) www.asca.org.au

Questions??Email for reading list

clearinghouse@unsw.edu.au

And subscribe... to the ADFV Clearinghouse

www.adfvc.unsw.edu.au