Truly trauma informed: creating safe

environments

Gabriella Grant, Director California Center of Excellence for

Trauma Informed Care, Santa Cruz CA www.trauma-informed-california.org

Trauma-Informed Recovery

• SAMHSA (12/2011): – “Recovery is a process of change through which

individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

– “Recovery is supported by addressing trauma : Services and supports should be trauma-informed to foster safety (physical and emotional) and trust as well as promote choice, empowerment, and collaboration.”

Trauma Informed: Core values

• Safety • Trustworthiness • Choice • Collaboration/connection • Empowerment

(Harris and Fallot, 2001)

SAMHSA: Trauma & Justice Strategic Initiative

• To reduce the pervasive, harmful and costly health impact of violence and trauma – By integrating trauma-informed approaches

throughout the health and behavioral health care systems and

– By diverting people with substance use and mental disorders from criminal and juvenile justice systems into trauma-informed treatment and recovery

SAMHSA Lead Larke Huang October 19, 2010

Federal Focus

• Administration for Children and Families (HHS) – Child welfare professionals must understand the

impact of trauma on child development and learn how to effectively minimize its effects without causing additional trauma.

• https://www.childwelfare.gov/responding/trauma.cfm

• Federal Partners Committee on Women and Trauma – Report from the Federal Intergovernmental

Partnership on Mental Health Transformation, 2011 • http://www.vawnet.org/Assoc_Files_VAWnet/WomenAndTr

auma.pdf

Trauma-informed safety

• Trauma-informed: create a milieu that acknowledges the impact of trauma and attempts to create a sense of safety

• Trauma-specific: services whose primary task is to address the impact of trauma and to facilitate trauma recovery

• All social service programs benefit from becoming trauma

informed and can choose to become also trauma-specific.

Trauma lack of safety

Safety = Empowerment and connection

Trauma = disempowerment

and disconnection

What is trauma? • An event or circumstance that overwhelmed a

person’s ability to cope with the situation, leading to a sustained loss of safety.

• Cumulative impact over time, the more events, the less an ability to cope, the more safety is lost.

Overwhelming event

Inability to cope Loss of safety

Complex trauma

Unsafe home base (presence of harm, absence of safety)

Survival strategies in unsafe home base feel unproductive

and confusing outside of home base

Punitive and shaming interventions exacerbate

unsafe behaviors and alienate children from helpers and help

Unsafe outside the home relationships that feel safe and

more accepting than home, self, or help

Complex domestic violence

Unsafe homebase, abuse, chaotic home, instability unmet needs for safety,

connection,

Behaviors that temporarily resolve the problem but look

problematic outside home

Punitive and shaming interventions that blame

victim, use controlling mechanisms to force change,

rules that confuse safety

Unsafe dynamics “feel” safer: Return to DV relationship, new

DV relationship, suicide, chronic substance abuse, self-

harm

Central trauma roles

Bystander Perpetrator

Rescuer Victim

Integrated Self

Complex trauma = Trauma roles

Unsafe home base: Perpetrator

Unproductive behaviors: Victim

Unsafe interventions:

Bystander

Unsafe out-of-home relationships and

situations: Rescuer

Trauma uninformed interventions • Do not know what trauma is or how to recognize signs – trauma

blindness • Serve trauma survivors without being aware that any ever

trauma happened (never ask) – trauma muteness • Do not involve consumers/end-users in decision-making,

reinforcing past negative dynamics of powerlessness – trauma deafness

• Treat survivors for presenting issues (often related to trauma) without connecting them to trauma -- disconnection

• Do not know the impact of trauma over the lifespan – denial/minimization

• Do not recognize that trauma is central to the development of most social problems and diseases -- isolation

• Responding disproportionately to trauma triggers, escalation while blaming the consumer as instigator – hyper-reactivity

The key is safety

• Domestic violence, crisis intervention, physical health are all safety issues.

• Parenting is a safety issue. • Unsafe behaviors and thoughts are a safety

issue • Providing publicly funded services are a

safety issue.

Trauma Informed Intervention

Safe base, safe housing, safe relationships

Understanding behaviors as attempts to solve a

problem that becomes the basis of empowerment

Collaboration that is safety focused and choice driven

to strengthen clients’ abilities and relationships

Reconnection to social, work and family activities that promote safety and

trustworthiness

Who can be trauma-informed • Mental health and substance abuse services • Hospitals and medical treatment centers • Nursing homes and adult protective services • Child protective services and children-focused

agencies • Criminal justice and prisons, jails, detention • Residential programs, housing, DV and other

shelters and social service programs • Schools and dissemination of information • Libraries, public transportation, environmental

health – just about any place

Trauma-informed services are ‘safety increase’ oriented

An approach to services that looks at safety as the key to helping people who are

struggling

Created by youth in a homelessness program ~ San Diego Youth Services

Thank you!

• Gabriella Grant, Director • gabbygrant@me.com • CA Center of Excellence for Trauma Informed

Care • www.trauma-informed-california.org • 916-267-4367