This presentation was part of Embody's Safe Healthy Strong 2015 conference on sexuality education (www.ppwi.org/safehealthystrong). Embody is Planned Parenthood of Wisconsin's education and training programs. Learn more: www.ppwi.org/embody DESCRIPTION Attendees will learn about the impact of trauma on the emotional brain and how it in turn impacts adolescent sexual behavior and decision making. Attendees will learn how to interview, intervene, and be pro-active with these youth during annual health exams, sex education in schools, and general conversations/interventions around sexual behavior. Specific examples of proactive provision of safety strategies for vulnerable youth will be provided by a trainer with extensive experience. ABOUT THE PRESENTERS Lora Schroeder, MSW, LCSW-Clinical Case Manager, is a Licensed Clinical Social Worker who holds a Bachelor’s degree in Psychology and a Master’s degree in Social Work from the University of Wisconsin-Milwaukee. She has over 20 years of clinical experience with chronically mentally ill adults, children and families. Lora worked for Transitional Living Services in Milwaukee, working intensely with adult mental health clientele and helped develop and facilitate this program in Ozaukee County as well. Lora spent over three years at Washington County Department of Social Services, placing children into treatment foster care and conducting family court appointed custody studies. During her 15 years at Community Care Resources, Lora has provided on-going clinical case management services for youth in treatment foster homes, and group and individual therapy with children in the specialized group care homes, providing STOP (Adolescent Sexual Offender Program) therapy as well as attachment work. Lora currently provides Trauma Focused Cognitive Behavior Therapy to clients who have severe trauma histories. Jamie Heinen, MSSW, has been employed with Community Care Resources for seven years. She received her Master’s degree in Social Work from UW-Madison in 2006 and is currently licensed as an Advanced Practice Social Worker. Jamie has spent her entire social work career working within the Child Welfare System, specifically working with foster parents and youth in out-of-home care placements in a variety of settings and has a wealth of knowledge in this area. Her six years working for Milwaukee County gave her ample experience advocating for and restoring youth and families. In addition to pursuing her LCSW, Jamie recently earned her Equine Specialist in Mental Health and Learning Horsemanship Certification. Joy Nyhuis-Wing, LCSW, earned her MSSW at Loyola University of Chicago and has worked with children, adolescents, and their families in a professional capacity since 1994, including case management, individual and family therapy, in-home therapy, and group counseling. As a Clinical Case Manager over the past 17 years, she has provided numerous trainings to foster parents.

1. Impact of trauma on the
emotional brain and resultant
sexual behavior.
Lora Schroeder, Joy Nyhuis-Wing, Jamie Heinen.
Community Care Programs
6716 Stone Glen Drive
Middleton, WI 53562
lora@communitycareresources.com; joy@communitycareresources.com; jamie@communitycareresources.com

2. Disclaimers
1. The goal of this workshop is to start a conversation about stress and trauma
and how to identify and manage it in the clinic or treatment setting.
2. One size fits one. What works for one client or consumer, may need
‘tweaking’ for another.
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3. What is Trauma?
• Trauma is defined as an event or series of events that happens to
you or someone you love.
• The events are perceived as dangerous, uncontrollable and trigger
intense fear, helplessness or horror.
• A tornado hits your home
• Living with a drug addicted parent who never has food in the
house and yells at you all the time.
• Living in a home where there is domestic violence.
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4. Developmental Trauma
• It is usually the person’s experience
of the event, not the event itself
that is traumatizing
• Developmental trauma events are
often interpersonal in nature and
happen early in a person’s
life/caregiving experiences.
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5. Exercise #1
• List the traumas that your clients have experienced
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6. Wisconsin & Adverse Childhood Events
(2011-2012)
• 58% experienced at least 1 ACE in childhood
• 14% experienced at least 4 ACEs
• Results
• Emotional abuse – 29%
• Physical abuse – 17%
• Sexual abuse – 11%
• Violence between adults in household – 16%
• AODA in household – 27%
• Untreated mental illness in household – 16%
• Separation/divorce of parents – 21%
• Incarcerated household member – 6%

7. Stressors v. Traumas
• Stressors = Traumas when the stressful experience is:
• recurring, unremitting or exceeds the coping capacity of the youth
• Coping capacity =
• Coping skills + a Supportive Environment in which to demonstrate those
skills
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8. • Trauma affects people in different ways depending on the age and
developmental level at which the traumas occurred
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9. • Traumatic experiences early in development make it
harder to learn more sophisticated and mature behaviors
later on because the supporting neurons are not available
No stable base for future development
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10. 3 Important Brain Development Principles
Brain Principle #1
The brain grows from the
bottom up. Starting with
the most basic instincts
needed for survival. Then
getting more and more
complex as one
accumulates experiences.
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11. © CommunityCarePrograms, 2014 11
• Think about when the trauma occurred in a child’s life
and ask:
“what social, emotional and cognitive skills might not
have developed because of the traumas?”

12. Advantages of Brain Language
• Talking about the brain takes blame out of the conversation.
• Taking blame away increases emotional safety.
• Taking blame away opens hearts and minds to new possibilities.
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13. Areas of the Brain
• Hippocampus
• Associated with memory, organizing, & storing
• Amygdala
• Associated with emotional responses
• Prefrontal Cortex/Frontal Cortex
• Associated with motor functions, planning, reasoning, judgment, impulse control

15. The Emotional Brain 101
• All brains have 2 danger alarms called amygdalaes that live in the center of
the brain.
• These danger alarms function like smoke alarms, detecting danger/threat and
sending signals to the body to reduce harm and ensure safety.
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16. The Result?
• Amygdalae get bigger, while the hippocampi and parts of the Prefrontal
Cortex (PFC) shrink (McEwen, 2007)

17. The Result?
• Now we have a ‘perfect storm’ – over functioning Amygdalae
and under functioning Prefrontal Cortex and Hippocampi.
• Bigger amygdalae means more emotionally reactive.
• Smaller hippocampi mean less effective working memory skills.
• Smaller Prefrontal Cortex (PFC) means less effective affect
regulation, poor decision making, less problem solving skills.

20. Fight, Flight or Freeze
• When the danger alarms go off, they send signals that prepare the body for…
• Fight, flight or freeze.
• These signals make the heart beat faster and pump blood to arms and legs.
• The alarm signals release adrenaline and tell the gut to shut down and send its blood
to the arms and legs.
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21. Triggers for the Danger Alarms
• Each one of us has our own unique triggers.
• Triggers can be inside of us or outside.
• An inside trigger might be remembering your mother crying because your father
went to jail.
• An outside trigger might be getting an eviction notice from the landlord.
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22. • Ask the client what makes them distressed and label these experiences
as “triggers”
• Help them eliminate or avoid as many triggers as possible
• Help them create a “green plan” listing ways to feel better after being
triggered
Know the Triggers
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23. • A Re-enactment cycle is the person reacting in the same way to new or different
situations (eg. a script, pattern or habit).
• The person is reacting today as if the bad things from the past were still happening.
• eg. A teacher offers a mild reminder to re-focus and the youth yells back “You can’t
tell me what to do!”
Recognize Re-Enactment Cycles
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24. Balancing Emotions and Solutions
• Thankfully, we are not at the mercy of our emotional brains.
• We have other brain structures that have developed to help us solve
problems and conflicts…
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25. The Problem Solver
• The Problem Solver is also called the Prefrontal Cortex (PFC).
• Its job is to plan, organize and solve problems.
• It can help calm the danger alarms (Amygdalae) and figure out how to
make things better.
• If the Problem Solver is weak, it cannot help keep the danger alarms calm.
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26. Problem Solver’s Job
• One of the problem solver’s jobs is to calm, soothe and down-regulate the Danger
Alarms
• The Problem Solver needs practice in order to build a superhighway to the Danger
Alarms
• What kind of practice?
• Practice in calming the body and brain

27. Problem Solver Strategies
• Regular meditation and mindfulness
• Learning how to release tension by exhaling
• Repetitive motor activities like folding socks, walking side-by-side, bouncing, rocking
• Brain soothers like melodic music & calming aromas
• Distraction activities like playing video games, watching t.v., playing on the
computer
• Helping others

28. Problem Solver
• The Problem Solver needs practice in order to build a superhighway to the
Danger Alarms.
• Start with yourselves. If your Danger Alarms can stay calm, you will be
better able to help your clients.

29. Let’s Talk About Sex, Baby!
• How do I talk with kids about sex?
• Social Workers, therapists, youth ministers...people who work with
kids…struggle with this too!

30. Typical Sexual Behavior
• Sexually explicit conversation with peers
• Obscenities and jokes within the cultural norm
• Sexual innuendo and flirting
• Solitary masturbation
• Kissing, hugging, holding hands
• Foreplay with mutual informed consent and peer-aged
partner
• Sexual intercourse plus full range of sexual activity

31. Concerning Sexual Behavior
• Sexual preoccupation or anxiety
• Pornographic interest
• Promiscuity
• Verbally sexually aggressive themes or obscenities
• Invasion of others’ body space especially after re-
direction
• Risk factors from PSA tools

32. Safety Planning
In Home
At School
In the Community

33. Try Just-In-Time Interventions
• See the troubled behavior as the “tip of
the iceberg” with trauma memories,
worries and deficits lying below the water
line.
• Normalize problem behaviors by saying
“of course you’d behave this way, now let’s
help you try a new way.”
• Disclaimer: Know your youth. One size
fits one.
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34. Just-In-Time Interventions
• Depersonalize the negative behavior.
This is about all the people who have hurt
them before you.
• Normalize problem behaviors by
reminding yourself “of course they’d
behave this way, that’s how they’ve
survived”.
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35. Do the Opposite
• Respond with behaviors that are soothing and opposite to what the client expects
• Eg. If you believe that the client has experienced domestic or childhood violence,
respond with a quiet voice, downcast eyes and physically back up.
• Say, “I’m sorry that I don’t understand. I would like to help. Please tell me again
what you need.”
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36. Create a Sense of Safety with Body Language
and Words
• Use a calm but clear voice when asking a question.
• Talk softly and smile.
• Make gentle eye contact or look at the floor.
• Back-up or sit down – stay out of their bubble
• Reassure them that they are safe (eg. “I want to help you sort this out. Please
help me understand the problem.”)
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37. Ask Questions
• “Tell me what will help.”
• “ I am here to help. Let’s work together to solve this problem. Can you do
that?
• “Can you step into this treatment room with me, so we have some privacy?”
• “Can you start from the beginning so I understand what you want?”
• “Is there someone in your life who can help us sort this out?”
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38. • 1) Understanding the patient's perspective: Ask the patient what they
think is going on to engage them and gain an understanding of their fears
and worries.
• 2) Wait a bit longer to respond to a patient: When given the chance, a
patient will continue to explain themselves, their symptoms, thoughts or
concerns if you wait a few extra seconds to respond after they finish
speaking.
• 3) Explain their symptoms back to them: Paraphrase what they told you
to make sure you're understanding them

39. Manage Your Own Distress First
Take a moment to notice and name your own body sensations,
feelings and thoughts
Use brief mindfulness practices to calm yourself before
addressing the youth’s behavior
Resist anger and invite compassion for yourself and the student
– anger never solves anything well…

40. Just-In-Time Strategies for Adults
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• Count 10 exhales as you let your face relax
• Feel your feet on the ground or your ‘sits’ bones on the chair
• Assume the best
• Think out loud
• Summarize what you hear or see and ask for clarification
• Be aware of your 5 senses and what you see, hear, smell, feel and taste – this will slow you down
and give your PFC time to come ‘online’
• Postpone judgment

41. Practice breathing to relax. Or..
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42. Exercise #2 - Square Breathing
• Draw a large square on a piece of blank paper.
• Start in the upper left hand corner
• On the inhale, use a finger to trace the top line to the 2nd corner
• On the exhale, trace the line to the 3d corner
• On the inhale, trace the line to the 4th corner
• On the exhale, trace the line back to the first corner.
• Repeat
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43. Add Body Scan
• After you’ve practiced breathing relaxation for a while, add Body Scan
• Starting at the top of your head, imagine each body part relaxing and
releasing on the exhale. Work your way from the crown of the head down to
your toes
• Pay special attention to your eyes, teeth and jaws
• Spend extra time on the places you carry the most tension – eg. Shoulders,
neck or feet

44. • Introduce and practice it during calm times
• Use the colored zones for younger children and the numbers for
older youth
• Ask them for a rating before and after a discussion or interaction
• Remind them that being in the “yellow” zone simply means their
danger alarms are going off.
Use the Feelings Thermometer
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45. – 10 _______________________________________
– 9 _______________________________________
– 8 _______________________________________
– 7 _______________________________________
– 6 _________________________________
– 5 _________________________________
– 4 _________________________________
– 3 _______________________________________
– 2 _______________________________________
– 1 _______________________________________
Exercise #3: Feelings Thermometer
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47. Resources
1. https://www.healthcaretoolbox.org/index.php
2. A Trauma Informed Approach for Adolescent Sexual Health
3. by Joann Schladale, M.S., L.M.F.T.
4. Resources for resolving violence, inc.
5. The National Center for Trauma Informed Care http://www.nasmhpd.org
6. Trauma-Informed Care for Women Veterans Experiencing Homelessness: A Guide for Service
Providers http://www.dol.gov/wb/trauma/

48. 5. www.womenveteransconnect.org
6. Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult
Survivors of Childhood Sexual Abuse was researched and written by Candice L.
Schachter, Carol A. Stalker, Eli Teram,Gerri C. Lasiuk and Alanna Danilkewich
7. http://www.integration.samhsa.gov/clinical-practice/trauma
8. http://www.nctsnet.org/resources/topics/creating-trauma-informed-systems The
National Child Traumatic Stress Network
9. The National Center for PTSD ; Veterans Health http://www.va.gov/health/
http://www.ptsd.va.gov