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Healing Minds. Changing Attitudes

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This program was previously recorded. Please do not attempt to phone in your questions.

May 8th is recognized as National Children's Mental Health Awareness Day. AETN takes a look at Post-Traumatic Stress Disorder in children and youth. Post-traumatic stress disorder or PTSD is an anxiety disorder that can develop after experiencing a life-threatening event. Children and teens can experience extreme reactions to traumatic events such as sexual abuse, physical abuse, disasters, violent crimes or accidents according to the National Institute of Mental Health and the PTSD: National Center for PTSD, U. S. Department of Veteran Affairs. The first hour features a documentary. Following, a panel of experts discuss what PTSD is, the causes, signs and symptoms, diagnosis, and treatments.

Panelists

This program is underwritten by Arkansas Mental Health Research and Training Institute, Division of Behavioral Health Services of the Arkansas Department of Human Services.

Transcript

PLEASE STAND BY FOR TODAY'S EPISODE OF "ARKANSAS WEEK" MADE POSSIBLE BY...

HEY, I COULD DIE AND I COULD BE THE NEXT ONE DEAD.

WHAT TRAUMA TIESES AND TRIGGERS WHAT'S CALLED THE AMYGDALA IN THE BRAIN WHICH IS A FLIGHT FREE CENTER.

IT TRULY IS A CHANGE IN THE BRAIN AND A CHANGE IN THE STRESS HORMONES THAT ARE GOING THROUGH THE BODY.

ALL OUR BRAINS HAVE WHAT WE CALL HORMONES BECAUSE THE BRAIN NOW HAS BEEN WIRED FOR DANGER AND IT'S TRIGGERED INTO THIS FIGHT/FLIGHT. WE JUST DON'T GET OVER A TRAUMATIC EVENT. IT CONTINUES TO IMPACT US.

I WOULD HEAR MY MOM SCREAM IN THE MIDDLE OF THE NIGHT. IT GOT TO THE POINT WHERE SHE STARTED BEATING ME AND MY SISTER. I LET MY ANGER BUILD UP AND DIDN'T TALK TO ANYBODY ABOUT IT.

HOLD EVERYTHING ASIDE, IT'S LIKE A BOMB AND YOU GET LIKE READY TO EXPLODE IF SOMEBODY PUSH THAT LAST BUTTON.

MOST KIDS WHO HAVE EXPERIENCED VIOLENCE OFTENTIMES HAVE EXPERIENCED MULTIPLE TYPES OF VIOLENCE. IN THE KIDS WE SEE, THE AVERAGE NUMBER OF DIFFERENT TYPES OF VIOLENT TRAUMA IS 4. AND, SO, COMPLEX TRAUMA THEN AFFECTS MULTIPLE AREAS OF THE BRAIN BECAUSE IT'S ONGOING.

MAYBE IT'S GANG WARFARE. MAYBE IT'S DRUG USE AND ABUSE IN THE FAMILY. MAYBE IT'S DOMESTIC VIOLENCE. MAYBE IT'S BULLYING AT SCHOOL. IF THERE IS A LAYERING EFFECT, A CUMULATIVE THAT CHANGES LITERALLY THE DNA.

WHEN I STARTED OFF WITH THE HUGGING GAME. HE WOULD TAKE US INTO HIS ROOM. WE WOULD SIT ON HIS LAP AND HE WOULD HAVE US -- WE WEREN'T SUPPOSED TO TELL ANYONE.

I WAS 5, I WOULD HAVE TO LEAVE KINDERGARTEN CLASS AND GO HOME AND HAVE SEX WITH THIS MAN WHO WAS IN HIS 50S. I REMEMBER THE WALK HOME AND CRYING AND FALLING DOWN AND HAVING TO GET BACK UP AND WALKING ON.

CHILD SEXUAL ABUSE EXISTS IN THE NEIGHBORHOOD. IT EXISTS UNFORTUNATELY AT OUR SCHOOLS, AT OUR CHURCHES, AT OUR HOMES, EVERYWHERE, AND THERE ARE CHILDREN OUT THERE SUFFERING. HE

THE FIRST WAS IN HIGH SCHOOL. I MET A GUY AT A CHURCH AND HE WANTED TO BE MY FRIEND. I THOUGHT IT WOULD BE GREAT. AND INSTEAD HE ASSAULTED ME AND I FELT VERY SCARED.

WHEN YOU HAVE A CHILD THAT DOESN'T GET TO WORK THROUGH THAT ABUSE IN THE APPROPRIATE MANNER, THAT ABUSE DOESN'T GO AWAY. IT LIVES IN THAT CHILD.

EXPOSURE TO VIOLENCE IN CHILDHOOD HAS BEEN FOUND TO BE ASSOCIATED WITH A REALLY UNBELIEVABLE RANGE OF LONG-TERM IMPACTS.

VERY YOUNG CHILDREN WHO ARE EXPOSED TO VIOLENCE MANY TIMES HAVE DIFFICULTY ESTABLISHING A TRUSTING RELATIONSHIP. THESE CHILDREN HAVE FEARS.

YOU'RE TWICE AS LIKELY TO DEVELOP DEPRESSION. YOU'RE PROBABLY THREE TIMES AS LIKELY TO DEVELOP SOME TYPE OF ANXIETY DISORDER.

IF THEY ARE SCHOOL AGE THEY MAY HAVE VERY, VERY SERIOUS BEHAVIOR PROBLEMS. AS WE LOOK AT ADOLESCENTS, WE SEE CHILDREN RUNNING AWAY, SOMETIMES CHILDREN MAY BE INVOLVED IN THE JUVENILE JUSTICE SYSTEM WHICH PUTS THE CHILD AT RISK FOR BEING AN ADULT OFFENDER. AND, SO, THE COST OF VIOLENCE IS STAGGERING.

I FELT ISOLATED. NOBODY KNEW WHAT I WAS GOING THROUGH.

TO GO FOR YEARS WITHOUT TALKING ABOUT IT, I IMPLODED.

FINALLY, AFTER LIKE STRESSING AND STRESSING AND KEEPING EVERYTHING BOTTLED UP AND EVERYTHING BUILDING UP, I JUST FINALLY BROKE DOWN ONE DAY AND ATTEMPTED SUICIDE.

SUICIDE IS THE THIRD LEADING CAUSE OF DEATH IN CHILDREN AND ADOLESCENTS IN THIS COUNTRY. WE ALWAYS ASK IN EVERY CASE, WHAT ROLE MIGHT CHILD ABUSE PLAY?

MY MOTHER, SHE KNEW THAT STUFF WAS GOING ON, BUT IT SEEMED LIKE SHE DIDN'T REALLY CARE. SHE NEVER STOPPED THE ABUSE. AND TO THIS DAY I NEVER FORGOT THAT. WHAT SOME OF MY FAMILY MEMBERS HAVE DONE TO ME.

THESE ARE TRAUMATIZED KIDS AND, SO, HOW DO WE THEN AS ADULTS, PROFESSIONALS, CAREGIVERS PUT A SYSTEM AROUND CHILDREN THAT REALLY IS --

GOOD JOB, OKAY.

WHAT DO WE DO DIFFERENTLY TO HELP REWIRE THEIR BRAIN AND THEN ULTIMATELY HOW DO WE BUILD CAPACITY IN ORDER TO REALLY HELP OUR KIDS?

EVERYBODY COMES TOGETHER. WHETHER IT'S IN THE COMMUNITY, IN THE HOME, IN THE SCHOOL, WHEREVER CHILDREN ARE. AND CHILD BY CHILD, THINK OF WAYS IN WHICH WE CAN INTERVENE EARLY AND EDUCATE PEOPLE ABOUT WHAT CHILDREN NEED IN ORDER TO GROW, TO THRIVE, AND TO CONTINUE TO BE RESILIENT HUMAN BEINGS.

VIOLENCE IN THE HOME AND VIOLENCE AGAINST CHILDREN AT THE HANDS OF CAREGIVERS IS ONE OF THE MOST SERIOUS TYPES OF VIOLENCE THAT KIDS CAN EXPERIENCE.

WHEN CHILDREN DON'T RECEIVE SERVICES FOR TRAUMA-RELATED PROBLEMS, WE KNOW THAT THEY ARE AT GREATER RISK FOR BEING REVICTIMIZED AND FOR OTHER TYPES OF PROBLEMS. SO, IT'S VERY IMPORTANT THAT WE PROVIDE TO KIDS THAT WE SERVE THE BEST POSSIBLE TREATMENT.

HERE AT THE MEDICAL CENTER AT CENTRAL GEORGIA, WE SEE CHILDREN THAT HAVE BEEN MALTREATED THROUGH PHYSICAL ABUSE, NEGLECT AND SEXUAL ABUSE KIDS. A PEDIATRICIAN JUST HAS TO REALIZE THAT WHEN THEY SEE HE THINGS THAT THEY NEED TO TAKE NOTE OF THINGS. YOU KNOW THIS DOES PRESIDENT LOOK RIGHT OR THAT STORY DOESN'T SOUND RIGHT. THEY HAVE TO BE PROACTIVE.

THERE ARE MANY BAD THINGS THAT HAPPEN IN THE LIVES OF CHILDREN THAT ARE NOT NECESSARILY TRAUMATIC. WHEN WE SAY TRAUMATIC, WE MEAN THAT THERE IS A THREAT EITHER TO THE LIFE, THE HEALTH, PHYSICAL INTEGRITY OF A CHILD IN A WAY THAT IT VERY LIKELY RAISES FEAR AND ANXIETY.

THESE ABUSED CHILDREN USUALLY HAVE SOME EMOTIONAL PROBLEMS. SO, WE NEED GOOD MENTAL HEALTH PEOPLE TO DEAL WITH THE AFTERMATH. THE CHILD HAS TO BE ABLE TO EXPRESS THEMSELVES AND BE ABLE TO TALK THROUGH THEIR FEELINGS.

THERE'S NO ONE SET PROFILE FOR HOW KIDS RESPOND TO TRAUMATIC EVENTS. IT'S IMPORTANT TO KEEP IN MIND THAT NOT EVERY CHILDHOOD EXPERIENCE IS A TRAUMATIC EVENT, NECESSARILY HAS LONG-STANDING PROBLEMS.

SO, THE KEY IS TO DO A REAL CLEAR ASSESSMENT.

WE'RE IN FOSTER CARE. WHEN DID THAT HAPPEN?

THERE IS A CUMULATIVE EFFECT OF TRAUMA. THE MORE TRAUMATIC EVENT THE CHILD EXPERIENCES, THE HARDER IT IS TO DEAL WITH SUBSEQUENT EVENTS.

CHILDREN THAT HAVE BEEN EXPOSED TO VIOLENCE OFTENTIMES HAVE DIFFICULTY PROCESSING EMOTION. THEY HAVE DIFFICULTY PROCESSING THINGS COGNITIVELY AS WELL. THIS TRANSLATES INTO DIFFICULT AND SOMETIMES DYSFUNCTIONAL BEHAVIOR FOR THEM.

WE KNOW FROM STUDIES THAT CHILDREN THAT HAVE BEEN PHYSICALLY ABUSED ARE MORE AGGRESSIVE. THEY HAVE MORE SCHOOL PROBLEMS. THEY HAVE POOR SOCIAL INTERACTIONS.

WE NOW HAVE A VARIETY OF INTERVENTIONS THAT HAVE A SIGNIFICANT THRESHOLD OF EMPIRICAL RESEARCH DEMONSTRATING THAT THEY ACTUALLY WORK WITH KIDS WHO HAVE BEEN VICTIMIZED, KIDS FROM ALL ETHNIC BACKGROUNDS, KIDS FROM ALL SORTS OF FAMILIES, ALL AREAS OF THE COUNTRY. ONE OF THE HARDEST THINGS THAT WE HAVE TO DEAL WITH IN THE CHILD VICTIM WORLD IS HOW DO WE PUT A CHILD IN CONTACT WITH A TRAINED THERAPIST?

WHEN LAW ENFORCEMENT IS COMING INTO CONTACT WITH THESE CHILDREN, WHEN GUARDIANS ADD LIGHT ME ARE IN PROTECTIVE SERVICES, THEY REALLY NEED TO BE TRAINED TO PROVIDE APPROPRIATE REFERRALS FOR EVIDENCE-BASED TREATMENTS.

THE HARM INFLICTED ON THIS YOUNG BOY WAS HORRENDOUS.

FROM THE MOMENT A CHILD COMES INTO THE CHILD WELFARE SYSTEM INTO OUR COURTS, WE FOCUS ON THAT CHILD, WHAT THAT CHILD'S NEEDS ARE. WE HE TRY TO USE RESEARCH AND SCIENCE TO ANTICIPATE WHAT SOME OF THE PROBLEMS WILL BE. FOR EXAMPLE, IF THIS IS A VERY YOUNG CHILD 1 TO 3, WE KNOW FROM THE RESEARCH THAT THEY HAVE 4 TO 5 TIMES GREATER CHANCE OF HAVING A DEVELOPMENTAL DELAY THAN CHILDREN IN THE GENERAL POPULATION.

WE HE SET UP A SYSTEM OF CARE ONCE WE IDENTIFY THE PROBLEM TO TREAT IT AND FOLLOW-UP TO MAKE SURE THAT THE CHILD GETS THE TREATMENT DEVELOPMENTALLY, PSYCHOLOGICALLY, EMOTIONALLY AND PHYSICALLY AS WELL.

WE REALLY USE A VARIETY OF DIFFERENT EVIDENCE-BASED INTERVENTIONS FOR THE KIDS WE HE SEE. PROBABLY THE MOST COMMON ONE WE USE IS TRAUMA FOCUSED COGNITIVE BEHAVIOR. CBFT IS REAL YOU A FLEXIBLE TYPE OF TREATMENT THAT CAN BE ADAPTED TO DIFFERENT TYPES OF TRAUMA PROBLEMS, TO DIFFERENT TYPES OF ETHNIC GROUPS. YOU CAN INTEGRATE CULTURAL CONSTRUCTS INTO IT.

CHILD PSYCHOTHERAPY IS ONE OF THE EVIDENCE-BASED PRACTICES WE HAVE INCORPORATED INTO OUR CORE.

IT IS AN AMAZING INTERVENTION. WE HAVE MOMS WHO COME TO US IN OUR COURT DO NOT KNOW THAT THEY SHOULD SMILE AT THEIR BABY. THEY DO NOT KNOW THAT WHEN THEIR BABY CRIES THEY SHOULD PICK THEIR BABY UP. THEY THINK THEY'RE SPOILING THE BABY.

IF THERE IS A WAY TO STOP THE INTER GENERATIONAL TRANSMISSION OF CHILD MALTREATMENT, THIS IS IT.

VIRTUALLY ALL EFFECTIVE INTERVENTIONS FOR CHILDREN EXPOSED TO VIOLENCE INVOLVE PARENTS, CAREGIVERS, OR OTHER FOLKS WHO ARE IN CHARGE OF TAKING CARE OF THIS CHILD.

WHAT IS THE NAME OF THAT BABY?

WHEN CHILDREN DON'T DEAL WITH THEIR ABUSE ISSUES, THEY HAVE PROBLEMS LATER ON IN LIFE. THERE ARE A LOT OF PHYSICAL THINGS, EMOTIONAL THINGS. THERE IS A VERY IMPORTANT STUDY CALLED THE "A" STUDY ABOUT THE ADVERSE CHILDHOOD EXPERIENCES WITH ABUSE AND VIOLENCE AND IT HAS SHOWN THOSE PEOPLE THAT HAVE BEEN EXPOSE TODAY THAT HAVE HIGH BLOOD PRESSURE, DIABETES, HEART PROBLEMS, DEPRESSION. SO, WE KNOW THAT WE NEED TO TAKE CARE OF THOSE CHILDREN THAT HAVE BEEN ABUSED AND MAYBE THAT CAN HELP WITH PREVENTING THOSE ADULTHOOD DISEASES THAT WILL AFFECT THEM LATER ON IN LIFE.

COMING UP WITH NEW CREATIVE WAYS OF SPREADING EVIDENCE-BASED SERVICES SO THAT EVERY VICTIMIZED CHILD IN EVERY CORNER OF THE COUNTRY HAS ACCESS TO THE EFFECTIVE INTERVENTIONS THAT THEY NEED IS OUR BIGGEST CHALLENGE IN THE FIELD RIGHT NOW.

WE HAVE SEEN SO MANY CHILDREN COME INTO SCHOOLS WHO ARE EXPOSED TO VIOLENCE, ISSUES THAT PLACE OUR CHILDREN IN JEOPARDY EVERY SINGLE DAY.

BULLYING AND HARASSMENT.

DOMESTIC VIOLENCE, NEGLECT, ABUSE.

WE'VE HAD A MULTITUDE OF SUICIDES.

I'VE GOT KIDS THAT HAVE SEEN A DEAD BODY IN THE STREET. THEY THINK, AM I GOING TO BE NEXT?

WE HAD A FIRST GRADER CHOKING HIMSELF, SAYING, HE HE WANTED TO DIE.

SURVIVAL TRUMPS LEARNING FOR CHILDREN WHO HAVE TRAUMA IN THEIR LIFE. AND WHEN SURVIVAL TRUMPS LEARNING LEARNING IS GOING TO BE COMPROMISED.

EVERY STUDENT SPENDS 6 TO 7 HOURS A DAY IN SCHOOL. IF A LIVE IN A CHAOTIC ENVIRONMENT AT HOME, MANY TIMES THE SCHOOL IS THE ONLY SAFE, SANE PLACE WHERE THEY FEEL THEY ARE BEING REGARDED. IT BECOMES A REALLY IMPORTANT SURVIVAL TOOL IN STUDENTS' LIVES.

NOW, WHO CAN SING A WAY THAT SOMEONE IS --

CHILDREN WHO DEAL WITH TRAUMATIC ISSUES, THEIR MIND IS NOW ON THE SCHOOLWORK. AS EDUCATORS, WE NEED TO ADDRESS THE EMOTIONAL, THE SOCIAL, THE PHYSICAL AND THE INTELLECTUAL PARTS OF CHILDREN.

WHEN YOU THINK OF ONE-THIRD OF THE STUDENTS THAT ARE IN YOUR CLASSROOM IMPACTED BY THE TRAUMAS THAT ARE GOING ON IN THEIR LIFE --

COMPASSION SCHOOLS IN WASHINGTON STATE AND THE TRAINING THAT A COMPANY THAT IS REALLY TO HELP TEACHERS BETTER UNDERSTAND WHAT TRAUMA DOES TO STUDENTS' ABILITY TO LEARN.

MY STAFF WENT THROUGH EXTENSIVE TRAINING. THEY WELCOMED IT. IT WAS A HUGE PARADIGM SHIFT, A CHANGE IN ATTITUDE AND PERCEPTIONS. THEY TALKED ABOUT ADVERSE CHILDHOOD EXPERIENCED AND HOW IT AFFECTED THE CHILD.

WE ASK A STUDENT, WHAT HAPPENED TO YOU, INSTEAD OF WHAT'S WRONG WITH YOU. WE KNOW THE PROBLEMS THAT THEY HAVE, BUT REALLY UNDERSTANDING HOW IT AFFECTS THEM, THE LONG-TERM EFFECTS OF IT HAVE BEEN REAL HELPFUL TO US.

SOMETIMES IT'S THE QUIET KIDS. THEY PUT ON A MASK AND YOU HAVE NO IDEA WHAT'S GOING ON. I'M ALWAYS ASKING, HEY, HOW IS IT GOING? WE'RE HERE TO HELP YOU. IT'S ALL ABOUT BUILDING A RELATIONSHIP WITH THE KIDS.

WE HAVE TO BE ABLE TO INTERVENE RIGHT AWAY. WE BUILD SAFETY PLANS. WE WORK WITH THE PARENTSES AND WE SAY, THIS IS THE PLAN THAT WE HAVE BUT WE WANT YOUR INPUT. WHAT CAN YOU DO TO SUPPORT US?

WHEN YOU DEAL WITH CHILDREN WHO HAVE TRAUMA, THE CONVENTIONAL METHODS OF DEALING WITH THEM ARE OFTEN NOT EFFICABLE. MANY OF OUR KIDS NEEDED TO LEARN HOW TO CALM DOWN. SO, WE STARTED YOGA AND THE KIDS ABSOLUTELY LOVE IT.

THIS IS --

SWINGING TREE.

SWINGING TREE.

TURN TEACHERS INTO COUNSELORS OR SOCIAL WORKERS FOR THE STUDENTS, BUT TO REALLY CREATE THE CLIMATE AND THE CULTURE IN THE SCHOOL THAT BENEFITS AN ABILITY TO LEARN.

SCHOOL-AGE CHILDREN CAN EXPERIENCE A WIDE RANGE OF TRAUMATIC EVENTS REGARDLESS OF WHETHER A CHILD LIVES IN AN URBAN AREA OR A SUBURBAN OR RURAL AREA. IS THERE A LOT OF CRIME IN THE CHILD'S NEIGHBORHOOD? IS THERE DRUG USE AND ABUSE? EXPERIENCES THAT ADULTS NEED TO ASK ABOUT.

WE KNOW THAT THERE IS A LINK BETWEEN ACADEMIC ENGAGEMENT AND SCHOOL ENGAGEMENT AND TRAUMATIC STRESS AND VIOLENCE. SOME OF THE SYMPTOMS THAT OUR CHILDREN PRESENT WITH IN SCHOOL, LIKE REEXPERIENCING HYPER AROUSAL, AVOIDANCE, THOSE THINGS SHOW UP AS PROBLEMATIC BEHAVIORS IN THE SCHOOL SETTING.

WHEN WE CREATED CBIS THAT'S KIND OF THE BEHAVIORAL INTERVENTION FOR TRAUMA IN SCHOOLS, WE WANTED TO CREATE AN INTERVENTION THAT WAS SCHOOL FRIENDLY. THE GOAL OF CBIS IS TO GIVE OUR STUDENTS A SET OF SKILLS. IT HELPS THE STUDENTS DEAL WITH THE PAST TRAUMA THAT THEY'VE EXPERIENCED AND ALSO HELPS THEM DEAL BETTER IN THE FUTURE WITH THINGS THAT MAY BE STRESSFUL FOR THEM.

WE'RE GOING TO BE USING THE FEAR THERMOMETER. I KNOW IT WILL ASSESS HOW WE'RE FEELING.

C BERNANKE ~ CBIS IS A 10-WEEK INTERVENTION THAT GIVES GROUP SESSIONS. IT INCLUDES ALL KINDS OF ACTIVITIES THAT MAKE TRAUMA BEARABLE.

WE TALK ABOUT DIFFERENT RELAXATION STRATEGIES THAT WE CAN USE WHEN WE'RE FEELING STRESSED OUT. HE

IT'S AN INTERVENTION THAT IS FUN AND IS APPROPRIATE FOR KIDS AND ADOLESCENT DEVELOPMENTAL STAGE. THEY LEARN WAYS TO COPE WITH THE ANXIETY, HOW TO WORK THROUGH THOSE MOMENTS WHEN THEY'RE THINKING ABOUT THE INCIDENT. REALLY TEACHING THEM PROBLEM SOLVING SKILLS.

WHAT THAT MEANS IS THAT WE HAVE CHILDREN THAT ARE BETTER ABLE TO ATTEND IN CLASS, BETTER ABLE TO HAVE STRONG SOCIAL RELATIONSHIPS AND MAKE HEALTHY ATTACHMENTS TO BOTH PEERS AND ADULTS. THOSE ARE THE THINGS THAT MAKE FOR SUCCESSFUL, PERSONAL, AND ACADEMIC LIVES.

OUR SCHOOL SYSTEM, EVERYBODY IS RESPONSIBLE FOR OUR CHILDREN FROM THE CUSTODIAN TO THE COOK TO THE CLASSROOM TEACHER TO THE SCHOOL SECRETARY TO THE BUILDING PRINCIPAL.

EVERY SCHOOL IN GRAND FORKS COUNTY HAS SIGNED ON TO DO PRIMARY PREVENTION AND INTERVENTION FOR KIDS. FOR TOMORROW'S PROJECT, ADDRESSES CHILDHOOD EXPOSURE TO ALL TYPES OF VIOLENCE.

WE WORK CLOSELY WITH PARTNERS ACROSS OUR COMMUNITY TO MAKE SURE OUR STUDENTS ARE SAFE.

WE BRING THERAPISTS THAT ARE TRAINED IN TRAUMA THERAPIES INTO THE SCHOOL TO MEET WITH STUDENTS WHO HAVE BEEN EXPOSED TO VIOLENCE. IT'S IMPORTANT TO HAVE TRAUMA-INFORMED CARE, TRAUMA-INFORMED TEACHING.

BULLYING CAN STAY WITH YOU FOREVER AND IT CAN LEAVE SCARS. IT CAN TEAR YOU APART.

WE HAVE INDICATOR THAT BULLYING IS GOING ON, ESPECIALLY CYBER BULLYING, THE ANTITRAINING THAT GAVE US THE BACKGROUND HOW TO CONDUCT TRAINING AND HOW TO TRAIN OTHER TEACHERS.

WE HAVE OUR OWN SOCIAL WORKERS AND COUNSELORS. SO, IF THERE IS A REPORT OF BULLYING OR VIOLENCE, WE HAVE A SYSTEMATIC WAY TO MANAGE THAT ACROSS ALL OUR SCHOOL FACILITIES.

OUR COUNSELORS DO A VERY GOOD JOB OF ALERTING STAFF OF POTENTIAL STUDENTS THAT ARE GOING THROUGH PROBLEMS. IF WE HEAR THAT STUDENTS ARE GOING THROUGH SOME KIND OF ABUSE WE'RE OBLIGATED TO REPORT THAT. A LOT OF STUDENTS DON'T UNDERSTAND THAT THEY ARE IN ABUSIVE SITUATIONS, SO, WE FOCUS A LOT ON RELATIONSHIPS, TALKING ABOUT WHAT IS A NORMAL HEALTHY RELATIONSHIP LOOK LIKE.

ONE OF THE POINTS WE WANTED TO GET ACROSS IS WE CAN BE ABUSIVE WITHOUT EVEN THINKING ABOUT IT. COACHES SEE THING AND HEAR THINGS THAT OTHER ADULTS DON'T. THEY'RE IN SITUATIONS ON A PRACTICE FIELD, IN A LOCKER ROOM, ON A BUS WHERE THEY CAN ACTUALLY SEE TEACHABLE MOMENTS. WE CAN IMPART SO MUCH MORE THAT THE KIDS CAN TAKE WITH THEM WHEN THEY LEAVE THAT'S GOING TO HAVE A GREAT INFLUENCE NOT ONLY ON THEMSELVES, BUT ON THE PEOPLE IN THEIR LIVES.

THINKING OF OUR CHILDREN IS EVERYBODY'S RESPONSIBILITY. THEY'RE OUR KIDS. THEY'RE OUR LEGACY AND THEY NEED TO BE TAKEN CARE OF.

HOST: WE WOULD LIKE TO THANK THE OFFICE OF VICTIMS OF CRIME FOR THAT VIDEO. WE HOPE YOU FOUND IT INFORMATIVE. BEFORE WE CONTINUE WITH THE NEXT PIECE, I WANT TO TELL YOU ABOUT A PROGRAM THAT IS HELPING TO IMPROVE THE CARE FOR TRAUMATIZED YOUTH ALL ACROSS ARKANSAS AND HERE TO TALK ABOUT IT IS DR. THERESA, PROFESSOR AND CHIEF PSYCHOLOGIST AT THE PSYCHIATRIC RESEARCH INSTITUTE AT UMAS. THANK YOU SO MUCH FOR BEING HERE TO DISCUSS OBVIOUSLY WHAT IS A VERY TIMELY SUBJECT AND A VERY IMPORTANT TOPIC AS WELL.

THANK YOU.

HOST: THIS INITIATIVE NOW IS DESIGNED TO REACH STUDENTS AND YOUNG PEOPLE IN A VERY BROADWAY ALL ACROSS THE STATE.

YES, IT'S AN INITIATIVE WHERE WE ARE TRYING TO MOVE SOME OF THESE TREATMENTS OUT INTO THE STATE OF ARKANSAS. AS THE VIDEO SHOWED, ONE OF THE THINGS THAT'S REALLY IMPORTANT IS FOR EVERY CHILD TO BE ABLE TO GET ACCESS TO SOME OF THESE TREATMENTS THAT WE KNOW ARE EFFECTIVE. AND, SO, THIS PARTICULAR PROGRAM, RBEST WHICH STAND FOR ARKANSAS BUILDING EFFECTIVE SERVICES FOR TRAUMA, IS USING THOSE TREATMENTS OUT INTO THE REAL WORLD WHERE CLINICIANS SEE CHILDREN EVERY DAY. AND WE HAVE TRAINED ABOUT 700 THERAPISTS ALREADY IN 62 COUNTIES ACROSS THE STATE AND PARENTS, TEACHERS, PEOPLE CAN ACCESS AND FIND OUT WHO THOSE MENTAL HEALTH PROFESSIONALS ARE BY GOING ON OUR WEBSITE AND CLICKING ON THE COUNTY WHERE THEY LIVE AND THEY CAN ACTUALLY FIGURE OUT WHO THOSE THERAPISTS ARE WHO HAVE BEEN TRAINED.

HOST:

HOST: IT'S AWESOME HAVING THAT NUMBER TRAINED. IT'S PRETTY IMPRESSIVE. I WAS ASKING YOU DURING THE AIRING OF THE BROADCAST, ABOUT HOW IMPORTANT IT IS TO HAVE THESE KINDS OF SERVICES AND HOW ARKANSAS IS REALLY ONE OF THE STATES LEADING THE WAY, IF YOU WILL.

IT REALLY IS. IT'S KIND OF SURPRISING BECAUSE UNFORTUNATELY ARKANSAS IS SO MUCH AT THE BOTTOM OF SO MANY DIFFERENT INDICES THAT WE SEE. BUT ON THIS PARTICULAR ONE, WE ACTUALLY ARE LEADING THE WAY AND PART OF THAT HAS TO DO WITH THE STATE LEGISLATURE ACTUALLY PUTTING THIS INTO PLACE ABOUT FOUR OR FIVE YEARS AGO AND MAKING SURE THAT WE HAD THE FUNDS TO BE ABLE TO PROVIDE SOME OF THESE SERVICES. IT ACTUALLY STARTED WORKING WITH CHILDREN WHO HAD BEEN SEXUALLY AND PHYSICALLY ABUSED AND WE'RE NOW BEING ABLE TO DO THAT FOR THOSE OUT THERE IN THE COMMUNITY AS WELL AS IN THE CHILD ADVOCACY CENTERS.

HOST: HOW PREVALENT -- YOU KNOW, IT SEEMS THAT WE HEAR IT MORE AND MORE ABOUT ABUSED CHILDREN. HOW PREVALENT ARE INSTANCES OF ABUSE IN ARKANSAS? ARE WE HE PARR WITH THE COUNTRY? OR WOULD YOU SAY WE'RE SEEING INCREASED NUMBERS?

WE HAVE, I THINK IN THE LAST REPORT THAT WAS AVAILABLE, THERE WERE ABOUT 11,000 CHILDREN IN THE YEAR WHO EXPERIENCED SOME TYPE OF MALTREATMENT, AND ABOUT 20% OF THOSE WITH PHYSICAL ABUSE AND ABOUT 20% OF THOSE WERE SEXUAL ABUSE. WE ARE ON PARR WITH THE REST OF THE NATION AS FAR AS PHYSICAL ABUSE IS CONCERNED, BUT THE NATIONAL AVERAGE FOR SEXUAL ABUSE IS ABOUT 10%. SO, WE'RE ABOUT 10% HIGHER THAN THE NATIONAL AVERAGE FOR SEXUAL ABUSE.

HOST: WHAT ARE WE ATTRIBUTING THAT KIND OF INCREASE?

YOU KNOW, IT'S REALLY HARD TO KNOW. IT MIGHT BE ONE THING MAYBE, BUT WE'RE GETTING MORE REPORTS AND THAT IT'S NOT NECESSARILY HAPPENING MORE, BUT WE'RE GETTING MORE REPORTS HERE IN ARKANSAS. IT MAY ALSO BE THAT IT'S A MORE RURAL AREA AND SOMETIMES THERE IS MORE ISOLATION AMONG FAMILIES AND SO THERE ARE THINGS LIKEV THAT THAT HAPPEN MORE FREQUENTLY. IT'S REALLY HARD TO KNOW WHY THAT'S HAPPENING, BUT I THINK OUR ROLE IS TO FIGURE OUT HOW TO PREVENT IT A LITTLE BIT BETTER AND THEN TO TREAT THE CHILDREN THAT IT'S AFFECTING.

HOST: THAT'S EXACTLY WHAT ARBEST IS AIMING TO DO. WE'LL TALK A LITTLE MORE ABOUT THAT LATER IN THE PROGRAM. BUT I WANT YOU TO VISIT WITH US BRIEFLY ABOUT THAT AND WHAT SHE IS BRINGING TO THE IMPROVEMENTS IN THERAPY.

WELL, DR. JUDITH COHEN ALONG WITH HER COLLEAGUE, DR. ANTHONY, CO-DEVELOPED A TREATMENT THAT YOU'RE GOING TO BE HEARING ABOUT A LITTLE BIT MORE IN THIS VIDEO, THE NEXT ONE WE'RE GOING TO SHOW. AND THEY REALLY PUT TOGETHER A REALLY EFFECTIVE TREATMENT THAT WORK ON DEVELOPING CHILDREN'S COPING SKILLS AFTER THERE'S BEEN A TRAUMATIC EVENT AND THEN AFTERWARDS KIND OF GOING THROUGH THAT TRAUMATIC EVENT IN A WAY THAT KIND OF PROCESSES WHAT HAPPENED TO THEM AND HELPS CHANGE SOME OF THE DISTORTED BELIEFS THAT OCCUR AFTER SOMETHING LIKE THAT HAPPENED. AND THEY HAVE ACTUALLY BEEN WORKING VERY CLOSELY WITH US, DR. MANORINO HAS COME TO ARKANSAS. HE'S COMING FOR HIS FIFTH TIME IN THE SPRING TO TRAIN SOME OF OUR THERAPISTS AND THEN THEY ALSO WORK ON NATIONAL CALLS WITH US TO HELP THERAPISTS AFTER THEY'VE GONE THROUGH THE TRAINING TO BE ABLE TO IMPLEMENT THE THERAPY. SO, YOU'LL SEE DR. JUDITH COHEN IN THIS VIDEO AND SHE'S ACTUALLY BEEN JUST SO MARVELOUS IN THE WAY THAT SHE'S HELPED US OVER THE YEARS.

HOST: WE'RE LOOKING FORWARD TO THAT AND WE'RE ALSO LOOKING FORWARD TO TALKING MORE ABOUT SIGNS AND SYMPTOM. SO, HOPEFULLY WE'LL BE ABLE TO HELP PARENTS AT HOME HAVE SOME BETTER COPING MECHANISMS SO THEY CAN IN TURN HELP THEIR CHILDREN. THANK YOU VERY MUCH.

THANK YOU.

HOST: WE WANT YOU TO STAY WITH US IT'S OKAY TO REMEMBER NOW. UNDERSTANDING CHILDHOOD TRAUMATIC STRESS.

THE NATIONAL CHILDHOOD STRESS NETWORK IS A LAB RA ARETIVE RESEARCH IN CLINICAL INSTITUTIONSES INTEGRATED WITH COMMUNITY LEVEL TREATMENT CENTERS. THE NETWORK'S MISSION IS TO RAISE THE STANDARD OF CARE AND IMPROVE ACCESS TO SERVICES FOR TRAUMATIZED CHILDREN, THEIR FAMILIES, AND COMMUNITIES THROUGHOUT THE UNITED STATES. TO LEARN MORE, PLEASE VISIT OUR WEBSITE AT WWW.NCTSNET.ORG.

ALL CHILDREN AND ADULTS ACTIVELY PARTICIPATING IN THE PRODUCTION OF THIS VIDEO HAVE COMPLETED AN INFORMED CONSENT PROCESS AND HAVE VOLUNTEERED FREELY TO PARTICIPATE IN THIS PROJECT. CHILDREN DEPICTED IN THIS PRODUCTION ARE EITHER ACTORS OR SURVIVORS OF CHILDHOOD TRAUMATIC GRIEF WHO HAVE COMPLETED AND ARE NO LONGER IN ACTIVE TREATMENT. WE THANK THEM FOR THEIR PARTICIPATION AND CONTRIBUTIONS TO THIS VIDEO. YOU ARE LOOKING AT THE IMAGES OF FEAR, HELPLESS, CONFUSION, AND EVEN TERROR. FEELINGS THAT OCCUR WHEN CHILDREN UNEXPECTEDLY EXPERIENCE THE TRAUMATIC DEATH OF A LOVED ONE. WHILE IT IS CERTAINLY TRUE THAT DEATH IS A PART OF LIFE, THE PAIN OF LOSING A LOVED ONE CAN SOME TIME CONSUME THE LIVES OF OUR CHILDREN IN WAYS THAT WE ARE JUST BEGINNING TO UNDERSTAND. AND, SO, AS PARENTS, TEACHERS AND HEALTH CARE PROFESSIONALS AND THE COMMUNITY AND AS A COUNTRY, WE ARE OBLIGATED TO HELP OUR KIDS WHEN THEY NEED IT MOST. IT IS OUR JOB TO REACH OUT, TO HELP OUR CHILDREN HEAL AND TO REMIND THEM THAT IT'S OKAY TO REMEMBER. DR. JUDITH COHEN IS MEDICAL DIRECTOR AT ALLEGHENY GENERAL HOSPITAL IN PITTSBURGH. SINCE 1981, SHE AND HER COLLEAGUES HAVE BEEN TREATING CHILDREN AND FAMILIES FORCED TO DEAL WITH THE TRAUMATIC DEATH OF A LOVED ONE DUE TO SUCH CIRCUMSTANCES AS SHOOTINGS, STABBINGS, DRUG RELATED DEATH AND THE DEVASTATING IMPACT OF INNER CITY GANG VIOLENCE. IN 1994, HOWEVER, THE CENTER WAS CONFRONTED WITH A NEW CHALLENGE THAT RESULTED IN LOOKING AT THE PHENOMENA OF TRAUMATIC LOSS EVEN MORE CLOSELY. LATE IN THE AFTERNOON ON SEPTEMBER 8, U.S. AIR FLIGHT 427 CRASHED OUTSIDE OF PITTSBURGH, KILLING EVERYONE ON BOARD. IN THE WEEKS AND MONTHS THAT FOLLOWED, DR. COHEN AND HER COLLEAGUES WITNESSED FIRSTHAND THE EMOTIONAL DEVASTATION THE TRAGEDY HAD CAUSED. IT WAS THEIR JOB TO COUNSEL MANY OF THE GRIEVING CHILDREN WHOSE PARENTS UNEXPECTEDLY DIED THAT DAY.

THE CRASH OF FLIGHT 427 WAS THE FIRST TIME THAT WE HAD A COMMUNITY-LEVEL TRAUMA IN WHICH LARGE NUMBERS OF CHILDREN LOST THEIR PARENTS AND OTHER LOVED ONES UNDER VERY TRAUMATIC CIRCUMSTANCES. FROM THESE CHILDREN AND FAMILIES WE LEARNED THAT IN CIRCUMSTANCES WHERE CHILDREN EXPERIENCE BOTH TRAUMA AND DEATH THAT IT'S VERY IMPORTANT FOR US TO ADDRESS BOTH THE TRAUMA AND LOSS/GRIEF ISSUES TOGETHER. THIS WAS A TURNING POINT FOR OUR PROGRAM BECAUSE WE HE STARTED TO SYSTEMATICALLY THINK ABOUT HOW TO TREAT CHILDHOOD TRAUMATIC GRIEF, HOW TO RECOGNIZE IT AND HOW BEST TO ADDRESS THOSE PROBLEMS IN CHILDREN.

THE TRAGEDY OF FLIGHT 427 WAS AN EXTRAORDINARY OCCURRENCE THAT PROFOUNDLY AFFECTED THE WORK OF THE TEAM IN PITTSBURGH. UNFORTUNATELY, TRAUMATIC EVENTS ARE MORE WIDESPREAD THAN WE OFTEN REALIZE. TRAUMATIC LOSSES IMPACT CHILDREN ACROSS THE COUNTRY EVERY DAY AS A RESULT OF ACCIDENTAL DEATH, COMMUNITY VIOLENCE, MEDICAL TRAUMA, WAR, NATURAL DISASTERS, MOTOR VEHICLE ACCIDENTS, AND OTHER UNPREDICTABLE TRAUMATIC EVENTS. AS OUR AWARENESS OF TRAUMATIC GRIEF CONTINUES TO GROW, CLINICIANS AND RESEARCHERS ARE TRYING TO UNDERSTAND THE IMPACT ON OUR NATION'S CHILDREN AND FAMILIES AND THE BEST WAYS TO HELP THEM. WE KNOW CHILDREN GRIEVE, OFTEN VERY DEEPLY. EXPERTS ALSO KNOW THAT LEFT UNADDRESSED, TRAUMATIC GRIEF CAN INTERFERE WITH LATER DEVELOPMENT AND POTENTIALLY LEAD TO SERIOUS EMOTIONAL, SOCIAL, AND BEHAVIORAL PROBLEMS IN ADOLESCENTS OR ADULTHOOD. DR. ALICIA LIEBERMAN IS THE DIRECTOR OF THE CHILD TRAUMA RESEARCH PROJECT AT SAN FRANCISCO GENERAL HOSPITAL. SHE HAS WRITTEN AND LECTURED EXTENSIVELY AND IS A CONSULTANT TO GOVERNMENT AGENCIES AND PRIVATE FOUNDATIONS NATIONALLY AND ABROAD. DR. LIEBERMAN SPECIALIZES IN TREATING TRAUMATIZED CHILDREN AGES 5 AND UNDER. HE

IT'S QUITE COMMON FOR YOUNG CHILDREN TO EXPERIENCE THE DEATH OF A LOVED ONE IN THE EARLY YEARS. ACTUALLY, MUCH MORE COMMON THAN WE HAD ORIGINALLY ANTICIPATED.

PERHAPS MOST PAINFUL OF ALL IS WHEN A CHILD LOSES A PARENT. IT IS ESTIMATED THAT 5% OF ALL CHILDREN IN THE U.S. EXPERIENCE THE DEATH OF A PARENT BEFORE THE AGE OF 15. FURTHER, AT LEAST 60,000 CHILDREN EXPERIENCE THE SUICIDAL DEATH OF A RELATIVE ACROSS OUR NATION EACH YEAR.

WE ARE FINDING, FOR EXAMPLE, THAT CHILDREN UNDER 3 ARE OFTEN PRESENT WHEN A SIBLING OR A PARENT DIES IN TRAUMATIC CIRCUMSTANCES. THESE ARE OFTEN YOUNG CHILDREN WITH YOUNG PARENTS AND, SO, WE HAVE TO REMEMBER THAT YOUNG PARENTS DON'T USUALLY DIE BECAUSE OF CHRONIC ILLNESS. THEY DIE BECAUSE OF ACCIDENTS OR BECAUSE OF DOMESTIC VIOLENCE OR IN COMMUNITY VIOLENCE.

THE DEATH OF A PARENT OR CAREGIVER IS AN ESPECIALLY DIFFICULT EVENT FOR A CHILD. BECAUSE OF THE SIGNIFICANCE OF THE PARENT-CHILD RELATIONSHIP, CHILDREN WHO LOSE A PARENT ARE LIKELY TO FACE PARTICULAR CHALLENGES. FOR THIS REASON, IT MAY BE ESPECIALLY IMPORTANT TO ENSURE THAT THE CHILD IS SUPPORTED AND OFFERED ANY NEEDED HELP AND INTERVENTION FOR TRAUMATIC GRIEF REACTIONS.

CHILDREN ARE MUCH MORE VULNERABLE TO THE EFFECTS OF A TRAUMATIC DEATH BECAUSE PARTICULARLY WHEN THEY ARE DEPENDENT ON THE PERSON WHO DIED, AT THE MOMENT OF THE DEATH THEIR TENDENCY IS TO TURN TO THE CAREGIVER FOR HELP AND, SO, THE CHILD IS LEFT TO HIS OWN DEVICES AND YOUNG CHILDREN HAVE VERY UNDEVELOPED EMOTIONAL AND COGNITIVE RESOURCES TO COPE WITH TRAUMATIC CIRCUMSTANCES. THEY REALLY NEED ADULTS TO HELP THEM COPE WITH THEIR FEELINGS BECAUSE WHEN A CHILD IS NOT DEVELOPING WELL, THE CHILD CAN REALLY MOVE FROM A HEALTHY DEVELOPMENT OR TRAJECTORY TO A SELF-DEFEATING TRAJECTORY WITH LONG-TERM CONSEQUENCES INTO ADULTHOOD.

IN SOME CASES, WHEN CHILDREN EXPERIENCES TRAUMATIC GRIEF REACTIONS AND DO NOT RECEIVE APPROPRIATE HELP OR TREATMENT, THEY CAN DEVELOP MORE SERIOUS PROBLEMS THAT CAN IMPACT THEIR DEVELOPMENT AND RELATIONSHIP THROUGHOUT THEIR LIVES. CHILDHOOD TRAUMATIC GRIEF IS A CONDITION THAT CHILDREN MAY DEVELOP AFTER A LOVED ONE DIES UNDER CIRCUMSTANCES THAT THEY PERCEIVE AS TRAUMATIC.

CHILDHOOD TRAUMATIC GRIEF IS A CONDITION IN WHICH CHILDREN LOSE LOVED ONES UNDER VERY UNEXPECTED FRIGHTENING, TERRIFYING TRAUMATIC CIRCUMSTANCES, DEVELOP SYMPTOMS OF POSTTRAUMATIC STRESS DISORDER AND OTHER TRAUMA SYMPTOMS WHICH INTERFERE WITH THEIR ABILITY TO PROGRESS THROUGH TYPICAL GRIEF TASKS. BECAUSE THEY'RE STUCK ON THE TRAUMATIC ASPECTS OF THE DEATH. THIS PREVENTS THEM FROM BEING ABLE TO GRIEVE THE LOSS OF THEIR LOVED ONE AND CAN AFFECT THEM IN PROFOUND WAYS THAT CAN LAST THE REST OF THEIR LIVES.

ONE OF THE FEW PEOPLE WHO HAD DISCUSSED HELPING PEOPLE WITH THEIR CONDITION.

DR. ROBERT PINES IS A NATIONALLY RECOGNIZED EXPERT ON CHILDREN AND TRAUMA. HE HE WAS A LEAD CONSULTANT AFTER THE OKLAHOMA CITY BOMBING AND THE COLUMBINE SHOOTINGS. TODAY HE IS CO-DIRECTOR OF THE NATIONAL CENTER FOR CHILD TRAUMATIC STRESS.

MANY YEARS AGO WHEN I BEGAN SOME OF THIS WORK WITH CHILDREN WHO HAD WITNESSED A PARENT'S MURDER, I WORKED WITH AN 11 YEAR OLD GIRL, JUST ABOUT 12, WHO HAD BEEN AT HOME ASLEEP IN HER BEDROOM WHEN AN ESTRANGED BOYFRIEND FROM WHOM THERE HAD BEEN A RESTRAINING ORDER CAME IN AFTER MANY MONTHS AWAY AND SHOT AND KILLED HER MOTHER ON THE LIVING ROOM SOFA, AWAKENING HER SO THAT SHE ACTUALLY BECAME A WITNESS TO THE KILLING AS WELL AS TO THE AFTERMATH. SHE FOUND THE CHALLENGES OF THIS DEATH VERY DIFFICULT AFTERWARDS. IT WAS HARD FOR HER TO TALK ABOUT A MOTHER WHO SHE DEERLY LOVED WITHOUT GOING BACK TO WHAT IT WAS LIKE BEING IN THAT ROOM. WHAT HAPPENS AFTERWARDS WHEN YOU'RE IN THAT CIRCUMSTANCE IS THE FOCUS ON YOUR MOM HAS BEEN KILLED, NOT ON WHAT IT'S LIKE TO BE STANDING AT THE DOOR AND FROZEN IN PLACE WORRIED FOR YOURSELF AS WELL AS FOR WHAT'S HAPPENING TO YOUR MOTHER. NO ONE WAS HELPING WITH THAT.

LISA WAS EMOTIONALLY STUCK BACK AT THE SCENE OF THE MURDER. NORMAL LIFE EXPERIENCES BECAME REMINDERS OF THE EVENT, OFTEN TRIGGERING SELF-DESTRUCTIVE BEHAVIORS.

IF YOU'VE SEEN A FIGHT ESCALATE INTO A DEATH, THEN ANY TIME YOU SEE CONFLICT YOU MAY EXPECT IT TO ESCALATE INTO SOMETHING MUCH MORE SERIOUS WHICH MEANS YOU WON'T ENGAGE IN SOME OF THE NORMAL DAILY THINGS THAT HAVE TO GO ON IN INTERPERSONAL LIFE AND HAVE A CONSTRUCTIVE OUTCOME. VIOLENT EXPERIENCES CAN INTERRUPT GAINING THAT CONFIDENCE. YOU NEED THAT FOR SCHOOL. YOU NEED THAT FOR LATER LIFE. YOU NEED THAT FOR LATER EVENTS THAT HAPPEN IN LIFE.

ANOTHER COMMON SYMPTOM OF CHILDHOOD TRAUMATIC GRIEF IS DEPRESSION.

THE DEPRESSION IS A COMMON OCCURRENCE AFTER TRAUMATIC BEREAVEMENT. SO, YOU NOW HAVE A CHILD WHO MAY HAVE BOTH TRAUMATIC STRESS AND DEPRESSIVE CONDITION WHICH CAN TAKE A REAL HEAVY TOLL ON CHILD DEVELOPMENT AND MAY CARRY LONG TERM CONSEQUENCES FOR THE CHILD.

AN UNEXPECTED DEATH, PARTICULARLY WHEN IT IS TRAUMATIC, GENERATES WHAT WE CALL SECONDARY ADVERSITIES WHICH ARE UNEXPECTED STRESSES IN THE WAY THE FAMILY CONDUCTS THE EVERYDAY LIFE OF THE FAMILY AND OF THE CHILD.

SECONDARY ADVERSITIES CAN INCLUDE SUCH CHALLENGING ISSUES AS A CHANGE IN THE PRIMARY CAREGIVER FOR THE CHILD, A CHANGE IN THE CHILD'S PLACE OF RESIDENCE OR SCHOOL, A DISRUPTION TO THE FAMILY'S FINANCIAL STABILITY, OR EVEN INVOLVEMENT WITH LAW ENFORCEMENT, OR THE JUDICIAL SYSTEM.

ALL THESE ARE QUESTIONS THAT THE FAMILY IS GRAPPLING WITH. OFTEN WITHOUT GUIDANCE. AND IT'S IMPORTANT FOR THE THERAPIST TO RAISE THESE QUESTIONS HE AND TO PARTICIPATE AS A PARTNER IN COMING UP WITH DECISIONSES THAT WILL BE SUPPORTIVE OF THE CHILD.

WE NOW KNOW THAT THE THOUSANDS OF CHILDREN WHO WITNESS THE VIOLENT OR TRAUMATIC DEATH OF A LOVED ONE EVERY YEAR ARE EXTREMELY VULNERABLE. WITHOUT CAREFUL INTERVENTION, THE SYMPTOMS OF CHILDHOOD TRAUMATIC GRIEF COULD HAVE LIFELONG CONSEQUENCES THAT IMPACT NOT JUST THE CHILD BUT ALSO FAMILIES, FRIENDS, AND COMMUNITIES. HOW CAN CHILDREN BECOME UNSTUCK FROM DWELLING ON THE TRAUMATIC CIRCUMSTANCES OF THE DEATH? THERE ARE ESTABLISHED TREATMENTS FOR BEREAVEMENT AND POSTTRAUMATIC STRESS DISORDER. IN THE PAST DECADE, RESEARCHERS HAVE BEGUN TO ADAPT THEM FOR THE TREATMENT OF CHILDHOOD TRAUMATIC GRIEF. IN SEPTEMBER OF 2001, THIS GROUNDWORK PROVED VITAL. MORE THAN 10% OF NEW YORK CITY PUBLIC SCHOOL STUDENTS HAD FAMILY MEMBERS WHO WERE INVOLVED IN SOME WAY IN THE WORLD TRADE CENTER ATTACKS. FOR THESE CHILDREN, IT WAS A TRAUMATIC EXPERIENCE UNLIKE ANY THEY HAD EVER SEEN BEFORE. DR. ROBIN GOODMAN HAD WORKED MANY YEARS WITH CHILD CANCER PATIENTS. FOLLOWING THE ATTACK ON THE WORLD TRADE CENTER, SHE COLLABORATED WITH AN EXPERT IN TRAUMA, DR. ALISSA BROWN TO DEVELOP A CLINICAL AND RESEARCH PROGRAM FOR BEREAVED FAMILY OF THE DISASTER. THE TRAGEDY PROVIDED AN OPPORTUNITY TO APPLY THE BEST RESEARCH TO REAL WORLD PROBLEMS.

WORKING WITH BEREAVED CHILDREN, YOU RECALL SOME ARE DOING BETTER AND SOME ARE NOT DOING BETTER AFTER A PERIOD OF TIME AND YOU WONDER WHY. AND WHEN 9/11 HAPPENED THERE WAS A BIG GROUP OF CHILDREN THAT ALL HAD A VERY SPECIFIC TRAUMATIC EXPERIENCE AND THEN IT START TODAY MAKE SENSE THAT THE TRAUMATIC ASPECT OF THAT KIND OF A DEATH REALLY MIGHT BE WHAT'S INTERFERING WITH KIDS' ABILITY TO KIND OF GRIEVE WHAT WE THINK OF AS TYPICAL AND SOMETIMES HELPFUL WAY. WHEN CHILDREN HAVE AN EXPERIENCE LIKE THIS, IT IS A RATHER SIGNIFICANT EVENT IN THEIR LIFE. WHAT YOU REALLY HELP THEM DO IS FIGURE OUT A WAY TO INTEGRATE THE EXPERIENCE INTO THEIR LIFE AND HAVE IT BECOME PART OF THEIR LIFE AS THEY MOVE ON, NOT THE ONLY PART OF THEIR LIFE. WORKING WITH CHILDREN BEREAVED BY 9/11 YOU REALLY GOT TO SEE THIS KIND OF CONDITION WHERE THERE WERE CONSTANT REMINDERS IN THE MEDIA, THERE WERE STREET NAMINGS, THERE WERE TV SHOWS, THERE WERE BOOKS, AND THOSE PROMPTED AND TRIGGERED ALL SORTS OF REACTIONS IN KIDS AND THEIR PARENTS. AFTER 9/11 IT WAS VERY CLEAR HOW A TRAUMATIC SITUATION CAN REALLY AFFECT ONE'S REACTIONS TO THE LOSS AND DEATH OF SOMEONE THAT'S SO SPECIAL AND MAKES IT MORE COMPLICATED.

RESEARCHERS AND CLINICIANS WHO HAVE WORKED WITH AND STUDIED CHILDREN EXPERIENCING TRAUMATIC GRIEF REACTIONS HAVE FOUND THAT CHILDREN'S REACTIONS TO TRAUMATIC REMINDERS ABOUT THE PERSON WHO DIED OR REMINDERS OF HOW THE PERSON DIED CAN BE PARTICULARLY CHALLENGING. THE CHILD MAY BECOME DISTRESSED WHEN DIFFERENT PEOPLE, PLACES, OR SITUATIONS TRIGGER UPSETTING THOUGHTS AND MEMORIES. IN THERAPY, THE CHILD COMES TO IDENTIFY AND UNDERSTAND THE TRIGGERS AND HOW TO COPE WITH THEM. EXPERTS ON CHILD TRAUMATIC GRIEF HAVE IDENTIFIED THREE MAIN TYPES OF TRAUMATIC REMINDERS THAT CAN BE DISTRESSING FOR CHILDREN.

THERE ARE THREE KINDS OF REMINDERS THAT CHILDREN MAY EXPERIENCE WHICH CAN CAUSE SYMPTOMS OR DIFFICULTIES. THE FIRST IS A TRAUMA REMINDER. AND A TRAUMA REMINDER IS ANY PERSON, PLACE, SITUATION OR PROMPT THAT WILL MAKE THE CHILD THINK ABOUT THE TRAUMATIC NATURE OF THE DEATH. THE OTHER KINDS OF REMINDERS ARE LOSS REMINDERS AND CHANGE REMINDERS. LOSS REMINDERS ARE ANY SITUATION OR PERSON OR PLACE THAT REMINDS THE CHILD OF THE PERSON WHO DIED. THE THIRD TYPE OF REMINDER IS A CHANGE REMINDER, AND THIS IS RELATED TO SECONDARY ADVERSITIES THAT CHILDREN MAY EXPERIENCE AS THE RESULT OF A DEATH OF A PARENT OR LOVED ONE. A CHANGE REMINDER IS ANYTHING THAT REMINDS THE CHILD THAT THEIR CIRCUMSTANCES IN LIFE HAVE CHANGED AS A RESULT OF THE PERSON'S DEATH. SO, TRAUMA, LOSS, AND CHANGE REMINDERS CAN SEGUE INTO TRAUMA SYMPTOMS AND CAN INTERFERE WITH THE CHILD'S ABILITY TO GRIEVE THE DECEASED PERSON. IF CHILDREN DON'T ADDRESS THEIR TRAUMA REMINDERS EITHER BY CREATING A TRAUMA NARRATIVE OR THROUGH SOME OTHER METHOD OF DIRECTLY CONFRONTING THEIR TRAUMATIC MEMORIES, THEY ARE UNLIKELY TO AVOID THOSE REMINDERS. THIS CAN LEAD TO CHILDREN BELIEVING THAT THEY DON'T HAVE AN ABILITY TO COPE WITH UPSETTING FEELINGS SO THAT THE ONLY WAY TO COPE IS BY AVOIDING OR EVEN BECOMING EMOTIONALLY NUMB.

CLINICIANS AND RESEARCHERS FROM THE NATIONAL CHILD TRAUMATIC STRESS NETWORK REPRESENTING DIVERSE PROFESSIONAL BACKGROUNDS AND AREAS OF EXPERTISE HAVE COLLABORATED AND AGREED ON THE MOST HELPFUL ASPECTS OF TREATMENT FOR CHILDHOOD TRAUMATIC GRIEF. THE TREATMENT INCORPORATES ELEMENTS USED BY EXPERTS WITH A MORE TRADITIONAL PSYCHOTHERAPY APPROACH AND THOSE USING A MORE STRUCTURED SKILLED-BASED FORMAT. THESE INTERVENTION TECHNIQUES HAVE BEEN SHOWN TO BE EFFECTIVE AND SHOULD BE INDIVIDUALIZED WITH THE FAMILY'S FAMILY AND CULTURAL BELIEFS. THEY SHOULD BE ADAPTED TO YOUNG CHILDREN, GROUPS AND TEENS. IT IS OFTEN BEST TO HELP THE CHILD EXPERIENCING CHILDHOOD TRAUMATIC GRIEF COPE WITH BOTH THE TRAUMA AND THE GRIEF RELATED REACTIONS. IN THE CONTEXT OF A STRONG AND TRUSTING THERAPEUTIC RELATIONSHIP, THE CHILD AND THERAPIST CAN BEGIN THE GRADUAL PROCESS OF COPING WITH TRAUMATIC LOSS. ONE WAY THIS IS DONE IS BY FIRST HELPING THE CHILD AND PARENT LEARN SPECIFIC SKILLS FOR MANAGING DISTRESSING THOUGHTS, FEELINGS, AND BEHAVIORS SUCH AS THEIR WORRIES, GUILT, NIGHTMARES, OR AVOIDANCE. A BEGINNING STEP IS TO TEACH THE CHILD TO IDENTIFY AND BETTER CONTROL HIS OR HER REACTIONS TO UNPLEASANT REMINDERS AND MEMORIES. ONLY WHEN THE CLINICIAN BELIEVES THE CHILD HAS GAINED THESE NEW SKILLS AND IS READY, THE CHILD BEGINS THE PROCESS OF CONFRONTING HIS OR HER TRAUMATIC EXPERIENCE IN A SAFE, R TRUSTING AND CONTROLLED ENVIRONMENT. ONE METHOD FOR HELPING THE CHILD DEAL WITH A TRAUMATIC DEATH IS BY HAVING THE CHILD TELL HIS OR HER STORY THROUGH THE CREATION OF A TRAUMA NARRATIVE. A TRAUMA NARRATIVE CAN BE TOLD IN WORDS, DRAWINGS, OR OTHER CREATIVE ACTIVITIES APPROPRIATE TO THE CHILD'S INTEREST AND DEVELOPMENTAL LEVEL. COMPLETING THE NARRATIVE CAN HELP REDUCE TRAUMATIC GRIEF REACTIONS AND ALLOW THE CHILD TO BETTER ENGAGE IN HEALTHY ACTIVITIES, FOCUSED ON MORE POSITIVE MEMORIES. LEARN INTRA-THERAPY AFTER WITNESSING THE DEATH OF HER YOUNG SISTER. AFTER A GRADUAL PROCESS, THE THERAPIST WORKED WITH HER TO IDENTIFY AND COPE WITH DISTRESSING TRAUMATIC REMINDERS AND MEMORIES. LORE ENWAS READY TO ADDRESS WHAT HAPPENED TO HER SISTER. LAUREN WORKED CLOSELY WITH HER THERAPIST TO WORK IN A TRAUMA NARRATIVE. WHAT FOLLOWS IS AN EXAMPLE OF HOW A TRAUMA NARRATIVE WAS UTILIZED AS PART OF A SUCCESSFUL TREATMENT EXPERIENCE. THE NARRATIVE OF LAUREN'S MEMORY IS TOLD IN HER OWN WORDS AND DRAWINGS.

MY SISTER DIED ON DECEMBER 27, 2000. SHE WAS 5-1/2 YEARS OLD.

ON A DAY LIKE ANY OTHER, EIGHT-YEAR OLD LAUREN WAS PLAYING ON A SECOND FLOOR SUN PORCH WITH HER YOUNGER SISTER KELLEY. LAUREN BRIEFLY LEFT THE PORCH. WHEN SHE RETURNED SHE COULDN'T FIND HER SISTER. KELSEY HAD CLIMBED THROUGH A WINDOW OF THE PORCH AND FALLEN FROM A SECOND STORY WINDOW TO THE GROUND BELOW.

I WAS STARING AT HER. HER EYES WERE CLOSED.

LAUREN IMMEDIATELY RAN TO GET HER FATHER.

DAD, KELSEY IS ON THE GROUND. WE WENT OUTSIDE. I FELT SAD AND I WAS SCARED.

THEY CALLED THE AMBULANCE AND WAITED THE LONG MINUTES FOR IT TO ARRIVE. IN LAUREN'S CASE HER PARENTS BROUGHT HER TO THERAPY ABOUT SIX MONTHS AFTER THE DEATH OF HER SISTER. AND SHE STILL EXPERIENCED, AS YOU WOULD EXPECT, A LOT OF ANXIETY, SADNESS, NIGHTMARES, DIFFICULTY SLEEPING, AND EVEN SOME AVOIDANCE. SHE AVOIDED PLAYING IN THE BACKYARD, FOR EXAMPLE, BECAUSE THAT'S WHERE SHE FOUND HER SISTER. EVERY TIME SHE WOULD EXPERIENCE A DAILY REMINDER OF HER SISTER, EVEN A POSITIVE MEMORY, THAT WOULD SIMULTANEOUSLY TRIGGER THE TRAUMATIC MEMORIES SO THAT THE USUAL GRIEVING PROCESS WOULD BE HALTED OR INTERRUPTED. SO, CREATING THIS TRAUMA NARRATIVE IS A WAY TO HELP THE CHILD, GUIDE THE CHILD THROUGH TELLING THEIR STORY. JUST A LITTLE AT A TIME, GENTLY GUIDING THEM THROUGH IT, BUT ALWAYS ENCOURAGING THEM TO MOVE FORWARD. I DON'T THINK PEOPLE, PARTICULARLY CHILDREN, HAVE THE ABILITY TO JUST WALK THEIR WAY INSTINCTIVELY THROUGH THOSE TRAUMA RESPONSES. IT REALLY NEEDS A SPECIAL KIND OF GUIDANCE.

THE TRAUMA NARRATIVE IS JUST ONE STEP IN THE PROCESS OF HEALING. THE FULL THERAPY PROCESS CAN TAKE MANY MONTHS.

I THINK PARENT INVOLVEMENT IN THIS TREATMENT PROTOCOL IS REALLY CRITICAL. IT ALSO HAPPENS TO BE VERY COMPLICATED BECAUSE OFTENTIMES THE PARENT OR CAREGIVER IS HAVING THEIR OWN TRAUMATIC GRIEF RESPONSE.

LAUREN'S FATHER RODE TO THE HOSPITAL IN THE AMBULANCE WITH KELSEY, DRIVEN BY A NEIGHBOR, LAUREN FOLLOWED. AT THE HOSPITAL, LAUREN AND HER PARENTS WAITED TOGETHER WHILE KELSEY WAS IN THE OPERATING ROOM. FINALLY, THE DOCTOR EMERGED AND CONVEYED THE AWFUL NEWS.

WE DEFINITELY WEREN'T PREPARED. I MEAN, YOU READ IT IN THE PAPERS. YOU THINK IT'S NOT GOING TO HAPPEN TO YOU, NOT GOING TO HAPPEN TO US. WE'RE PRETTY GOOD PARENTS WITH YOUR KID. THEN AN ACCIDENT HAPPENS. YOU DON'T GET TO SAY GOOD-BYE, YOU KNOW. SO MANY THINGS YOU JUST DON'T GET TO EXPERIENCE. THERE ARE TIMES I DIDN'T EVEN WANT TO GET OUT OF BED, BUT I HAVE LAUREN. WHAT WOULD WE DO WITHOUT MAKING SURE SHE GOT THE HELP NEEDED? BY GETTING HER HELP IT HELPED ALL OF US.

WE WATCHED LAUREN GROW EVERY DAY AND KELSEY IS STILL KELSEY. SHE'S JUST -- SHE'LL ALWAYS BE 5 YEARS OLD AND THAT'S REALLY HARD THAT SHE'S NOT GOING TO GROW UP. I MEAN, SHE'D BE 9 YEARS OLD TODAY.

ONE IMPORTANT THING WE KNOW ABOUT KIDS IN THIS SITUATION IS YOU CAN'T ALWAYS TELL BY LOOKING. SO, WHAT YOU HAVE TO DO IS LOOK AT HOW THEY'RE BEHAVING. SOME TIME WHAT THEY'RE NOT SAYING OR WHAT THEY'RE NOT DOING. PROFESSIONALS AND TEACHERS HAVE TO LOOK AT THEIR CHILDREN AND THINK ABOUT WHAT MIGHT BE GOING ON THAT IS UNSPOKEN. UNFORTUNATELY THERE IS OFTEN A TENDENCY TO THINK EITHER THAT KIDS WILL GET OVER SOMETHING THAT'S AWFUL OR THAT IT WASN'T THAT BAD FOR A CHILD. AND BOTH OF THOSE KINDS OF ATTITUDES AREN'T HELPFUL FOR KIDS THAT HAVE CHILD HOODS WITH TRAUMATIC GRIEF.

BECAUSE VIOLENCE AND TRAUMA ARE OFTEN CONCENTRATED IN URBAN NEIGHBORHOODS, THERE ARE HUNDREDS OF COMMUNITIES ACROSS THE COUNTRY FACED WITH THE REALITY OF CHILDHOOD TRAUMATIC GRIEF EVERY DAY. TRAUMATIC LOSS IS ONE OF MANY TYPES OF TRAUMA FACED BY OUR NATION'S CHILDREN. EXPOSURE TO TRAUMA CAN ALSO RESULT FROM SUCH ISSUES AS COMMUNITY AND DOMESTIC VIOLENCE, ABUSE, MALTREATMENT, MEDICAL TRAUMA, NATURAL DISASTERS, AND OTHER TRAUMATIC EVENTS. THE PROBLEM OF CHILD TRAUMATIC STRESS IS SO PREVALENT THAT THE U.S. FEDERAL GOVERNMENT DECIDED TO TAKE ACTION AND FORM THE NATIONAL CHILD TRAUMATIC STRESS NETWORK. THE NETWORK WAS ESTABLISHED IN 2001 THROUGH A CONGRESSIONAL INITIATIVE AND IS ADMINISTERED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBSTANCE ABUSE AND ADMINISTRATION. IT SPANS THE NATION AND INCLUDES LEADING UNIVERSITIES, HOSPITALS, AND COMMUNITY TREATMENT CENTERS. THE NATIONAL CHILD TRAUMATIC STRESS NETWORK ALLOWS EXPERTS SUCH AS DOCTORS COHEN, GOODMAN, LIEBERMAN AND PINES COLLABORATE EFFECTIVELY IN ESTABLISHING STANDARDIZED TREATMENTS FOR CHILDHOOD TRAUMATIC GRIEF AND OTHER FORMS OF CHILDHOOD TRAUMATIC STRESS. THE NETWORK'S MISSION IS TO RAISE THE STANDARD OF CARE AND IMPROVE ACCESS TO SERVICES FOR TRAUMATIZED CHILDREN AND FAMILIES ACROSS OUR NATION.

THE NATIONAL CHILD TRAUMATIC STRESS NETWORK IS A VERY UNIQUE FEDERAL LEGISLATION. IT'S UNIQUE IN A NUMBER OF DIFFERENT WAYS. FIRST OF ALL, IT'S A VERY LARGE CHILD MENTAL HEALTH INITIATIVE ADDRESSING A POPULATION OF CHILDREN AND FAMILIES THAT OFTEN HAVE NOT GOT MUCH ATTENTION WITHIN OUR SOCIETY. WE KNOW THAT VERY FEW CHILDREN WHO HAVE THESE KINDS OF EXPERIENCES ARE GETTING ILL RIGHT NOW.

WE HAVE SOME PRELIMINARY EVIDENCE THAT THE KINDS OF TREATMENT WE'RE DISCUSSING ARE EFFECTIVE IN DECREASING NOT ONLY CHILDREN'S TRAUMATIC GRIEF BUT ALSO THEIR POSTTRAUMATIC STRESS DISORDER SYMPTOMS, THEIR DEPRESSION, THEIR ANXIETY, THEIR BEHAVIOR PROBLEMS, AND WE ALSO HAVE SOME INFORMATION THAT SUGGESTS THAT PARENTS WHO PARTICIPATE IN THIS TREATMENT ALSO RESOLVE THEIR OWN POSTTRAUMATIC STRESS DISORDER DISORDER AND DEPRESSIVE SYMPTOMS.

THROUGH EFFORTS OF THE NATIONAL CHILD TRAUMATIC STRESS NETWORK, WE ARE BEGINNING TO MAKE GREAT STRIDES IN THE TREATMENT OF CHILD TRAUMATIC STRESS REACTIONS SUCH AS CHILD TRAUMATIC GRIEF. WE KNOW THAT EVERY CHILD IS UNIQUE AND EACH RESPONDS DIFFERENTLY BASED ON CULTURE, DEVELOPMENTAL LEVELS, AND OTHER VARIABLES. BUT IN THE END THEY ALL HAVE ONE THING IN COMMON. THEY ARE SUFFERING AND NEED OUR HELP. ♪♪ ♪♪

MEDICAL AND MENTAL HEALTH PROFESSIONALS HAVE LEARNED MUCH FROM THE VIOLENT EVENTS OF RECENT DECADES, BOTH ABOUT THE EFFECT OF TRAUMA ON KIDS AND WAYS TO HELP. AS THE WORD SPREADS, FEWER AND FEWER KIDS AND FAMILIES WILL SUFFER.

WE HOPE THAT FOR CHILDREN WITH TRAUMATIC GRIEF, ONCE THEY'VE COMPLETED TREATMENT, ALTHOUGH THE TRAUMATIC LOSS WILL ALWAYS BE A SAD MEMORY, IT WILL BE SOMETHING THAT HOPEFULLY WILL MAKE THEM STRONGER, THAT THEY CAN GROW FROM, AND PARTICULARLY WE HOPE THAT THEY WILL SEE IT AS ONLY ONE EVENT IN THEIR LIVES RATHER THAN MAKING THEIR CENTRAL IDENTITY ONE OF A VICTIM.

CHILDREN ARE HAVING TO DEAL WITH VERY ADULT-SIZED PROBLEMS THESE DAYS IN TERMS OF VIOLENCE AND TRAUMA AND DEATH AND IT REALLY TAKES THE ADULTS TO SHOW THESE KIDS WHERE THEY CAN GET HELP AND THAT IT'S OKAY TO GET HELP BECAUSE KIDS REALLY DEPEND ON THE GROWN UP TO TAKE CARE OF THEM AND DO THE RIGHT THING.

MORE THAN JUST THE FACT OF THE DEATH, WHAT TRULY IT'S LIKE TO BE UNDER THOSE CIRCUMSTANCES? BUT TO ALLOW YOURSELF TO GET INTO THAT WORLD, IT'S NOT AN EASY WORLD TO GET INTO. IT'S ONE OF US WOULD RATHER NOT BE HAPPENING TO ANYONE. BUT WE'VE LEARNED TO NOT ONLY TO LEGITIMATIZE AND UNDERSTAND, BUT TO APPRECIATE THE COMPLEXITY OF THOSE EXPERIENCES IN THE WAYS IN WHICH THEY ARE REMINDER OF TRAUMA AND THE LOSS REMINDERS. OUR CHILDREN COME OUT ON THE OTHER SIDE SO THAT THEY COME OUT EXTREMELY CONSTRUCTIVE VIEWS ABOUT HOW THEY'D LIKE TO MAKE THE WORLD BETTER.

LAUREN AND HER PARENTS SUCCESSFULLY COMPLETED THERAPY. WHILE THE MEMORY OF KELSEY'S DEATH WILL ALWAYS BE WITH THEM, AS A FAMILY THEY HAVE MADE THIS EXPERIENCE INTO A POSITIVE PART OF THEIR LIVES. NOW IN A POSITION TO HELP OTHERS STRUGGLING WITH SIMILAR PROBLEMS, LAUREN AND HER PARENTS WERE PLEASED TO SHARE THEIR STORY FOR THE MAKING OF THIS VIDEO. IN FACT, THE SONG YOU ARE LISTENING TO WAS WRITTEN BY LAUREN'S FATHER IN HONOR OF KELSEY. ♪♪ I THINK OF YOU I THINK OF YOU

AMIDST THE PROBLEMS OF TODAY'S SOCIETY, A VISION IS EMERGING. WHILE WE WILL NEVER BE ABLE TO COMPLETELY ELIMINATE THE SUFFERING IN OUR CHILDREN'S LIVES, EVERY DAY WE ARE LEARNING THAT THERE ARE WAYS TO HELP. EVERY DAY PARENTS, TEACHERS AND HEALTH CARE PROFESSIONALS ALL ACROSS THE COUNTRY ARE PROVING THAT HELP IS ON THE WAY. TOGETHER AS WE STRIVE FOR A BRIGHTER FUTURE, WE CAN HELP OUR CHILDREN UNDERSTAND THAT THERE IS HOPE, THAT THEY CAN HEAL, AND IT'S OKAY TO REMEMBER. IF YOU OR A PARENT, CAREGIVER, OR OTHER CONCERNED ADULT WORRIED ABOUT A CHILD WHO MAY BE EXPERIENCING CHILDHOOD TRAUMATIC GRIEF REACTION, PLEASE CONSULT WITH A QUALIFIED MEDICAL OR MENTAL HEALTH CARE PROVIDER WHO WORK WITH CHILDREN IN YOUR COMMUNITY. PRACTITIONERS ARE STRONGLY ENCOURAGED TO SEEK OUT ADDITIONAL CONSULTATION, TRAINING AND SUPERVISION IN ORDER TO DEVELOP YOUR EXPERTISE RELATED TO CHILDHOOD TRAUMATIC GRIEF AND ITS TREATMENT. FOR ADDITIONAL RESOURCES, PLEASE CONSULT THE COMPANION TRAINING VIDEO AND PRINT CURRICULUM. TO LEARN MORE ABOUT CHILDHOOD TRAUMATIC GRIEF OR OTHER ISSUES RELATED TO CHILD TRAUMATIC STRESS, PLEASE VISIT OUR WEBSITE AT NCTSNET.ORG. ♪♪ THIS IS HOW MUCH YOU'RE LIKE YOUR MOTHER VERY LOVING AND CARING YOU ARE LIKE NO OTHER BEFORE I GO TO SLEEP WE THANK GOD AT THE END OF THE DAY AND THAT'S HOW WE THINK OF HOW MUCH YOU WERE LIKE YOUR MOTHER VERY CARING AND LOVING LIKE NO OTHER THINK OF YOU I THINK OF YOU ♪♪ I DO ♪♪

HOST: WELCOME BACK TO THE PANEL DISCUSSION PORTION OF HEALING MINDS, CHANGING ATTITUDES. I'M YOUR HOST PAMELA SMITH. WE WERE TALKING ABOUT POSTTRAUMATIC STRESS DISORDER, PTSD, IN CHILDREN AND YOUTH. AND JOINING US TO SPEAK FURTHER ABOUT THIS TOPIC ARE DR. THERESA KRAMER A PROFESSOR AND CHIEF PSYCHOLOGIST AT THE PSYCHIATRIC INSTITUTE AT UMAS. ADULT PROGRAM MANAGER BEHAVIORAL HEALTH SERVICES AT THE ARKANSAS DEPARTMENT OF HUMAN SERVICES. MEGAN HOLT, A LICENSED CLINICAL SOCIAL WORKER AND DIRECTOR OF CLINICAL SERVICES AT THE BRIDGE WAY. DR. JOSHUA FITSLER, ASSISTANT PROFESSOR AT THE PSYCHIATRIC INSTITUTE AT UMAS AND DR. MOLLIE GUTHRITE AT THE PSYCHIATRIC RESEARCH INSTITUTE AT UMAS. WE WANT TO THANK EVERYONE ON THE PANEL FOR BEING HERE WITH US AND WE THANK YOU FOR WATCHING TONIGHT AND YOU ARE WELCOME TO JOIN US BECAUSE OUR PHONE LINES ARE OPEN TO TAKE YOUR CALLS. THE TOLL FREE NUMBER IS 1-800-63 2-2 88 6. YOU CAN ALSO E-MAIL US. WE'RE GOING TO JUMP INTO OUR DISCUSSION BECAUSE IT IS TIMELY IN LIGHT OF THE UNFORDTHTHCTIONTIONV NAT -- UNFORTUNATE INCIDENTS IN THE FORKNER AREA. MANY ARE AFFECTED BY THE TRAGEDY OF THE TORNADOS. WHEN YOU SEE THESE KIND OF OCCURRENCES WE KNOW HE IT IS SO TRAGIC FOR ADULTS. HOW IN THE WORLD DO WE EXPECT CHILDREN TO COPE WITH THAT?

WELL, A LOT OF CHILDREN ARE VERY RESILIENT SO, WE KNOW THAT A LOT OF THEM WILL COPE VERY WELL WITH IT. SOME OF IT DEPENDS ON WHAT'S ACTUALLY HAPPENED. SOME CHILDREN MIGHT HAVE BEEN REALLY IN THE MIDDLE OF EVERYTHING AND LOST A LOT, INCLUDING FAMILY MEMBERS. SO, THERE'S A REAL DIFFERENCE AS THEY WERE SHOWING IN THE VIDEO, YOU CAN EXPERIENCE A TRAUMATIC EVENT. A LOT OF TIMES IF THERE IS A SIGNIFICANT LOSS, ALONG WITH THAT, THEN YOU HAVE THAT TRAUMATIC GRIEF THAT MAKES IT EVEN MORE COMPLICATED.

HOST: AND WHAT WOULD YOU IN YOUR ROLE AS A SOCIAL WORKER IN TERMS OF HELPING TO PROVIDE SOME COPING MECHANISMS -- WE WERE TALKING ABOUT THIS EARLIER THIS EVENING. YOU KNOW, WE'RE DRIVING BACK AND FORTH SEEING THESE IMAGES AND SOME OF THESE CHILDREN ARE ACTUALLY LIVING, YOU KNOW, THEY'RE LIVING IN THAT MOMENT RIGHT NOW. WHAT WOULD YOU ADD TO THAT?

I DEFINITELY WOULD BE LOOKING FOR CHANGES IN BEHAVIORS. LOOK AT THOSE CHANGES IN BEHAVIORS AS CLUES INTO HOW THAT CHILD OR EVEN ADULTS AROUND YOU MIGHT BE COPING WITH WHAT IS GOING ON AND SEEK OUT HELP. THERE IS HELP AVAILABLE. THERE ARE MANY TRAINED PROFESSIONALS IN THE AREA THAT CAN HELP. HE AT THE BRIDGE WAY WE HAVE TRAINED CLINICIANS. AND WE ALSO HELP PEOPLE WHO MIGHT BE EXPERIENCING SIGNIFICANT PROCESS RELATED TO THE TRAUMA. IF THEY FEEL LIKE THEY MIGHT BE WILLING TO PUT THEMSELVES IN DANGER RELATED TO THAT CRISIS.

HOST: AND THEN FOR THE CHILDREN WHO INTERACT WITH THE FAMILIES WHO HAVE ACTUALLY GONE THROUGH THE TRAGEDIES, I'M SURE WE NEED TO BE PROVIDING SOME COPING TOOLS FOR THEM AS WELL BECAUSE THEY'RE PROBABLY TRYING TO DEAL WITH HOW THEIR FRIENDS ARE EXPERIENCING THESE KINDS OF TRAGEDIES.

ABSOLUTELY. AND I KNOW THERE ARE MENTAL HEALTH PROFESSIONALS THAT HAVE BEEN WORKING WITH SOME OF THE SCHOOL SYSTEMS DIRECTLY IN THE COMMUNITIES LIKE BOLOGNIA. WE'VE BEEN REACHING OUT TO THEM AND PROVIDING SOME SUPPORT BECAUSE A LOT OF THESE ARE ACTUALLY TRAINED THROUGH THE PROGRAM THAT WE OFFER THROUGH UMAS. SO, I THINK THAT THERE IS HELP AVAILABLE OUT THERE AND CERTAINLY WE WOULD BE HAPPY TO CONNECT THEM UP WITH THERAPISTS THROUGH THE PROGRAM THAT WE HAVE, ARKANSAS BUILDING EFFECTIVE SERVICES FOR TRAUMA.

HOST: I APPRECIATE YOUR SAYING THAT. WE WANT TO REMIND THOSE WATCHING AT HOME TONIGHT. ESSENTIAL OUR HEARTS AND THOUGHTS ARE WITH YOU AS YOU CONTINUE TO COPE AND HOPEFULLY GET SOME -- YOU CAN NEVER SAY CLOSURE BECAUSE THERE IS NO SUCH THING AS CLOSURE, BUT HAVE SOME MEASURE OF PEACE AS A RESULT OF DEALING WITH THE TRAGEDY. NOW, WHEN WE TALK ABOUT PDSD, TYPICALLY WE TALK ABOUT IT IMPACTING ADULTS. WE DON'T NECESSARILY THINK ABOUT IT AFFECTING CHILDREN. IS THIS A NEW DIAGNOSIS OR IS THIS SOMETHING THAT HAS BEEN AROUND FOR A LONG TIME?

NO, ACTUALLY ANNIE CASEY DID SOME RESEARCH SEVERAL YEARS AGO AND THEY FOCUSED ON CHILDREN IN THE FOSTER CARE SYSTEM. AND SOME OF THE BILL BOARDS AND PLACARDS THEY HAD ON BUSES TALKED ABOUT THE LIKELIHOOD OF A CHILD IN THE FOSTER CARE SYSTEM, A HIGHER PERCENTAGE OF CHILDREN IN THE FOSTER CARE SYSTEM EXPERIENCING PTSD THAN RETURNING WAR VETERANS.

HOST: WOW.

SO, IT'S BEEN AROUND FOR SOMETIME. I THINK THAT POTENTIALLY WE HAVEN'T BEENS AS ATTUNED TO ADDRESSING THOSE ISSUES WITH CHILDREN. AS WE WERE TALKING ABOUT EARLIER, IT'S BECAUSE THEY CAN'T -- THEY CAN'T DESCRIBE WHAT ANXIETY MEANS. THEY HE CAN'T DESCRIBE WHAT DEPRESSION MEANS. THEY CAN SAY I FEEL GOOD OR I FEEL BAD. AND, SO, WE FOCUS ON HELPING THE CHILD TO FEEL GOOD AND NOT REALLY UNDERSTANDING THE UNDERLYING ISSUES THAT MAY BE GENERATING THOSE FEELINGS FOR CHELSEY DEN.

TO PIGGYBACK OFF OF THAT, YOU MAKE A GOOD POINT THAT CHILDREN ARE JUST AS LIKELY TO EXPERIENCE PTSD AS ADULTS. SO, IT'S NOT THAT EITHER ADULTS OR CHILDREN ARE MORE OR LESS LIKELY, THE PRESENTATION -- THE WAY THAT PTSD IS WORK IS DIFFERENT IN CHILDREN THAN ADULTS.

HOST: WELL, LET'S TALK ABOUT THAT. SO, HOW WOULD IT LOOK DIFFERENT?

ONE IMPORTANT DIFFERENCE IS THAT CHILDREN ACTUALLY MIGHT REENACT SOME OF THE TRAUMA IN THE WAY THEY PLAY. NOT AS LIKELY TO SEE THAT IN ADULTS.

HOST: AND ALSO IN THE VIDEO WE SAW WHERE THEY SAID IT MAY BE THAT THEY'RE NOT SAYING OR WHAT THEY'RE NOT DOING. SO, WHAT WOULD YOU LOOK FOR IN THAT CASE?

YOU CAN LOOK FOR CHANGES IN APPETITE, CHANGES IN SLEEP PATTERNS, CHANGES IN HOW THEY INTERACT WITH THEIR FRIENDS. THEY MAY BECOME MORE ISOLATED AND YOU MAY NOT BE ABLE TO ABSORB THAT. IMPORTANTLY SOMETIMES WE MISLABEL A CHILD. WE SAY THEY HAVE A BEHAVIORAL PROBLEM. IN REALITY WHAT'S HAPPENED IS THERE IS SOME TYPE OF TRAUMA THEY'VE EXPERIENCED. THAT SOMETIMES THE PARENTS MAY NOT EVEN KNOW ABOUT AND, SO, THERE ARE MAYBE SOME CHANGES THAT YOU OBSERVE BUT IT'S NOT THAT OBVIOUS. SO, I THINK IT'S REALLY IMPORTANT FOR US TO REALLY LOOK A LITTLE BIT MORE CLOSELY AND DO REALLY GOOD SEAMS WHEN WE SEE THERE ARE CHANGES THAT OCCUR. BECAUSE IT MAY NOT BE ATTENTION DEFICIT DISORDER OR BEHAVIOR DISORDER. IT MAY ACTUALLY BE THAT THERE HAVE BEEN SOME TRAUMAS THAT HAVE OCCURRED WITH THIS CHILD, AND THOUGH ARE THE SYMPTOMS YOU'RE SEEING.

HOST: I HEAR YOU SAYING THAT. BUT WHERE WOULD A PARENT START? WHAT IS THE FIRST STEP WHEN YOU MAY HAVE THAT KIND OF CONCERN?

I THINK THE FIRST THING YOU WOULD DO IS TALK TO PRIMARY CARE PHYSICIAN. MOST PEOPLE FEEL PRETTY COMFORTABLE GOING TO THE PEDIATRICIAN OR FAMILY PHYSICIAN AND TALKING TO THEM ABOUT SOME OF THE CHANGES THAT THEY'VE OBSERVED. SO, THAT MIGHT BE A GOOD PLACE TO START. AND THEN IF THEY RECOGNIZE THAT MAYBE THEY DON'T KNOW HOW TO HELP, THEY MIGHT MAKE A REFERRAL TO A MENTAL HEALTH PROFESSIONAL WHO IS TRAINED IN HOW TO ASSESS TRAUMA AND WHO REALLY CAN DO A MUCH MORE THOROUGH SCREENING OF THAT CHILD.

AND THAT'S REALLY WHAT SOME OF THE -- KIND OF ADVANCED THERAPIES THAT WE WERE LISTENING TO IN THE FILM AS WELL RELATED TO DR. COHEN'S RESEARCH.

YES. SO, THERE ARE LOTS OF THERAPIES. IT DEPENDS ON WHETHER YOU ARE A CHILD, AN ADOLESCENT OR ADULT, BUT THERE ARE DIFFERENT TYPES OF THERAPIES THAT ADDRESS DIFFERENT TYPES OF ISSUES. SO, FOR VERY SMALL CHILDREN WHO HAVE EXPERIENCED TRAUMA, THERE IS A THERAPY THAT'S CALLED CHILD PARENT PSYCHOTHERAPY AND THAT'S REALLY WHERE YOU HAVE THE YOUNG CHILD AND THE PARENT WORKING TOGETHER. WHEREAS TRAUMA FOCUSED COGNITIVE BEHAVIOR THERAPY IS FOR OLDER CHILDREN IN ADOLESCENCE. THE PARENTS ARE INVOLVED IN THE TREATMENT BUT NOT QUITE AS MUCH AS YOU WOULD SEE WITH THE REALLY YOUNG CHILDREN. AND THEN FOR ADULTS, YOU WOULD ALSO SEE MORE OF THE COG ANY 3XI PROCESSING THERAPY. THAT'S ALSO CALLED EXPOSURE THERAPY. THOSE ARE THE ONES WE KNOW ARE EFFECTIVE. SO, THERE IS A WIDE RANGE OF THERAPIES THAT WE KNOW NOW ARE REALLY EFFECTIVE FOR PTSD AND FOR TRAUMA EXPOSURE. AND YOU WANT IT TO MAKE SURE YOU HAVE SOMEONE WHO IS FAIRLY KNOWLEDGEABLE AND WELL TRAINED IN THOSE AREAS.

I'M SORRY, GO AHEAD.

PART OF THAT IS THAT THE EXPERIENCE OF A TRAUMA IS VERY PERSONAL AND THE WAY THAT I WOULD REACT TO A TRAUMA IS GOING TO BE DIFFERENT THAN THE WAY YOU BRIE ACT TO TRAUMA. SO, THAT'S WHERE ESPECIALLY THE COGNITIVE -- THE COGNITIVE BEHAVIORAL APPROACH REALLY WORK BECAUSE YOU'RE TALKING WITH THE INDIVIDUAL ABOUT THEIR PERCEPTION, THEIR BELIEFS THAT ACTUALLY TRIGGER SOME OF THOSE BEHAVIORS OR ISSUES THAT THEY'RE STRUGGLING WITH. AND WHEN I TALKED WITH FOLKS ABOUT THIS BEFORE, I'VE ACTUALLY BEEN IN A TORNADO. WHEN I WAS IN THE FOURTH GRADE, IT HIT OUR SCHOOL WHILE WE WERE ACTUALLY THERE.

HOST: WOW.

AND I WAS IN ONE AREA AND MY BROTHER WAS IN ANOTHER AREA. HE WAS IN THE FIRST GRADE. WELL, AFTER THAT, EVERY TIME A THUNDER STORM CAME, MY REACTION WAS, I'M SCARED, I WANT TO BE CLOSE TO MY MOM, ALL OF THOSE KINDS OF THINGS. MY LITTLE BROTHER WANTED TO RUN OUTSIDE AND WATCH. WE EXPERIENCED A SIMILAR SITUATION OR A SIMILAR TRAUMA, BUT OUR REACTIONS WERE TOTALLY DIFFERENT. AND THAT'S WHY WE HAVE TO BE REALLY SKILLED IN WORKING WITH INDIVIDUALS THAT EXPERIENCE TRAUMA BECAUSE OF THE WAY THAT IT'S PLAYED OUT IN THEIR OWN LIVES.

HOST: SURE.

I'M JUST GOING TO ADD I THINK A REALLY IMPORTANT MESSAGE FROM THIS TYPE OF PANEL IS EVIDENT-BASED TREATMENTS EXIST AND THAT NO ONE NEEDS TO SUFFER WITH THIS AND BELIEVE THAT MAYBE THERE IS NOT HELP AVAILABLE AND MAYBE THEY ARE THE ONLY ONE SUFFERING WITH IT. THAT IS NOT THE CASE. THERE IS REALLY GOOD HELP AVAILABLE. THERE ARE WELL TRAINED PROFESSIONALS AVAILABLE.

HOST: THAT'S A REALLY GREAT MESSAGE TO SHARE TONIGHT OBVIOUSLY. TO SAY YOU'RE NOT ALONE AND THERE ARE SUPPORT SYSTEMS IN PLACE. YOU TALKED ABOUT THERAPIES. LET'S TALK A LITTLE ABOUT THE MEDICATIONS OF A THERAPY IN ADDITION TO WHAT DR. KRAMER WAS MENTIONING. I'M SURE THEY WORK HAND IN HAND, DON'T THEY HE?

THEY DO. AND CERTAINLY I'M A BIG ADVOCATE FOR THERAPY AS THE FIRST INTERVENTION. AS YOU GET TO KNOW A CHILD AND WE HAD A PROGRESSION IN THERAPY, YOU MIGHT REALIZE THE ACTIONS ARE DIFFERENT. THEY HE MAY HAVE MORE ANXIETY AND MORE MOOD SYMPTOMS THAT REALLY NEED TO BE TARGETED AT THE LEVEL OF MEDICATION. BECAUSE AS DOCTOR IS STUDYING THE BRAIN AND IMAGING OF THE BRAIN AND HOW TRAUMA AFFECTS THE BRAIN, PER SE, HOW IT -- HOW IT AFFECTS REGULATING YOUR EMOTIONS, HOW IT AFFECTS INCREASING REACTIVITY. MEDICATION CAN HELP INTERVENE IN THOSE PLACES AS WELL ALONG WITH THE THERAPY. BUT THE BEST, THE VERY BEST TREATMENT WOULD BE THE COMBINATION OF THE THERAPY AND THE MEDICATION.

HOST: DOCTOR, TALK A LITTLE ABOUT THAT, IF YOU WILL, ABOUT YOUR RESEARCH.

SURE. THE RESEARCH THAT WE'RE DOING AT THE PSYCHIATRIC RESEARCH INSTITUTE, WE'RE TRYING TO UNDERSTAND HOW TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY IS CHANGING HOW CHILDREN'S BRAIN FUNCTIONS, CHILDREN WHO EXPERIENCE PHYSICAL OR SEXUAL ASSAULT. IN THESE CHILDREN, SOMETHING THAT WE KNOW IS THAT THERE'S PARTS OF THEIR BRAIN THAT PROCESSES EMOTIONS. AFTER THE EXPERIENCE, PHYSICAL OR SEXUAL ABUSE, THOSE NETWORKSES IN THE BRAIN BECOME MORE ACTIVE OR STRONGER. BUT AT THE SAME TIME THE NETWORKS IN THE BRAIN THAT HELP US CONTROL OR REGULATE OUR EMOTIONS OR CONTROL OR REGULATE OUR BEHAVIOR, THOSE ACTUALLY GET WEAKER. SO, WHEN YOU COMBINE BOTH OF THOSE IT'S KIND OF A PERFECT STORM FOR SOMEONE TO HAVE LOTS OF EMOTIONAL PROBLEMS AND NOT HAVE VERY GOOD CONTROL OF IT. AND THE RESEARCH THAT WE'RE DEALING WITH, WE'RE TRYING TO UNDERSTAND THE BEST TREATMENT THAT WE HAVE, THE TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY. HOW WELL DOES THAT THERAPY HELP TARGET THESE BRAIN NETWORKS AND HOW WELL DOES IT MAY BE NORMALIZE BRAIN FUNCTIONING IN THE NETWORK. AND WE'RE NOT COMPLETELY DONE WITH THE STUDY THAT WE'RE DOING RIGHT NOW. SOME OF THE PRELIMINARY DATA THAT WE HAVE IS THAT THIS TREATMENT ACTUALLY IS CHANGING THE BRAIN FUNCTION IN THESE CHILDREN. WE DID A SIMILAR STUDY WITH ADULTS WHO WERE -- WHO HAD POSTTRAUMATIC STRESS DISORDER RELATED TO PHYSICAL OR SEXUAL ASSAULT. IN THIS STUDY WE'RE ACTUALLY ABLE TO DO THE EXPOSURE THERAPY THAT DR. KRAMER MENTIONED WHILE THEY WERE IN AN FMI SCANNER. WE GOT TO SEE HOW THEIR BRAIN CHANGED IN REAL TIME WHILE THEY WERE ENGAGED IN THIS TREATMENT. IT WAS ONE 15-MINUTE VERY BRIEF EXPOSURE SESSION BECAUSE IT WAS DONE IN THE CONTEXT OF AN FMRI SESSION. WE SAW EVEN JUST IN THOSE 15 MINUTES THAT THE BRAIN WAS CHANGING, THAT IT WAS STARTING TO NORMALIZE.

HOST: OKAY. BEFORE YOU GO ON, IF YOU MIGHT RELATE TO PEOPLE, WHAT DOES THAT MEAN WHEN YOU SAID THAT YOU'RE ABLE TO SEE WHAT WAS GOING ON? WHAT WAS HAPPENING WITH THE CHILD AS PART OF THAT SESSION?

ABSOLUTELY. IN THIS STUDY IT WAS WITH ADULTS. AND THE TECHNOLOGY THAT WE'RE USING WAS FUNCTIONAL MAGNETIC RESONANCE IMAGE. ING.

HOST: THAT'S THE FMRI.

PEOPLE HAVE AN MRI WHEN THEY GO TO THE HOSPITAL, THEY MIGHT HAVE A SCAN DONE OF THEIR ELBOW OR OF THEIR SKULL. THAT LETS YOU SEE WHAT DOES THAT PART OF THE BODY LOOK LIKE. BUT IN FUNCTIONAL MAGNETIC RESONANCE IMAGING, WE'RE ABLE TO SEE WHAT IS THE BRAIN DOING, HOW IS IT CHANGING OVER TIME, HOW IS IT ACTIVE OR NOT ACTIVE AT DIFFERENT POINTS IN TIME. SO, WITH THAT KIND OF TECHNOLOGY, WE CAN LOOK AND SEE HOW DOES THE FUNCTIONING OF THE BRAIN CHANGE WHILE THE PERSON IS ENGAGED IN THIS THERAPEUTIC PROCESS. SO, WE'RE ABLE TO SEE THAT EVEN JUST IN THAT 15 MINUTES ENGAGED IN THE THERAPEUTIC PROCESS WAS CHANGING THE FUNCTIONING OF THE BRAIN.

HOST: WOW.

THAT'S PROMISING. WHEN I TALK ABOUT THIS RESEARCH I LIKE TO TELL PEOPLE THAT BECAUSE IT'S OPTIMISTIC, RIGHT? SO, THERE'S LOTS OF RESEARCH SHOWING THAT TRAUMA CHANGES BRAIN FUNCTION. I THINK THE TAKE HOME MESSAGE IS EFFECTIVE TREATMENTS CAN CHANGE IT BACK.

HOST: THAT'S AWESOME RESEARCH.

I THINK IN RELATION TO THAT, TOO, I THINK IT'S WONDERFUL THAT WE ARE ABLE TO SEE THAT. NOT ONLY AS THE BRAIN IS BASICALLY FUNCTIONING, BUT WE ALSO SEE THAT IN SO MANY OF THE KID THAT WE'RE TREATING. EITHER THROUGH THE RESEARCH INSTITUTE OR ACROSS THE STATE BECAUSE WE GET A LOT OF FEEDBACK FROM THE THERAPIST THAT WE'VE TRAINED OVER TIME AND WE HAVE CONSULTATION WITH THEM. ONE OF THE THINGS THEY SAY THEY ARE JUST AMAZED. THEY SAY, WE DEPTH HAVE THE SKILLS TO DO WHAT WOULDER DOING NOW AND WE ARE SEEING SUCH SIGNIFICANT CHANGES IN THE CHILDREN WHO HAVE BEEN SEXUALLY ABUSED OR PHYSICALLY ABUSED. SO, IT'S JUST -- IT'S VERY EXCITING. I THINK WE'RE REALLY ON THE CUSP OF REALLY MAKING SOME INROADS INTO BEING ABLE TO TREAT THIS. AND I THINK IT IS WONDERFUL THAT IT'S COME TO ARKANSAS AND WE'VE GOT SUCH GOOD THINGS THAT ARE GOING ON HERE.

HOST: LET'S REMIND FOLKS IF YOU WILL, I THINK IT IS IMPORTANT FOR THEM TO KNOW, IF YOU CAN PUT THAT ON THE SCREEN IF YOU DON'T MIND ABOUT RBEST. IT IS A USEFUL TOOL FOR YOU TO GET INFORMATION FOR PARENTS. THEY HAVE A SPECIFIC PAGE FOR PARENTS AND THEN THEY ALSO HAVE INFORMATION FOR CLINICIANS. SO, THIS IS SOME USEFUL INFORMATION THAT HOPEFULLY WILL CONTINUE TO ADVANCE TREATMENT FOR YOUNG PEOPLE.

YES. THE CLINICIANS CAN ACTUALLY LEARN WHEN THE NEXT TRAINING IS AND FIND OUT HOW TO REGISTER FOR THAT. AND PARENTS CAN ACTUALLY LEARN BY GOING ONTO THE MAP AND MARKING THEIR COUNTY WHERE THE MENTAL HEALTH PROFESSIONALS ARE WHO HAVE BEEN TRAINED IN THIS PARTICULAR TREATMENT.

HOST: WELL, THAT IS VERY PROMISING AND HOPEFULLY LOTS OF PEOPLE TAKE ADVANTAGE OF IT. I WANT TO GO BACK TO TALK ABOUT THE MISS LABELING JUST A BIT BECAUSE I'M SURE SOME FOLKS WHO MAY BE AT HOME WATCHING THIS, PARTICULARLY WHO HAVE CHILDREN WHO MAY TEND TO ACT OUT, THEY PROBABLY HAVE HAD SOME OTHER KINDS OF DIAGNOSES. SO, WHAT IS THE MOST APPROPRIATE WAY FOR DETERMINING OR DISTINGUISHING WHEN IT IS AND WHEN IT ISN'T PTSD?

WELL, I THINK THE LAST IMPORTANT THING TO KNOW IS GET A GOOD TRAUMA ASSESSMENT. IT CONSISTS OF TWO THINGS. NUMBER ONE, YOU WANT TO KNOW THE TRAUMA HISTORY. YOU WANT TO KNOW WHAT HAS THIS CHILD BEEN EXPOSED TO. SO, YOU HAVE SOME REALLY GOOD STANDARDIZED INSTRUMENTS THAT HELP YOU AS A CLINICIAN TO BE ABLE TO DETERMINE ALL THE DIFFERENT KINDS OF STRESSORSES THAT A CHILD COULD HAVE BEEN EXPOSED TO. AND THEN YOU WANT TO KNOW WHAT ARE THE SYMPTOMS THAT THEY ARE EXPERIENCING AND THERE ARE LOTS OF DIFFERENT KINDS OF QUESTIONNAIRES AND INSTRUMENTS THAT YOU CAN ADMINISTER THAT WILL HELP YOU TO UNDERSTAND. IF YOU REALLY FOCUS ON POSTTRAUMATIC STRESS DISORDER, THERE REALLY ARE THREE CATEGORIES OF SYMPTOMS. THERE ARE NOW WITH THE NEW DIAGNOSTIC MANUAL THAT'S COME OUT. TROPICAL STORM' ACTUALLY FOUR CATEGORIES. WE FOCUS ON THE INTRUSIVE SYMPTOMS WHICH ARE NIGHTMARES AND FLASH BACKS AND KIND OF RELIVING THINGS AND GOING OVER AND OVER IT IN YOUR MIND. AND THEN AVOIDANCE SYMPTOMS WHICH IS REALLY TRYING TO STAY AWAY FROM REMINDERS, KIND OF NUMBING OUT, MAYBE ISOLATING YOURSELF A LITTLE BIT. AND WHAT WE CALL THE HYBRID, ALWAYS LOOKING OVER YOUR SHOULDER, STARTLED REACTIONS, MAYBE BEING OVERLY IRRITABLE. SO, YOU LOOK AT ALL OF THOSE SYMPTOMS AND YOU TRY AND FIGURE OUT, IS THIS REALLY APPLICABLE TO THIS PARTICULAR CHILD? SO, WHAT YOU SEE IS IS IT PTSD OR IS IT MORE ADHD OR IS IT MORE OF A MOOD DISORDER OR MAYBE A GENERAL ANXIETY DISORDER. AND IT REALLY TAKE JUST SOME CAREFUL PROBING TO BE ABLE TO REALLY DIFFERENTIATE WHAT'S GOING ON WITH THIS CHILD.

I THINK IT'S REALLY ABOUT GOOD HISTORY TAKING.

VERY GOOD HISTORY, YES.

AND RELATIONSHIP BUILDING. THAT'S THE PCP ON THE FRONT END OF THAT MAKING THE INITIAL ASSESSMENT TRYING TO GATHER FACTS. IF IT'S A MENTAL HEALTH PROVIDER, WHOEVER IT IS, IT'S REALLY ABOUT HAVING A RELATIONSHIP, BUILDING THAT RELATIONSHIP, AND TAKING A VERY GOOD THOROUGH HISTORY. NOT BEING AFRAID TO ASK ABOUT THINGS.

AS WE WERE -- GO AHEAD.

I JUST MENTIONED THE HISTORY AND I THINK THAT'S A GREAT POINT. I THINK PSYCHO EDUCATION IS HELPFUL. A LOT OF PARENTS MIGHT BE HEARING FROM THE TEACHER, FOR INSTANCE, ABOUT LOW CONCENTRATION, POSSIBLY IRRITABILITY, BEHAVIOR ISSUES COMING IN. THE TEACHER MIGHT MENTION, I THINK YOU NEED TO GET AN ADHD SCREENER. KIND OF PLANT THAT SEED. IF I CAN GET SOME PSYCHO EDUCATION FOLLOWING THAT HISTORY, IT HELPS THEM TO UNDERSTAND AND YOU CAN SEE ESPECIALLY WITH THE IMAGING THAT YOU WERE DOING NOW, AND THAT PERFECT STORM BETWEEN THEIR EMOTIONAL REGULATIONS, WHY A KID WOULD HAVE THESE SYMPTOMS. THERE IS SOME OVERLAP BETWEEN DIAGNOSIS. SO, WHEN I EDUCATE THE PARENT, THEY SUDDENLY WILL BE ABLE TO GIVE A BIGGER PICTURE, A BETTER HISTORY FOR ME. SUDDENLY THINGS CLICK LIKE A LIGHT BULB. YES, YOU'RE RIGHT, THEY LOST THEIR COUSIN LAST AUGUST AND I DIDN'T REALIZE THAT WAS SO IMPORTANT. AND WE CAN KIND OF MOVE FORWARD FROM THOSE DISCUSSIONS. I FIND THAT TO BE EXTRAORDINARILY HELPFUL.

HOST: MR. INVESTIGATE A, I WAS JUST ABOUT TO ASK YOU.

CHILDREN ACTUALLY COMMUNICATE THEIR TRAUMA OR THEIR STRUGGLES WITH US IN WHISPERS. ~ VEGA AS WE WERE TALKING ABOUT IN THE BREAK ROOM EARLIER, WE BETTER BE LISTENING BECAUSE OUR REACTION TO THE WAY THAT THEY WHISPER THEIR FEELINGS OR THEY GIVE US INSIGHT INTO THEIR EMOTIONS REALLY DETERMINES THE REACTION OR RELATIONSHIP WE'RE GOING TO HAVE WITH THEM ESPECIALLY AS CLINICIANS, THAT WE -- IF WE SAY WE CAN BE TRUSTED, IF WE'RE SAYING THAT WE CAN BE COUNTED ON, WE REALLY NEED TO FOLLOW THROUGH ON THOSE KINDS OF THINGS AND NOT IGNORE THOSE GENTLE WHISPERS THAT CHILDREN GIVE US THAT ARE INSIGHT INTO THEIR EMOTIONAL STRUGGLE.

HOST: BECAUSE YOU SAID EVERY ACTION -- WHAT WAS THE QUOTE YOU SAID, EVERY ACTION HAS A --

ALL BEHAVIOR HAS MEANING.

HOST: ALL BEHAVIOR HAS MEANING, OKAY. SO, ELABORATE A LITTLE BIT MORE ON THAT FOR THE BENEFIT OF FOLKS AT HOME.

SURE. AS DR. KRAMER WAS TALKING ABOUT, ZONING OUT, NUMBING OUT, THE CHILD IS TRYING TO PROTECT THEMSELVES SO THEY ARE NOT EXPERIENCING THAT TRAUMA. OR THEY ARE SO CAUGHT UP IN THEIR TRAUMA THAT THEY'RE REEXPERIENCING IT SO HE THEY SHUT DOWN EMOTIONALLY. AND, SO, IF WE'RE NOT ATTUNED TO THAT AND IF OUR SYSTEMS ARE NOT ADEQUATELY PREPARED TO UNDERSTAND THE IMPACT THAT TRAUMA PLAYS IN THE LIVES OF CHILDREN AND IN ADULTS AS WELL, THEN WE MISS THOSE OPPORTUNITIES TO ACTUALLY PROVIDE THAT CORRECT DIAGNOSIS AND TREATMENT THAT'S NECESSARY IN ORDER TO HELP THAT CHILD OR ADULT TO BETTER UNDERSTAND THEMSELVES AND THEN TO DEVELOP THE SKILLS THAT THEY NEED IN ORDER TO COPE APPROPRIATELY.

HOST: WE SHOULDN'T HAVE THE ATTITUDE, THEY'LL GET PAST IT, THEY'RE CHILDREN, THEY'LL GROW OUT OF THAT, DON'T WORRY ABOUT IT.

THERE HAVE BEEN RESEARCH STUDIES ABOUT WHAT HAPPENS TO CLINICAL SYMPTOMS RELATED TO POSTTRAUMATIC STRESS DISORDER SYMPTOMS, VALUE SYMPTOMS, DEPRESSION SYMPTOMS OVER TIME. AND WHAT WE HAVE FOUND IS THAT IMMEDIATELY AFTER A TRAUMA, THE NORMATIVE RESPONSE, NORMAL RESPONSE TO HAVE A LOT OF ANXIETY, TO HAVE DEPRESSION OR TO HAVE PROBLEMS SLEEPING, BUT MOST CHILDREN AND MOST ADULTS AFTER TRAUMA WILL RECOVER NATURALLY. AND ACTUALLY THE RESEARCH IS SHOWING THAT THEY'LL RECOVER NATURALLY TYPICALLY WITHIN THREE MONTHS. BUT AFTER THAT POINT, IF THE SYMPTOMS DON'T RECOVER ON THEIR OWN, THEN THEY TYPICALLY DON'T ON THEIR OWN. THAT'S REALLY KIND OF THE TIPPING POINT WHEN THE CHILD, ADULT NEEDS INTERVENTION VERSUS WHEN IT'S GOING TO GO AWAY ON ITS OWN.

THERE IS A NEED NOT BEING MET, SO, I THINK ABOUT MY KIDS WHEN THEY WERE LITTLE AND THEY'RE TRYING TO GET YOUR ATTENTION WHILE YOU MIGHT BE READING. THEY DON'T JUST SAY MOM ONCE. THEY KEEP ON, MOM, MOM, MOM, MOM. IT'S THAT SAME THING WITH US AND OUR NEEDS. IF THEY'RE NOT MET, IF THEY DON'T RECOVER, THEY'LL CONTINUE AND GET LOUDER AND LOUDER. THAT'S WHY IT'S IMPORTANT TO LISTEN TO THE BEHAVIORS.

HOST: WE APPRECIATE THAT. WE'RE GOING TO GO AHEAD AND START TAKING SOME OF YOUR QUESTIONS OR ACTUALLY HAVING THE PANEL RESPOND TO SOME OF YOUR QUESTIONS. BUT WE WANT TO REMIND YOU THAT YOU ARE WELCOME TO CALL TONIGHT. 1-800-662 --. WE ARE INVITING YOU TO JOIN IN THIS IMPORTANT CONVERSATION AND HOPEFULLY GET SOME USEFUL INFORMATION THAT WILL BENEFIT YOUR FAMILIES AND YOUR CHILDREN. THIS QUESTION NOW IS ABOUT REACTIVE ATTACHMENT DISORDER. FIRST OF ALL, YOU'RE GOING TO HAVE TO EXPLAIN WHAT THAT IS AND THEN ANSWER THE QUESTION. BUT IS REACTIVE ATTACHMENT DISORDER CAUSED BY PTSD?

DR. GATHRIGHT, WOULD YOU LIKE TO TAKE THAT QUESTION?

IT'S MORE COMPLEXION. ~ COMPLEX. I CAN ANSWER HONESTLY. ATTACHMENT DISORDER, CHILDREN WHO HAVE EXPERIENCED PATHOLOGICAL NEGLECT OR TRAUMA, OR THEIR VERY, VERY BASIC NEEDS HAVE NOT BEEN CARED FOR MIGHT MEET THE CRITERIA FOR REACTIVE ATTACHMENT AND HAVE DIFFICULTY WITH RELATIONSHIPS AND ATTACHMENT. I THINK WE'RE MOVING IN A DIRECTION THAT REALLY LOOKS MORE AT TRAUMA FROM A PTSD, POSTTRAUMATIC STRESS DISORDER THAN ALL THE SYMPTOM DR. KRAMER TALKED ABOUT, ALL THE CATEGORIES OF SYMPTOMS, THINKING ABOUT THOSE AND THINKING ABOUT THE TREATMENTS FOR THAT LEVEL THAN JUST THE FACT THAT THIS CHILD HAD TRAUMA NOW HAS RELATIONSHIP DIFFICULTIES. BECAUSE I THINK PEOPLE GET STUCK IN THAT IN THAT THEY THINK THAT JUST BECAUSE A CHILD HAS A TRAUMA AND MAYBE WITHIN FOSTER CARE THEY MIGHT HAVE DIFFICULTY WITH RELATIONSHIPS, THAT MUST BE ATTACHMENT DISORDER. I THINK IT'S MUCH MORE COMPLEX THAN THAT AND I THINK WE HAVE TO BE VERY CAREFUL ABOUT DIAGNOSES SUCH AS THAT.

THAT'S A GOOD POINT BECAUSE IT SPEAKS TO THE IDEA THAT OUR LABELS FOR THESE PROBLEMS CHANGE OVER TIME. SO, WHAT WE LABEL NOW AS REACTIVE ATTACHMENT DISORDER, IN 20 YEARS WE MIGHT HAVE A DIFFERENT LABEL.

ABSOLUTELY.

AN EFFECTIVE TREATMENT, BE SURE IT IS PTSD AND PROVE SOME OF THE OTHER SYMPTOMS AS WELL. IT CAN HELP RULE OUT SOME OF THOSE POSSIBILITIES.

THAT'S ACTUALLY WHAT I WAS GOING TO SAY. THE TREATMENT FOR PTSD AND REACTIVE ATTACHMENT DISORDER ARE VERY SIMILAR. SO, YOU REALLY KIND OF ADDRESSING SOME OF THE UNDERLYING ISSUES BY THE THERAPIES. AS LONG AS YOU'VE GOT SOMEBODY WHO REALLY KNOWS HOW TO PROVIDE THOSE EFFECTIVE TREATMENTS.

HOST: WHERE WOULD ONE BEST DETERMINE WHO CAN MEET THOSE NEEDS? I MEAN, OBVIOUSLY IF YOU'VE GOT TO INCREASE YOUR LEVEL OF AWARENESS FIRST ABOUT THE CONCERN. BUT THEN WHERE DO YOU START? WHO DO YOU REACH OUT TO?

I THINK YOU'VE GOT SEVERAL DIFFERENT AVENUES AND I THINK, YOU KNOW, YOU'VE ALWAYS GOT UMAS. WE CAN ALWAYS HANDLE CALLS ABOUT THAT IF YOU REALERY INTERESTED IN HOOKING UP WITH A SERVICE IN YOUR AREA, WHO HAS BEEN TRAINED IN CBT, THEY SHOULD BE ABLE TO ADDRESS THAT. BUT ALSO ALL KINDS OF CLINICAL SERVICES WHERE THERE IS A LICENSED MENTAL HEALTH PROFESSIONAL AND THAT'S WHAT YOU WANT TO MAKE SURE IS YOU'VE GOT SOMEBODY WHO HAS GOT THE LICENSE WHO ACTUALLY IS TRAINED AND SKILLED ENOUGH TO BE ABLE TO TREAT YOUR CHILD WELL.

EMS OFFERS A SERVICE TO PHYSICIANS THROUGHOUT THE STATE AND APN, EVEN IF A CHILD IS PRESENTING TO A PRIMARY CARE PHYSICIAN, THE PEDIATRICIAN, THE APN. AND THE PHYSICIAN IS KIND OF SCRATCHING THEIR HEAD, WHAT'S GOING ON? I'M NOT REALLY SURE. THEY CAN MAKE A CALL TO OUR SITE SERVICE WHICH WILL PUT THEM IN CONTACT WITH THE CHILD PSYCHIATRIST WITHIN 10 OR 15 MINUTES 24 HOURS A DAY 7 DAYS A WEEK. SO, PHYSICIANS HAVE THAT AS A WAY TO KIND OF MAYBE HELP TRIAGE OR SCREEN OR HELP TO DIRECT WHERE COULD WE GET SERVICES FOR THIS CHILD.

HOST: AND IT'S REALLY IMPORTANT, TOO, I THINK AS I HEAR YOU GUYS DISCUSSING THIS, THE INTERRELATIONSHIP BETWEEN ALL OF THE PHYSICIAN AND THE MEDICAL CLINICIANS THAT ARE TREATING A CHILD SO THAT THEY'RE ALL TALKING TO EACH OTHER AND UNDERSTAND EXACTLY WHAT THE APPROPRIATE THERAPIES ARE.

AND THAT'S ACTUALLY PART OF A TRAUMA INFORMED SYSTEM IS THAT YOU DO HAVE EVERYBODY IN THE SAME PLACE AT THE SAME TIME AND THEY'RE ALL TALKING TO EACH OTHER. OTHERWISE YOU'VE GOT PEOPLE GOING ONE WAY, TREATMENT PLAN GOING THIS WAY AND ANOTHER PLAN GOING THAT WAY. AND YOU HAVE NO ACTUAL CONGRUENCE OR CONTINUITY ACROSS CARE. SO, I THINK THAT'S PART OF THE TRAUMA INFORMED SYSTEM AS YOU WERE TALKING ABOUT.

HOST: WE'RE GOING TO LET MR. VEGA CHIME IN ON THAT. ONE OF THE THINGS HE SAID HE SPECIFICALLY WANTED TO TALK ABOUT TONIGHT.

AS WE TALK ABOUT SPECIFIC TRAUMA AND SOME INTERVENTIONS LIKE TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY ASK THOSE TYPES OF INTERVENTIONS, WITHOUT A TRAUMA INFORMED SYSTEM, THEY REALLY FALL SHORT OF MEETING THE NEED OF THE INDIVIDUAL BECAUSE A TRAUMA INFORMED SYSTEM MEANS THAT THE RECEPTIONIST UNDERS WHAT TRAUMA IS WHEN A PERSON COMES IN TO A PRIMARY CARE PHYSICIANS OFFICE OR INTO A COUNSELING CLINIC. THAT THE JANITOR UNDERSTANDS THAT IN A RESIDENTIAL TREATMENT FACILITY, THAT EVERYONE THAT'S INVOLVED WITH PROVIDING TREATMENT OR NOT NECESSARILY PROVIDING TREATMENT BUT IS INVOLVED IN THAT SYSTEM UNDERSTANDS THE IMPACT THAT TRAUMA HAS IN THE LIVES OF THE INDIVIDUALS THAT ARE SEEKING TREATMENT THERE. AND A TRAUMA INFORMED SYSTEM REALLY BEGINS TO MOVE US FROM LOOKING AT THINGS THROUGH THE PATHOLOGICAL LENS, ASKING PEOPLE WHAT'S WRONG WITH YOU AND BEGINNING TO LOOK AT WHAT ACTUALLY HAPPENED TO A PERSON AND UNDERSTANDING THAT THE BEHAVIOR THAT WE MAY BE SEEING IS ACTUALLY THEM ACTING OUT OR REEXPERIENCING A TRAUMATIC EVENT THAT THEY MAY HAVE UNDERGONE EARLY ON IN THEIR LIVES. AND AS WE WERE TALKING ABOUT, IT'S A LENS AND DR. CRAMER BROUGHT THIS UP AND TALKED ABOUT THIS AS AN EXAMPLE. I TAKE MY GLASSES OFF, I CAN STILL SEE BUT I CAN'T SEE AS CLEARLY. BUT WHEN I PUT MY GLASSES BACK ON, YOUR FACE BECOMES MORE DEFINED. AND I CAN ACTUALLY SEE YOU FOR WHO YOU ARE. AND THAT'S WHAT A TRAUMA INFORMED SYSTEM DOES FOR THE INDIVIDUALS THAT SEEK SERVICES, IS IT HELPS US TO ACTUALLY GET A CLEARER, CLEARER VIEW OF THE ISSUES THAT THEY'RE STRUGGLING WITH.

HOST: THAT IS A GREAT ANALYSIS. THANK YOU FOR SHARING THAT. WE HAVE A QUESTION NOW FROM CROSS COUNTY. WHERE CAN SOMEONE RECEIVE TRAINING FOR TREATMENT OF PTSD? DR. KRAMER, THAT SOUNDS LIKE YOU.

THAT'S A GREAT QUESTION. THERE ACTUALLY IS SOME FANTASTIC ONLINE COURSES THAT YOU CAN TAKE JUST TO KIND OF THROE HE DEUCE YOU TO SOME DIFFERENT TYPES OF THERAPY. ~ INTRODUCE THEY'RE OFFERED THROUGH THE UNIVERSITY OF SOUTH CAROLINA. IF YOU GOOGLE SOUTH CAROLINA AND GO TO COGNITIVE PROCESSING THERAPY FOR ADULTS OR PTSD FOR CHILDREN, YOU CAN DO AN ONLINE COURSE IF YOU'RE A TRAINED MENTAL HEALTH CLINICIAN. OBVIOUSLY THROUGH AR BEST, IF YOU'RE INTERESTED IN DOING MORE OF THE FACE TO FACE TRAINING AND FOLLOW-UP WITH CONSULTATION CALLS AND GETTING FEEDBACK ON HOW YOU'RE DOING IN YOUR THERAPEUTIC SKILLS, THEN YOU CAN ACTUALLY CONTACT US AND NEXT TRAINING IS IN JUNE IN NORTHWEST ARKANSAS.

HOST: OKAY.

LET US KNOW AND WE'LL BE HAPPY TO GET THAT SET UP FOR YOU.

HOST: REMEMBER YOU CAN GET ADDITIONAL INFORMATION ONLINE. WE HAVE THAT WEBSITE FOR YOU. AND I DO LIKE WHAT YOU SAID ABOUT YOU HAVE TO BE A TRAINED THERAPIST.

YES.

HOST: SO, PEOPLE WHO ARE INTERESTED IN THAT KIND OF ADDITIONAL TRAINING, THEY NEED TO BE AWARE OF THAT. HERE'S ANOTHER QUESTION. A NEPHEW LIVES IN ANOTHER STATE. BIOLOGICAL DAD COMMITTED SUICIDE. SHOULD UNCLE BE CONCERNED ABOUT HIS NEW ISSUE OF ATTENTION PROBLEM, WHICH IS AFFECTING HIS SCHOOLWORK AND NOW ON MEDICATION? SO, I GUESS WE CAN START ON THIS END AND WE CAN GO DOWN TO DR. GATHRIGHT.

SO, IF I UNDERSTAND THE QUESTION CORRECTLY, IT'S A BOY WHO LOST HIS FATHER?

HOST: TO SUICIDE.

TO SUICIDE. YEAH, I THINK THE FIRST THING THAT WOULD BE REALLY HELPFUL IS TO MAKE SURE THAT THERE IS A MENTAL HEALTH PROFESSIONAL THAT IS INVOLVED IN THIS CHILD'S LIFE AND HE CAN ACTUALLY DO A GOOD REFERRAL ASSESSMENT. SOME OF WHAT YOU WANT TO LOOK AT IS WHAT ELSE HAPPENED IN THIS CHILD'S LIFE. SO, BEFORE THAT SUICIDE THERE MAY HAVE BEEN A LOT OF DISRUPTION IN THE FAMILY. THERE MAY HAVE BEEN DEPRESSION ON THE PART OF THE FATHER. THERE MAY HAVE BEEN OTHER THINGS THAT WERE GOING ON IN THAT CHILD'S LIFE THAT AFFECT KIND OF HOW THEY ARE NOW. AND THEN WITH THAT OCCURRING, OBVIOUSLY THAT IS A TRAUMATIC EXPERIENCE FOR THAT CHILD. SO, YOU WANT TO HAVE SOMEBODY AGAIN LIKE DR. GATH RIGHT MENTIONED, YOU WANT TO HAVE A GOOD THOROUGH HISTORY OF THE COURSE OF THE CHILD'S SYMPTOMS. AND BE SURE, THEN, THAT WHATEVER IS GOING ON THAT IT'S NOT ADHD, THAT IT'S NOT SOMETHING ELSE BESIDES THE TRAUMA. SO, JUST DOING A REALLY THOROUGH ASSESSMENT WOULD BE THE GOOD STARTING POINT FOR THAT. IF HE'S ON MEDICATION HE'S PROBABLY BEING SEEN BY SOMEONE.

FOR ME AS A CLINICIAN, I FEEL A REALLY GOOD RULE OF THUMB IS IF YOU THINK YOU HAVE THE DIAGNOSIS AND MAYBE YOU'VE DONE AN ASSESSMENT, IF THINGS DON'T REALLY GET BETTER AND IF YOU'RE USING EVIDENCE-BASED TREATMENT, THAT'S THE GOOD THING YOU ARE USING EVIDENCE-BASED TREATMENT. USING MEDICATION AND NOTHING SEEMS TO GET BETTER, IT'S TIME TO STEP BACK, MAYBE CHANGE THE LENS, MAYBE YOU NEED A NEW PRESCRIPTION, RIGHT? AND IT LOOK AND SEE, AM I PROVIDING EVIDENCE-BASED TREATMENT FOR THE CORRECT DIAGNOSIS? SO, IN THIS PARTICULAR CHILD, IF UNCLE IS CONCERNED BECAUSE HE'S ON ALL THESE MEDICINES, THING DON'T REALLY SEEM TO GET BETTER, YES, ABSOLUTELY. I THINK IT'S TIME TO TAKE A STEP BACK AND REEVALUATE WHAT MIGHT BE REALLY GOING ON.

JUST TO ADD A LITTLE BIT TO THAT, YOU KNOW, IF WE WERE CONCERNED THAT THE CHILD HAD A VIRUS HE WOULDN'T HESITATE TO BRING HIM INTO THE DOCTOR TO CHECK IT OUT. SOMETIMES THERE IS A STIGMA AGAINST MENTAL ILLNESS, YOU DON'T WANT TO DO ANYTHING WITH IT OR TALK ABOUT IT. BUT IN THIS CASE I DON'T THINK THAT THERE IS ANY REASON TO BE CAUTIOUS ABOUT BRINGING HIM IN FOR AN ASSESSMENT. THERE'S NO HARM THAT CAN BE DONE WITH THAT.

HIS UNCLE, SOUNDS LIKE HE LIVES FAR AWAY. THIS PARTICULAR CHILD MIGHT NEED A LOT OF SUPPORT NOW THAT THE FATHER IS GONE. WHO IS PROVIDING THAT SUPPORT? MAYBE THERE IS A WAY THE UNCLE CAN STEP IN AND BE A ROLE MODEL FOR THAT PARTICULAR CHILD OR FIND SOMEONE WHO MIGHT BE CLOSER TO THE FAMILY BUT HELP UNDERSTAND WHAT HE'S GOING THROUGH.

HOST: SURE. WELL, THIS CALLER WANTED TO THANK US FOR HAVING THIS PROGRAM ON TELEVISION TONIGHT. SO, I JUST WANTED TO SHARE THAT WITH YOU AND HOPEFULLY YOU GOT SOME INFORMATION THAT I WILL BE ABLE TO SHARE WITH YOUR NEPHEW. NOW, THEY'RE IN GARLAND COUNTY. DO YOU HAVE A SPECIFIC LOCATION THAT YOU WOULD RECOMMEND OR WHERE WOULD YOU DIRECT THEM IN TERMS OF GETTING ACCESS TO INFORMATION?

GARLAND COUNTY, I DON'T KNOW OFF THE TOP OF MY HEAD, BUT THEY CAN GO ONLINE AND CHECK OUT GARLAND COUNTY AND SEE WHETHER OR NOT THERE IS SOMEBODY THAT'S BEEN TRAINED IN THAT AREA. OR CALL US AND TOMORROW WE CAN KIND OF HELP DIRECT YOU. I DON'T KNOW WHAT THE COMMUNITY MENTAL HEALTH CENTER IS IN THAT AREA, BUT WE CAN TRY TO HELP.

HOST: ALL COMMUNITIES HAVE --

COMMUNITY COUNSELING.

HOST: ALL COMMUNITIES HAVE MENTAL HEALTH SERVICE.

YES.

HOST: THAT'S THE GREAT NEWS, IS THAT THERE IS A RESOURCE IN THEIR AREA. I'M SORRY, I WASN'T TRYING TO PUT YOU ON THE SPOT. I KNOW YOU DON'T KNOW. [LAUGHTER]

HOST: THAT'S THE E-MAIL ADDRESS. I'M KIDDING YOU. IT'S GREAT TO KNOW THE RESOURCES ARE THERE. SO, THAT'S HELPFUL TO YOU TONIGHT.

> THIS QUESTION NOW IS ABOUT REEXPERIENCING WITHOUT GIVING OR WORKING THROUGH REEXPERIENCING WITHOUT GIVING AWAY TOO MUCH INFORMATION IN YOUR PRESENT LIFE. I'M NOT REAL SURE. I THOUGHT MAYBE YOU CAN HELP.

I WONDER IF THEY MEAN LIKE YOU ARE BEING TRIGGERED. FOR EXAMPLE, AT WORK YOU'RE BEING TRIGGERED WITH FRIENDS. SOMETIMES WITH PTSD, YOU'RE ACTUALLY -- YOUR SYMPTOMS ARE TRIGGERED BY SOMETHING THAT REMINDS YOU OF THE ORIGINAL TRAUMA. SO, FOR EXAMPLE, YOU KNOW, SOMETIMES WITH INDIVIDUALS WHO HAVE BEEN THROUGH A TORNADO AND THE SIRENS WENT OFF, ON WEDNESDAYS WHEN THE SIRENS GO OFF AT NOON, IT CAN TRIGGER ANXIETY AND TRIGGER SYMPTOMS JUST BECAUSE IT'S A REMINDER OF THAT ORIGINAL EVENT. SO, THAT COULD BE WHAT THEY'RE TALKING ABOUT, IS WHAT DO YOU DO WHEN YOU ARE TRIGGERED AND YOU DON'T ALWAYS WANT EVERYBODY AROUND YOU TO KNOW WHAT'S GOING ON AND WHAT YOU'RE EXPERIENCING. AND, SO, ONE OF THE THINGS TO DO IS TO REALLY DEVELOP SOME COPING STRATEGIES THAT CAN HELP GET YOU TALI THE 5 TO 10 MINUTES WHEN YOU MIGHT BE STARTING TO HAVE A PANIC ATTACK ~ OR REALLY THAT ANXIETY IS KIND OF GOING SKY HIGH. IS TO DEVELOP THOSE COPING SKILLS. A THERAPIST CAN HELP YOU WITH THAT. THERE ARE BREATHING TECHNIQUES. MUSCLE RELAXATION TECHNIQUES. NOW WITH SMART PHONES AND IPHONES, YOU CAN ACTUALLY GO ONLINE AND YOU CAN GET -- DOWNLOAD APPS THAT WILL TAKE YOU THROUGH A RELAXATION EXERCISE.

HOST: THAT YOU FOR MENTIONING THAT.

INTERESTING DR. KRAMER SAID THAT ABOUT THE SIRENS ON WEDNESDAY. I LIVE IN --

HOST: DOES THAT TRIGGER SOMETHING FOR YOU?

IT ACTUALLY DID. THE SIRENS WENT OFF ON LAST -- THE 27TH ON SUNDAY AND, OF COURSE, THEY WERE SAYING IT'S COMING IN THIS DIRECTION. SO, OF COURSE, I'M TRYING TO FIGURE OUT WHAT I'M GOING TO DO. BUT WEDNESDAY I'M SITTING IN MY OFFICE AND THE SIRENS GO OFF AND I'M THINKING, OH, THERE'S ANOTHER TORNADO COMING. AND I LOOK AT MY WATCH AND REALIZE IT'S NOON. AND, SO, ALL OF THOSE THINGS -- THOSE TRAUMA TRIGGERS, IT REALLY IS A SELF-AWARENESS. THAT'S WHERE THAT RELAXATION AND THINGS COME IN. EVEN WHEN YOU'RE REEXPERIENCING A TRAUMA, YOU HAVE TO REALIZE THAT YOU'RE NOT IN THAT MOMENT AND TRYING TO GROUND YOURSELF AND WHERE YOU ARE. AND TRAUMA TRIGGERS HAPPEN TO EACH AND EVERY ONE OF US ALL THE TIME. IT'S JUST BASED ON -- OUR REACTION ARE DIFFERENT AND THAT'S WHAT WE HAVE TO BE AWARE OF.

HOST: SURE. THAT WAS SOMETHING I NOTICED IN ONE OF THE VIDEOS WHERE THEY HAVE THE KID, IT LOOKED LIKE THEY WERE DOING YOGA.

UM-HM.

HOST: SO, I

HOST: I THINK OBVIOUSLY THE MORE WE WORKOUT WHAT THERAPIES WORK FOR THAT CHILD, THAT'S GREAT.

THERE ARE ALSO THINGS YOU CAN DO WITH REALLY YOUNG CHILDREN WHEN THEY ARE EXPERIENCING THE TRIGGERS. WHAT YOU FIND IS SOME CHILDREN WHO HAVE BEEN SEXUALLY OR PHYSICALLY ABUSED WILL HAVE SOME TRIGGERS AND IT WILL INCREASE THEIR ANXIETY. SO, YOU CAN WORK WITH THEM AROUND HEAVY BLANKET, PUTTING A HEAVY BLANKET AND WRAPPING THEM IN THAT HEAVY BLANKET WHEN THEY'RE STARTING TO FEEL THAT ANXIETY. THERE ARE THINGS YOU CAN DO FOR REALLY YOUNG CHILDREN THAT CAN HELP MANAGE THAT.

HOST: THAT'S GREAT TO KNOW. HERE IS A QUESTION FOR YOU, MS. MEGAN. WHAT HAS BEEN DONE FOR KIDS WITH AUTISM OR AUTISTIC DEVELOPMENT DISORDERS WHO HAVE BEEN STRICKEN WITH PTSD?

THAT'S A TOUGH ONE. WITH AUTISM IN GENERAL, THERE IS A DIFFERENT PROTOCOL OF CARE. IF THEY HAVE EXPERIENCED A TRAUMA, IT WOULD DEPEND ON WHERE THEY'RE AT ON THE SPECTRUM. IF THEY WOULD BE A GOOD FIT FOR POTENTIALLY A TPBFC MODEL. I HATE TO SAY IT COMES BACK TO ASSESSMENT BUT IT DOES. BECAUSE THE SPECTRUM IS VERY BROAD AND IT WOULD BE A CHALLENGE TO KNOW FOR SURE IF THEY WOULD HAVE THE ABILITIES TO UNDERSTAND AND PROCESS THAT PARTICULAR EVIDENCE-BASED PRACTICE.

HOST: THE NEXT QUESTION IS WHERE CAN HELP BE FOUND?

ALWAYS LICENSED HEALTH MENTAL HEALTH CLINICIANS. IF WE CANNOT HELP YOU, WE CAN REFER YOU TO THOSE WHO CAN. YOU CAN ALWAYS GO TO THE AR BEST WEBSITE AND SEE EACH OF THE AREAS. CORRECT ME IF I'M WRONG, I BELIEVE THERE IS AT LEAST ONE IN EVERY SINGLE COUNTY AT THIS POINT IN TIME.

HOST: ALMOST.

ALMOST? [MULTIPLE VOICES]

QUITE REMARKABLE.

WE CAN REFER YOU TO THOSE WHO MIGHT BE HELPFUL. SO DEFINITELY CALL THE BRIDGE WAY AND WE'LL DIRECT YOU IN THE RIGHT TYPE OF CARE.

IN CENTRAL ARKANSAS THERE ARE AT LEAST A COUPLE THERAPISTS WHO ARE SPECIALISTS IN AWE ADVERTISE MANY SPECTRUM DISORDER AND -- SO IT DEPENDS WHERE THEY RESIDE.

HOST: WELL, THEY CAN AGAIN GO TO THAT AR BEST WEBSITE AND HOPEFULLY GET SOME INFORMATION. AND THIS WAS COMING FROM PLATE COUNTY. THANK YOU VERY MUCH FOR CALLING IN TONIGHT. AND, YEA, WE HAVE AN E-MAIL THAT WE GOT IN. WE ALWAYS LOVE TO HEAR FROM YOU IN WHATEVER WAY IS CONVENIENT FOR YOU. BUT THIS ONE IS ABOUT REACTIVE DETACHMENT. COULD IT BE MISTAKEN FOR ADHD? AND COULD EARLY ABSENCE OF A PARENT OR POVERTY CAUSE SIMILAR SYMPTOMS, LIKE MOVING AROUND A LOT?

I THINK IT GOES BACK TO THE SAME MESSAGE, THE ASSESSMENT AND OVERLAP. WE ARE PROVIDING EDUCATION TO FAMILIES ABOUT DIFFERENT DIAGNOSES AND THE OVERLAP OF SYMPTOMS YOU SEE IN ADHD OR PTSD ARE JUST GENERALIZING. I LIKE TO ADDRESS CIRCLES. I LIKE TO ADDRESS CIRCLES AND INTERCONNECT MY CIRCLES BECAUSE THEN I CAN SHOW THEM HOW THERE IS AN OVERLAP HERE. THERE MAY BE SEPARATE SYMPTOMS BUT THERE IS AN OVERLAP. I THINK IT GOES BACK TO, AGAIN, REALLY THE IMPORTANCE OF BUILD ASSESSMENT AND REALLY THINK ABOUT IT FROM DIFFERENT LENSES OR IN DIFFERENT CIRCLES.

ONE OF THE THINGS THAT YOU FIND WITH COMPLEX TRAUMA WHICH IS REALLY EXPERIENCING TRAUMATIC EVENTS. SO, FOR EXAMPLE, A CHILD MAY BE PHYSICALLY ABUSED AND THEN THEY ARE ACTUALLY TAKEN OUT OF THEIR HOME AND THEN THEY'RE PLACED IN FOSTER CARE AND THEY'RE SEPARATED FROM THEIR SIBLINGS AND AFTER THAT THEY HAVE TO GO TO A NEW SCHOOL. THEY HAVE THIS WHOLE SERIES OF EVENTS THAT UNFOLD THAT REALLY IS TRAUMATIC AND IT JUST KIND OF COMPOUNDS ITSELF. SO, THE COMPLEX TRAUMA OFTENTIMES WHICH YOU'LL SEE IT DID YOU CHILDREN OR THE CONFLICT, THEY KIND OF WITHDRAW AND THEY ARE NOT TRUSTING OF RELATIONSHIPS. THAT'S WHERE SOMETIMES YOU GET THAT REACTIVE ATTACHMENT DISORDER DIAGNOSIS THAT COMES ABOUT. THEY HAVE BEEN TRAUMATIZED AND THEY DO HAVE KIND OF THAT PTSD AVOIDANCE AND SHUTTING DOWN PROCESS THAT OCCURS. BUT THEY ALSO ARE NOT VERY TRUSTING OF MANY PEOPLE IN THEIR ENVIRONMENT BECAUSE OF WHAT'S HAPPENED TO THEM. SO, YOU MAY SEE THAT REACTIVE ATTACH MANY. AND IT MAY BE APPROPRIATE AND IT MAY NOT. BUT YOU JUST HAVE TO BE REALLY CAREFUL WITH THAT. ~ ATTACHMENT

I THINK IT'S IMPORTANT THERE IS AN EVENT, A CHILD MOVING FROM PLACE TO PLACE AND THERE IS INSTABILITY IN THEIR LIFE IN GENERAL. THE TRAUMA IS STILL ONGOING IN MANY WAYS. THIS IS WHY I THINK THAT WE START TO SEE THESE OVERLAP OF SYMPTOMS, DIFFICULTIES WITH RELATIONSHIP TRUST. TRUST IS THE BIG KEY. IF YOUR TRAUMA IS ALWAYS KIND OF ONGOING, IT GOES FROM PLACE TO PLACE TO PLACE AND THERE IS NO STABILITY, WHO CAN YOU TRUST? CONSIDERING THAT, JUST BECAUSE THERE IS THIS ONE EVENT, THERE ARE STILL THESE SERIES OF EVENTS THAT CONTINUE TO GO.

HOST: THIS QUESTION NOW IS FROM FAULKNER COUNTY. IS THERE AN EFFECTIVE TREATMENT OR CURE -- WE TALKED ABOUT SOME THERAPIES, BUT IS THERE A CURE FOR PTSD?

YOU KNOW, SOME OF IT DEPENDS UPON THE SEVERITY OF THE PTSD AND THE EVENTS THAT OCCURRED. WITH SOME INDIVIDUALS, A VERY BRIEF TREATMENT CAN ACTUALLY ADDRESS THE SYMPTOMS AND REDUCE THEM FAIRLY EFFECTIVELY. WITH SOME FOLK THAT HAVE HAD LONG-TERM TYPE OF ABUSE, WHETHER IT'S EMOTIONAL ABUSE, PHYSICAL ABUSE, SEXUAL ABUSE, IT' GOING TO REQUIRE MORE INTERVENTION. YOU CAN GET A REDUCTION IN TREATMENT, BUT YOU CAN ALWAYS STILL HAVE SOME OF THOSE TRIGGERS THAT CAN COME UP. SO, A LOT OF IT DEPENDS ON, YOU KNOW, WHAT WE CALL A LOT OF FACTORS THAT COME OUT, SOME OF IT IS ABOUT WHAT'S HAPPENED BEFORE, WHAT'S HAPPENED SINCE THEN, THE SEVERITY OF THE TRAUMA, WHAT THAT -- WHO IT WAS, WHETHER IT WAS A RELATIVE OR STRANGER. WE'VE GOT A WHOLE LOT OF FACTOR THAT COMBINE. FOR THE MOST PART, YES, WE CAN GET A REDUCTION IN THE SYMPTOMS. JOSH PROBABLY CAN ADD TO THAT BECAUSE HE KNOWS A LOT OF THE RESEARCH AND HE'S HAVE WELL VERSED IN THAT.

I THINK YOU HIT THE NAIL ON THE HEAD. I THINK THE CALLER ASKED A QUESTION ABOUT THE IDEA OF A CURE.

YES.

IT IS SIMPLISTIC TO THINK ABOUT HOW MEMORIES WORK. OUR MEMORIES REALLY DON'T ERASE. OUR BRAIN WORKS THROUGH ADDITION, IT DOESN'T WORK THROUGH SUBTRACTION. SO, MEMORIES ARE NEVER GOING TO GET OUT OF THERE. SO, IF THE GOAL IS TO GET RID OF THE TRAUMATIC MEMORY, THAT'S NOT GOING TO HAPPEN. WE DON'T HAVE A CURE FOR THAT. BUT WHAT WE'RE REALLY GOOD AT DOING IS TEACHING COPING SKILLS SO THAT MEMORY ISN'T AS PAINFUL. AN INDIVIDUAL CAN LIVE A PERFECTLY HEALTHY, HAPPY LIFE WITH A QUALITY OF LIFE EVEN THOUGH THEY STILL HAVE THAT MEMORY OF PAIN. YOU CAN TAKE AWAY FROM IT.

HOST: THANK YOU BOTH, ALL THREE OF YOU FOR ADDING TO THAT. LET'S TALK ABOUT RESOURCES NOW THAT WOULD BE AVAILABLE AND, OF COURSE, WE KNOW NAMI IS A GREAT PLACE TO GET HELP. THIS QUESTION IS FROM JEFFERSON COUNTY. PLEASE SHARE MORE ABOUT WHAT [INAUDIBLE].

I'M NOT SURE OF THE RESOURCES THAT THE CALLER IS INTERESTED IN, BUT THERE ARE -- THERE IS A WONDERFUL WEBSITE, NATIONAL CHILD TRAUMATIC STRESS NETWORK, AND I THINK WE ACTUALLY HAVE THAT WEBSITE HERE. NCTSN.ORG. THEY HAVE JUST ABOUT ANY --

HOST: WE CAN PUT THAT ON THE SCREEN, TOO, IF YOU DON'T MIND. NCTSN.ORG.

THEY HAVE RESOURCE HE FOR SCHOOL TEACHERS, FOR PARENTS, FOR PEOPLE WHO HAVE ACTUALLY BEEN EXPOSED TO TRAUMA. EVERY KIND OF TRAUMATIC EVENT THAT YOU CAN POSSIBLY IMAGINE. SO, IF YOU GO, TONIGHT IF YOU GO ONTO THE WEBSITE AND LOOK AT IT, IT SAYS WHAT'S NEW UP IN THE RIGHT-HAND CORNER AND THEY HAVE ACTUALLY A WHOLE SERIES OF THINGS THAT THEY'VE DONE FOR TORNADO SURVIVORS. AND THEY ACTUALLY WERE PART OF THAT NCTSN NETWORK. SO, IMMEDIATELY ON THAT MONDAY MORNING THEY WERE E-MAILING US RESOURCE HE THAT WE COULD SEND OUT TO THE MENTAL HEALTH PROFESSIONALS ACROSS THE STATE. SO, IT'S A WONDERFUL WEBSITE AND IT WILL HAVE JUST ABOUT ANYTHING THAT YOU'RE INTERESTED IN KNOWING ABOUT. FOR A LOT OF DIFFERENT GROUPS.

HOST: WE TALK ABOUT THE CHILDREN AND THAT'S THE TOPIC OF OUR DISCUSSION TONIGHT. WE CERTAINLY -- WAS NOT LOST ON US ABOUT THE EFFORTS OF ALL OF OUR RESCUE WORKER BECAUSE THEY ARE UNDERGOING, I'M SURE, QUITE A BIT AS THEY WORK TO TRY TO HELP OUR FAMILIES.

AND THAT'S SOMETHING THAT WE REALLY HAVE TO BE AWARE OF. AND WE WERE DISCUSSING THIS EARLIER AS WELL, THAT SECONDARY TRAUMA. AND IT LEADS TO COMPASSION FATIGUE WHERE WE GET SOMEWHAT JADED. AND AS WE WERE DISCUSSING EARLIER, THINKING ABOUT TO THE FIRST TIME YOU SAT DOWN WITH SOMEONE IN A CLINICAL SETTING AND THEY SHARED THEIR STORY OF ABUSE WITH YOU, YOUR REACTION THEN TO YOUR REACTION NOW WHEN SOMEONE SITS DOWN AND SHARES ARE GENERALLY DIFFERENT BECAUSE WE HAVE TO BEGIN TO PROTECT OURSELVES FROM THOSE EMOTIONAL RESPONSES. AND THE SAME THING IS TRUE FOR THE VOLUNTEERS AND THE RESCUERS THAT WE NEED TO ENSURE THAT WE'RE PROVIDING SUPPORT FOR THEM AND HELPING THEM TO WORK THROUGH THE TRAUMA OF SEEING SOMEONE'S HOME DESTROYED OR SEEING SOMEONE THAT'S LOST THEIR LIVES AS A RESULT OF THE TORNADO.

THAT'S KIND OF PART OF THAT TRAUMA INFORMED SYSTEM YOU TALKED ABOUT EARLIER, ENSURING THAT THE SYSTEM IS CARED FOR IN ITS TOTALITY. SO, IT'S NOT EVEN JUST THE PARENT. IT IS THE CLASSMATES. IT'S THE TEACHER. IT IS THE WORKERS. IT IS EVERYONE THAT MIGHT BE TOUCHED BY THAT SYSTEM AND HOW WE RESPOND TO EACH OTHER AND WHEN WE CHANGE THOSE LENSES AND ENSURING WE GET THE PROPER CARE BECAUSE WITH COMPASSION FATIGUE, THERE ARE EVIDENCE-BASED PRACTICES, THERE ARE SIMILAR WE CAN WORK WITH TO HELP REDUCE SYMPTOMS.

HOST: WE CANNOT STRESS ENOUGH WE CONTINUE TO THINK ABOUT THE FOLK WHO WERE IMPACTED BY THE STORMS AND WE CERTAINLY WANT THE VERY BEST FOR THEM.

> A QUESTION NOW ABOUT TREATING PTSD. WHAT IS THE EARLIEST AGE YOU WOULD RECOMMEND A CHILD GETTING TREATMENT? AND I GUESS THAT BACKS UP THE QUESTION, HOW DO YOU KNOW -- HOW EARLY CAN YOU DIAGNOSE IT? AND THEN WHAT IS THE EARLIEST AGE YOU CAN TREAT A CHILD?

USUALLY IF YOU THINK ABOUT TRADITIONAL THERAPY, A CHILD NEEDS TO BE VERY VERBAL TO BE ABLE TO ENGAGE IN THERAPY. THE TFCBT WAS ACTUALLY DEVELOPED FOR VERY YOUNG CHILDREN, AS YOUNG AS THREE YEARS OLD. SO, YOU CAN ACTUALLY START AT A FAIRLY YOUNG AGE IF THE CHILD IS VERBAL. BUT IF THEY'RE NOT VERBAL, YOU CAN ALSO DO LIKE THE CHILD PARENT PSYCHOTHERAPY, THE PARENT ACTUALLY GETS DOWN AND DID YOU SOME OF THE THERAPY WITH THE CHILD BEING GUIDED BY THE THERAPIST. THAT CAN BE AS YOUNG AS A YEAR OR TWO. SO, THERE ARE DIFFERENT THINGS THAT CAN BE DONE. AND A LOT OF THAT IS WORKING MORE WITH THE IMPORTANT.

HOST: VERY IMPORTANT TO HAVE THE WHOLE FAMILY, I'M SURE, INVOLVED IN TERM OF HAVING ADEQUATE SUPPORT.

YES.

HOST: THANK YOU FOR THAT. LET'S TAKE A QUESTION NOW ABOUT MEDICATIONS FOR PTSD, DR. GATH RIGHT, RIGHT UP YOUR ALLEY ~. DO THOSE MEDICATIONS MAKE YOU FORGET THE PAIN OR DO THEY JUST MAKE YOU NUMB?

I WOULD SAY NEITHER. IT GOES BACK TO WHAT DR. CISLER SAID A FEW MINUTES AGO. MEDICATION ISN'T GOING TO SUBTRACT OUT THE PAIN OR THE MEMORY OR ANY OF THOSE THING. SOMETIMES -- I'LL GIVE AN EXAMPLE. WE TALKED ABOUT THE AROUSAL SYMPTOMS WHERE PEOPLE WERE IRRITABLE OR THEY MIGHT BE CONSTANTLY LOOKING OVER THEIR SHOULDER OR THEY MIGHT BE KIND OF JUMPY. MEDICATION MIGHT HELP TO DECREASE SOME OF THAT SO THAT THEN THEY'RE MORE AVAILABLE TO WORK IN THERAPY AND DO THE PROCESSING THAT THEY REALLY NEED TO DO. FOR ME THAT'S HOW MEDICATIONS REALLY HELP INDIVIDUALS. IT'S NOT ABOUT TAKING AWAY THE PAIN. IT'S NOT ABOUT NUMBING BECAUSE THERE IS A LOT OF PROCESSING THAT NEEDS TO GO ON. THERE IS PROCESSING THAT WHAT IN COPING SKILLS AND HELPING TO MODULATE YOUR EMOTIONS AND SO FORTH.

HOST: SO, IN COPING SKILLS WE SAW A NUMBER OF THINGS THAT THEY FEATURED IN THIS VIDEO. WHAT ADVICE DO YOU GIVE? BECAUSE I KNOW EVEN BEYOND WHAT THE PARENT HELPED THE CHILDREN WORK THROUGH WHEN THEY'RE GOING BACK TO THE SCHOOL ENVIRONMENT, WHAT ADVICE DO YOU GIVE TO TEACHERS WHO MAY, WHO MAY INTERACT WITH THESE CHILDREN?

THAT'S A REALLY GOOD QUESTION BECAUSE IT IS IMPORTANT FOR THE ADULTS AND THE CHILD'S ENVIRONMENT TO HAVE SOME KNOWLEDGE ABOUT WHAT'S HAPPENED WITH THIS CHILD. IT'S REALLY PROVIDING PSYCHO EDUCATION TO THE PARENT ABOUT WHAT THE EFFECTS OF TRAUMA ARE, PTSD SYMPTOMS IF THAT'S WHAT THE CHILD HAD SO THEN THE PARROTTV CAN COMMUNICATE WITH THOSE OTHER ADULTS AND CAN ACTUALLY MAKE SURE THAT THAT CHILD IS IN A SAFE ENVIRONMENT, THAT THEY FEEL PROTECTED THAT IF A CHILD DOES EXPERIENCE IN THE CLASSROOM, THE TEACHER CAN UNDERSTAND THAT AND HELP IMAGINAGE THAT. BUT ALSO TEACHING THE CHILD HOW THEY MANAGE THEM AS WELL. IT'S KIND OF TRYING TO GET AT THIS PROBLEM SEVERAL DIFFERENT DIRECTION AND CREATING THE SAFEST AND BEST ENVIRONMENT FOR THE CHILD.

NTSN CHILD TRAUMATIC STRESS NETWORK HAS MATERIAL FOR EDUCATOR AS WELL. THEY WOULD BEABILITY ABLE TO PRINT SOME OF THAT MATERIAL OFF AND REALLY GAIN SOME AS HOW TO MAKE THEIR CLASSROOMS, IF NECESSARY, A SAFE ENVIRONMENT FOR CHILDREN ~.

HOST: THAT'S GREAT TO KNOW. ARE WE DOING A BETTER JOB THAN WE HAD BEEN IN TERM OF HELPING OUR KIDS?

I THINK WE'RE DOING A BETTER JOB. I THINK PEOPLE ARE TALKING ABOUT THIS MORE WHICH I THINK IS THE MOST IMPORTANT THING EVEN, PROGRAMS LIKE IT, THAT SHOW WE CAN TALK ABOUT THIS TOPIC AND WE CAN REALLY FIGURE OUT HOW TO HELP OUR CHILDREN. YOU KNOW, ONE OF THE THINGS I THINK IS JUST SO IMPORTANT TO REMEMBER IS THAT THIS INTER GENERATIONAL. SO, TRAUMA IS PASSED DOWN FROM ONE GENERATION TO ANOTHER AND WE HAVE TO BE ABLE TO STOP IT AT SOME POINT. SO, THAT'S REALLY WHAT A LOT OF THE PREVENTION EFFORTS ARE AIMED AT, IS REALLY FIGURING OUT HOW DO WE STOP THIS, HOW DO WE PUT AN END TO THIS SO IT'S NOT PASSED DOWN TO THE NEXT GENERATION.

HOST: AND I WOULD ALSO ADD THAT THERE ARE RESOURCES AND TOOLS AVAILABLE FOR THE FAMILY AND THE COMMUNITY, RIGHT. WE JUST NEED TO MAKE SURE WE TAP INTO THOSE RESOURCES. WE HAVE TIME FOR ONE PARTING COMMENT AND WE'RE GOING TO GIVE YOU THAT OPPORTUNITY, DR. KRAMER.

I'D JUST LIKE TO THANK EVERYBODY FOR BEING HERE TONIGHT. IT WAS JUST SUCH A PLEASURE TO BE ABLE TO BE HERE AND TO BE ABLE TO TALK ABOUT THE KINDS OF THINGS THAT WE'RE TALKING ABOUT. AND MY HEART REALLY DOES GO OUT TO THE PEOPLE OF BOLOGNIA AND PEOPLE DEALING WITH SO MUCH TRAUMA IN THE LAST COUPLE OF WEEKS.

HOST: ABSOLUTELY. AND I'M SURE THE PANEL WOULD ECHO THOSE SENTIMENTS. THANK YOU VERY MUCH FOR BEING HERE. A VERY HE IMPORTANT, TIMELY DISCUSSION. WE HOPE THAT IT HELPED FAMILY TONIGHT. WE THANK YOU FOR WATCHING. ♪♪ ♪♪ ♪♪ ♪♪ ♪♪

HEALING MINDS, CHANGING ATTITUDES IS UNDERWRITTEN BY THE MENTAL HEALTH RESEARCH AND TRAINING INSTITUTE.