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    Complex Trauma & TBRI

    In this article from the National Library of Medicine, they seek to elucidate the impact of trauma among children and youth who have experienced foster care or institutionalization. Harvard University, in 2005, released data confirming that children in the U.S. foster system experienced trauma in the form of post-traumatic stress disorder (PTSD) at a rate more than twice that of combat veterans (Pecora, White, Jackson, & Wiggins), making this a particularly vulnerable population of children and youth.

    A trusted adult holding a child's hand
    trusted adult and child

    Early trauma and stress can have a lasting effect on development, triggering delays in social competence (Becker-Weidman, 2009), development of dysfunctional coping behaviors, and significantly altering a child's brain chemistry, particularly when the adverse condition is chronic and there is a lack of nurturing support (Bremner, 2003; Carrion, 2006).


    For many adopted and foster children, these dysfunctional behaviors create barriers to the development of healthy relationships in new family environments, and without intervention, problem behaviors tend to persist and intensify into adolescence (Verhulst, 2000). These children have been victims of "complex trauma,” resulting from multiple, diverse psychologically overlapping incidents (e.g., chronic sexual abuse, physical abuse, or even ongoing painful medical procedures induced by a chronic medical condition). Children and youth suffering from complex trauma most often exhibit disorders related to attachment systems, affect regulation, physiology, dissociation, behavioral control, cognition, and self-concept (Cook, Blaustein, Spinazolla, & van der Kolk, 2003). These types of disorders can lead to a variety of diagnoses typically treated with a combination of different approaches.


    There are three factors, first identified by van der Kolk (2005), and later discussed by Bath (2008) as the three main “pillars” that should be included in any program designed to treat complex trauma. These are (a) development of safety, (b) promotion of healing relationships, and (c) teaching of self-management and coping skills. These elements parallel the three evidence-based principles of Trust-Based Relational Intervention (TBRI) developed at the Texas Christian University Institute of Child Development.


    The three TBRI principles are:


    1. Empowerment—attention to physical needs;


    2. Connection—attention to attachment needs; and


    3. Correction—attention to behavioral needs.


    These principles help both caregiver and child learn healthy ways of interacting so both are able to play a role in the healing process.


    The TBRI empowering principles address the ecological (external/environmental) and physiological (internal/physical) needs of the child. By ensuring these basic needs are met, the effectiveness of the connecting and correcting principles are greatly improved. Second, the connecting principles address relational and attachment needs, focusing on awareness, engagement, and attunement. Third, the correcting principles teach self-regulation and appropriate boundaries, and promote healthy behaviors for caregiver and child


    To read the article in full and learn more about the 3 TBRI principles go to the National Library of Medicine.

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