ATTACHMENT/TRAUMA

Occupational therapy practitioners can serve an important role in addressing trauma at the universal, targeted, or intensive levels of intervention.

Therapists can adopt a bottom-up, a top-down or a mixed directional approach to clients’ assessment, it is important to be cognisant of both assessment approaches and the implications associated with each. Occupational therapists should decide which assessment direction is the most appropriate so as to ensure the provision of high quality, and client-centred service.

Image by Artur Aldyrkhanov

Children who have experienced complex trauma need environments and opportunities to regain a sense of personal safety, competence, and pleasurable connection to others. Safety, predictability, and “fun” are essential ingredients for helping a child to be “in the moment” where all learning, skill development, and healing happen (van der Kolk, 2005). Because occupational therapy practitioners have specialized training in task analysis and environmental modification, they can optimize the child-environment-occupation fit to enable successful activity engagement and social participation.

Traumatized children have difficulties handling emotions, sensations, stress, and daily routines. They often feel hopeless, worthless, and incompetent (van der Kolk, 2005). Occupational therapy practitioners work with other disciplines to structure environments, teach cognitive strategies, and develop social and emotional
skills that promote self-regulation, competence development, trust building and confidence, and resilience through participation.

In the Home, occupational therapy practitioners work with caregivers to create predictable routines. Children who experience trauma often feel out of control. Practitioners provide opportunities in the home that are predictable and routinized, and that allow the children to have a sense of control. They can also create structured daily routines, promote safe family activities, and support self-regulation, including addressing sleep and eating issues.

Children who experienced trauma in early childhood often have difficulty developing healthy attachments to caregivers. Occupational therapy practitioners who understand attachment theory work with caregivers to create a healthy attachment and encourage bonding through developmentally appropriate childhood occupations. As attachment is a co-regulation process the therapist has to be mindful of the parents / carers sensory attachment profile. Regulation will not occur if either the child or the parent / carer is over or under-regulated.

In School, occupational therapy practitioners promote social interactions among peers and support the teachers to create a safe and nurturing environment that enhances learning. They help educators and staff understand the impact of trauma on learning and identify supports, create an environment that promotes self-regulation and predictability, and help establish an environment to secure the child’s trust.

The ability to reliably analyse and interpret either sensory or attachment behaviour is highly specialised and requires years of post-graduate training and experience. There is a growing recognition that a transdisciplinary approach is needed when working with families.

Occupational therapists with training in trauma and sensory-based interventions are qualified to:

  • Provide trauma-informed sensorimotor arousal regulation interventions in collaboration with mental health professionals (LeBel & Champagne, 2010; Warner, Spinazzola, Westcott, Gunn & Hodgdon, 2014;).

  • Teach children mindfulness strategies to reduce stress and to cope with overwhelming emotions.

  • Provide environments and opportunities intentionally designed to increase a traumatized child’s sense of mastery, connection, and resiliency.

  • Provide opportunities for play and social interaction to facilitate the development of likes, interests, and motivators.

In order to support the Promotion of Childhood Trauma such as:

  • Raise awareness about the occurrence and impact of child trauma.

  • Create a culture of nonviolence through promoting positive behaviours.

  • Foster children’s interests in healthy and safe play and leisure occupations.

  • Teach children positive coping skills, relational skills, and problem-solving skills.

  • Model and teach staff and adults who serve survivors of trauma principles of emotional regulation and co-regulation.

And Support the Prevention of Childhood Trauma

  • Recognize signs and symptoms of trauma.

  • Provide group-based interventions focused on self-regulation and sensory modulation, as well as self-efficacy.

  • Use self-awareness techniques to teach children emotional regulation strategies.

  • Educate parents and teachers about healthy discipline, including the use of positive behavioural supports and ways to effectively deal with crises.

Components of the Safe Place model diagram

Physiological Regulation

Physiological regulation refers to children’s capacity to regulate their bodily processes. Very early on, children are working on organizing their sleep-wake and elimination cycles and body temperature. Children demonstrate the emerging ability to regulate their physical processes in order to meet both their internal needs and external demands in accordance with social and cultural contexts. Within this system, our patterns of relating to the world and our reactions to fear are established. The sympathetic nervous system (SNS) functions like a gas pedal in a car. It triggers the fight-or-flight response, providing the body with a burst of energy so that it can respond to perceived dangers. The parasympathetic nervous system (PNS) acts like a brake. It promotes the "rest and digest" response that calms the body down after the danger has passed.