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花一点时间思考你在与孩子一起工作时挣扎的时间。也许孩子觉得烦躁，没有关注或与其他孩子争论和战斗。想想展示这些行为的孩子如何被标记为“困难的孩子”或“坏孩子”以及如何影响他们对自己，他们的能力以及别人如何看待他们的方式。

作为一名护理者，您在塑造孩子在家庭环境之外的初始体验方面发挥着重要作用。虽然与表现出挑战性行为的孩子一起工作可能很困难，但重要的是要退后一步，考虑其他可能会导致你在你的环境中经历的行为的因素。有关与表现出挑战性行为的儿童合作的更多信息，请回顾虚拟实验室重点主题课程，yabo11vipyabo11vip支持有挑战行为的儿童。

最近，您可能已阅读或听到“创伤创新的护理”一词或“创伤敏感学校”。创伤知识的护理与使用幼儿一起使用的个人特别相关。The federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) defines “trauma-informed care” as an approach that is grounded in understanding and responding to the impact of trauma in a way which focuses on the strengths of the survivor and prioritizes the physical, psychological, and emotional safety for all involved (2014).

创伤知识的护理旨在帮助创伤的幸存者在他们的环境中感到安全，安全，并鼓励和建造幸存者的机会重建他们生活中的控制权和赋权。为了纳入创伤知识的方法，有必要了解创伤以及创伤的幸存者可能会如何处理他们的经历。

我们可能会认为创伤是影响个人儿童或家庭的创伤，但是，重要的是考虑在社区一级发生的创伤。约翰霍普金斯城市健康研究所表示，整个社区通过压迫，种族歧视，普遍贫困或邻里暴力的经验忍受创伤。由于创伤发生在这些各种水平并且在多种环境中，因此创新的小心事件开始出现在刑事司法系统，学校和医疗保健设置（2013）等领域。

Another assumption we may have regarding trauma is that it occurs as a single, one-time event that a survivor has witnessed or experienced. However, trauma is complicated and can be experienced in several ways. Trauma can beacute, appearing as a single one-time event such as a home burglary or a serious car accident, or it can be慢性的, occurring repetitively and over an extended period of time. Chronic trauma may include exposure to war, repetitively witnessing community violence, or extended displacement from a natural disaster.

复杂的traumaadds an additional layer to traumatic experiences and is considered to be especially invasive and disruptive to a child’s development. Complex trauma consists of varied and multiple traumas and often stems from experiences with trusted caregivers in early childhood. Children that have been neglected, or emotionally, sexually, or physically abused may be dealing with complex trauma.

复杂的心理创伤可以对年轻人尤其有害children because it occurs within the caregiving system, or with the individual that is supposed to be a source of safety and stability in a child’s life. Complex trauma in early childhood can interfere with a child’s ability to form a secure attachment to a caregiver. Attachment theory suggests that children’s early experiences with their primary caregivers are critical and have a lasting impact on children’s lives (Bowlby, 1969). Children that struggle to form a positive secure attachment to their caregivers within the first few years of life due to complex trauma may have difficulties forming healthy intimate relationships or establishing and maintaining healthy boundaries in adulthood. For more information on attachment theory in early childhood, see these Virtual Lab School lessons in the婴儿幼儿轨道：认知发展课程三节andSelf and Cultural Understanding Lesson One。

Trauma in Families

创伤可能发生在不同的层次，并由个人、家庭和整个社区经历。有些家庭承受着各种潜在的创伤情况或经历。例如，父母离婚、监禁家庭成员或诊断晚期疾病都有可能成为家庭的创伤经历。一些家庭可能面临的另一种普遍的创伤经历是无家可归，估计有130万儿童在美国某一特定时间遭受无家可归。慢性无家可归对幼儿可能造成创伤，并使他们面临其他创伤经历的危险，并可能对他们的发展产生不利影响。有关无家可归特别会对您工作的儿童和家庭产生影响的更多信息，请在本课程结束时查看参考资料和资源部分。想想布兰妮的故事：

请记住，家庭令人难以置信的弹性，并且在体验创伤时可以作为彼此的重要支持来源。请记住，创伤可能会发生各种级别，而且不仅经过个体儿童而经历，而且也可能影响家庭或社区。

创伤的症状

每个孩子都是独特的经历和处理创伤。由于儿童流程经验没有标准或预期的方式，因此儿童可能会或可能不会证明的广泛的认知，社会，情感或身体症状。

为了了解儿童可能在暴露于创伤后表现出的症状范围，有必要考虑孩子的发展阶段。孩子们在其生命的第一年以惊人的速度发展，每个人都具有独特的挑战和重要的发展里程碑。创伤的一些症状可能会影响所有年龄段的儿童，而不考虑到发展阶段。例子包括进食或睡觉，噩梦，愤怒或愤怒，不合理的恐惧或异常强烈的惊吓反应的重大变化。其他症状可能与某些发育阶段相关联。

The following list identifies common symptoms that children may exhibit following exposure to trauma, broken down by developmental stage. It’s important to note that not all children exposed to trauma will experience these symptoms and several of the symptoms listed can be part of typical development or unrelated to trauma. When considering the symptoms that survivors of trauma may experience, it’s important to consider the severity of the symptoms and the impact these symptoms can have on the everyday lives of children and their families.

虽然有一系列症状，儿童可能表现出由于创伤，但程序员工看到的最常见症状是：刺眼，焦虑，烦躁，冲动，难以集中，侵略和挑战性行为。暴露于创伤可以表现为挑战性的行为，这是对工作人员的压倒性和令人沮丧的行为。重要的是要记住孩子使用行为作为一种沟通形式，而且由于他们所经历的创伤，他们可能表达困难或挑战性的行为。了解创伤可能对儿童发展和行为的影响是至关重要的，以便您可以对其需求进行敏感和敏感。有关了解和响应具有挑战性行为的更多信息，请参阅VLS重点主题课程：yabo11vip支持ing Children with Challenging Behaviorand儿童与青年的性发展与行为。

创伤压力

When we encounter a stressful situation, our bodies react to protect us from the perceived threat; you may have heard this referred to as the “fight or flight” reaction. It’s normal for our bodies to increase heart rate, begin to sweat, or become hyper-alert following a situation we believe to be dangerous. These immediate physiological reactions return to normal once we feel that the danger has passed. However, some children that have experienced trauma can have longer-lasting reactions that interfere with their daily lives and their physical and emotional development (NTCSN, 2003).

持久创伤的儿童处于发展儿童创伤压力的风险增加。国家儿童创伤应力网络描述了创伤压力作为对创伤的反应，这显着干扰了孩子的功能和完成日常活动的能力。具有创伤压力的儿童可能会体验重大症状，例如强烈的情绪不安，抑郁或焦虑，严重的行为变化，注意力困难，以及进食或睡觉的问题。

多年来，与创伤有关的疼痛可能持续存在。创伤的提醒，如人，地方，物品，嗅觉或纪念品，可能会带来与创伤相关的困难或强烈情绪，并且可以在一定程度上进行预期。例如，当以某种方式提醒过去的创伤事件时，通过见证家庭暴力可能会遇到激烈的焦虑的成年人（例如，成年人彼此大吼大叫或看到个人吼叫），或者看到个人受到震惊或看到个人受到击中）。

While trauma can be a life-altering experience, not all children develop traumatic stress that interferes with their daily lives. In fact, there are several factors that can influence the severity of symptoms that children may experience. The National Child Traumatic Stress Network outlines several factors that may affect the way a survivor may process or experience the trauma.

Severity of the event	活动有多严重？孩子或他们喜欢受伤的人有多糟糕？有没有人去医院？警察涉及吗？孩子是否与护理人员分开？家庭成员死了吗？
接近事件	孩子们实际上是在活动发生的地方吗？他们看到这个活动发生在某人身上还是他们是受害者？他们在电视上看了这个活动吗？他们听到有人谈论这个活动吗？
照顾者反应	家人是否相信孩子正在讲述真相？护理人员如何应对孩子的需求，他们是如何应对这一活动的？
创伤的之前的历史	被重复暴露于创伤的儿童更有可能开发创伤应激反应。
Family and community factors	文化、种族和种族的儿童,他们的足总milies and communities can be a protective factor.

虽然有几个因素可能会增加孩子发展创伤应激症状的风险，但也有各种各样的保护因素这有助于鼓励健康应对和缓冲措施，免受与创伤相关的有害和持久症状。家庭或社区内的一些重要保护区因素可以帮助促进生存创伤的儿童的恢复力或愈合，包括强大的文化身份，稳定的住房，经济稳定，获得医疗保健，与支持性信仰界的隶属度以及与家庭的联系和朋友介绍未经暴力组织的期货。考虑玛丽亚和她的家人的保护区：

作为一个看护人和教育者，您在帮助儿童开发恢复能力方面发挥着重要作用，以便更好地保护它们经历与暴露于创伤相关的有害症状。通过在您的环境中使用创伤知识的护理，您可以帮助孩子感到安全，建立信任，并在您的房间里有声音和选择，所有这些都支持健康的应对，并促进接触创伤后的恢复力。

评估创伤：ACE研究

一个著名的研究,探讨了far-reaching impact of exposure to trauma during childhood is The Adverse Childhood Experiences Study (ACE). The ACE study is one of the most expansive investigations to date and explores the connection between adversity in childhood and later-life health and well-being (Centers for Disease Control and Prevention, 2016). In 1995, the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente collected data from over 17,000 individuals in California. The participants of this study were asked to complete surveys about their childhood experiences as well as their current health statuses. Findings from this study suggest that adverse childhood experiences are common—nearly 2/3 of participants reported at least one ACE and more than 1 in 5 participants reported enduring three or more ACEs during childhood (CDC, 2016).

虽然没有孩子可能会经历的每一个王牌的完整列表，但ACE研究中确定的不利童年经历包括以下创伤事件的例子：

• 身体虐待
• 性虐待
• 情绪虐待
• 身体忽视
• 情绪疏忽
• 见证亲密的合作伙伴暴力
• 目睹你的母亲以暴力的方式对待
• 家庭内的物质滥用
• 家庭精神病
• 父母分离或离婚
• 被监禁的家庭成员

Aces在整个寿命中的影响

ACE研究的调查结果表明，童年更不利的经历个人持久，其成年期间健康和社会问题的风险越高。当孩子们有ACE时，它可以创造变化和结果，包括：

• Disrupted neurodevelopment

  当孩子们从创伤中经历极度压力而没有支持效果的支持，它会改变大脑如何发展。压力导致身体释放更多的皮质醇，当升高与健康问题相关时的激素。

• Social emotional and cognitive impairments

  The parts of the brain that control decision-making, impulse control, and processing of emotions may develop differently in children who have experienced trauma. These children may need more help developing relationships with others and may require specialized strategies or more help and time to learn new skills.

• 采用健康风险行为

  患有较多的ACE的人可能更容易发生健康风险行为，如药物和酒精滥用，身体不活跃，吸烟和无保护性行为。

• 疾病，残疾和社会问题

  ACEs are also associated with more health and social issues including heart disease, cancer, depression, unintended pregnancy, and poor academic achievement.

• 早期死亡

  一个人的ACE数量与其预期年龄有关。这意味着，与ACE较少的人相比，ACE数量越高的人死亡越年轻。

After learning about Laci’s story, it’s important to remember that although adverse childhood experiences can have significant effects on one’s life, strong relationships are an important protective factor. Children are resilient and although some may experience significant ACEs, family and community supports can help children better cope with these experiences and disrupt an otherwise negative trajectory. In the next lesson, you will learn more about the role you and your program play in supporting children and youth through adverse experiences to promote resilience.

See

Listen as experts on trauma-informed care discuss trauma and its effects on children and youth, adverse childhood experiences, and the importance of building resilience through relationships. Are there children and youth in your program who have experienced trauma? How does your program support the development of resilience?

创伤知情护理概论

不利的童年体验和创伤生活事件

通过关系建立弹性

做

完成本课程

参观创伤知识护理课程指南有关本课程内部期望的更多信息，以及随附的学习，探索以及在整个课程中提供的资源和活动的列表。

请注意每节课末尾的参考资料和资源部分，概述参考资料来源和资源，以查找有关所涵盖主题的更多信息。当你完成课程时，你不需要查看所有的在线参考资料。但是，如果您感兴趣，或应培训师、教练或管理员的要求，欢迎您进一步探索资源。