trauma informed care - arizona state university · trauma-informed care has been recognized by...

Trauma Informed Care

Presented by Kelly TannerProgram Director, Harbor House928-718-0442Kelly@azyp.org

Purpose of the Training

To train organizational leaders and staff to support and partner with other staff members at multiple levels of an organization in a cohesive effort to implement a Trauma Informed Care model of prevention and intervention services.

Learning Objectives

Participants will learn or refresh their knowledge of basic concepts related Trauma Informed Care. Topics of focus will include definitions; signs of trauma; related behavior; effect of trauma on youth and families.

Understanding the need for the training

• People who care may not have the skills to do so as effectively as they think or would like.

• The way we demonstrate care for others can prevent progress and can unintentionally cause increased anxiety and fear in survivors of trauma.

• One voice within an organization is not sufficient to promote and maintain an environment of respect and care.

• Remembering we are not effective unless we are whole ourselves.

“Trauma”

Any injury whether physically or emotionally inflicted. May cause any level of distress, shock or pain and may result in lasting mental and physical effects.

Traumatic Event - The specific incident that may result in symptoms, either physical, mental or emotional.

In Trauma-Informed Care, we tend to reference individuals as those who have survived a traumatic event as “survivors” rather than labeling the individuals as “traumatized” or “victims”. Note that the term victim is utilized in legal circles on an ongoing basis.

PTSD

PTSD Diagnostic Criteria • Re-experiencing the event • Avoiding the stimuli and numbing of

responsiveness • Increased arousalMood DisordersPersonality DisordersComplex Trauma***

Types of Trauma

Personal ProfessionalFamilialEnvironmentalSystemicOrganizationalHistorical

Why do people respond differently?

Pre-event factors

Event factors

Post-event factors

Personal characteristics

Pre-Event Factors

• Previous exposure to trauma or child abuse• Level of coping skills• Previous Mood or Anxiety Disorders• Family stability or instability • Family history of criminal behavior • Trouble with authority • Presence or absence of social support • Age at the time of the event – under age 25• Level of support

Event Factors

• Geographic nearness to the event • Level of exposure to the event • The event’s meaning to the victim • Being a survivor of multiple traumatic events • Duration of the trauma • The existence of an on-going threat• Societal response (media, perception, legal

issues, etc.)

Post Event Factors

• The absence of social support• Lack of available services• Legal implications • Not being able to do something about

what happened • Being passive rather than active• Inability to find meaning in the

experience

Personal Characteristics

• Internal control factors • Resiliency• Self-efficacy • Intelligence • Sense of coherence• Strength (physical and emotional)• Motivation to deal with the trauma• Optimistic attitude • Personal beliefs

Impact of Trauma

I. AttachmentII. BiologyIII. Affect and Impulse Regulation IV.Dissociation V. Behavioral ControlVI.Cognition VII.Self-Concept VIII.Systems of Meaning/ Sense of Purpose and

Meaning in Life

Attachment

• Healthy or insecure attachment • Inability to trust • Social isolation• Difficulty attuning to others• Exploitation or abuse by others

Biology

• Sensorimotor developmental problems• Hypersensitivity to physical contact• Somatization• Increased medical problems• Problems with coordination and balance • The Inability to feel pain while conscious

Affect and Impulse Regulation

• Difficulty with emotional self-regulation• Intense affect easily triggered • Difficulty describing feeling • Problems describing internal states• Difficulty communicating desires• Excessive risk taking and self destructive acts • Suicidal ideation

Dissociation

• Apathy• Inability to feel for others• Sense of separating or “away-ness”

for periods of time• Loss of time (minutes, hours or

days)

Behavioral Control

Poor impulseSelf-destructive behavior

Aggression against othersSleeping and eating disorders

Substance abuseExcessive compliance

Oppositional behaviorResistance

Cognition

• Problems focusing on and completing tasks• Difficulty planning and anticipating • Learning difficulties • Difficulties in attention regulation and executive

functioning • Problems with language development• Problems with being oriented to time and

space

Self-Concept

• Lack of a continuous, predictable sense of self

• Sense of ineffectiveness • Feeling permanently damaged • Poor sense of separateness• Low self-esteem • Shame and guilt • Disturbances of body image

Systems of Meaning

• Lack of belief in a positive or full future

• Hopeless and pessimistic attitude• Problems sustaining beliefs• Sense of no purpose in life• Crisis of faith

Family Impact

• Loss and grief• Separation and divorce• Domestic violence• Economic challenges due to loss of work,

etc. • Home environment• Runaway and/or homeless episodes• Legal issues including immigration

Impact on Health

• Adverse Childhood Experiences Study (ACES) • A major American research project that poses

the question of whether, and how, childhood experiences affect adult health decades later (Kaiser).

• It documents the conversion of traumatic emotional experiences in childhood into organic disease later in life.

ACES Pyramid

Behavioral and Cognitive functionsof the prefrontal cortex

• Controlling impulses• Inhibiting inappropriate behavior• Initiating appropriate behavior • Stopping an activity upon completion • Shifting behavior when situations change• Providing a temporary mental workspace for

working memory

On the Brain

• Neutral memories are stored in the left side of the brain (logic).

• Traumatic memories are stored in the right side of the brain (emotion).

• When stressful events occur, the memories are stored in the right (emotional) side of the brain.

• In order to process that event, our brain allows us to access “safe” images and memories from the left (logic) side of the brain.

• The corpus callosum allows the two halves of the brain to communicate with each other.

Trauma Specific Interventions

“Trauma-specific interventions are designed specifically to address the consequences of trauma in the individual and to facilitate healing. Programs generally recognize the survivor’s need to be respected, informed, connected, and hopeful regarding their own recovery; the interrelation between trauma and symptoms of trauma (e.g. substance abuse, eating disorders, depression, anxiety, etc.); and the need to work in a collaborative way with survivors (and also with family and friends of the survivor) and with other human services agencies in the manner that will empower survivors and consumers.”

SAMHSA

Evidence-Based?

Trauma-Informed Care has been recognized by SAMHSA as an evidence-based intervention philosophy.

There are numerous models of Trauma-Informed Care.

Organizations may choose to operate from a Trauma-Informed perspective and/or select a specific intervention model appropriate for specific services.

National Center for Trauma-Informed Care http://mentalhealth.samhsa.gov/nctic/default.asp

Trauma-Informed organizations, programs and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization.

Trauma-Informed Services

1. Take the trauma into account .2. Avoid triggering trauma reactions and/or traumatizing

the individual.3. Adjust the behavior of staff and the organization to

support the individual’s coping capacity.4. Allow survivors to manage their trauma symptoms

successfully so that they are able to access, retain and benefit from the services.

(Harris & Fallot)

Core Principles of TIC

• Safety (physical and emotional)• Trustworthiness• Individualized• Collaboration• Forward Thinking• In Context

(Fallot & Harris, 2006)

Building Trust

Trauma Informed Care & Positive Youth Development

For programs that provide services to youth, it is critical to remember that there is strong alignment with the approaches of Positive Youth Development.

Specifically:IndividualizedStrengths-basedPartnershipServices, Opportunities and Supports

Thank you for all of your –• Hard Work• Enthusiasm• Willingness to make a

Difference!