# data[].attributes.attachment_link.readable_text
What Is Cap4Kids?
Are you looking for reliable, up-to-date information about resources in the Philadelphia area for children and families? You've come to the right place! Cap4Kids will help you find many community agencies that exist to improve or enhance the lives of children, teens and families.

How Does Cap4Kids Work?
Please become familiar with the Parent Handouts to the left. They are the backbone of this project. They are broken down by category and within each handout, you will find a description of the social service agency, their address, and a phone number. You may also find a link to the agency's web site that you can access and learn more about that agency. You can also easily print any parent handout by clicking on the handout, or subcategory, and choosing print from your web browser. You can also print a single resource by typing in the name of the resource in the Google search bar, and printing just the one. Your selected parent handout will be sent to your printer in a custom printer friendly format. You can also download the handouts to your desktop as a pdf to share/email with others. You must have Adobe, Google Chrome or Firefox to convert to pdf. Click print, then pdf and viola!

All handouts can also be translated into over 30 languages using the Translate button at the top of the site. If you don't know where to find a resource, just click on the Google Search above the Parent Handouts to the left.

To have Cap4Kids on your mobile device, just open the website on your phone's internet browser and click "add to home screen" and voila, Cap4Kids is on your phone.

For Providers
Download the parent handouts, and give them to the families that you have identified that are in need of a particular service. After you distribute the handout, document which handout you gave so that you can get feedback at the next encounter.

Click here for Suggested ways to use the Parent Handouts.

There are also various Resources, Laws and Definitions that pertain to families, sample advocacy letters as well as a downloadable Cap4Kids poster.

Please use the Cap4Kids website frequently, and let us know how we can make this resource as useful as possible.

JOIN THE MAILING LIST!
Interested in Cap4Kids? This mailing list will update you on any changes to the website including: new advocacy organizations, announcements and additions to the site. Your information will not be used for any other purposes.

# data[].attributes.attachment_link.title
Philadelphia | Part of the Cap4Kids Network

# data[].attributes.attachment_link.description
What Is Cap4Kids? Are you looking for reliable, up-to-date information about resources in the Philadelphia area for children and families? You've come to the right place! Cap4Kids will help you find many community agencies that exist to improve or enhance the lives of children, teens and families. How Does Cap4Kids Work?

# data[].attributes.attachment_link.provider_name
Center on the Developing Child at Harvard University

# data[].attributes.attachment_link.readable_text
One way to understand the development of resilience is to visualize a balance scale or seesaw. Protective experiences and coping skills on one side counterbalance significant adversity on the other. Resilience is evident when a child's health and development tips toward positive outcomes - even when a heavy load of factors is stacked on the negative outcome side.

The single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver, or other adult. These relationships provide the personalized responsiveness, scaffolding, and protection that buffer children from developmental disruption. They also build key capacities-such as the ability to plan, monitor, and regulate behavior-that enable children to respond adaptively to adversity and thrive. This combination of supportive relationships, adaptive skill-building, and positive experiences is the foundation of resilience.

Children who do well in the face of serious hardship typically have a biological resistance to adversity and strong relationships with the important adults in their family and community. Resilience is the result of a combination of protective factors. Neither individual characteristics nor social environments alone are likely to ensure positive outcomes for children who experience prolonged periods of toxic stress. It is the interaction between biology and environment that builds a child's ability to cope with adversity and overcome threats to healthy development.

Research has identified a common set of factors that predispose children to positive outcomes in the face of significant adversity. Individuals who demonstrate resilience in response to one form of adversity may not necessarily do so in response to another. Yet when these positive influences are operating effectively, they "stack the scale" with positive weight and optimize resilience across multiple contexts. These counterbalancing factors include

1. facilitating supportive adult-child relationships;

2. building a sense of self-efficacy and perceived control;

3. providing opportunities to strengthen adaptive skills and self-regulatory capacities; and

4. mobilizing sources of faith, hope, and cultural traditions.

Learning to cope with manageable threats is critical for the development of resilience. Not all stress is harmful. There are numerous opportunities in every child's life to experience manageable stress-and with the help of supportive adults, this "positive stress" can be growth-promoting. Over time, we become better able to cope with life's obstacles and hardships, both physically and mentally.

The capabilities that underlie resilience can be strengthened at any age. The brain and other biological systems are most adaptable early in life. Yet while their development lays the foundation for a wide range of resilient behaviors, it is never too late to build resilience. Age-appropriate, health-promoting activities can significantly improve the odds that an individual will recover from stress-inducing experiences. For example, regular physical exercise, stress-reduction practices, and programs that actively build executive function and self-regulation skills can improve the abilities of children and adults to cope with, adapt to, and even prevent adversity in their lives. Adults who strengthen these skills in themselves can better model healthy behaviors for their children, thereby improving the resilience of the next generation.

# data[].attributes.attachment_link.description
One way to understand the development of resilience is to visualize a balance scale or seesaw. Protective experiences and coping skills on one side counterbalance significant adversity on the other. Resilience is evident when a child's health and development tips toward positive outcomes - even when a heavy load of factors is stacked on the negative outcome side.

# data[].attributes.headline
Center for the Developing Child-Harvard University

# data[].attributes.subject
Center for the Developing Child-Harvard University

# data[].attributes.attachment_link.description
Since you are looking at this site with an older browser, you will not be able to see any graphics or formatting. For better results, please upgrade your browser.

# data[].attributes.headline
Trauma Informed Approach and Interventions

# data[].attributes.subject
Trauma Informed Approach and Interventions

# data[].attributes.attachment_link.readable_text
Trauma-Informed Approach

According to SAMHSA's concept of a trauma-informed approach, "A program, organization, or system that is trauma-informed:

1. Realizes the widespread impact of trauma and understands potential paths for recovery;

2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;

3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and

4. Seeks to actively resist re-traumatization."

A trauma-informed approach can be implemented in any type of service setting or organization and is distinct from trauma-specific interventions or treatments that are designed specifically to address the consequences of trauma and to facilitate healing.

SAMHSA's Six Key Principles of a Trauma-Informed Approach

A trauma-informed approach reflects adherence to six key principles rather than a prescribed set of practices or procedures. These principles may be generalizable across multiple types of settings, although terminology and application may be setting- or sector-specific:

1. Safety

2. Trustworthiness and Transparency

3. Peer support

4. Collaboration and mutuality

5. Empowerment, voice and choice

6. Cultural, Historical, and Gender Issues

From SAMHSA's perspective, it is critical to promote the linkage to recovery and resilience for those individuals and families impacted by trauma. Consistent with SAMHSA's definition of recovery, services and supports that are trauma-informed build on the best evidence available and consumer and family engagement, empowerment, and collaboration.

Trauma-Specific Interventions

Trauma-specific intervention programs generally recognize the following:

The survivor's need to be respected, informed, connected, and hopeful regarding their own recovery

The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety

The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers

# data[].attributes.attachment_link.description
According to SAMHSA's concept of a trauma-informed approach, "A program, organization, or system that is trauma-informed: Realizes the widespread impact of trauma and understands potential paths for recovery; Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and Seeks to actively resist re-traumatization."

# data[].attributes.attachment_link.readable_text
Children and youth who have experienced foster care or orphanage-rearing have often experienced complex developmental trauma, demonstrating an interactive set of psychological and behavioral issues. Trust-Based Relational Intervention (TBRI) is a therapeutic model that trains caregivers to provide effective support and treatment for at-risk children. TBRI has been applied in orphanages, courts, residential treatment facilities, group homes, foster and adoptive homes, churches, and schools. It has been used effectively with children and youth of all ages and all risk levels. This article provides the research base for TBRI and examples of how it is applied.

Keywords: adoption, complex developmental trauma, foster care, trauma-informed intervention

The three TBRI principles are

The Empowering Principles

We know that a child's emotional development, including the ability to form secure attachments, is affected by ecological and physiological factors ( Bronfenbrenner & Morris, 1998; Lickliter, 2008). The empowering principles set the stage for positive change by ensuring healthy conditions for children. For example, a child who is chronically hungry due to poverty has little capacity for learning or joyful play because his fear of hunger dominates his thoughts and behaviors. Also, creating an environment that fosters felt-safety is a critical component in this process. This assumption emphasizes the difference between a child actually being safe and feeling safe. For although an adoptive parent may know with certainty that the child they adopted from hard places will never suffer devastating hunger or malnutrition again, the message must be conveyed in ways the child can understand. For these parents, partnering with their child to create a sense of safety may include strategies such as helping the child shop for nourishing snacks (e.g., fruit, nuts, raisins) to put in a specially prepared bowl in their room. Wearing a fanny pack with nutritious snacks may also give "evidence" to the child that they will not be hungry again. Before, the caregiver knew that food would always be available, but now with these strategies, the child has tangible evidence that his or her needs will be met. By providing this type of concrete evidence, a caregiver can partner with their child to create a powerful sense of felt-safety. The main TBRI empowering principles are summarized below.

Safe and structured environment

A major detrimental outcome of complex developmental trauma is chronic fear, which impacts both cognitive and emotional functioning ( Anda et al., 2006; Perry, 2001). However, children who feel that their environment and relationships are safe and predictable can learn to trust others and develop healthy emotions and behaviors that are trust-driven rather than fear-driven ( Knight, Smith, Cheng, Stein, & Helmstetter, 2004). All TBRI principles and practices are designed to create this sense of felt-safety in children.

A key ingredient to creating a safe, predictable environment is to ensure smooth transitions for children. The three main types of transitions are (a) daily transitions, (b) major life transitions, and (c) developmental transitions.

Daily transitions are the "joints" that connect daily experiences, and these pose challenges for children who are fear-driven and for those with poor self-regulation. By explicitly managing daily transitions (e.g., providing children with advance notice before transitions) problem behaviors can be reduced significantly ( Sainato, 1990). Simply alerting a child who, for example is swimming, that in "five minutes we'll need to get out of the pool," can provide these transitions. A more emotionally fragile child may require a series of transition alerts. For example, giving alerts at 15, 10, 5, and 1 minute before a transition.

Major life transitions (e.g., first day of school, joining a new family) are also stressful. We can help children negotiate these difficult situations through a variety of strategies, including life books, memory books, storytelling, and journaling ( Cowan & Cowan, 2003; Pennebaker & Stone, 2004; Nicolopoulou, Barbosa de Sa', Ilgaz, & Brockmeyer, 2010). Life books can be used, for example with a former foster child who has had numerous placement changes prior to adoption and who is fearful of changes or transitions. Creating pages with photos, drawings, and personal notes can help the child begin to settle in with a knowledge that he has arrived in his "forever family." Story telling is a powerful tool that has been used across cultures for many generations. Around a fireplace, a hearth, or a kitchen table, the telling of our stories has provided continuity and transition throughout time. A high-ranking marine officer reported in personal conversation, that post-traumatic stress disorder was unknown among the military until the Viet Nam war because of this powerful telling of stories. Before that time, soldiers were transported to and from war in large transport ships, spending weeks or even months crossing the ocean. During the days of their long journey, it is reported that they played cards by the hours and told their stories over and over and over again. Being safe with others who understood their story and "giving voice" to their fears, pains, terrors and hopes, provided a healing transition for those military personnel returning from war.

Developmental transitions occur as the brain continues to reorganize itself during major developmental milestones throughout the lifespan (e.g., the transition from infancy to toddlerhood, the transition from childhood to adolescence) ( Nelson, 2011). These transitions can be seen as opportunities to positively impact a system while it is unstable and reorganizing itself ( Brazelton, 2000; Niklasson, Niklasson, & Norlander, 2010). Overall, we can help children feel safe by increasing predictability and perceived control throughout the day (e.g., charting daily or life events) ( Pennebaker & Stone, 2004). Family or daily rituals are also an effective way to increase predictability, manage transitions, and build family cohesion ( Crespo, Kielpikowski, Pryor, & Jose, 2011). Knowing, for example, that the family will eat dinner together each evening at 6:00 p.m. becomes a stabilizing ritual in the life of a developing child.

Telling of our stories has been a mechanism for healing throughout recorded history in all cultures and ages. On a recent trip to Africa, part of our team met with the First Lady of an African nation that experienced genocide during the previous generation. Aware of the deep, gaping wounds that left their mark on all generations of that nation, the First Lady asked how to bring healing to victims of genocide for whom much of healthy development had come to a halt. Our answer was categorically clear-throughout all time, we have healed by the telling of our stories.

Sensory needs

Children with histories of institutionalization (long-term hospitalization or orphanage care), trauma, and/or prenatal or perinatal stress often have sensory processing disorders that can negatively impact behavior, social skills, motor skills, and academic performance ( Cermak, 2009; Cermak & Groza, 1998). These children may exhibit mystifying behaviors. For example, they may seem to be "picky eaters" refusing foods with exception of a singular texture food. Oral sensitivity to foods of different texture is often a clue to Sensory Processing Disorder. In addition, they may constantly break pencils and crayons if they have a sensory issue with pressure (called a proprioceptive deficit). Children who are volatile if their socks or turtleneck sweaters are too tight might be also manifesting the same proprioceptive deficit. One elementary-school child we served was punished for punching another child in the stomach while standing in line for lunch before the principal and teacher were alerted to his sensory deficit in processing the pushing and shoving of the child standing behind him. Sensory Processing Disorder (SPD) limited the boy's capacity to understand that the child he hit had not intended to harm him, but was rather jostling playfully while waiting for lunch. Behaviors such as this are frequently misunderstood as malicious, rather than sensory defensiveness, creating additional risk for children and youth with SPD.

However, sensory processing deficits can be overcome with appropriate interventions that address the sensory system ( Ayres, 1972a, 1972b; Fazlioglu & Baran, 2008; Kemmis & Dunn, 1996; Parham, 1998). For instance, a protocol of regular, caring touch improves physiological health, attachment issues, and sensory issues ( Field, Hernandez-Reif, & Diego, 2005; Montagu, 1986). Also, programs including a daily schedule of frequent, systematic somatosensory stimulation followed by physical activity have documented significant improvement for children with sensory issues ( Fazlioglu & Baran, 2008; Purvis, McKenzie, & Cross, 2012; Purvis & Cross, 2007). Sensory activities, sensory diets (a daily schedule of sensory activities and experiences), and sensory rooms have all shown to help children and adolescents organize their mental and emotional states ( Dorman et al., 2009; Kranowitz, 2006; Miller & Fuller, 2007).

Nutrition

We know that good nutrition is important for behavior development ( Pollit, 1988; Powell & Grantham-McGregor, 1985). Proper nutrition, including multi-vitamin and multi-mineral supplements, can improve cognitive and emotional functioning with behaviorally disordered children ( Kaplan, Crawford, Gardner, & Farrelly, 2002; Kaplan, Fisher, Crawford, Field, & Kolb, 2004; Walsh, Glab, & Haakenson, 2004). Foods such as turkey, fish, whole grains, nuts, lentils, and Omega-3 fatty acids provide the building blocks for healthy brain chemistry and improved behavior in children ( Benton, 2007; Bourre, 2004; Garland & Hallahan, 2006; Uauy & Dangour, 2006). Longitudinal research documents increased levels of aggression and violence among youth who suffered early malnutrition ( Galler, Bryce, Waber, Medford, Eaglesfield, & Fitzmaurice, 2011; for a review see Raine, 2002). Caregivers of those who experienced significant early malnutrition may find great benefit in specialized testing and intervention, such as may be offered by a certified nutritionist or medical doctor who specializes in functional medicine.

Children and youth with histories of prenatal exposure to substance (i.e., drugs, alcohol) and those who experience early hardships often have significant changes to insulin receptor sites, making them subject to dramatic shifts in behavior when their blood sugar begins to drop below optimal levels. In our work with children, we implement a protocol of offering nutritious snacks every two hours. Regularly scheduled snacks and meals (that include protein and complex carbohydrates) are empowering because they ensure adequate, sustained blood sugar levels to support positive behaviors, stable moods, and optimal cognitive functioning including attention and self-regulation ( Benton, Brett, & Brain, 1987; Benton & Stevens, 2008; Gailliot et al., 2007). Caregivers we have trained in TBRI report significant positive changes in behavior simply by stabilizing blood sugar levels. This is obviously a challenge in settings where food availability is limited and where costly nutritious snacks are outside the financial means of a family or facility. In our work with orphanage staff in Romania, Ethiopia, and Rwanda, some facilities we have trained were only able to make more frequent, but smaller portions of the gruel that was available to them.

Hydration also improves mental functioning, including attention and memory performance ( Edmonds & Burford, 2009; Wilson & Morley, 2003). Of note, one neurotransmitter, glutamate, is associated with aggressive behaviors, seizures, and various volatile behaviors. This neurotransmitter is more active in conditions of dehydration. Behavior and cognition can be improved simply through making water and other hydrating drinks readily available ( Bar-David, Urkin, & Kozminsky, 2005; Edmonds & Jeffes, 2009). We have analogous findings in our research, in which we teach caregivers to offer water and food every two hours to children and youth in their care. A TBRI-informed residential facility in Texas that houses nearly 200 adolescents who are unable to live with their families, recently began offering snacks and drinks every two hours, as well as making them readily available at all times. Caregivers in that facility have documented significant improvements in both mood and behavior. In taped interviews, staff noted a significant deepening of trust with the youth, as they experienced felt-safety about their needs for food. In all, frequent, healthy snacks and drinks can improve children's behavior.

Other empowering principles

Adequate sleep is a primary determinant of child and adolescent well-being, including cognitive functioning and emotion regulation ( Mindell et al., 2011). Children from hard places often have sleep dysregulation for a variety of reasons, including the fact that some of them were harmed in the night. Consulting with one residential facility in the case of two youngsters, ages five and six, who were in protective custody of Child Protective Services, we recommended that the siblings be provided with weighted blankets for bedtime, which provide deep muscle input and calming ( Novak, Scanlan, McCaul, MacDonald, & Clarke, 2012). Calling early the next morning, delighted staff reported that both boys slept soundly through the night for their first time since coming into protective custody. These seemingly simple tools can have significant impact in providing a healing environment for at-risk youngsters.

Also, regular physical activity promotes cognitive, social, and emotional development ( Best, 2010) and deep-breathing exercises (e.g., yoga or other) improve well-being and mental functioning ( Peck, Kehle, Bray, & Theodore, 2005; Stueck & Gloeckner, 2005). For example, a program developed for school-age children at Yale University, ABC for Fitness ( Katz et al., 2010), creates opportunities for brief bursts of physical activity such as jumping jacks or running in place every 60 minutes during school hours. Documented changes include not only lowering of obesity, increasing physical fitness, and improving academic performance, but also lowering of medications such as those for asthma and ADHD.

The Hope Connection summer day camp for children with histories of abuse, neglect, and trauma provides physical activity, dance movement, or opportunities for outdoor play every two hours. Data from the camp documents dramatic reduction in the stress chemical, cortisol, as well as reduction in negative behaviors and significant improvement in positive behaviors ( Purvis, Cross, Federici, et al., 2007). We have implemented similar activities in schools, RTCs, homes, and orphanages with equal success. Overall, the TBRI empowering principles meet children's basic physical needs and support healthy emotional, relational, and behavioral development.

The Connecting Principles

The connecting principles enable both child and parent to experience the personal and interpersonal behaviors that build trust and lead to secure attachment. This set of principles closely resembles behavioral connections between a mother and her newborn infant, consisting of sustained eye contact, affectionate touch, and consistently high levels of attention to needs. Biological mothers naturally "give voice" to their infants, and TBRI is designed to "give voice" to those who didn't have that opportunity from their biological parents. Building secure attachment relationships is important, including findings that the origins of self-regulation stem from a child's attachment relationships ( Geva & Feldman, 2008; Schore, 1994, 2001). As an attentive mother meets her infant's needs, she "imposes" regulation on the child-imposing warmth when the infant is cold, food when the infant is hungry, comfort when the infant is upset. In each case, the parent provides an "external modem" for regulation of physical and emotional needs. This tender, consistent meeting of needs becomes the foundation on which this developing child will learn to regulate his own needs and emotions. Connecting principles provide the foundation for attachment and self-regulation and include: awareness (of others and self), playful engagement, and attunement. An overview of the connecting principles follows.

Observational awareness

Work with traumatized children requires keen awareness ( Endsley, 2006). It is critical for caregivers to observe their children's behavioral and physiological responses during interactions to monitor anxiety and comfort level ( Grietens & Hellinckx, 2003; Siegel, 1999). By recognizing signs of stress and anxiety, caregivers can respond appropriately to children who are often unable to verbalize their needs. TBRI emphasizes recognition of nonverbal markers of anxiety such as pupil dilation, heart rate, depth of respiration, and muscle tension so that needs do not go unmet ( Perry, 1994). Insightful caregivers who become deeply aware of nonverbal cues of fight, flight, or freeze can often avert adverse behavioral episodes through attentive responsiveness.

Self-awareness

It is also critical for caregivers to be aware of their own emotional state, attachment style, and emotional availability. Empirical studies have found that the attachment style of a primary adult caregiver predicts the child's attachment style ( Dozier, Stovall, Albus, & Bates, 2001; Steele, Steele, & Fonagy, 1996; Steele, Hodges, Kaniuk, Hillman, & Henderson, 2003; Steele et al., 2009), and child's well-being ( Madigan, Moran, Scheungel, Pederson, & Otten, 2007; Cassidy, 2001; Ward, Lee, & Lipper, 2000). In our work with the highest risk children and youth we frequently find caregivers who have significant unresolved childhood or early adult histories of their own and are inadvertently triggering maladaptive behaviors in the children they are serving. For example, a woman who had the stillbirth of an infant may guard her heart unknowingly so that she doesn't experience the wrenching loss again. These individuals, though fully available for their child's physical needs, may find it difficult to be emotionally available for healing connections with their child.

In our international work, we frequently find a high percentage of orphanage staff that were themselves orphanage-reared. Because they never received tender, attentive care, it is a significant challenge for them to give tender, attentive care. We typically plan to implement nurturing activities with caregivers themselves during our days of training orphanage staff. The good news is that an adult's attachment style can change ( Cassidy, 2001; Crowell, Treboux, & Waters, 2002) and one objective of TBRI is to provide steps that adults can take to facilitate positive changes in their attachment styles. One family, who under our supervision implemented TBRI principles in their home with their violent eleven-year-old son, found that the mother's attachment style was dramatically altered from being dismissing of attachment to being secure in her attachment relationships. The boy, who had multiple psychiatric diagnoses and had a history of aggression against his mother and sister required intense attention to his needs and yet, in learning to recognize her son's needs, this mother began to recognize her own unmet needs and to deal with her own childhood attachment experiences and attachment needs.

In addition to education about promoting healthy attachment, caregivers who implement TBRI often take the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985). Feedback from the AAI informs caregivers about their own attachment styles and provides awareness of emotional "filters" that influence their perceptions of their children and their behaviors toward them. Caregivers are then shown positive steps they can take to form secure attachment relationships with their children.

Skills of attachment

The skills of attachment ( Cassidy, 2001) are consistent with TBRI. These are: giving care, seeking care, feeling comfortable with an autonomous self, and negotiation. The connecting principles cultivate "giving care and seeking care," which are modeled and practiced as part of TBRI nurture group activities (some of these nurture activities are derived from Theraplay activities) ( Jernberg & Booth, 1999; Purvis, Cross, Federici, et al., 2007). Connecting principles also promote "feeling comfortable with an autonomous self," which is important for healthy relationships and stems from secure attachment. Various types of "negotiation" and compromise are found in the connecting and correcting principles. TBRI trained caregivers can actually reduce aggression in the children they serve by "giving voice." In TBRI-informed environments, a child who is misbehaving may be asked, "Can you tell me with your words and not your behavior?" For a child or youth who persists in misbehavior we may offer negotiation opportunities, such as "If you don't want to turn the TV off now, would you like to ask for a compromise?" This giving of voice, as we call it, often becomes a firm foundation for developing trusting relationships, especially for children who lost their voices early in childhood because of the unresponsive or abusive environments in which they were harmed.

Playful engagement

Playful engagement produces warmth and trust between caregivers and children ( Panksepp, 2000, 2002). It disarms fear, promotes attachment, and builds social competence ( Brown, 2009; Jernberg & Booth, 1999; Robison, Lindaman, Clemons, Doyle-Buckwalter, & Ryan, 2009). Mothers who engage their infants in playful interactions naturally enhance development of attachment, socialization, and language ( Montagu, 1986). However, if a child lacked this type of early playful connection, it can be cultivated through therapeutic play activities. Theraplay is an attachment-based model of playful interaction that resembles the natural playful activities observed between nurturing parents and their infants. Theraplay activities can be used to teach parents of older children to interact playfully. These activities closely resemble the interaction style that is at the heart of TBRI.

In a typical Theraplay session, the therapist guides parent and child to engage in nurturing, playful interactions that include playful touch and eye contact ( Booth & Lindaman, 2000; Fesperman & Lindaman, 1998; Jernberg, 1984; Lindaman, 1996). It has been our experience that even adolescents who seem resistant and challenging actually love the opportunities for joyful, silly laughter and games. Through playful engagement, caregivers can become attuned and responsive to the children's immediate needs. Insightful caregivers can even redirect negative behaviors playfully, such as a child who is demanding forcefully that the parent give them juice may be asked playfully, "Are you askin' or tellin'?" or "Can you try that again with respect?" I recently observed the father of a four-year-old whose son did not want him to put on his shoes, and he demanded "NO! Mommy do it!" The insightful father gently guided him to ask with respect, to which his youngster replied, "Can mommy please put on my shoes?"

Attunement

Attunement has been defined by Merriam-Webster's Dictionary as the capacity to "bring into harmony" or "to make aware or responsive." Regardless of the intervention used, effectiveness of parent-child interventions is correlated to the degree that parents are involved with and are responsive in creating this type of harmony ( Mahoney, 2009). Through verbal and nonverbal nurturing communications between caregiver and child, attunement can be achieved through matching behaviors, eye contact, voice and inflection, body position, and safe touch. For instance, voice quality (tone, volume, cadence) is a powerful part of interpersonal engagement ( Finset & Del Piccolo, 2011; Malloch & Trevarthen, 2010) and touch is a powerful tool for nonverbal communication, but must be used carefully with formerly abused children and youth ( Field, 2003; Finset & Del Piccolo, 2011). Matching, the act of mimicking facial expressions, sounds, or actions, develops naturally in healthy parent-child relationships and fosters attachment and felt-safety ( Field, 1995; Jonsson, Clinton, & Fahrman, 2001; Schore, 1994). Behavioral state matching can facilitate harmonious social interactions with children of any age ( Bernieri & Rosenthal, 1991; Field et al., 1992).

While maltreated children may have little or no experience with matching, foster or adoptive parents can learn to initiate age-appropriate matching interactions or activities to develop a stronger connection to their child (Zuckerman & Spielberger, 1976). At times in our work with at-risk children, we will offer snacks such as Tootsie Roll Pops. Of interest, as a child feels safe in our care, he will begin to request the same color Tootsie Roll Pop as his mentor. However, there may also be times when a caregiver chooses the same color snack as their young buddy, only to see the child return that candy to the bowl and chose another color. This simple behavior provides an important clue about how closely the child can be connected to his caregivers at that time. When caregivers are taught to carefully, attentively enter the child's physical and emotional space, a new foundation for trust begins to emerge, bringing with it behavioral and physiological gains. Data from our summer camps demonstrate dramatic improvement in behavior coupled with dramatic reduction of the stress chemical, cortisol. For the children whose fear and reactivity is reduced (as evidenced by reduced stress chemical cortisol), gains in behavior, cognition, and even language are greatest ( Purvis & Cross, 2006).

Overall, the connecting principles give caregivers tools to build trusting, secure attachment relationships with their children. Improving the caregiver-child relationship is key to reversing the adverse effects of early stress on the brain, reducing stress-related behavior, and improving psychosocial functioning ( Fisher, Gunnar, Dozier, Bruce, & Pears, 2006). It has been said that relationship-based trauma can only be healed through a nurturing relationship and the capacity for connecting is the core ingredient for cultivating that type of relationship.

The Correcting Principles

Parental regulation of food, warmth, sensory input, and emotional soothing during infancy and early childhood provide physical and emotional security that create a foundation for the development self-regulatory behaviors. Maltreated children often lack this foundational regulatory support ( Als, Lester, Tronick, & Brazelton, 1982; Brazelton & Greenspan, 2000; Tronick, 1995). Regulatory disordered infants with moderate to severe difficulties will not outgrow these issues without intervention ( DeGangi, Porges, Sickel, & Greenspan, 1993). In our summer camp for at-risk children, we play regulatory games to teach self-calming and self-awareness. For example, in one of our learning groups (called a Nurture Group) we will practice several skills for self-regulating, such as deep breathing, using fidgets, and pressing the parasympathetic pressure point just over the middle of their lip. Due to the holding of their finger sideways to press across the top of their lips, the children call this activity the "magic mustache." After the children practice self-calming, we then give them toy Nerf guns with instructions: "There are only two rules for shooting someone. First, you must not shoot in the face and second, you must ask permission and only shoot the Nerf gun IF they say yes." Regulatory skills are practiced in numerous ways through this playful activity. The children practice self-calming/regulation both before the game and after the game. In addition, they must regulate their actions, first asking permission, second waiting for an answer, and third, NOT shooting their Nerf gun toward a child who says "no" or toward the face of a child who says "yes." When learned in this playful setting, these regulatory skills generalize to other settings at a fairly impressive rate. In addition to our summer camp protocol, we have implemented these activities in schools, homes, residential facilities, group homes, and orphanages.

The objective of the correcting principles is to build the child's social competence ( Miltenburg & Singer, 1999) which can only be successful after establishing a foundation of empowerment and connection. The correcting principles are also based on cognitive behavioral therapy (CBT), which is effective in treating a wide range of childhood disorders, including depression ( Stark, Sander, & Hauser, 2006; Verdeli, Mufson, & Lee, 2006), aggression ( Lochman, Powell, & Whidby, 2006; Sukhodolsky, Kassinove, & Gorman, 2004), and post-traumatic stress disorder ( Cohen, 2005; Dalgleish, Meiser-Stedman, & Smith, 2005). Behavioral training that is proactive, rather than reactive, is effective in improving social problem-solving and conflict management skills in children ( Webster-Stratton & Hammond, 1997). In the example of the Nerf game, the children are practicing appropriate behaviors, which begin to pervade other interactions. This proactive teaching reduces the need for corrective action by adults. By planning how to handle predictable problem issues in advance, the child is prepared to react more appropriately with the practiced replacement behavior ( Colvin & Sugai, 1988; Colvin, Sugai, & Patching, 1993). The correcting principles consist of both proactive and responsive strategies to promote appropriate behaviors.

Proactive behavioral strategies

TBRI proactive strategies are designed as preventative teaching measures, and consist of verbal reminders, behavioral rehearsals, role play with others or with puppets, teaching life value terms, and demonstrations of rule-following or socially appropriate behaviors that are presented in settings where problem behavior is likely. For example, role-playing involves practicing a "script" between caregiver and child to allow the child to practice appropriate responses to frustrations he or she may encounter. Working with a 16-year-old who was in a residential treatment facility (RTC) due to acts of violence against her family, we found that script practice has currency even for older youth. We would practice "showing respect" through a playful script, but first start by showing "NO respect" giving the youth an opportunity to play-act her aggression, and her typically mouthy responses. Then we would follow with a behavioral re-do, and do the same skit with the young woman then practicing respectful words. Adult caregivers involved in the script practice as well as the young woman, laughed with delight as they took turns being, first the defiant child, and then the staff person. Even this young woman who had tried to cut her mother's throat with a butcher knife was able to learn new prosocial skills in the context of this playful, proactive environment. Another script that yielded positive outgrowth with this high-risk adolescent was "use your words." Previous to our work with her, when overwhelmed, she would try to run away, swallow something sharp to harm herself, or even try to choke or hang herself with a drawstring from her jersey. Through practicing in safe, playful settings through skits and puppet-play, she learned to use words like "I am feeling so sad" or "I am angry about that!"

Life-value terms help create a language and culture of mutual respect; similar in purpose to character education programs ( Lee & Perales, 2005; Purvis, Cross, & Sunshine, 2007). Practice with life values provides children with tools to resolve issues appropriately in real-life situations. Life-value terms include: using respect, making eye contact, using words to replace negative behaviors, being gentle and kind, accepting consequences, accepting "no," asking permission, and others. When proactive strategies are practiced regularly, problem behaviors become less frequent as children internalize appropriate behaviors for getting their needs met. With the young woman in the RTC for example, violent incident reports were reduced by 70% within weeks, through these playful interactive exercises. Although behavioral gains were almost immediate for this teenager, it is important to remember that it takes sustained, consistent, repetitions over time, in order for a youngster to be able to self-regulate with the support of an attentive adult. Based on current understanding of brain development and our own experience, lasting change will require, on average, one month per year of age for a child or youth from hard places to develop new beliefs and new behaviors, supported by compensatory brain development.

Responsive behavioral strategies

While proactive training is effective, there may still be instances when challenging behaviors are exhibited (although these should decrease over time) and in these cases responsive strategies may be necessary. Responsive strategies include Levels of Response and the IDEAL Approach, which were developed as part of the TBRI correcting principles to guide caregivers in resolving problem behaviors when they occur.

Levels of Response, described next, identify responsive practices that are matched in intensity to the level of risk or challenge, and yet are purposeful in maintaining the connection with the child or youth:

Level One: Playful Engagement -A low-level challenge, for example mouthiness or verbal disrespect, may be met with playful engagement. For example in response to a child who demands "Give me that crayon!" the caregiver may respond playfully, "Are you askin' or tellin'?" Then the caregiver guides the child to a behavioral re-do in which the child asks with respect for the crayon.

Level Two: Structured Engagement -With a slightly elevated challenge, such as when the child doesn't respond appropriately to playful engagement, the caregiver may offer choices. For example, a six-year-old on the playground who demanded that her teacher pick her up and carry her in, was asked at Level One, if she was "askin' or tellin'." The youngster replied forcefully that she was telling, to which the teacher responded, "You have two choices, you may ask with respect or you may simply walk into the building yourself." At that level, the young girl asked with respect, and the teacher then carried her playfully into the building.

Level Three: Calming Engagement -When there is a risk of full escalation, the caregiver must be carefully attuned to this danger. At this level, caregivers are encouraged to give the child or youth a chance to do "time-in" and think about what they need while the adult is nearby. An alternative we have used in RTCs and homes with adolescents, is that in advance of difficult behaviors, the caregiver and youth may choose a "quiet place" to which the youth can ask to go when they need time to self-regulate. Typically after a few minutes the adolescent is able to return to the conversation, knowing what they need to say or do.

Level Four: Protective Engagement -At Level Four there is significant threat of violence or harm by the child, either to himself or to someone else. At this level, TBRI encourages caregivers to contain the violence while remaining calm and reassuring. Caregivers should seek formal training in an intervention accepted by laws in their state or regulations of their organization. When the violence passes, the caregiver remains with the child or youth until the connection is re-affirmed and the youngster feels safe and secure again.

Notably, in each of these levels, the goal is to sustain connectedness while guiding the child to appropriate behaviors and responses, and for the child to know that a safe adult will help them regulate until they are able to regain self-regulation. Levels are not intended as a punishment, but rather as a regulatory support. Negotiation is a critical component of all TBRI strategies, as we seek to give voice to children who have lost their voices. In particular, negotiation is vital in both proactive and responsive strategies because many harmed children and youth have learned to use violence, manipulation, control, or triangulation to keep themselves safe and to get their needs met. We significantly diminish the frequency, intensity, and duration of behavioral episodes by "giving voice" for negotiation. One adolescent girl we served had been sexually abused by numerous adults and was indiscriminant in touching adults who worked with her in our camp. We engaged her in negotiating her need for healthy touch and hugs by demonstrating first, how to get a hug by asking (NOT simply coming to adults and touching them indiscriminately). In addition, we demonstrated healthy touch and unhealthy touch, letting her practice with us. Finally, we demonstrated body-space with a game of hula-hoops-with both adult and teen each holding a hoop around their body. The adult holding a hula-hoop around herself demonstrated "This is my body-space. No one can come into my body-space without permission." Following, the adult said, "That is your body space and no one can come into your space without permission. So how can I get a hug from you if I want one?" Then the teenager practiced the skills of negotiating her need for hugs and safe touch by asking with respect for safe, physical affection.

The IDEAL response, described next, is an acronym to remind caregivers of the five principles that should be used when challenging behaviors occur:

I-Respond immediately to the behavior ( Hester, Hendrickson, & Gable, 2009) because research proves that learning is greatest when the response is in swift temporal proximity to the behavior.

D-Respond directly to the child through eye contact, giving them undivided attention, and bringing them nearer to you physically for teaching and guidance ( Danforth, 2006) because research documents significant shifts in brain chemistry and activity during eye contact and proximity.

E-Respond in an efficient and measured manner. This is reflected in Levels of Response, in which caregivers use the least amount of firmness, corrective effort, and verbal directive that is required to correct the behavior ( Hester, Hendrickson, & Gable, 2009). This strategy also helps children gain trust, knowing adults will not overreact to their behaviors

A-The response is action-based. Redirect the child to practice an appropriate behavior alternative. Physically lead them through a real-life "re-do" when possible. Once the "re-do" is successful (because they used the appropriate alternative behavior), praise the child ( Heimlich & Ardoin, 2008; Hohnke & Sur, 1999; Reed, 1996).

Trust-Based Relational Intervention® (TBRI®) Abbreviated Intensive Program Activity List

Empowering principles - ecological and physiological concerns

∗Support more primitive systems so that the child can function at higher cognitive and emotional levels.

Snack or meal every two hours

Sensory integration activity every two hours

Provide consistent rituals and routines (e.g., morning & bedtime rituals)

Connecting principles - building trust and meeting relational needs

∗Giving care, seeking care, negotiating needs, being autonomous self

Affectionate activities (reading, snuggling, talking, walks, crafts, etc.)

Family time - "No hurts, stick together, have fun"

Playful engagement with child

Correcting principles - teaching children to be self-managers

∗Proactive strategies

Role rehearsal (using a partner or puppets)

Reading goal chart (at meals and bedtime)

Mutual story-telling (discussing appropriate responses and behaviors)

"Checking engines" (emotional self-check)

Common Challenges
Transitions between activities, taking items without permission, taking turns, explosive jealousy, aggression when told "no", environments that are overstimulating, & unstructured situations.

∗At the beginning of the TBRI® program, correcting activities are practiced multiple times during the day. As the child's behavior improves, time spent engaged in correcting activities can be reduced.

Als H., Lester B. M., Tronick E. Z., Brazelton T. B. Toward a research instrument for the assessment of preterm infants' behavior (APIB) In: Fitzgerald H., Lester B. M., Yogman M. W., editors. Theory and research in behavioral pediatrics. New York, NY: Plenum Press; 1982. pp. 35-63.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Author.; 2013.

Ayres A. J. Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services; 1972b.

Barber B. K., Harmon E. L. Violating the self: Parental psychological control of children and adolescents. In: Barber B. K., editor. Intrusive parenting: How psychological control affects children and adolescents. Washington, DC: American Psychological Association; 2002.

Bernieri F. J., Rosenthal R. Interpersonal coordination: Behavior matching and interactional synchrony. In: Feldman R. S., Rimé B., editors. Fundamentals of nonverbal behavior. New York, NY: Cambridge University Press; 1991. pp. 401-432.

Booth P. B., Lindaman S. L. Theraplay as short term treatment for enhancing attachment in adopted children. In: Kaduson H. G., Schaefer C. E., editors. Short term play therapy for children. New York, NY: Guilford Press; 2000.

Brazelton T. B., Greenspan S. I. The irreducible needs of children: What every child must have to grow, learn, and flourish. Cambridge, MA: Perseus Books Group; 2000.

Bronfenbrenner U., Morris P. A. The ecology of developmental processes. In: Damon W., Lerner R. M., editors. Handbook of child psychology. 5th ed. New York, NY: John Wiley & Sons.; 1998.

Brown S. Play: How it shapes the brain, opens the imagination, and invigorates the soul. New York, NY: Avery Trade; 2009.

Carrion V. G. Understanding the effects of early life stress on brain development. In: Lieberman A., DeMartino R., editors. Interventions for children exposed to violence. IV. New Brunswick, NJ: Johnson & Johnson Pediatric Institute; 2006. pp. 45-64.

Cermak S., Groza V. Sensory processing problems in postinstitutionalized children: Implications for social work. Child and Adolescent. 1998.

Cook A., Blaustein M., Spinazolla J., van der Kolk B. White paper from the National Child Traumatic Stress Network Complex Trauma Task Force. Los Angeles, CA: National Center for Child Traumatic Stress; 2003. Complex trauma in children and adolescents. Retrieved from http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTrauma_All.pdf.

Cowan P. A., Cowan C. P. Normative family transitions, normal family processes, and healthy child development. In: Walsh F., editor. Normal family processes: Growing diversity and complexity. New York, NY: Guilford Press; 2003. pp. 424-459.

Endsley M. R. Expertise and situation awareness. In: Anders Ericsson K., Charness N., Feltovich P. J., Hoffman R. R., editors. The Cambridge handbook of expertise and expert performance. New York, NY: Cambridge University Press; 2006. pp. 633-651.

Field T. Psychologically depressed parents. In: Bornstein M. H., editor. Handbook of parenting. Vol. 4. Mahwah, NJ: Erlbaum; 1995. pp. 85-99.

Field T. M. Touch. New York, NY: Bradford Books; 2003.

Finset A., Del Piccolo L. Nonverbal communication in clinical contexts. In: Rimondini M., editor. Communication in cognitive behavioral therapy. New York, NY: Springer Science and Business Media; 2011. pp. 107-128.

George C., Kaplan N., Main M. Adult Attachment Interview. Berkeley, CA: University of California; 1985. Unpublished Manuscript.

Jernberg A. M., Booth P. B. Theraplay: Helping parents and children build better relationships through attachment-based play. 2nd ed. San Francisco, CA: Jossey-Bass.; 1999.

Kranowitz C. The out-of-sync child: Recognizing and coping with sensory processing disorder. rev. ed. New York, NY: Penguin Putnam; 2006.

Lochman J. E., Powell N. R., Whidby J. M. Aggressive children: Cognitive behaviorial assessment and treatment. In: Kendall P. C., editor. Child and adolescent therapy: Cognitive-behavioral procedures. 3rd ed. New York, NY: Guilford Press; 2006. pp. 33-81.

Malloch S., Trevarhen C. Communicative musicality: Exploring the basis of human companionship. New York, NY: Oxford University Press; 2010.

Miller L. J., Fuller D. A. Sensational kids: Hope and help for children with sensory processing disorder. New York, NY: Perigree Trade; 2007.

Montagu A. Touching: The human significance of the skin. New York, NY: Harper; 1986.

Nelson C. A. Neural development and lifelong plasticity. In: Keating D. P., editor. Nature and nurture in early child development. New York, NY: Cambridge University Press; 2011. pp. 45-69.

Pennebaker J. W., Stone L. D. Translating traumatic experiences into language: Implications for child abuse and long-term health. In: Koenig L. J., Doll L. S., O'Leary A., Pequegnat W., editors. From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention. Washington, DC: American Psychological Association; 2004. pp. 201-216.

Perry B. D. Neurobiological sequelae of childhood trauma: Post-traumatic stress disorders in children. In: Murburg M., editor. Catecholamine function in post-traumatic stress disorder: Emerging concepts. Washington, DC: American Psychiatric Press; 1994. pp. 253-276.

Perry B. D. The neurodevelopmental impact of violence in childhood. In: Schetky D., Benedek E. P., editors. Textbook of child and adolescent forensic psychiatry. Washington, DC: American Psychiatric Press; 2001. pp. 221-238.

Pollitt E. A critical view of three decades of research on the effect of chronic energy malnutrition on behavior development. In: Schurch B., Scrimshaw N., editors. Chronic energy deficiency: Consequences and related issues. Lausanne, Switzerland: IDECG-Nestle Foundation; 1988.

Purvis K. B., Cross D. R. Facilitating behavioral change in adopted children suffering from sensory processing disorder. In: Atwood T. C., Allen L. A., Ravenel V. C., Callahan N. F., editors. Adoption factbook IV. Washington, DC: National Council for Adoption; 2007. pp. 375-379.

Purvis K. B., Cross D. R., Pennings J. S. Trust-Based Relational InterventionTM: Interactive principles for adopted children with special social-emotional needs. Journal of Humanistic Counseling, Education, and Development. 2009;48:3-48.

Purvis K. B., Cross D. R., Sunshine W. L. The connected child: Bring hope and healing to your adoptive family. New York, NY: McGraw-Hill; 2007.

Purvis K. B., McKenzie L. B., Cross D. R. A spontaneous emergence of attachment behavior and a correlation with sensory deficits: A brief report. 2012. Manuscript submitted for publication.

Reed E. S. The necessity of experience. New Haven, CT: Yale University Press; 1996.

Schore A. N. Affect regulation and the development of self: The neurobiology of emotional development. Hillsdale, NJ: Erlbaum; 1994.

Siegel D. J. The developing mind. New York, NY: Guilford; 1999.

Stark K. D., Sander J., Hauser M. Depressive disorders during childhood and adolescence. In: Mash E. J., Barkley R. A., editors. Treatment of childhood disorders. 3rd ed. New York, NY: Guilford Press; 2006. pp. 336-407.

Steele M., Hodges J., Kaniuk J., Steele H., Asquith K., Hillman S. Attachment representations and adoption outcome: On the use of narrative assessments to track the adaptation of previously maltreated children in their new families. In: Wrobel G., Neil E., editors. International advances in adoption research for practice. New York, NY: Wiley-Blackwell; 2009. pp. 193-215.

# data[].attributes.attachment_link.title
Trust-Based Relational Intervention (TBRI): A Systemic Approach to Complex Developmental Trauma

# data[].attributes.attachment_link.description
Children and youth who have experienced foster care or orphanage-rearing have often experienced complex developmental trauma, demonstrating an interactive set of psychological and behavioral issues. Trust-Based Relational Intervention (TBRI) is a therapeutic model that trains caregivers to provide effective support and treatment for at-risk children.

# data[].attributes.attachment_link.readable_text
James Redford, documented the lives of staff and students of Lincoln Alternative High School in Walla Walla, Washington as the director of "Paper Tigers" . Students at this high school had behavioral issues and poor academic performances and were usually suspended from school. After discovering the studies on adverse childhood experiences (ACEs), the high school changed its approach to handling the students with kindness and in-school suspension versus automatic punitive punishments.

The staff at the high school takes into account the students' lives at home as children who suffer from an ACE or trauma, which can come in the form of physical, sexual, or emotional abuse, can increase the risk of certain diseases, behavioral issues, learning problems, substance abuse, and early death. This can happen because the stress associated with these experiences can change the way a child's brain develops. The teaching methods and behavior management at Lincoln help to combat the "toxic stress" by caring for the students' lives outside school and having a gentler approach towards their behaviors. The new approach is doing so well at Lincoln that it is entering the doors of other high schools in Washington such as Big Picture High School and the Kent School District.

In the documentary, Redford showcases the social and human side to ACEs rather than the science behind the approach to treating the children. He highlights the idea of ACEs while allowing the students to film their own lives, providing a more personal perspective on the effect of their traumas as well as their struggles, hopes, and dreams. It also demonstrates how teachers are helping the students change their lives in a positive way using new science and fresh methods. In addition, "Paper Tigers" provides insight into how others, such as family members and parents, can help children experiencing the negative impacts of ACEs.

The trailer for "Paper Tigers" can be found here. ( http://papertigersmovie.com ) The documentary has been screened at the Seattle International Film Festival.

Kristine Alarcon graduated at the University of San Francisco with a Bachelors of Science in Biology. She is working towards certification in Sterile Processing and Distribution. She is a Social Media Assistant at Cancer InCytes Magazine.

Orenstein, Walker. "Seattle film festival to screen film on Lincoln HS." Walla Walla Union-Bulletin. Retrieved on May 29, 2015. http://union-bulletin.com/news/2015/may/29/seattle-film-festival-screen-film-lincoln-hs/

"Paper Tigers." http://papertigersmovie.com

Redford, James. "Paper Tigers." James Redford. Retrieved on May 29, 2015. http://jamesredford.com/all-films/direction-current-films/aces/

Photo Credit : http://papertigersmovie.com

Written By CancerINCYTES

"Paper Tigers": A Documentary about Adverse Childhood Experiences was originally published @ Cancer inCYTES Blog and has been syndicated with permission.

Subscribe to the SJS Weekly Newsletter

# data[].attributes.attachment_link.title
"Paper Tigers": A Documentary about Adverse Childhood Experiences * SJS

# data[].attributes.attachment_link.description
By: Kristine AlarconJames Redford, documented the lives of staff and students of Lincoln Alternative High School in Walla Walla, Washington as the director of "Paper Tigers,". Students at this high school had behavioral issues and poor academic performances and were usually suspended from school. After discovering the studies on ...

# data[].attributes.attachment_link.description
Register on the right to create a personal map for each child. Your child's information will remain confidential.As you answer questions, you can save tips and resources to your child's map to help your child learn and grow.

# data[].attributes.attachment_link.provider_name
Centers for Disease Control and Prevention

# data[].attributes.attachment_link.description
Download CDC's free Milestone Tracker app to complete a milestone checklist for your child. Available for iOS and Android in English and Spanish.

# data[].attributes.attachment_link.keywords[]
day after day the price you pay: managing your second-hand shock

# data[].attributes.attachment_link.title
Vicarious Trauma Institute - Helping the World's Heroes to Reveal, Release, Reconnect

# data[].attributes.attachment_link.description
Vicarious Trauma Institute - Training, Workshops, Presentations, and Books about the symptoms and treatment of Vicarious Trauma - co-founders: Ellie Izzo, PhD and Vicki Carpel Miller. Located in Scottsdale, Arizona. Services available world-wide.

# data[].attributes.headline
Community Health Needs Assessment Philadelphia

# data[].attributes.subject
Community Health Needs Assessment Philadelphia

# data[].attributes.attachment_link.readable_text
You have JavaScript disabled

Nadine Burke Harris' healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma.

Why you should listen

Pediatrician Nadine Burke Harris noticed a disturbing trend as she treated children in an underserved neighborhood in San Francisco: that many of the kids who came to see her had experienced childhood trauma. She began studying how childhood exposure to adverse events affects brain development, as well as a person's health as an adult.

Understanding this powerful correlation, Burke Harris became the founder and CEO of the Center for Youth Wellness, an initiative at the California Pacific Medical Center Bayview Child Health Center that seeks to create a clinical model that recognizes and effectively treats toxic stress in children. Her work pushes the health establishment to reexamine its relationship to social risk factors, and advocates for medical interventions to counteract the damaging impact of stress. Her goal: to change the standard of pediatric practice, across demographics.

What others say

"[Nadine Burke Harris] believes that regarding childhood trauma as a medical issue helps her to treat more effectively the symptoms of patients. Moreover, she believes, this approach, when applied to a large population, might help alleviate the broader dysfunction that plagues poor neighborhoods." - The New Yorker

# data[].attributes.attachment_link.description
Nadine Burke Harris' healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma.

# data[].attributes.attachment_link.keywords[]
quotes about the solution to adult problems

# data[].attributes.attachment_link.keywords[]
quotes on the solution to adult problems

# data[].attributes.attachment_link.title
The Solution To Adult Problems Quotes, Quotations & Sayings 2018

# data[].attributes.attachment_link.description
The Solution To Adult Problems quotes - 1. The solution to adult problems tomorrow depends on large measure upon how our children grow up today. Read more quotes and sayings about The Solution To Adult Problems.

# data[].attributes.attachment_link.readable_text
This graphic shows that the highest rate of economic returns comes from the earliest investments in children, providing an eye-opening understanding that society invests too much money on later development when it is often too late to provide great value. It shows the economic benefits of investing early and building skill upon skill to provide greater success to more children and greater productivity and reduce social spending for society.

This graphic is formatted for use on social media and insertion into presentations, handouts and press releases.

# data[].attributes.attachment_link.title
The Heckman Curve - The Heckman Equation

# data[].attributes.attachment_link.description
This graphic shows that the highest rate of economic returns comes from the earliest investments in children, providing an eye-opening understanding that society invests too much money on later development when it is often too late to provide great value. It shows the economic benefits of investing early and building skill upon skill to provide...

# data[].attributes.attachment_link.title
Philadelphia ACE Survey | ACES Philadelphia

# data[].attributes.attachment_link.description
In conjunction with the Public Health Management Corporation's Household Health Survey, researchers surveyed 1,784 adult participants in Philadelphia about the original ACEs and five additional community-level stressors. Using a more socioeconomically and racially diverse urban population, Conventional (household) and Expanded (community-level) ACEs were measured to help understand whether Conventional ACEs alone can sufficiently measure adversity, particularly among various subgroups.

# data[].attributes.attachment_link.title
National Child Traumatic Stress Network - Child Trauma Home |

# data[].attributes.attachment_link.description
Terrorism & Disasters Readiness, Response, Recovery Tools, PFA, and SPR. Learning Center for CHild and Adolescent Trauma Education and online community. Understanding Child Traumatic Stress What it is. Why it matters.

# data[].attributes.attachment_link.readable_text
JOIN US FOR LIVE LEARNING IN 2018!

JUNE 12 - 14, 2018 - Attend our 3rd International Neurosequential Model Symposium in Banff, Alberta Canada! Click here for Early Bird Registration (thru 1/15/18)

Consider adding on an NMT or NME Boot Camp as part of the symposium!

ATTEND A BOOT CAMP!

The ChildTrauma Academy's Bootcamps offer an accelerated, face-to-face learning experience and serve as the kick-off to our year-long, self paced NMT & NME Individual Training Certification Programs. Enrollment in a Bootcamp includes payment for the full year of self-paced learning.

NMT Boot Camp in Banff 2018 - Read the overview for clinicians here & enroll here!

NME Boot Camp in Banff 2018 - Read the overview for educators here & enroll here!

NMT Phase I Boot Camp in Silkeborg, Denmark Jan. 31 & Feb. 1, 2018 - Read the overview & enroll here!
A complete list of Boot Camps is listed here!

# data[].attributes.attachment_link.description
JOIN US FOR LIVE LEARNING IN 2018! JUNE 12 - 14, 2018 - Attend our 3rd International Neurosequential Model Symposium in Banff, Alberta Canada! Click here for Early Bird Registration (thru 1/15/18) Consider adding on an NMT or NME Boot Camp as part of the symposium! ATTEND A BOOT CAMP!

# data[].attributes.attachment_link.title
How Adverse Childhood Experiences Affect Adult Illness

# data[].attributes.attachment_link.description
Donna Jackson Nakazawa, author of 'Childhood Disrupted' discusses how Adverse Childhood Experiences (ACEs) affect adult illness such as heart disease, autoimmune disease and cancer.