ENHANCING MULTIDISCIPLINARY RESPONSES TO POLYVICTIMIZATION: A NATIONWIDE TRAINING INITIATIVE

1. ENHANCING MULTIDISCIPLINARY RESPONSES TO POLYVICTIMIZATION: A NATIONWIDE TRAINING INITIATIVE The Trauma Center at Justice Resource Institute1, Musicaro, R., Spinazzola, J., van der Kolk, B., Procopio, S., Yarrow, A; University of Connecticut Health Center Child Trauma Clinic2, Ford, J.; My Life, My Choice3, Grace, L.G.; Washington State University, Blodgett, C.; University of Chicago Pritzker School of Medicine4, Stolbach, B.; Enlace Chicago5, Bocanegra, K.; Drexel University College of Medicine6, Rich, L.; Alaska Child Trauma Center7, Arvidson, J. To reference this poster, please use the following citation: Musicaro, R., Spinazzola, J., van der Kolk, B., Procopio, S., Yarrow, A, Ford, J.,…Arvidson, J. (2014, May 28-31). Psychological trauma: Neuroscience, attachment, and therapeutic interventions. Poster presented at 25th Annual International Trauma Conference, Seaport World Trade Center, Boston, MA. This product was supported by grant number 2012-VF-GX-K009, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

2. ENHANCING MULTIDISCIPLINARY RESPONSES TO POLYVICTIMIZATION: A NATIONWIDE TRAINING INITIATIVE The Trauma Center at Justice Resource Institute1, Musicaro, R., Spinazzola, J., van der Kolk, B., Procopio, S., Yarrow, A; University of Connecticut Health Center Child Trauma Clinic2, Ford, J.; My Life, My Choice3, Grace, L.G.; Washington State University, Blodgett, C.; University of Chicago Pritzker School of Medicine4, Stolbach, B.; Enlace Chicago5, Bocanegra, K.; Drexel University College of Medicine6, Rich, L.; Alaska Child Trauma Center7, Arvidson, J. I. Understanding Polyvictimization • Definition: exposure to multiple forms of maltreatment or violence. • Papers vary in exposure criteria. • Can be categorically defined, dimensionally defined, or defined using statistical techniques • Pervasive problem in the US: 10-25% in the general population; 5-55% in high risk or clinical samples (Ford at al., 2009) • Types of Victimization: Sexual, Physical, Emotional Abuse, War, Oppression, Neglect, Terrorism, Rape, Assault, Dating Violence, Robbery, Witness to Murder, Ethnic Cleansing, Loss through violent death, exposure to shootings, street violence, etc., Commercial Sexual Exploitation/Human Trafficking, Custodial Interference/Family Abduction II. Understanding Complex Trauma • Definition: children’s exposure to multiple traumatic events, often of an invasive, interpersonal nature, and the wide-ranging, long-term impact of this exposure (Spinazzola et al., 2005) • Emphasizes the range and depth of short/long-term effects of polyvictimization in children and adults (Cook et al., 2005) • Youth in foster care: 70.4% of 2,251 experienced 2+ types of interpersonal victimizations by caregivers; 11.5% reported all five. NCTSN Children: Out of sample of 1,699, 77.6% exposed to multiple and/or prolonged trauma (Greeson et al., 2011) To reference this poster, please use the following citation: Musicaro, R., Spinazzola, J., van der Kolk, B., Procopio, S., Yarrow, A, Ford, J.,…Arvidson, J. (2014, May 28-31). Psychological trauma: Neuroscience, attachment, and therapeutic interventions. Poster presented at 25th Annual International Trauma Conference, Seaport World Trade Center, Boston, MA. This product was supported by grant number 2012-VF-GX-K009, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

3. ENHANCING MULTIDISCIPLINARY RESPONSES TO POLYVICTIMIZATION: A NATIONWIDE TRAINING INITIATIVE The Trauma Center at Justice Resource Institute1, Musicaro, R., Spinazzola, J., van der Kolk, B., Procopio, S., Yarrow, A; University of Connecticut Health Center Child Trauma Clinic2, Ford, J.; My Life, My Choice3, Grace, L.G.; Washington State University, Blodgett, C.; University of Chicago Pritzker School of Medicine4, Stolbach, B.; Enlace Chicago5, Bocanegra, K.; Drexel University College of Medicine6, Rich, L.; Alaska Child Trauma Center7, Arvidson, J. III. Complex Trauma Domains of Impact Complex Adaptation to Polyvictimization • Attachments and Relationship • Physical Health: Body and Brain • Emotional Responses • Dissociation • Behavior • Cognition: Thinking and Learning • Self-Concept and Future Orientation • (Cook et al., 2005) IV. Developmental Impact of Polyvictimization • Poor readiness for learning and compromised brain development • Compromised brain function in multiple regions and networks (Lanius et al., 2010; Simmons et al., 2009) • Failure in school • Early academic failure and poor retention in grades K-1 (Rowe & Eckenrode, 1999) • Expulsion • Children with complex behavioral issues are the most likely to be expelled (Gillam, 2005) • Dropping out • High school students exposed to adverse life stressors exhibited more academic failures and truancy (Blodgett et al., 2010) • Legal problems • Polyvictimization is associated with delinquency in adolescents (Ford, Elhai, Connor, & Frueh, 2010) • For incarcerated adults, higher number of traumatic events correlated with lower age of first arrest (Carlson & Shafer, 2010) • Lost productivity and income • Adults with history of neglect/abuse make $5,000 less per year (Currie & Widom, 2010) • Poor health and premature death • Polyvictimization increases risk for fatal health problems such as stroke, heart disease and diabetes (Felitti et al., 1998) V. Impact in Special Populations • Urban Communities of Color:face issues ofchronic environmental stress, unemployment, poverty, racism, micro-aggressions, Invisibility Syndrome, role strain, disproportional incarceration rates, health disparities, education disparities, residential segregation. • LGBTQ individuals: criminal victimization occurs against a backdrop of widespread harassment based on orientation. • Commercial Sexual Exploitation of Youth and Adults: the person is treated as a commercial and sexual object; high risk for enduring abuse, violence and sexually transmitted infections. To reference this poster, please use the following citation: Musicaro, R., Spinazzola, J., van der Kolk, B., Procopio, S., Yarrow, A, Ford, J.,…Arvidson, J. (2014, May 28-31). Psychological trauma: Neuroscience, attachment, and therapeutic interventions. Poster presented at 25th Annual International Trauma Conference, Seaport World Trade Center, Boston, MA. This product was supported by grant number 2012-VF-GX-K009, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

4. ENHANCING MULTIDISCIPLINARY RESPONSES TO POLYVICTIMIZATION: A NATIONWIDE TRAINING INITIATIVE The Trauma Center at Justice Resource Institute1, Musicaro, R., Spinazzola, J., van der Kolk, B., Procopio, S., Yarrow, A; University of Connecticut Health Center Child Trauma Clinic2, Ford, J.; My Life, My Choice3, Grace, L.G.; Washington State University, Blodgett, C.; University of Chicago Pritzker School of Medicine4, Stolbach, B.; Enlace Chicago5, Bocanegra, K.; Drexel University College of Medicine6, Rich, L.; Alaska Child Trauma Center7, Arvidson, J. VI. Responding to Polyvictimization • For Educators: • Introduce screening of caregiver and child as a key organizational change and universal practice. • Increase staff engagement, consultation, and professional development in trauma. • Start the conversation making explicit the link between social/emotional development and academic outcomes, school readiness, and school success. • Polyvictimization is significantly a trans-generational problem- parents and children need to be the focus of care. • Create anti-violence initiatives and LGBTQ-inclusive curricula and policies to reduce hate violence and harassment. • View teachers as mentors and attachment resources, and schools as sanctuaries to reduce risk of continued traumatization. • Attorney General’s Task Force Recommendations: Develop and implement policies that aim to keep children in school rather than relying on policies that lead to suspension and expulsion and drive children into the juvenile justice system. • NCTSN educator toolkit, PFA for Schools Massachusetts Advocates for Children and policy actions. • For Healthcare Providers: • Consider the impact of trauma on health or symptoms. • Screen for Sexually Transmitted Infections. • Regularly screen for injection drug use. • Provide sex-education and risk-reduction messages for adolescents. • Regularly screen for victimization and domestic violence. • For Law Enforcement and Justice System Professionals: • Increase awareness of the connection between child maltreatment and delinquency. • Use NCTSN Bench Cards as guidelines for trauma-informed judges (www.NCTSN.org). • Utilize trauma-informed questions to identify children who need trauma-informed services from a behavioral health professional. • Ensure that all important figures are present in court and legal cases: have complete information from all systems affecting child. • Abandon correctional practices that traumatize individuals further and reduce opportunities for them to become productive members of society. • Help, do not punish, victims of sex trafficking. • Enact policies that prohibit police profiling, inclusive of race, sexual orientation, gender identity and expression. • End provision of “mutual restraining orders”. • For Mental Health Professionals and Social Workers: • Focus on improving family relationships and intervening early. • Routinely screen for abuse and victimization in youth and adults. • Advocate for implementation of policies that address bias-based discrimination and victimization. To reference this poster, please use the following citation: Musicaro, R., Spinazzola, J., van der Kolk, B., Procopio, S., Yarrow, A, Ford, J.,…Arvidson, J. (2014, May 28-31). Psychological trauma: Neuroscience, attachment, and therapeutic interventions. Poster presented at 25th Annual International Trauma Conference, Seaport World Trade Center, Boston, MA. This product was supported by grant number 2012-VF-GX-K009, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.