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Trust‐Based Relational Intervention (TBRI)
Exploring the Empowering, Connecting, and Correcting
Dr. Martie GillenTBRI Practitioner
Associate Professor, Family, Youth and Community SciencesUniversity of Florida
Faculty Affiliate, Florida Institute for Child Welfare
Session Outline
•Adverse childhood experiences (ACEs)
•Brain development
•Trust‐Based Relational Intervention (TBRI)
These materials are copyrighted to the Karyn Purvis Institute of Child Development and may not be reproduced, copied or altered in any way. They are expressly authorized to be used solely by the licensed TBRI® Practitioner to which they were given. In addition they may not be used in part, or in whole, except as training in Trust‐Based Relational Intervention®.
©Copyrighted materials of the Karyn Purvis Institute of Child Development
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Adverse Childhood Experiences (ACEs)
What is the Adverse Childhood Experiences (ACE) Study?
3 Types of ACEs
Source: Centers for Disease Control and PreventionCredit: Robert Wood Johnson Foundation
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Source: Putnam, F., Harris, W., Lieberman, A., Putnam, K., & Amaya‐Jackson, L. The childhood adversities narrative (CAN). Retrieved from Childhood Adversities Narrative: http://www.canarratives.org/
Brain Development
Risk Factors•Difficult pregnancy
• Can be for reasons including medical, drugs/alcohol, crisis or other trauma.
• Can be due to persistent, high level of stress throughout pregnancy.
•Difficult birth • A difficult or traumatic birth is risky for many reasons (e.g., perhaps the newborn was briefly without oxygen, leading to mild neurological insult).
•Early hospitalization • Children who experience early hospitalization often experience painful touch rather than nurturing, comforting touch in the first days of life.
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Risk Factors•Abuse
• Children from abusive backgrounds know to always be on guard. Their brains have been trained to be hyper vigilant to the environment around them.
•Neglect • The message sent to a child from a neglectful background is ‘you don’t exist.’
• Children from neglectful backgrounds often suffer from the most severe behavioral problems and developmental deficits.
•System Effects• Neighborhoods, schools, environmental
•Natural or Man‐Made Traumas • Any number of traumas in the child’s life (witnessing an extreme event, for example) can cause the child’s developmental trajectory to change in response.
Brain Architecture is Built Over Time
•The early years matter because the interaction between early experience and gene expression shapes the maturing architecture of the brain
•The development of the brain incorporates experience, whether positive or negative, that shapes the brain’s capacities
Understanding Brain Growth
•Prenatal•First Year•(Age 5)•Age 8•Age 12•Age 16
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Brain Architecture is Built Over Time
•Brain development is built in a hierarchical, “bottom‐up” sequence, with advanced skills built on more basic capabilities
•As it develops, the quality of brain architecture establishes a sturdy or weak foundation for learning and behavior
Source: Siegel, D. & Bryson, T. (2011). The Whole Brain Child.
Source: Siegel, D. & Bryson, T. (2011). The Whole Brain Child.
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Fight, Flight, Freeze
•Brain responds to primitive level when children:•Feel out of control•Receive too much sensory input
•Do not receive enough sensory input
Fight, Flight, Freeze
Flight Examples• Running away• Distracting behavior
• Changing subject
Fight Examples
• Hitting
• Kicking
• Yelling
Freeze Examples• Melting down• Whining/ Clinging
• ‘Zoning out’
Trauma and the Brain•Children who experience trauma may fail to develop the part of their brain responsible for executive function –emotion, reason, rational, etc.
•Complex Developmental Trauma affects all areas• Brain
• Less “grey matter” and significantly fewer neuropathways• Beliefs
• Dysregulation, disconnection, and distrust• Self‐harm, high risk behaviors – substance abuse and promiscuity
• Body• More prone to chronic illness• Lower body weight and stamina
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Source: Perry, B. (2002). Childhood experiences and the expression of genetic potential: What childhood tell us about nature and nurture. Brain and Mind, 3, 79‐100.
Source: Barth et al. (2008). Credit: Center on the Developing Child at Harvard University.
Source: ACES Connection https://www.acesconnection.com/blog/is‐it‐adhd‐or‐child‐traumatic‐stress‐a‐guide‐for‐clinicians‐nctsn‐august‐2016
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Chronology vs. development vs. emotional Age
•Take a child’s chronological age•Half it – that’s their developmental age•Half that – this is their emotional age
•Suddenly, you’ve gone from working with a rowdy 14‐year old to working with an upset 3.5‐year old
•The good news? Children’s brains are plastic and we can change the chemistry to catch up with development and chronology
3 Pillars Trauma‐Informed Care
1. Safety•Felt safety•Give the child a voice
2. Connection•Relationships are the most important part
3. Coping•Teach kids how to regulate themselves
Trust‐Based Relational Intervention (TBRI)A trauma informed approach for working with children.
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Trust‐Based Relational Intervention (TBRI®)
•What is TBRI?•A holistic intervention that has been developed over the past decade
•An evidence based practice that meets the needs of the “whole child”
•An approach to caregiving that is developmentally respectful, responsive to trauma, and attachment‐based
Who uses TBRI®?
•Principles of TBRI have been used in homes, schools, camps residential facilities, day cares
• It is designed for use with children & youth of all ages & all risk levels
Felt Safety
•Children who aresafe don’t necessarily feelsafe.
•What helps children feel safe?
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The Attachment Cycle
Foundationfor:Trust
Self‐worthSelf‐efficacy(voice)Self‐regulationMentalhealth
Changing our View
•What’s WRONG with you?
•What HAPPENED to you?
How does the adult interpret the child’s behavior?
Willful Disobedience
Survival Behavior
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TBRI® Principles
TBRI® Connecting PrinciplesMindfulness StrategiesEngagement Strategies
TBRI® Empowering PrinciplesPhysiological StrategiesEcological Strategies
TBRI® Correcting PrinciplesProactive StrategiesResponsive Strategies
Trust‐Based Relational Intervention®
CORRECTING!
Empowering
CONNECTING!
Trust‐Based Relational Intervention®
CORRECTING!
Empowering
CONNECTING!
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TBRI® Connecting PrinciplesMindfulness Strategies
Engagement Strategies
Connecting Principles: Mindfulness Strategies
•Examining one’s past•Being conscious of your own relationship histories
•Mindful interactions•Being aware of what you bring to interactions with your children
Connecting Principles: Engagement Strategies
•Connecting with children •Behavioral Matching•Nurturing touch•Warm eyes•Voice quality•Playful engagement•Find ways to say YES
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Sharing Power
•Why might children from hard places crave control?
•Sharing appropriate levels of power:•Builds trust•Empowers children/gives voice
Choices
•Offer appropriate autonomy
•Are concrete and easy to understand•Are always outcomes that parent and child will be happy with
Compromises
•Allows child to ask for another choice•Negotiation practice•Are not ‘giving in’
•Still have structure, limits•Caregiver still in charge
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Life Value Terms
•Short phrases•Teach social skills•Practiced with scripts
Show respect No hurts (from Group Theraplay ®)Gentle & kind Use your wordsCooperate & Compromise Stick together (from Group Theraplay ®)Consequences Ask permissionAsking or telling? Listen & mind
TBRI® Empowering PrinciplesPhysiological Strategies
Ecological Strategies
Empowering Principles: Physiological Strategies
• Internal physical needs• Blood sugar
•Food every two hours•Protein snack at bedtime
• Sensory needs•Sensory activity every two hours
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Hydration
•Dehydration influences:•Concentration•Memory•Anxiety Level•Mood
Hydration Solutions
•Water Bottles
•Teach children to monitor urine frequency and color
Your body has plenty of water! Keep up the good water drinking!
Your body needs a li le more water! Go grab a glass!
You must be thirsty!
Functions of Sensory Input
•To alert the body and brain to important cues
•To protect the body and brain from becoming overwhelmed
•To select what is important to attend to
•To organize the brain automatically
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Functions of Sensory Input
•Children respond differently to sensory input•Sensory defensive•Sensory seekers
The Internal Senses•Vestibular sense•Proprioceptive sense•Tactile sense
Sensory Processing Disorder
•Vestibular, proprioceptive, and/or tactile sense does not develop properly
•Confused sensory interactions• Leads to difficulties in many domains
•Getting dressed• Riding in the car• Eating•Others?
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Regulation
External Regulation
•During first year – early toddler•The adult is solely responsible for meeting the needs of the child
•Child is hungry, adult feeds•Child is code, adult warms
Co‐Regulation
•Toddler and pre‐school years•Child learns to identify needs and seek help•Child may identify hunger, adult will meet need
•Adults and children work together to share regulation of child
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Teaching Self‐Regulation Skills
•Teaching visually:•Engine Plates
Teaching Self‐Regulation Skills•Teaching through touch/body:• Sensory buckets• Stretching/yoga•Pillow sandwich•Wall pushes•Weighted blankets•Massage
Teaching Self‐Regulation Skills
•Teaching through nose/mouth:•Deep breathing•Calming smells
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Empowering Principles: Ecological Strategies
•Daily Rituals•Transitions
Have you ever been sitting at your desk, concentrating on a project and all of a
sudden the fire alarm went off?
Imagine the following scenario for a child:
•Lindsey is sitting and coloring at the kitchen table.
•Suddenly, she hears her mother say, “Put your crayons away. Put your shoes on and get in the car. We have to go to the post office, the grocery store, and pick up the dry cleaning.”
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Daily Rituals
•Establish and practice routines; e.g., what to when you arrive, what to do when getting ready in the morning, etc.
•Post a schedule and give notice if it is going to change.
Transitions
•Daily transitions•Life transitions
Transitions
•During daily transitions, provide warnings leading up to the transition; e.g., • “Five minutes until we go to lunch,” • “Three minutes until we go to lunch,” • “One minute until we go to lunch.”
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Transition Formula
•Attention•Mention
•Distract•Didn’t we have fun doing ____ now we’re going to do _____.
•Act
Be A Detective
Be A Detective: Empower Your Child
•Notice patterns•Notice sensory preferences
•Be proactive
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TBRI® Correcting PrinciplesProactive Strategies
Responsive Strategies
Chase the why…
Behind the child’s behavior
AND
my response
How does the adult interpret the child’s behavior?
Willful Disobedience
Survival Behavior
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Willful Disobedience
Power StrugglesYOUTHADULT
IncreaseFrustration
Increase Resistance
Enforces More Rules
Oppositional Behaviors
Social Problems
Downward Spiral
Survival Behavior
Felt SafetyYOUTHADULT
ReducedFrustration
Awareness
Compassionate Understanding
Recognize Fears
Use Words
Upward Spiral
Give Voice
Sharing Power
•Can be counterintuitive•Parent still in charge•Child practices decision‐making skills
•Children learn, “Safe people listen to me.”
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Behavioral Scripts
•Re‐do•Choices•Compromises
Choices
•Offer appropriate control•Parent is still in charge•Make sure there is no ‘right or ‘wrong’ choice
Compromises
•Teach children:•Negotiation•Social skills•Words have power
•Keeps behavior moving forward
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Calming Engagement Plan
•What are 3 things you need when ______?•Weighted blanket•Wall push up•Quiet place
Playful Engagement
•Play disarms fear!!
•Have fun with the kids!
TBRI® Principles
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The IDEAL Response©
Immediate
Direct
Efficient
Action‐based
Leveled at the behavior, not the child
The IDEAL©
Response•Immediate
•Within 3 seconds•Better learning occurs
The IDEAL©
Response•Direct
•Stay engaged and connected•On child’s level•Eye contact
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The IDEAL©
Response
•Efficient•Only use amount of structure necessary•Keep behavior moving forward
•Always return to playfulness
The IDEAL©
Response•Action‐Based
•Active learning creates new brain connections•Re‐do
The IDEAL© Response
•Leveled at behavior, not child•Behavior is not who children are•How might you help children understand this?
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Levels of Response™
•Keep in Mind:•When it’s over, it’s over!•Stay connected to child at all times
•The goal is always to return to Playful Engagement
How can I help you?
•I am available to offer more trainings•Schools•Daycares•Community‐Based Care agencies•Guardian ad Litem•Foster/Adoptive Parent Associations•Therapy offices•Churches•Camps
Questions or Comments
Dr. Martie Gillen
Email: [email protected]
Office phone: 352‐392‐0404
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Resources•Empowered to Connect – April 5 & 6, 2019
•The Connected Child book by Karyn Purvis•Karyn Purvis Institute of Child Development https://child.tcu.edu/#sthash.3xnuumQe.dpbs
•Karyn Purvis Institute of Child Development –YouTube Channel https://www.youtube.com/channel/UCBW9RKLvTR5C46ey7gy3NuA
References• Barth et al. (2008). Credit: Center on the Developing Child at Harvard University.
• CDC. (2016). Adverse Childhood Experiences (ACEs). https://www.cdc.gov/violenceprevention/acestudy/index.html
• Felitti, V. & Anda, R. (2010). The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease.
• Perry, B. (2002). Childhood experiences and the expression of genetic potential: What childhood tell us about nature and nurture. Brain and Mind, 3, 79‐100.
• Pynoos, R. S., Steinberg, A. M., Layne, C. M., Liang, L., Vivrette, R. L., Briggs, E. C., & … Fairbank, J. A. (2014). Modeling constellations of trauma exposure in the National Child Traumatic Stress Network Core Data Set. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), S9‐S17.
References• Robert Wood Johnson Foundation. (2013). The Truth About ACEs Infographic. https://www.rwjf.org/en/library/infographics/the‐truth‐about‐aces.html
• SAMHSA. (2017). Adverse Childhood Experiences. https://www.samhsa.gov/capt/practicing‐effective‐prevention/prevention‐behavioral‐health/adverse‐childhood‐experiences
• Siegel, D. & Bryson, T. (2011). The Whole Brain Child.• The Anna Institute. https://www.theannainstitute.org/• Thompson, R. A., & Nelson, C. A. (2001). Developmental science and the media: Early brain development. American Psychologist,56(1), 5‐15.
• Trust‐Based Relational Intervention (TBRI). Practitioner Workbooks. Karyn Purvis Institute of Child Development. Texas Christian University.
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