creating a trauma informed system al killen-harvey, lcsw the harvey institute...
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Creating a Trauma Informed System
Al Killen-Harvey, LCSW
The Harvey [email protected]
619-977-8569
Creating a Trauma Informed System
Al Killen-Harvey, LCSW
The Harvey [email protected]
619-977-8569
Goals and ObjectivesGoals and Objectives
1.Describe the attributes of the various forms of trauma
2.Delineate the essential elements of a trauma informed system
3.Identify current potential “trauma reminders” for clients in your organization/agency
What Is Trauma?What Is Trauma?
Witnessing or experiencing an event that
poses a real or perceived threat
The event overwhelms the individual’s ability
to cope
Witnessing or experiencing an event that
poses a real or perceived threat
The event overwhelms the individual’s ability
to cope
Event vs. Experience Event vs. Experience
Types of Trauma(Event)
Types of Trauma(Event)
Acute traumaAcute trauma
Types of Trauma(Event/Experience)
Types of Trauma(Event/Experience)
Chronic trauma
Chronic trauma
Types of Trauma(Experience)
Types of Trauma(Experience)
Complex trauma
Historical TraumaHistorical Trauma
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Historical Trauma Historical Trauma
• Collective and cumulative emotional wounding across generations
• Cumulative exposure to traumatic events that not only affects an
individual, but continues to affect subsequent generations
• The trauma is a psychological injury held personally and transmitted
over generations
Situations That Can Be Traumatic
(Events)
Situations That Can Be Traumatic
(Events) • Physical or sexual abuse/witnessing domestic violence • Abandonment, betrayal of trust (such as abuse by a caregiver), or
neglect • The death or loss of a loved one • Automobile accidents or other serious accidents • Bullying • Life-threatening health situations and/or painful medical
procedures/Life-threatening illness in a caregiver • Witnessing or experiencing community violence (e.g., drive by
shooting, fight at school, robbery) • Witnessing police activity or having a close relative incarcerated • Life-threatening natural disasters • Acts or threats of terrorism
• Physical or sexual abuse/witnessing domestic violence • Abandonment, betrayal of trust (such as abuse by a caregiver), or
neglect • The death or loss of a loved one • Automobile accidents or other serious accidents • Bullying • Life-threatening health situations and/or painful medical
procedures/Life-threatening illness in a caregiver • Witnessing or experiencing community violence (e.g., drive by
shooting, fight at school, robbery) • Witnessing police activity or having a close relative incarcerated • Life-threatening natural disasters • Acts or threats of terrorism
What Is Traumatic Stress?(Experience)
What Is Traumatic Stress?(Experience)
• The physical and emotional responses of a person to events that threaten their life or physical integrity or someone critically important to the them (such as a parent, child or sibling)
• Traumatic events overwhelm a person’s capacity to cope and elicit feelings of terror, powerlessness, and out-of-control physiological arousal
• Trauma is experienced as a series of traumatic moments each penetrating deep in the person’s psyche
• The physical and emotional responses of a person to events that threaten their life or physical integrity or someone critically important to the them (such as a parent, child or sibling)
• Traumatic events overwhelm a person’s capacity to cope and elicit feelings of terror, powerlessness, and out-of-control physiological arousal
• Trauma is experienced as a series of traumatic moments each penetrating deep in the person’s psyche
People Vary in Their Response to Traumatic Events
People Vary in Their Response to Traumatic Events
The impact of a potentially traumatic event depends on many factors, including:
• Genetic makeup• Age and developmental stage• Perception of the danger faced• Whether the individual was the victim or a witness• Relationship to the victim or aggressor• Past experience with trauma• Adversities the individual faced following the trauma • The response to the events of the individual’s close
friends/caretakers
The impact of a potentially traumatic event depends on many factors, including:
• Genetic makeup• Age and developmental stage• Perception of the danger faced• Whether the individual was the victim or a witness• Relationship to the victim or aggressor• Past experience with trauma• Adversities the individual faced following the trauma • The response to the events of the individual’s close
friends/caretakers
Prevalence of Trauma in the United States
Prevalence of Trauma in the United States
Cumulative Impact of TraumaCumulative Impact of TraumaTraumas build upon one another creating a cumulative impact upon an individual’s:
• Neurobiology• Physiological Responses• Response to his/her environment• Ability to regulate emotions• Judgment and cognitive processes used in learning and decision making• Self concept and self-esteem• Social relationships and ability to trust• Worldview
Traumas build upon one another creating a cumulative impact upon an individual’s:
• Neurobiology• Physiological Responses• Response to his/her environment• Ability to regulate emotions• Judgment and cognitive processes used in learning and decision making• Self concept and self-esteem• Social relationships and ability to trust• Worldview
Effects of Trauma ExposureEffects of Trauma Exposure• Attachment: Traumatized individual’s feel that the world
is uncertain and unpredictable. They can become socially isolated and can have difficulty relating to and empathizing with others.
• Biology: Traumatized individual’s may experience problems with movement and sensation, including hypersensitivity to physical contact and insensitivity to pain. They may exhibit unexplained physical symptoms and increased medical problems.
• Mood regulation: Individual’s exposed to trauma can have difficulty regulating their emotions as well as difficulty knowing and describing their feelings and internal states.
• Attachment: Traumatized individual’s feel that the world is uncertain and unpredictable. They can become socially isolated and can have difficulty relating to and empathizing with others.
• Biology: Traumatized individual’s may experience problems with movement and sensation, including hypersensitivity to physical contact and insensitivity to pain. They may exhibit unexplained physical symptoms and increased medical problems.
• Mood regulation: Individual’s exposed to trauma can have difficulty regulating their emotions as well as difficulty knowing and describing their feelings and internal states.
Effects of Trauma ExposureEffects of Trauma Exposure• Dissociation: Some traumatized individual’s experience
a feeling of detachment or depersonalization, as if they are “observing” something happening to them that is unreal.
• Behavioral control: Traumatized individual’s can show poor impulse control, self-destructive behavior, and aggression towards others.
• Cognition: Traumatized individual’s can have problems focusing on and completing tasks, or planning for and anticipating future events. Some exhibit learning difficulties and problems with language development.
• Self-concept: Traumatized individual’s frequently suffer from disturbed body image, low self-esteem, shame, and guilt.
• Dissociation: Some traumatized individual’s experience a feeling of detachment or depersonalization, as if they are “observing” something happening to them that is unreal.
• Behavioral control: Traumatized individual’s can show poor impulse control, self-destructive behavior, and aggression towards others.
• Cognition: Traumatized individual’s can have problems focusing on and completing tasks, or planning for and anticipating future events. Some exhibit learning difficulties and problems with language development.
• Self-concept: Traumatized individual’s frequently suffer from disturbed body image, low self-esteem, shame, and guilt.
Maladaptive coping strategies can lead to behaviors including:
Sleeping/eating disorders
Substance abuse
High activity levels, irritability, or acting out
Emotional detachment, unresponsiveness, distance, or numbness
Hyper-vigilance, or feeling that danger is present even when it is not
Increased mental health issues (e.g. depression, anxiety)
Maladaptive coping strategies can lead to behaviors including:
Sleeping/eating disorders
Substance abuse
High activity levels, irritability, or acting out
Emotional detachment, unresponsiveness, distance, or numbness
Hyper-vigilance, or feeling that danger is present even when it is not
Increased mental health issues (e.g. depression, anxiety)
Overwhelming Emotion and Behavior
Adverse Childhood Experiences
Adverse Childhood Experiences
Emotional abuse
Physical abuse
Sexual abuse
Emotional neglect
Physical neglect
Emotional abuse
Physical abuse
Sexual abuse
Emotional neglect
Physical neglect
• Household dysfunction:
• Mother treated violently
• Household substance abuse
• Household mental illness
• Parental separation/divorce
• Incarcerated household member
• Household dysfunction:
• Mother treated violently
• Household substance abuse
• Household mental illness
• Parental separation/divorce
• Incarcerated household memberSource: Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The
Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.
Long-Term Trauma Impact–ACE Pyramid: CDC
Mechanisms by Which Adverse Childhood Experiences Influence Health and Well-being Throughout the Lifespan
Conception
Death
Adverse Childhood Experiences
• Abuse and Neglect (e.g., psychological, physical, sexual)• Household Dysfunction (e.g., domestic violence, substance abuse, mental illness)
Impact on Child Development•Neurobiological Effects (e.g., brain abnormalities, stress hormone dysregulation)•Psychosocial Effects (e.g., poor attachment, poor socialization, poor self-efficacy)
•Health Risk Behaviors (e.g., smoking, obesity, substance abuse, promiscuity)
Long-Term ConsequencesDisease and Disability•Major Depression, Suicide, PTSD•Drug and Alcohol Abuse•Heart Disease•Cancer•Chronic Lung Disease•Sexually Transmitted Diseases•Intergenerational transmission of abuse
Social Problems• Homelessness
• Prostitution• Criminal Behavior
• Unemployment• Parenting problems
• Family violence• High utilization of health and social services
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Source: Putnam, F.,& Harris, W. (2008). Opportunities to change the outcomes of traumatized children: Draft narrative. Retrieved from http://ohiocando4kids.org/Outcomes_of_Traumatized_Children
What is a Trauma-Informed
Child-Serving System?
What is a Trauma-Informed
Child-Serving System?A Trauma-Informed System
understands:
1) The potential impact of traumatic stress on the individual’s served by the system
2) How the system can either help mitigate the impact of trauma or inadvertently add new traumatic experiences
3) How to promote factors related to resiliency after trauma
A Trauma-Informed System
understands:
1) The potential impact of traumatic stress on the individual’s served by the system
2) How the system can either help mitigate the impact of trauma or inadvertently add new traumatic experiences
3) How to promote factors related to resiliency after trauma
Rule 1 of a Trauma-Informed System: Don’t Make It Worse
A Trauma-Informed System UnderstandsA Trauma-Informed System Understands
4) That exposure to trauma is inevitable when working in a social service agency
5) The impact of vicarious trauma on a social service workforce
4) That exposure to trauma is inevitable when working in a social service agency
5) The impact of vicarious trauma on a social service workforce
What can be done to help a traumatized client?
What can be done to help a traumatized client?
• Provide a safe place for the individual to talk about what happened. Set aside a designated time and place for sharing to help the individual know it is okay to talk about what happened.
• Give simple and realistic answers to the individual’s questions about traumatic events. Clarify distortions and misconceptions.
• Be sensitive to the cues in the environment that may cause a reaction in the traumatized individual. For example, individual’s may increase problem behaviors near an anniversary of a traumatic event.
• Provide a safe place for the individual to talk about what happened. Set aside a designated time and place for sharing to help the individual know it is okay to talk about what happened.
• Give simple and realistic answers to the individual’s questions about traumatic events. Clarify distortions and misconceptions.
• Be sensitive to the cues in the environment that may cause a reaction in the traumatized individual. For example, individual’s may increase problem behaviors near an anniversary of a traumatic event.
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Maximizing Physical and Psychological Safety for
Children and Families
Maximizing Physical and Psychological Safety for
Children and Families
Psychological Safety Psychological Safety
Psychological Safety Psychological Safety
What is it? What does it look like? How can you tell if a client
feels safe? How can you tell if a client
feels unsafe?
What is it? What does it look like? How can you tell if a client
feels safe? How can you tell if a client
feels unsafe?
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Maximizing Safety: Understanding
TraumaticResponses
Maximizing Safety: Understanding
TraumaticResponses They exhibit challenging behaviors and
reactions When we label these behaviors as
“bad” or “good” we forget that their behavior is a reflection of their experience
Many challenging behaviors are strategies that have helped them survive in the past
They exhibit challenging behaviors and reactions
When we label these behaviors as “bad” or “good” we forget that their behavior is a reflection of their experience
Many challenging behaviors are strategies that have helped them survive in the past
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When faced with people, situations, places, or things that remind them of traumatic events, individuals may experience intense and disturbing feelings tied to the original trauma.
These “trauma reminders” can lead to behaviors that seem out of place, but were appropriate—and perhaps even helpful—at the time of the original traumatic event.
When faced with people, situations, places, or things that remind them of traumatic events, individuals may experience intense and disturbing feelings tied to the original trauma.
These “trauma reminders” can lead to behaviors that seem out of place, but were appropriate—and perhaps even helpful—at the time of the original traumatic event.
Maximizing Safety: Understanding Trauma Reminders/Triggers
Factors that Enhance Resilience
Factors that Enhance Resilience
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Sources: Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227-238.
National Child Traumatic Stress Network, Juvenile Justice Treatment Subcommittee. (in preparation). Think trauma: A training for staff in juvenile justice residential settings. Will be available from http://www.nctsnet.org/resources/topics/juvenile-justice-system
Protective FactorsProtective Factors
1 Benzies, K., & Mychasiuk, R. (2009). Fostering family resiliency: A review of the key protective factors. Child & Family Social Work, 14, 103-114.
2 Koball, H., Dion, R., Gothro, A., Bardos, M., Dworsky, A., Lansing, J., … Manning, A. E. (2011). Synthesis of research and resources to support at-risk youth. Retrieved from Administration for Children and Families Office of Planning, Research, and Evaluation website:
http://www.acf.hhs.gov/programs/opre/fys/youth_development/reports/synthesis_youth.pdf
1 Benzies, K., & Mychasiuk, R. (2009). Fostering family resiliency: A review of the key protective factors. Child & Family Social Work, 14, 103-114.
2 Koball, H., Dion, R., Gothro, A., Bardos, M., Dworsky, A., Lansing, J., … Manning, A. E. (2011). Synthesis of research and resources to support at-risk youth. Retrieved from Administration for Children and Families Office of Planning, Research, and Evaluation website:
http://www.acf.hhs.gov/programs/opre/fys/youth_development/reports/synthesis_youth.pdf
Individual characteristics:
Cognitive ability
Self-efficacy
Internal locus of control (a sense of having control over one’s life and destiny)
Temperament
Social skills
Community characteristics:2
Positive school experiences
Community resources
Supportive peers and/or
Mentors
Individual characteristics:
Cognitive ability
Self-efficacy
Internal locus of control (a sense of having control over one’s life and destiny)
Temperament
Social skills
Community characteristics:2
Positive school experiences
Community resources
Supportive peers and/or
Mentors
Family characteristics:1
Family cohesion
Supportive parent-child interaction
Social support (e.g., extended family support)
Cultural protective factors:
Strong sense of cultural identity
Spirituality
Connection to cultural community
Protective beliefs and values
Cultural talents and skills
Family characteristics:1
Family cohesion
Supportive parent-child interaction
Social support (e.g., extended family support)
Cultural protective factors:
Strong sense of cultural identity
Spirituality
Connection to cultural community
Protective beliefs and values
Cultural talents and skills
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Enhance the Well-Being
and Resilience of
Those Working
in the System
Enhance the Well-Being
and Resilience of
Those Working
in the System
Enhance the Well-Being and Resilience of Those Working in the
System
Enhance the Well-Being and Resilience of Those Working in the
System
While behavioral health/social service support workers play an important role in supporting individuals, working with people who have experienced abuse, neglect, violence, and other trauma can cause staff to develop secondary traumatic stress reactions.
Agencies/organizations should collect information about trauma and secondary trauma experienced by staff, implement strategies and practices that build resilience and help staff manage stress, and address the impact of secondary traumatic stress both on individuals and on the system as a whole.
While behavioral health/social service support workers play an important role in supporting individuals, working with people who have experienced abuse, neglect, violence, and other trauma can cause staff to develop secondary traumatic stress reactions.
Agencies/organizations should collect information about trauma and secondary trauma experienced by staff, implement strategies and practices that build resilience and help staff manage stress, and address the impact of secondary traumatic stress both on individuals and on the system as a whole.
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Enhance the Well-
Being and
Resilience of
Those Working in
the System
System TraumaSystem Trauma
The system itself can be a highly reactive, traumatizing system without enough services and supports to assist the workforce in responding effectively.
The system itself can be a highly reactive, traumatizing system without enough services and supports to assist the workforce in responding effectively.
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Impact of Working with Victims of Trauma
Impact of Working with Victims of Trauma
• Trauma experienced while working in the role of helper has been described as:
– Compassion fatigue
– Secondary traumatic stress (STS)
– Vicarious traumatization
• STS is the stress of helping or wanting to help a person who has been traumatized.
• Unlike other forms of job “burnout,” STS is precipitated not by work load and institutional stress but by exposure to clients’ trauma (acute or cumulative).
• STS can disrupt social service workers’ lives, feelings, personal relationships, and overall view of the world.
STS Signs and SymptomsSTS Signs and Symptoms Avoidance (including of certain clients)
Preoccupation with clients/client stories
Intrusive thoughts/nightmares/flashbacks
Arousal symptoms
Thoughts of violence/revenge
Feeling estranged/isolated/having no one to talk to
Feeling trapped, “infected” by trauma, hopeless, inadequate, depressed
Having difficulty separating work from personal life
Avoidance (including of certain clients)
Preoccupation with clients/client stories
Intrusive thoughts/nightmares/flashbacks
Arousal symptoms
Thoughts of violence/revenge
Feeling estranged/isolated/having no one to talk to
Feeling trapped, “infected” by trauma, hopeless, inadequate, depressed
Having difficulty separating work from personal life 36
What can a professional do to address STS?
What can a professional do to address STS?
What can a supervisor or manager do to address STS?
What can the agency do?
Other resources/activities
What can a supervisor or manager do to address STS?
What can the agency do?
Other resources/activities
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Self-Care for RespondersSelf-Care for Responders1. Be aware of the signs. Professionals with compassion fatigue may exhibit
some of the following signs.
2. Don’t go it alone. Guard against isolation
3. Recognize compassion fatigue as an occupational hazard. Don’t judge yourself as weak or incompetent for having strong reactions to a trauma (it’s the cost of caring).
1. Be aware of the signs. Professionals with compassion fatigue may exhibit some of the following signs.
2. Don’t go it alone. Guard against isolation
3. Recognize compassion fatigue as an occupational hazard. Don’t judge yourself as weak or incompetent for having strong reactions to a trauma (it’s the cost of caring).
Self-Care for Professionals (continued)
Self-Care for Professionals (continued)
4. Seek help with your own traumas. Any social service worker who also has his or her own unresolved traumatic experiences,
is more at risk for compassion fatigue. 5. If you see signs in yourself, talk to a professional. If you are experiencing signs of compassion fatigue for more than two to three weeks, seek counseling with a professional who is knowledgeable about trauma.
4. Seek help with your own traumas. Any social service worker who also has his or her own unresolved traumatic experiences,
is more at risk for compassion fatigue. 5. If you see signs in yourself, talk to a professional. If you are experiencing signs of compassion fatigue for more than two to three weeks, seek counseling with a professional who is knowledgeable about trauma.
Contact InformationContact Information
Al Killen-Harvey, LCSW
The Harvey [email protected]
619-977-8569
Al Killen-Harvey, LCSW
The Harvey [email protected]
619-977-8569