I need someone to complete my sociology assignment

The 12 Core Concepts

Concepts for Understanding Traumatic

Stress Responses in Children and Families

NCTSN Core Curriculum on Childhood Trauma – The 12 Core Concepts 2

The National Child Traumatic Stress Network

Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) brings a singular and comprehensive focus

to childhood trauma. NCTSN’s collaboration of frontline providers, researchers, and families is committed to raising the standard of

care while increasing access to services. Combining knowledge of child development, expertise in the full range of child traumatic

experiences, and dedication to evidence-based practices, the NCTSN changes the course of children’s lives by changing the course

of their care.

Financial Support

This project was funded in part by the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of

Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily

reflect those of SAMHSA or HHS.

Citation

NCTSN Core Curriculum on Childhood Trauma Task Force (2012). The 12 core concepts: Concepts for understanding traumatic

stress responses in children and families. Core Curriculum on Childhood Trauma. Los Angeles, CA, and Durham, NC: UCLA-Duke

University National Center for Child Traumatic Stress.

Copyright © 2010, 2012 UCLA-Duke University National Center for Child Traumatic Stress, on behalf of the NCTSN Core Curriculum

on Childhood Trauma Task Force, and the National Child Traumatic Stress Network. All rights reserved. You are welcome to copy or

redistribute these Core Concepts in print or electronic form, provided the text is not modified, the NCTSN Core Curriculum on

Childhood Trauma Task Force is cited in any use, and no fee is charged for copies of this publication. Unauthorized commercial

publication or exploitation of this material is specifically prohibited.

Correspondence Relating to the Core Curriculum on Childhood Trauma

Anyone wishing to use any of these materials for commercial use must request and receive prior written permission from the NCTSN.

Permission for such use is granted on a case-by-case basis at the sole discretion of the NCTSN. Requests for permission to adapt or

license these materials, as well as general requests relating to the Core Curriculum on Childhood Trauma should be directed to the

NCTSN Learning Center Help Desk at [email protected] with "CCCT" in the Subject Line. General inquiries relating to products produced

by the National Child Traumatic Stress Network can be directed to the NCTSN National Resource Center at [email protected]. Other

NCTSN products can be viewed on its website at NCTSN.org, as well as the Learning Center for Child and Adolescent Trauma at

http://learn.nctsn.org/.

Acknowledgements

The Core Curriculum on Childhood Trauma is currently being developed by the NCTSN Core Curriculum on Childhood Trauma Task

Force, which is made up of members and affiliates of the National Child Traumatic Stress Network (NCTSN). The foundational ideas

for the Core Concepts portion of the Core Curriculum on Childhood Trauma, including the 12 Core Concepts, were developed and

endorsed by the Task Force during an expert panel meeting held in August 2007. The Task Force continues to meet at NCTSN all-

network conferences, via online presentations and discussions, and held a second expert panel meeting in August 2011.

NCTSN members who have served on the NCTSN Core Curriculum on Childhood Trauma Task Force since its inception in 2007

include (in alphabetical order): Robert Abramovitz, Lisa Amaya-Jackson, Harolyn Belcher, Frank Bennett, Steven Berkowitz, Lucy

Berliner, Margaret Blaustein, John Briere, Judith Cohen, Kathryn Collins, Lisa Conradi, Renee Dominguez, Abigail Gewirtz, Chandra

Ghosh Ippen, Jessica Gledhill, Alessia Gottlieb, (the late) Kevin Gully, Lisa Jaycox, (the late) Sandra Kaplan, Victor Labruna, Audra

Langley, Alicia Lieberman, Richard Kagan, Christopher Layne (Chair), Steven Marans, Ann Masten, Lou Ann Mock, Elana Newman,

David Pelcovitz, Frank Putnam, Robert Pynoos, Gilbert Reyes, Leslie Ross, Arlene Schneir, Jo Sornborger, Joseph Spinazzola, Alan

Steinberg, Virginia Strand (Co-Chair), Liza Suárez, William Saltzman, Glenn Saxe, Margaret Stuber, Elizabeth Thompson, Jim Van Den

Brandt, Kelly Wilson, Jennifer Wilgocki, and Marleen Wong.

Additional guidance (including attendance at Task Force meetings) has been provided by Adam Brown, Dee Foster, Mandy Habib,

Donna Humbert, Laurel Kiser, Susan Ko, Peter Kung, Cheryl Lanktree, Jan Markiewicz, Cybele Merrick, Mary Mount, Frederick

Strieder, Heather Langan, Bradley Stolbach, Nicole Tefera, and Patricia Van Horn.

Jennifer Galloway served as project manager for the Core Curriculum during its early years.

Gretchen Henkel, Deborah Lott, and DeAnna Griffin have provided assistance in editing, revising, and formatting the 12 Core

Concepts, as well as the CCCT clinical case vignettes, and in editing and formatting the CCCT learning facilitator guides.

We gratefully acknowledge the support of SAMHSA in this endeavor, especially from project officers Malcolm Gordon and Kenneth

Curl.

© 2010, 2012 by UCLA-Duke University National Center for Child Traumatic Stress 3

12 Core Concepts for Understanding Traumatic Stress Responses in Childhood

1. Traumatic experiences are inherently complex.

Every traumatic event—even events that are relatively circumscribed—is made up of different traumatic

moments. These moments may include varying degrees of objective life threat, physical violation, and

witnessing of injury or death. Trauma-exposed children experience subjective reactions to these different

moments that include changes in feelings, thoughts, and physiological responses; and concerns for the safety of others.

Children may consider a range of possible protective actions during different moments, not all of which they can or do

act on. Children’s thoughts and actions (or inaction) during various moments may lead to feelings of conflict at the time,

and to feelings of confusion, guilt, regret, and/or anger afterward. The nature of children’s moment-to-moment reactions

is strongly influenced by their prior experience and developmental level. Events (both beneficial and adverse) that occur

in the aftermath of the traumatic event introduce additional layers of complexity. The degree of complexity often

increases in cases of multiple or recurrent trauma exposure, and in situations where a primary caregiver is a perpetrator

of the trauma.

2. Trauma occurs within a broad context that includes children’s personal characteristics, life experiences,

and current circumstances.

Childhood trauma occurs within the broad ecology of a child’s life that is composed of both child-intrinsic and

child-extrinsic factors. Child-intrinsic factors include temperament, prior exposure to trauma, and prior history

of psychopathology. Child-extrinsic factors include the surrounding physical, familial, community, and cultural

environments. Both child-intrinsic and child-extrinsic factors influence children’s experience and appraisal of traumatic

events; expectations regarding danger, protection, and safety; and course of posttrauma adjustment. For example, both

child-intrinsic factors such as prior history of loss, and child-extrinsic factors such as poverty may act as vulnerability

factors by exacerbating the adverse effects of trauma on children’s adjustment.

3. Traumatic events often generate secondary adversities, life changes, and distressing reminders in

children’s daily lives.

Traumatic events often generate secondary adversities such as family separations, financial hardship,

relocations to a new residence and school, social stigma, ongoing treatment for injuries and/or physical

rehabilitation, and legal proceedings. The cascade of changes produced by trauma and loss can tax the coping

resources of the child, family, and broader community. These adversities and life changes can be sources of distress

in their own right and can create challenges to adjustment and recovery. Children’s exposure to trauma reminders and

loss reminders can serve as additional sources of distress. Secondary adversities, trauma reminders, and loss

reminders may produce significant fluctuations in trauma survivors’ posttrauma emotional and behavioral functioning.

4. Children can exhibit a wide range of reactions to trauma and loss.

Trauma-exposed children can exhibit a wide range of posttrauma reactions that vary in their nature, onset,

intensity, frequency, and duration. The pattern and course of children’s posttrauma reactions are influenced

by the type of traumatic experience and its consequences, child-intrinsic factors including prior trauma or loss,

and the posttrauma physical and social environments. Posttraumatic stress and grief reactions can develop over time

into psychiatric disorders, including posttraumatic stress disorder (PTSD), separation anxiety, and depression.

Posttraumatic stress and grief reactions can also disrupt major domains of child development, including attachment

relationships, peer relationships, and emotional regulation, and can reduce children’s level of functioning at home, at

school, and in the community. Children’s posttrauma distress reactions can also exacerbate preexisting mental health

problems including depression and anxiety. Awareness of the broad range of children’s potential reactions to trauma

and loss is essential to competent assessment, accurate diagnosis, and effective intervention.

NCTSN Core Curriculum on Childhood Trauma – The 12 Core Concepts 4

5. Danger and safety are core concerns in the lives of traumatized children.

Traumatic experiences can undermine children’s sense of protection and safety, and can magnify their

concerns about dangers to themselves and others. Ensuring children’s physical safety is critically important

to restoring the sense of a protective shield. However, even placing children in physically safe circumstances

may not be sufficient to alleviate their fears or restore their disrupted sense of safety and security. Exposure to trauma

can make it more difficult for children to distinguish between safe and unsafe situations, and may lead to significant

changes in their own protective and risk-taking behavior. Children who continue to live in dangerous family and/or

community circumstances may have greater difficulty recovering from a traumatic experience.

6. Traumatic experiences affect the family and broader caregiving systems.

Children are embedded within broader caregiving systems including their families, schools, and communities.

Traumatic experiences, losses, and ongoing danger can significantly impact these caregiving systems, leading

to serious disruptions in caregiver-child interactions and attachment relationships. Caregivers’ own distress

and concerns may impair their ability to support traumatized children. In turn, children’s reduced sense of protection

and security may interfere with their ability to respond positively to their parents’ and other caregivers’ efforts to provide

support. Traumatic events―and their impact on children, parents, and other caregivers―also affect the overall

functioning of schools and other community institutions. The ability of caregiving systems to provide the types of support

that children and their families need is an important contributor to children’s and families’ posttrauma adjustment.

Assessing and enhancing the level of functioning of caregivers and caregiving systems are essential to effective

intervention with traumatized youths, families, and communities.

7. Protective and promotive factors can reduce the adverse impact of trauma.

Protective factors buffer the adverse effects of trauma and its stressful aftermath, whereas promotive factors

generally enhance children’s positive adjustment regardless of whether risk factors are present. Promotive

and protective factors may include child-intrinsic factors such as high self-esteem, self-efficacy, and

possessing a repertoire of adaptive coping skills. Promotive and protective factors may also include child-extrinsic

factors such as positive attachment with a primary caregiver, possessing a strong social support network, the presence

of reliable adult mentors, and a supportive school and community environment. The presence and strength of promotive

and protective factors—both before and after traumatic events—can enhance children’s ability to resist, or to quickly

recover (by resiliently “bouncing back”) from the harmful effects of trauma, loss, and other adversities.

8. Trauma and posttrauma adversities can strongly influence development.

Trauma and posttrauma adversities can profoundly influence children’s acquisition of developmental

competencies and their capacity to reach important developmental milestones in such domains as cognitive

functioning, emotional regulation, and interpersonal relationships. Trauma exposure and its aftermath can

lead to developmental disruptions in the form of regressive behavior, reluctance, or inability to participate in

developmentally appropriate activities, and developmental accelerations such as leaving home at an early age and

engagement in precocious sexual behavior. In turn, age, gender, and developmental period are linked to risk for

exposure to specific types of trauma (e.g., sexual abuse, motor vehicle accidents, peer suicide).

9. Developmental neurobiology underlies children’s reactions to traumatic experiences.

Children’s capacities to appraise and respond to danger are linked to an evolving neurobiology that consists

of brain structures, neurophysiological pathways, and neuroendocrine systems. This “danger apparatus”

underlies appraisals of dangerous situations, emotional and physical reactions, and protective actions.

Traumatic experiences evoke strong biological responses that can persist and that can alter the normal course of

neurobiological maturation. The neurobiological impact of traumatic experiences depends in part on the developmental

stage in which they occur. Exposure to multiple traumatic experiences carries a greater risk for significant

neurobiological disturbances including impairments in memory, emotional regulation, and behavioral regulation.

Conversely, ongoing neurobiological maturation and neural plasticity also create continuing opportunities for recovery

and adaptive developmental progression.

© 2010, 2012 by UCLA-Duke University National Center for Child Traumatic Stress 5

10. Culture is closely interwoven with traumatic experiences, response, and recovery.

Culture can profoundly affect the meaning that a child or family attributes to specific types of traumatic events

such as sexual abuse, physical abuse, and suicide. Culture may also powerfully influence the ways in which

children and their families respond to traumatic events including the ways in which they experience and

express distress, disclose personal information to others, exchange support, and seek help. A cultural group’s

experiences with historical or multigenerational trauma can also affect their responses to trauma and loss, their world

view, and their expectations regarding the self, others, and social institutions. Culture also strongly influences the rituals

and other ways through which children and families grieve over and mourn their losses.

11. Challenges to the social contract, including legal and ethical issues, affect trauma response and

recovery.

Traumatic experiences often constitute a major violation of the expectations of the child, family, community,

and society regarding the primary social roles and responsibilities of influential figures in the child’s life.

These life figures may include family members, teachers, peers, adult mentors, and agents of social

institutions such as judges, police officers, and child welfare workers. Children and their caregivers frequently contend

with issues involving justice, obtaining legal redress, and seeking protection against further harm. They are often acutely

aware of whether justice is properly served and the social contract is upheld. The ways in which social institutions

respond to breaches of the social contract may vary widely and often take months or years to carry out. The perceived

success or failure of these institutional responses may exert a profound influence on the course of children’s

posttrauma adjustment, and on their evolving beliefs, attitudes, and values regarding family, work, and civic life.

12. Working with trauma-exposed children can evoke distress in providers that makes it more difficult for

them to provide good care.

Mental healthcare providers must deal with many personal and professional challenges as they confront

details of children’s traumatic experiences and life adversities, witness children’s and caregivers’ distress,

and attempt to strengthen children’s and families’ belief in the social contract. Engaging in clinical work may

also evoke strong memories of personal trauma- and loss-related experiences. Proper self-care is an important part of

providing quality care and of sustaining personal and professional resources and capacities over time.