Trauma informed services: An introductory overview

Transcription

1 Trauma informed services: An introductory overview Gabriella Grant, Director California Center of Excellence for Trauma Informed Care, Santa Cruz, California informed- california.org Who am I? Gabriella Grant, director of the California Center of Excellence for Trauma Informed Care. Facilitate seeking safety groups for PTSD + sub abuse. Master in policy studies, specifically criminal jussce policy and the female offender from the Johns Hopkins University. Worked for MD parole and probason, the CA Judicial Council, and contracted with the CA Dept. of Public Health, most recently. 1

2 With a neighbor What struggles have you experienced when trying to create a posisve connecson with a fellow peer? A common denominator: Trauma is the most common, the most preventable, and the most treatable factor affecsng recipients of social services. 2

3 Trauma- informed! safety Trauma- informed: create a milieu that acknowledges the impact of trauma and azempts 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. A lens an individual constructs a sense of self, of others, and of the world, affecsng Trauma changes how life choices and parscular coping strategies, resulsng in The impact of trauma felt throughout an individual s life and in areas of funcsoning quite far removed from the trauma and ones closely connected to the trauma (Harris & Fallot, 2001) 3

4 Federal focus: Children AdministraSon for Children and Families (HHS) Child welfare professionals must understand the impact of trauma on child development and learn how to effecsvely minimize its effects without causing addisonal trauma. hzps:// Federal leadership: Children Congress now requires that child welfare agencies address the issue of trauma when developing a plan for meesng the health and mental health needs of youth in foster care (PromoSng Safe and Stable Families Program, 2011) RecommendaSons: (1) mental health screenings and assessments of all youth in child welfare include measures of traumasc events and trauma- related symptoms (2) evidence- based, trauma- specific treatment begin when a youth in child welfare demonstrates a trauma- related symptom (3) a clinician not diagnose a youth in child welfare with a mental illness without first addressing the impact of trauma. Griffin, et al,

5 Federal leadership: Women Federal Partners CommiZee on Women and Trauma Report from the Federal Intergovernmental Partnership on Mental Health TransformaSon, 2011 & 2013 hzp:// WomenAndTrauma.pdf hzp:// Women_and_Trauma.aspx Emerging: Men PTSD hzp:// M- TREM hzp://macmhb.org/statewide%20trauma%20seminar/10%20app- A.3%20M- TREM%20slides%20p.13.pdf Military sexual trauma hzp:// Male child sexual abuse hzps://1in6.org DomesSc violence DomesSc Abuse Helpline for Men and Women hzp:// Men of Color hzp:// content/uploads/2012/09/ Chapter- 13- Trauma- Informed- PracSce- Rich- et- al..pdf 5

6 SAMHSA: Trauma & JusSce Strategic IniSaSve To reduce the pervasive, harmful and costly health impact of violence and trauma By integrasng trauma- informed approaches throughout the health and behavioral health care systems and By diversng people with substance use and mental disorders from criminal and juvenile jussce systems into trauma- informed treatment and recovery SAMHSA Lead Larke Huang October 19, 2010 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 potensal. Recovery is supported by addressing trauma : Services and supports should be trauma- informed to foster safety (physical and emosonal) and trust as well as promote choice, empowerment, and collaborason. 6

7 Trauma Informed: Core values Safety Trustworthiness Choice CollaboraSon/connecSon Empowerment (Harris and Fallot, 2001) TIP 57 7

8 How much trauma? The ACE study showed 67% of the general pubic have at least 1 ACE (Felio and Anda, 2005) Trauma is universal in child welfare (Finklehor 2011) Members of the military have higher rates of trauma than the general public (Blosnich 2014) 89% of women with MH/sub abuse reported either physical or sexual abuse and 58% reported both (Newmann and Salmann 2004). Over 66% of men seeking treatment for substance use disorder report one or more traumasc life events (Back et al., 2000) SMI, Public Services, Trauma Among SMI clients in public mental health, Childhood sexual abuse was the most common trauma Sudden death of a loved one second most common Average of 7 types of traumasc events over lifesme. The number of types of traumasc events experienced and Hispanic ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relason to events that occurred on average 20 years earlier, Clinical need to address trauma and loss throughout the lifespan, including their prolonged aqer- effects. Lu, et al.,

9 Trauma is neurobiological! Extreme threat Inadequate caregiving response Inability to modulate Overwhelming event Inability to cope Loss of safety Reduce exposure to overwhelming events Increase capacity to cope Increase safety physical and emosonal Threat acsvates stress response Exposure to extreme threat, parscularly early in life, combined with a lack of adequate caregiving responses significantly affect the long- term capacity of the human organism to modulate the response of the sympathesc and parasympathesc nervous systems in response to subsequent stress. 9

10 Complex trauma Unsafe home base (presence of harm, absence of safety) Love hurts Unsafe outside the home relasonships that feel safe and more accepsng than home, self, or help Pain is love Survival strategies in unsafe home base feel unproducsve and confusing outside of home base I AM BAD PuniSve and shaming intervensons exacerbate unsafe behaviors and alienate children from helpers and help Help hurts 10

11 SSll face experiment In 1975, Edward Tronick and colleagues first presented the ssll face experiment to colleagues at the biennial meesng of the Society for Research in Child Development. 11

12 Trauma! lack of safety Trauma = disempowerment and disconnecson Safety = Empowerment and connecson Universal screening/precausons Screen all clients for trauma We ask, they do not have to tell Assume trauma, even if no evidence nosce what changes (usually compassion, client- centered focus, solusons, hopefulness) Focus on increasing physical and emosonal safety 12

13 Felio, 2009 ACE Study compared to professionals in mental health, sub abuse, criminal jussce, homelessness, domessc violence, schools, healthcare. ACE Study findings EmoSonal abuse 11% Physical abuse 28% Sexual abuse 22% EmoSonal neglect 15% Physical neglect 10% One or no bio parents 23% Mother treated violently 13% Substance abuser in home 27% Mentally ill person in home 17% Household member in prison 5% No ACEs reported 33% Helping professionals (2013) n=521 EmoSonal abuse 50% Physical abuse 32% Sexual abuse 30% EmoSonal neglect 39% Physical neglect 16% One or no bio parents 43% Mother treated violently 19% Substance abuser in home 49% Mentally ill person in home 41% Household member in prison 15% No ACEs reported 15% Completed anonymously and voluntarily by azendees of trainings provided by CCE- TIC Compiled by the California Center of Excellence for Trauma Informed Care 13

14 Surprising? With a neighbor, discuss what was most surprising to you about the ACE study. What addisonal quessons do you have about the effect of trauma over the lifespan? Stages of Trauma Recovery Stage 1 Establishing Safety: Securing Safety Stabilizing symptoms Fostering self- care Stage 2: Remembrance and mourning ReconstrucHng the trauma Transforming traumahc memory Stage 3: ReconnecHon: ReconnecHon and forgiveness of self ReconnecHon with others Resolving the trauma Judith L. Herman,

15 There is Hope! All major research indicates that when people are given tools to cope with trauma and addichon, they improve, onen in quite short Hmeframes. - Dr. Lisa Najavits, Harvard Medical School Trauma Informed IntervenSon Safe base, safe housing, safe relasonships ConnecSon to social, work and family acsvises that promote safety and trustworthiness Understanding behaviors as azempts to solve a problem that becomes the basis of empowerment CollaboraSon that is safety focused and choice driven to strengthen abilises and relasonships 15

16 BECOMING TRAUMA INFORMED (CONTINUED FROM PAGE 1) Previous Practice Small waiting room with couch Intake process was not fully explained Intake rooms had institutional furnishings Staff told clients what treatment would be best for them Client involvement in the organization s work was minimal Staff members were not always aware of practices that could be re-traumatizing Current Practice Larger waiting room has better lighting and movable individual chairs. The intake process is explained, and each client receives a tour of the facility. Furnishings are comfortable, rooms are nicely decorated, and staff do not sit behind a desk. Treatment options are explained, and clients choose the services they will receive. There is much more client input. For example: clients sit on most standing committees, and clients participated in selection of interior paint colors. Staff now view services, situations, and activities through a trauma lens. For instance: paying attention to unlit areas, such as bathrooms and parking lots. Western ConnecScut 16

17 Safe coping Bingo! Trauma- informed services are safety increase oriented An approach to services that looks at safety as the key to helping people who are struggling 17

18 Core texts Trauma and Recovery, Judith Herman Using Trauma Theory to Design Service Systems, Harris and Fallot The Promise and PracSce of Trauma Informed Services, Gordon Hodas, MD The RelaSonship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behavior: ImplicaSons for Healthcare, Vincent Felio, MD and Robert Anda, MD Beyond Trauma, Stephanie Covington (tx manual) Seeking Safety, Lisa Najavits (tx manual) Thank you! Gabriella Grant, Director CA Center of Excellence for Trauma Informed Care informed- california.org