TRAUMA. How to Manage Trauma 33% 15sec 77% 35% HOW COMMON IS TRAUMA? TRAUMA CAN STEM FROM

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Bertram Arnold
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How to Maage Trauma Trauma occurs whe a perso is overwhelmed by evets or circumstaces ad respods with itese fear, horror, ad helplessess. Extreme stress overwhelms the perso s capacity to cope.

TRAUMA CAN STEM FROM 70% of adults i the U.S. have experieced some type of traumatic evet at least oce i their lives. That s 223.4 millio people.

Childhood abuse or eglect Physical, emotioal, or sexual abuse War ad other forms of violece Accidets ad atural disasters Grief ad loss Medical itervetios 15sec I the Uited States, a woma is beate

33% Witessig acts of violece Cultural, itergeeratioal ad historical trauma TRAUMA Trauma is a risk factor i early all behavioral health ad substace use disorders.

1 How to Maage Trauma Trauma occurs whe a perso is overwhelmed by evets or circumstaces ad respods with itese fear, horror, ad helplessess. Extreme stress overwhelms the perso s capacity to cope. There is a direct correlatio betwee trauma ad physical health coditios such as diabetes, COPD, heart disease, HOW COMMON IS TRAUMA? cacer, ad high blood pressure. TRAUMA CAN STEM FROM 70% of adults i the U.S. have experieced some type of traumatic evet at least oce i their lives. That s millio people. I public behavioral health, over 90% of cliets have experieced trauma. Childhood abuse or eglect Physical, emotioal, or sexual abuse War ad other forms of violece Accidets ad atural disasters Grief ad loss Medical itervetios 15sec I the Uited States, a woma is beate every 15 secods, a forcible rape occurs every 6 miutes. 33% Witessig acts of violece Cultural, itergeeratioal ad historical trauma TRAUMA Trauma is a risk factor i early all behavioral health ad substace use disorders. More tha 33% of youths exposed to commuity violece will experiece Post Traumatic Stress Disorder, a very severe reactio to traumatic evets. Nearly all childre who witess a paretal homicide or sexual assault will develop Post Traumatic Stress Disorder. Similarly, 90% of sexually abused childre, 77% of childre exposed to a school shootig, ad 35% of urba youth exposed to commuity violece develop Post Traumatic Stress Disorder % % % Sexually abused childre Childre Urba exposed to youth a school exposed shootig to violece Post-traumatic stress disorder (PTSD) is a metal health coditio that s triggered by a terrifyig evet. Symptoms may iclude flashbacks, ightmares ad severe axiety, as well as ucotrollable thoughts about the evet. 0

2 HELPFUL COPING STRATEGIES People ca ad do Ackowledge that you have bee through traumatic evets recover from trauma Coect with others, especially those who may have shared the stressful evet or experieced other trauma SYMPTOMS OF TRAUMA CHECKLIST Exercise try joggig, aerobics, bicyclig, or walkig Headaches, backaches, stomachaches, etc. Sudde sweatig ad/or heart palpitatios Chages i sleep patters, appetite, iterest i sex Costipatio or diarrhea Easily startled by oises or uexpected touch More susceptible to colds ad illesses Icreased use of alcohol or drugs ad/or overeatig Fear, depressio, axiety Relax try yoga, stretchig, massage, mediatio, deep muscle relaxatio, etc. Take up music, art, or other diversios Maitai balaced diet ad sleep cycle Avoid over-usig stimulats like caffeie, sugar, or icotie Commit to somethig persoally meaigful ad importat every day Write about your experiece for yourself or to share with others Outbursts of ager or rage Emotioal swigs Nightmares ad flashbacks re-experiecig the trauma Tedecy to isolate oeself or feeligs of detachmet Difficulty trustig ad/or feeligs of betrayal Self-blame, survivor guilt, or shame Dimiished iterest i everyday activities HOW TO TALK TO YOUR DOCTOR Make your doctor aware that you have experieced trauma, past or recet Help them uderstad what is helpful to you durig office visits, i.e., askig permissio to do a procedure, stayig as clothed as possible, explaiig procedures thoroughly, or havig a supporter stay i the room with you Ask for referrals to therapy ad behavioral health support ASK YOUR HEALTHCARE PROFESSIONAL ABOUT TREATMENTS TRADITIONAL TREATMENTS Cogitive Behavioral Therapy Eye Movemet Desesitizatio ad Reprocessig (EMDR) Therapy ALTERNATIVE TREATMENTS Eergy Processig Hypotherapy Neuro-Liguistic Programmig Massage Therapy Talk Therapy Pet or Equie Therapy Exposure Therapy Trauma ad Recovery Peer Support Groups Group Therapy Welless Recovery Actio Plaig (WRAP) For more iformatio, iterviews, ad research o trauma check out the Natioal Coucil s magazie editio o the topic

3 WHAT S YOUR ACE SCORE? Rob Ada, MD, MS, Co-Pricipal Ivestigator of the ACE Study, recetly developed this mii-versio of the ACE Study Questioaire, to help people calculate their ow ACE Scores. The ACE Score is the basis for ratig the extet of trauma a perso experieced durig childhood, ad to predict the likelihood that s/he will experiece oe or more forms of health, behavioral, ad/or social problems. You ow have the opportuity to calculate your ow ACE Score by aswerig the questios below. DONE CAL- CULATING YOUR SCORE? NOW WHAT? If you wat to read more about what your ACE Score meas, based o the fidigs of the ACE Study, see: ccdphp/ace/ fidigs.htm ACE Reporter Sprig,, 2007 Page 3

4 RESILIENCE Questioaire Please circle the most accurate aswer uder each statemet: 1. I believe that my mother loved me whe I was little. 2. I believe that my father loved me whe I was little. 3. Whe I was little, other people helped my mother ad father take care of me ad they seemed to love me. 4. I ve heard that whe I was a ifat someoe i my family ejoyed playig with me, ad I ejoyed it, too. 5. Whe I was a child, there were relatives i my family who made me feel better if I was sad or worried. 6. Whe I was a child, eighbors or my frieds parets seemed to like me. 7. Whe I was a child, teachers, coaches, youth leaders or miisters were there to help me. 8. Someoe i my family cared about how I was doig i school. 9. My family, eighbors ad frieds talked ofte about makig our lives better. 10. We had rules i our house ad were expected to keep them. 11. Whe I felt really bad, I could almost always fid someoe I trusted to talk to. 12. As a youth, people oticed that I was capable ad could get thigs doe. 13. I was idepedet ad a go-getter. 14. I believed that life is what you make it. How may of these 14 protective factors did I have as a child ad youth? (How may of the 14 were circled Defiitely True or Probably True?) Of these circled, how may are still true for me? your ace score/

5 Self Care & Protective Factors Stressors Negative Self Talk Statemets Distress Fight, Flight, Freeze

6 Module 4, Activity 4B Cultural Cotext Commuity Cotext Life Cotext Family Child Emotioal Chai of Custody School New Schools Substitute Care Child Protectio CPS Atty GAL Juveile/ Family Court Family Faith Commuity Evet(s) Fire Fighters/ EMT Metal Health Resiliece Buildig Medical RECOVERY Payor Law Eforcemet DA Victim Witess Crimial Court System Ifluece Offeder Cotact Parole / Priso Experiece shapes respose to future trauma Child Welfare Trauma Traiig Toolkit: Emotioal Chai of Custody March 2008 The Natioal Child Traumatic Stress Network

7 The Natioal Coucil for Commuity Behavioral Healthcare Seve Domais for beig a Trauma Iformed Orgaizatio Domai 1. Early Screeig ad Comprehesive Assessmet of Trauma Developig a respectful screeig ad assessmet process that is routie, competetly doe ad culturally relevat ad sesitive ad revisited over time Domai 2. Cosumer Drive Care ad Services Ivolvig ad egagig people who are or have bee recipiets of our services to play umerous roles (e.g., paid employee, voluteer, members of decisio makig committees, peer specialists) ad meaigfully participate i plaig, implemetig ad evaluatig our improvemet efforts Domai 3. Trauma-Iformed, Educated ad Resposive Workforce Icreasig the awareess, kowledge ad skills of the etire workforce to deliver services that are effective, efficiet, timely, respectful ad perso cetered takig ito cosideratio that service providers also have histories of trauma Domai 4. Provisio of Trauma-Iformed, Evidece Based ad Emergig Best Practices Icrease the awareess, kowledge ad skills of the cliical workforce i deliverig research iformed treatmet services desiged to address the cogitive, emotioal, behavioral, substace use ad physical problems associated with trauma Domai 5. Create a Safe ad Secure Eviromet Icrease the awareess, kowledge ad skills of the workforce to create a safe, trustig ad healig eviromet as well as examiig ad chagig policies, procedures ad practices that may uitetioally cause distress ad may retraumatize (cause harm) those we serve. Domai 6. Egage i Commuity Outreach ad Partership Buildig Recogize that the people we serve may be part of ad affected by a larger service system icludig housig, correctios, courts, primary health, emergecy care, social services, educatio ad treatmet eviromets such as substace use programs. We have a opportuity to egage ad icrease the awareess of these other service providers to the priciples ad practices of trauma-iformed care. I this way, our efforts are less likely to be udermied by other parts of the system. Domai 7. Ogoig Performace Improvemet ad Evaluatio The orgaizatio values a systematic approach to measurig performace o each of the core trauma-iformed domais. Data is used to track, measure ad aalyze performace improvemet i order to iform leadership ad its core implemetatio team o areas eedig improvemet as well as guidig the process of sustaiable chage. Cheryl Sharp, MSW, ALWF, Special Advisor for Trauma-Iformed Services cheryls@theatioalcoucil.org

8 Trauma Iformed Skill Buildig Suggestios Safety ad Stabilizatio Exteralizig Childre ad Adults travel up ad dow vulerability moutai very quickly ad eed skills at all places o the moutai Remember Top opportuities for growth for childre (ad adults) with complex trauma are Self Regulatio Skills Positive Self Idetity Co Regulatio Skills (beig i a trustig healthy relatioship with others) Childre with exteralizig behaviors who have experieced trauma struggle with these basic skills (Blaustei &Kiiburgh, 2010, p. 114) 1) Ackowledgig ad copig with vulerable emotios 2) Modulatig itese emotios, particularly i the face of key triggers such as ijustice, shame, etc. 3) Acceptig resposibility for actios i social coflict 4) Egagig empathy ad perspective takig i difficult relatioships All Iteractios Need to Embrace the Trauma Iformed Core Values from Fallot (2011) 1) Safety (all forms!!) 2) Trustworthiess 3) Choice (which icludes Voice) 4) Collaboratio 5) Empowermet OTHER TIPS Do t force a child to ackowledge a difficult emotio before they are ready Do ormalize their deied emotios (ackowledge, validate, uderstad) Respod to the NEED, do t react to the BEHAVIOR Uderstad that exteralizig behaviors protect a child from deep shame ad overwhelmig feeligs

9 Every Day (Self Care ad Protective Factors) Self Regulatio ( suscree ) Relaxatio ad Groudig Exercises Bilateral Movemet Attuemet Exercises Midfuless Scale (MAAS) Midfuless Exercise (sheet) breathig, oe thig Self Care Pla (daily practice) Self Awareess ( kowig your ski ) Educate childre about their triggers ad trauma resposes o Wise old owl (Haw Foudatio) o Guard Dog (Haw Foudatio) o Smoke Detector (Va der kolk) o Alarm System ( ARC book pp ) o Light Switch ( Please Explai Axiety to Me ) Teach ad practice with them idetificatio of feeligs ad eeds Egage them i Behavioral Experimets where the try somethig differet Teach about Thought Distortios ( thought distortio box ) so they ca begi to recogize thoughts they tell themselves that take them dow to Distress Valley Supportig beliefs that child or adult deserves good thigs Recogizig bumps i the road do t mea a crash Educatio o Body ad Complex Trauma ( checkig the weather, kowig your locatio ) Calm/Terrified Child Sampso Model Fight/Flight/Freeze Picture I the Distress Valley Emotioal Distress ( aloe o subur ) ACCEPTS Galvaic Ski Respose (had warmig) Distractio (madala) Vacatio meditatio Just Worryig Skill Relatioship Skills ( brigig a fried to the beach ) Empathic Commuicatio Skills (mirrorig) Chage/Acceptace choices Practicig how to idetify a feelig, state a eed, ad make a request

10 Distractio Skills for Reducig Distress (take from the ACCEPTS skill from DBT) o o o o o o o Activities (physical ad metal) metal vacatio, bi-lateral movemet (walkig), temperature chage Cotributig helpig others gets you out of yourself ad your stress (smilig, give complimet, ivite someoe to coffee, hold a door, do a favor) Comparisos Brigig perspective to curret situatio, what skills have helped you cope before (have helped your childre cope before) validate yourself Emotios Seek out activities that create feeligs that are OPPOSITE from the paiful oes you are experiecig (liste to music, favorite movie, work o a project --- favorite hobby) Push Away Put away distressig memories i a lock box or i the parkig lot for a little while ca do this i writig or metally Thoughts distract your thoughts with oe-thig exercises, read somethig ispirig, just worryig exercise Sesatios Ay physically vigorous activity or actively awakeig seses (brisk walk, cold bath/hot bath, splash cold water o face, lotios o your wrist, strog taste, bold colors (Madela), music) Pederso, L. (2012). The Expaded Dialectical Behavioral Therapy Skills Traiig Maual. Eau Claire: CMI Educatio Istitute, Ic. pp

11 Protective Factors Positive attitudes, values or beliefs Coflict resolutio skills Good metal, physical, spiritual ad emotioal health Positive self-esteem Success at school Good paretig skills Paretal supervisio Strog social supports Commuity egagemet Problem-solvig skills Positive adult role models, coaches, metors Healthy preatal ad early childhood developmet Participatio i traditioal healig ad cultural activities Good peer group/frieds Steady employmet Stable housig Availability of services (social, recreatioal, cultural, etc)

12 Characteristics of Families who Thrive Figley ad Kiser (2013) Helpig Traumatized Families (pg ) Clear acceptace of stressor(s) Family cetered locus of problem (shift from idividual) Solutio orieted problem solvig (ot blame) High tolerace for each other Clear ad direct expressios of commitmet ad affectios Ope ad Effective Commuicatio High Family Cohesio (fu ad ejoymet) Flexible Family Roles Predictability Effective resource utilizatio Belief i their ability to succeed Shared meaig (collaborative copig skills)

13 Module 4, Activity 4D Questios to Ask Metal Health Providers 1. Does the idividual/agecy that provides therapy coduct a comprehesive trauma assessmet? What specific stadardized measures are give? What did your assessmet show? What were some of the major stregths ad/or areas of cocer? 2. Is the cliicia/agecy familiar with evideced-based treatmet models? 3. Have cliicias had specific traiig i a evideced-based model (whe, where, by whom, how much)? 4. Does the idividual/agecy provide ogoig cliical supervisio ad cosultatio to its staff, icludig how model fidelity is moitored? 5. Which approach(es) does the cliicia/agecy use with childre ad families? 6. How are paret support, cojoit therapy, paret traiig, ad/or psychoeducatio offered? 7. Which techiques are used for assistig with the followig: Buildig a strog therapeutic relatioship Affect expressio ad regulatio skills Axiety maagemet Relaxatio skills Cogitive processig/reframig Costructio of a coheret trauma arrative Strategies that allow exposure to traumatic memories ad feeligs i tolerable doses so that they ca be mastered ad itegrated ito the child s experiece Persoal safety/empowermet activities Resiliecy ad closure 8. How are cultural competecy ad special eeds issues addressed? 9. Is the cliicia or agecy willig to participate i the multidiscipliary team (MDT) meetigs ad i the court process, as appropriate? Child Welfare Trauma Traiig Toolkit: Questios for Metal Health Providers March 2008 The Natioal Child Traumatic Stress Network

14 Module 6, Activity 6D Self-Care Ivetory Rate the followig areas i frequecy: 5 = Frequetly 4 = Occasioally 3 = Rarely 2 = Never 1 = It ever occurred to me Physical Self-Care Eat regularly (e.g. breakfast, luch ad dier) Eat healthy Exercise cosistetly Get regular medical care for prevetio Get medical care whe ecessary Take time off whe sick Dace, swim, walk, ru, play sports, sig or do some other physical activity that is ejoyable to self Take time to be sexual Get eough sleep Take vacatios Wear clothes you like Take day trips or mii-vacatios Make time away from telephoes Other Psychological Self-Care Make time for self-reflectio Egage i persoal psychotherapy Write i a joural Read literature that is urelated to work Do somethig i which you are ot a expert or i charge Child Welfare Trauma Traiig Toolkit: Self-Care Ivetory March 2008 The Natioal Child Traumatic Stress Network

15 Cope with stress i persoal ad/or work life Notice ier experiece (e.g., liste to ad recogize thoughts, judgmets, beliefs, attitudes ad feeligs) Provide others with differet aspects of self (e.g., commuicate eeds ad wats) Try ew thigs Practice receivig from others Improve ability to say o to extra resposibilities Other Emotioal Self-Care Allow for quality time with others whose compay you ejoy Maitai cotact with valued others Give self affirmatios ad praise Love self Reread favorite book or review favorite movies Idetify ad egage i comfortig activities, objects, people, relatioships ad places Allow for feelig expressio (laugh, cry, etc ) Other Spiritual Self-Care Allow time for reflectio Sped time with ature Participate i a spiritual commuity Ope to ispiratio Cherish ow optimism ad hope Be aware of omaterial aspects of life Cultivate ability to idetify what is meaigful ad its place i persoal life Meditate/pray Cotribute to causes i which you believe Read ispiratioal literature (lectures, music etc ) Child Welfare Trauma Traiig Toolkit: Self-Care Ivetory March 2008 The Natioal Child Traumatic Stress Network 2

16 Workplace or Professioal Self-Care Allow for breaks durig the workday Egage with co-workers Provide self quiet time/space to complete tasks Participate i projects or tasks that are excitig ad rewardig Set limits/boudaries with cliets ad colleagues Balace workload/cases Arrage work space for comfort Maitai regular supervisio or cosultatio Negotiate eeds (beefits, bouses, raise, etc ) Participate i peer support group Other * Review assiged umbers. Appreciate areas of stregths while makig positive chages i areas with sigificatly low scores to improve balace i life. Adapted by Metal Health Services for Homeless Persos, Ic. (MHS), Clevelad, OH. Used with permissio. Origial source: Ukow. Child Welfare Trauma Traiig Toolkit: Self-Care Ivetory March 2008 The Natioal Child Traumatic Stress Network

TRAUMA. How to Manage Trauma 33% 15sec 77% 35% HOW COMMON IS TRAUMA? TRAUMA CAN STEM FROM

TRAUMA. How to Manage Trauma 33% 15sec 77% 35% HOW COMMON IS TRAUMA? TRAUMA CAN STEM FROM How to Maage Trauma Trauma occurs whe a perso is overwhelmed by evets or circumstaces ad respods with itese fear, horror, ad helplessess. Extreme stress overwhelms the perso s capacity to cope. There is