adverse childhood experience (ace) · engagement phase tasks meet and begin building a relationship...

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Trauma Informed Care (TIC) and

Coordinated Services Teams (CST)

Lori Martin

White Pine Consulting Service

N3000 Rusch Road

Waupaca, WI 54981

(715) 258-5430

Email: [email protected]

Web: www.wicollaborative.org

Department of Health Services Southeast Regional Office

Waukesha, Wisconsin

Tuesday, March 24th, 2015

Scott Webb, LCSW

TIC Coordinator – Bureau of

Prevention, Treatment and Recovery

1 West Wilson, Room 850

Madison, WI

(608) 266-3610

[email protected]

Wisconsin Department of Health Services

Adverse Childhood Experience (ACE)

http://www.cdc.gov/nccdphp/ACE/

http://acestoohigh.com/

Wisconsin ACE Study

http://wichildrenstrustfund.org/files/WisconsinA

CEs.pdf

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National ACE Study

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ACE

Abuse

• Psychological (by parents)

• Physical (by parents)

• Sexual (anyone)

• Physical neglect

• Emotional neglect

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Household with:

• Substance abuse

• Mental illness

• Separation or divorce

• Domestic violence

• Imprisoned household

member


ACE Score = Trauma Dose

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Number of individual types of adverse

childhood experiences were summed:

ACE score Prevalence

0 32%

1 26%

2 16%

3 10%

4 or more 16%

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Original ACE Study Findings:

5


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Original ACE Study Findings:

4


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2011 Wisconsin ACE Study


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2011 Wisconsin ACE Study

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As ACEs increase, problems

increase:

• Alcoholism and alcohol

abuse

• Illicit drug use

• Risk for intimate partner

violence

• Eating disorders

• Multiple sexual partners

• Smoking

• Suicide attempts

• Chronic obstructive

pulmonary disease (COPD)

• Depression

• Ischemic heart disease

(IHD)

• Liver disease

• Sexually transmitted

diseases (STDs)

• Obesity

• Health-related quality of life

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A Comparison of Key Core Values

Coordinated Services Team

(CST) Initiative

Trauma Informed Care (TIC)

• Family-centered approach throughout

the process (voice, access and

ownership)

• Trustworthiness & Transparency

• Voice & Choice

• Empowerment

• Inclusiveness & Shared Purpose

• Ensuring Safety • Safety

• Strength-based • Resilience and Strength-Based

• Building resources on natural and

community supports

• Peer Support & Mutual Self-Help

• Collaborating across systems • Collaboration & Mutuality

• Gender/age/and culturally responsive • Cultural, Historical and Gender issues

• Promoting growth, learning and

recovery

• Change Process

• Providing unconditional care

• Oriented to meaningful outcomes

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Practicing by the Principles

� Family Involvement

– Family is involved in the planning at all times

– Family has voice, access, and ownership

� Collaborative/Team Practice

– Family and community supports, and service providers

working together to establish one plan

– Unconditional care in all systems involvement

� Individualized Plans

– Plans that are strength based, needs driven, individualized,

culturally competent, community based, and oriented to

meaningful outcomes

Collaboration with Families

� Voice: The child and parent have a voice in decisions

that are made.

� Access: The child and parent have access to needed

services and supports.

� Ownership: The child and parent agree with and

commit to any plan concerning them.

“Nothing about me without me”Quote from the National Mental Health Recovery Initiative

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The Referral Process

� Referring person and parent(s) complete Referral

Form

� Project staff reviews referral

� Referring person and project staff organize the

screening process, if necessary

• Referring person discusses referral to wraparound as

an option with the parent(s)

• Referring person discusses potential referral with

project staff

Enrollment in the CST Initiative

• Through the referral process, a family, the person making the

referral, and CST Initiative staff will determine if enrollment in

CST is appropriate.

• Once enrolled, a Service Coordinator will be identified to work

with the family and begin the process of developing the family’s

team.

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Engagement Phase Tasks

� Meet and begin building a relationship with the caregiver

� Explain the collaborative team process

� Address safety and immediate needs

� Gather perspectives on strengths and needs

� Begin Initial Assessment Summary of Strengths and Needs

� Begin to identify an emerging sense of mission

� Identify, invite and orient CST team members

� Arrange initial CST meeting

Individual and Family Culture

� Culture is defined as “the unique values, ideas, customs, skills,

arts, of a family or a people that are transferred, communicated

and passed along”

� “Culture” refers to the unique way an individual or family

operates and functions, including habits, characteristics,

preferences, roles, values, traditions etc.

� Sometimes we have difficulty identifying individual and family

culture or reflecting it in Plans of Care. Culture is much more

than ethnicity, language or food preferences. Without a quality

and thorough discovery of family culture, and without reflecting

that culture in the work of the team, plans are less likely to be

successful.

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Core Conditions in Engagement

� Genuineness– Being you

– Being consistent in what you say and do

– Communicating trustworthiness and acceptance

� Empathy– Communicate an understanding of and compassion for the

person’s experience

� Respect– Believing in the value of each person and the potential within

them

– Your ability to communicate respect in observable ways

Jodee Grailer-Liedtke

Qualifications for Team Involvement

To qualify for team involvement, individuals should:

– Have a role in the lives of the child and family

– Be supportive of the child/family

– Be supported for membership by the parent

– Be committed to participate in the process –

including regular team meeting attendance

– Participate in discussions

– Be involved in the Plan of Care

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Team Member Selection –

Family and Youth Voice and Choice

� The family and youth should be provided with support for

making informed decisions about whom they invite to join the

team, as well as support for dealing with any conflicts or

negative emotions that may arise from working with such team

members.

� The family and youth should be supported to explore options

such as inviting a different representative from an agency or

organization.

Source: National Wraparound Initiative – The Principles of

Wraparound; Chapter 2.1; Oct 1 2004

Psychiatrist

Social

Worker

Educator

Law

Enforcement

Nurse

Probation/

Parole

OfficerEmployment

Specialist

Vocational

Rehabilitation

Specialist

Service

CoordinatorTherapist

Formal Supports

Case Manager

Child Care

Provider

Veterans’

Services

Potential Team Members

Caregiver(s)

Relatives

Close

Friends

Neighbors

Religious

Community

Support

Groups

Tribal

Community

Advocacy

Groups

Natural Supports

Family

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Service Provider Orientation

• Explanation of the CST Process

• Role and Vision for the Family

• Perceived Needs

• Perceived Strengths

• Perception of What Works

Service Coordination:

Abilities for Effective Team Facilitation

� Ability to accurately listen

� Ability to communicate clearly

� Ability to develop trust of team members

� Ability to understand multiple perspectives

� Ability to intervene on ineffective behavior

� Ability to accept feedback without reacting defensively

� Ability to provide support and encouragement

� Ability to maintain and demonstrate patience

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Team Facilitation: Important Details

� Hold meetings when & where it is best for most

� Conduct regularly scheduled meetings

� Establish meeting time and end as planned

� Establish and follow an agenda

� Ensure that someone is responsible for taking and

distributing meeting minutes

Team Facilitation:

Promoting Participation

� Clarify team members’ roles, strengths, and goals

� Establish team guidelines

� Assure active and sincere participation by all team

member

� Identify “hidden agendas” and get them on the table

� Recognize and reward creativity, flexibility, and

volunteerism by team members

� Evaluate team member satisfaction with the process at

the end of meetings

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Child and Adolescent Needs and Strengths (CANS)

Youth Needs

• Trauma

• Life Functioning

• School

• Youth and Family Acculturation

• Youth Behavioral / Emotional Needs

• Youth Risk Behaviors

Youth Strengths

Current Caregiver Strengths and Needs

Identified Permanent Resource Strengths and Needs

Completing the CANS with the Family

Suggestions, Considerations, and Options

� Preparation

– Give the family an overview of the process

– Share information related to the CANS with the family, for

example, a copy of the narrative CST Assessment Summary –

CANS

– Gather relevant information

� Meet in an environment that is comfortable for the family

� Involve the youth, if possible

� Order of CANS Items – use your judgment and/or ask the family

where they feel most comfortable starting

� Try to focus on “the what”, try to redirect discussions about “the

why” or about planning

� Other suggestions and experiences….

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Developing Creative and Effective

Plans of Care

�Reach consensus on plan target needs

�Determine a measureable goal

�Determine objectives

�Determine tasks and activities

�Review and evaluate, make changes if

needed

White Pine Consulting Service, Inc.

Absence of a Plan for Crisis

� People are reactive rather than proactive

� People respond to crisis situations without

knowledge of the individual, and of what’s

worked and what hasn’t worked in the past

� In the absence of information about the

individual, best efforts may intensify the crisis

situation

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The Benefits of Planning for Crisis

� Reduces stress

� Provides safety

� Teaches skills

� Strengthens team

� Controls outcomes

Trauma

� Extreme stress that overwhelms a person’s ability to

cope and results in feeling vulnerable, helpless and

afraid

� Often interferes with relationships and fundamental

beliefs about oneself, others and one’s place in the

world

� May be witnessed or experienced directly

Source: Shift Your Perspective – Trauma Informed Care; Elizabeth Hudson, Wisconsin

Department of Health Services;

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Historical Trauma

� Collective and cumulative emotional and

psychological wounding across generations,

emanating from massive group trauma.

� Generates survivor guilt, depression, low self-

esteem, psychic numbing, anger, and physical

symptoms.

� Creates the community’s “soul mood” (Maria Yellow Horse

Brave Heart, PhD; Director of Native American and Disparities

Research, Center for Rural and Community Behavioral Health)

Source: Shift Your Perspective – Trauma Informed Care; Elizabeth Hudson, Wisconsin

Department of Health Services;

Triggers

� Something that sets off an action, process or series of events (such as fear, panic, upset, or agitation).

� Triggers can be internal and/or external

� Examples include:

– Lack of power or control

– Unexpected change

– Being touched

– Feeling threatened or attacked

– Feeling vulnerable or frightened

– Feeling shame

– Positive feelings or intimacy

Sources:

• Shift Your Perspective – Trauma Informed Care; Elizabeth Hudson, Wisconsin Department

of Health Services

• The Emerging Science of Trauma Informed Care – Kevin Ann Huckshorn, 2004

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Sensory ThalamusRelays sensory

and motor signals

Balance and

Orientation

Touch

Taste

Smell

Muscle

Coordination

SoundSight

HippocampusMemory, learning, and

emotions

AmygdalaEmotional Reactions

Very Fast

Response

slower

(LeDoux 1996)

The Effects of Trauma on

Decision Making

Trigger / Traumatic

Reminder

CortexThought, awareness, language,

memory, attention - regulates the

Hippocampus and Amygdala

Developing Plans for Crisis

� Consider strategies or interventions that have worked in the past

� Consider strengths of the family, youth, team, and community

� Discuss a process for evaluation of the Plan for Crisis

� Get signatures from individuals and agencies

involved in the plan’s development

� Discuss distribution and release of information

Source: The Emerging Science of Trauma Informed Care – Kevin Ann Huckshorn, 2004

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Planning for Transitions� Transitions to different setting

– New community

– New grade in school; different school

� Transitions from school year to summer

– Summer activities

– Childcare and/or respite

� Transition to different living environment

– Foster home

– Home of parent or caregiver

– Hospital or Residential Care Center

� Transition to “adulthood”

– Location of living status

– Educational/vocational options

� Transition out of the formal team process

– Voice, Access, and Ownership

When is a Team “Done”?

• Outcome indicators demonstrate that goals

are being met or in the process of being met

• Informal/natural supports are involved in

ongoing support to the family and youth

• Family and youth have access, voice and

ownership

• A plan for transition has been completed

Voice Access Ownership

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Alumni Involvement

� Informal Resource

� Advocacy

� Support Groups

� Coordinating Committee Membership

� State Committees / Policy-Making

www.wicollaborative.org

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