Trauma Informed Practices for Intimate Partner Violence Victim and Survivors

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1 Trauma Informed Practices for Intimate Partner Violence Victim and Survivors 18 th Annual International Conference on Violence Abuse and Trauma San Diego, CA September 9 th, 2013 Jacqueline Manley, MA Southern Indian Health Council, Inc. jmanley@sihc.org

2 Traumatic Events are: Sudden, unexpected, and extreme. May involve physical harm or perceived life threat. (Research has shown perception of life threats is a powerful predictor of the impact of trauma.) People experience these events as out of their control. Certain stages of life make people more vulnerable to the effects of trauma, including childhood, teenage years, and early 20s. All presuppose a greater impact on life in adulthood. (Tedeschi, 2011)

3 Response to Trauma Fear Helplessness Horror Trauma can result from experiences that are private (e.g. sexual assault, domestic violence, child abuse/neglect, witnessing IPV) or more public (e.g.war, terrorism, natural disasters).

4 Trauma is when people live with more fear than hope.

5 The Definition of Trauma-Informed Care Trauma-Informed Care is a strengthsbased framework that Is grounded in an understanding of (and on) responsiveness to the impact of trauma Emphasizes physical, psychological, and emotional safety for both providers and survivors Creates opportunities for survivors to rebuild a sense of control and empowerment. (Hopper, Bassuk, & Olivet, 2010)

6 Why Use a Trauma Informed Approach? Native children were forcibly removed from their homes and forced to attend boarding schools

7 Historical Trauma Defined The term used most often by scholars of American Indian trauma, is conceptualized as a collective complex trauma inflicted on a group of people who share a specific group identity or affiliation, ethnicity, nationality and religious affiliation.

8 Historical Events Community massacres Pandemic and covert spread of diseases Genocidal policies Forced relocation Removal of children Indian Boarding School Policies Forced cultural change Prohibition of spiritual & cultural practices Imposed poverty Wealth of land & natural resources taken

9 Impact on Tribal Communities Prohibition of language Loss of fluency of Tribal languages (generation gap) Disruption and loss of spiritual practices (1978) Loss of Tribal connection to sacred beliefs Loss of a sense of wholeness Ancestral Bones Disruption of cultural practices Division of generations Forced removal of children (ICWA) Diminished the integrity of the culture

10 Impact on Individuals Alienation from culture and tradition Alienation from collective community Loss of responsibility to others (tribal) Loss of a spiritual compass (moral/ethical hope) Breakdown of values and practices that maintained the integrity of families and guided the behavior of individuals (community 1 st, individual 2 nd, ) Over time, prejudicial, hate-based stereotypes took hold and are the ongoing historical trauma of shame. These continue to challenge the integrity of Indian culture because in many cases they have become a reality.

11 Historical Effects of Trauma & DV Silence: Stripped of dignity and Identity Tried to hide helplessness and sense of defeat Masked their humiliation Ignored their sense of shame Experienced survivors guilt Practiced avoidance out of warranted fear (Isolation on the Rez) Silence Resulted in: Post Traumatic Stress Disorder (PTSD) Profound depression Domestic Violence

12 Intergenerational Effects Insecure-Disorganized Parenting Style Emotionally inconsistent or unavailable parents Significant levels of unconscious anger Harsh, frightening, aggressive parental reactions Age-inappropriate expectations of children Lack of emotional validation to children Parents have similar historical trauma issues The cycle of transmission continues Poor Attachment Results in emotional dysregulation > ADHD, Bipolar Disorder, Complicated Grief, Depression A real and extremely complicated issue > Primary concern is: It s part of the psychosocial landscape

13 Signs & Symptoms Alcoholism (Addiction to Alcohol & Drugs) Prejudice Hate & racism among Indians is rampant Even greater is the general contempt for non-indians Isolation Never leaving the Rez. Discomfort off the Rez. Lends to misinterpretation of social cues Violence How Indians show their love A Destructive Remnant of HT Encouraged by Outsiders Lack of Trust Interactions frequently misperceived negatively Perception is. because I m Indian/Black/Hispanic/Poor

14 Historical Trauma Resulting in : Maladaptive survival and coping skills Substance abuse, depression, desperation, hopelessness, suicide, cultural paranoia, domestic violence including emotional and verbal abuse (physical and sexual), neglect, and anger management issues.

15 Impact of ACE Related Trauma In Indian Country Heart disease Cancer (1.4 x the national average) ( x national average depending on type and gender) Unintentional Injuries (Ages 1-44 = leading cause of death) Diabetes (2x the national average; Pima Indians = Highest rate in world) Chronic Liver Disease and Cirrhosis (3x the national average) Stroke (40% higher chance of dying than Caucasions) Chronic lower respiratory diseases (COPD, Emphysema, Chronic Bronchitis) Suicide (2-9x the national average) Nephritis, Nephrotic syndrome, and Nephrosis (Kidney Disease; Indian Women 40% higher risk of kidney/pelvic cancer death) Influenza and Pneumonia v Indian Infant Death Rate (40% higher risk than Caucasions)

16 SIHC Tribal Consortium Consortium ACE Average by Age Category and Gender Total A B C D E F G H I Male Female Total A B C D E F G H I Male Female Leon Altamirano, Psy.D., Mental Wellness / P.E.I. Supervisor

17 What Does All of This Mean? Great question. A lot of really smart people are working on this answer. What we do know Most of the people served in MH/SA treatment settings DOC or JJ systems Homeless systems have trauma histories. Many people served in other care systems have experienced trauma. People who are not in care settings may also experience trauma that means our staff, too. (Hodas, 2004; Frueh et al., 2005; Mueser et al., 1998; Lipschitz et al., 1999; NASMHPD, 1998)

18 Trauma Informed Awareness Walk

19 Trauma Informed Care: Resilience and recovery are possible with trauma-informed care Be aware of the biases, stigma and judgment attached to those who find themselves repeatedly in the legal system. Challenge your preconceived notions regarding addiction, crime and the possibility for healing.

20 Client/Individual Focused It means meeting the client where they are, screening, looking for indicators of triggers using grounding techniques to calm client if triggered. Making the person feel safe, comfortable and respected. Understanding how trauma impacts one s life from all avenues. How to best meet the needs of trauma survivors.

21 Knowledge, Awareness and Education Knowledge of different types of trauma, understanding there are various types of trauma. Practitioners who are aware of the impact trauma has on mental health and are sensitive to providing services to address this facet which impacts so many people. Staying abreast about the latest researched based programs, strategies, and organizations that can assist individuals in a myriad of capacities who have suffered traumatic events.

22 Self-Care Focused Services that take the time to engage in self-care practices that help to manage stress linked to their own past traumas and possible compassion fatigue.

23 Programs That Understand Trauma Programs/agencies that are working with clients must understand the role that traumas may have had on an individual s life and being able to include this information when providing services to these very individuals.

24 Implementing TIC: Starting Points Do an organizational self-assessment if you feel the need to explore your agency s readiness. Or just do it. Identify and use a theory-based model as a guide. Document your organization s beliefs/ vision in writing and train staff accordingly. Strive to avoid any practices that may be retraumatizing in your system. (Hopper et al., 2010) Implement universal trauma screening on admission, using standardized measures.

25 Inge Missmahl: Bringing Peace to the Minds of Afghanistan You have felt me; and because you have felt me, I have felt myself; now I want to reconnect with my family. inge_missmahl_brings_peace_to_the_mind s_of_afghanistan.html

26 Empathy Significant in Being TI What was realized from the interaction was how significant the expression of empathy is to initiate the healing process fostering a connection and setting the stage for effective growth and care.

27 Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending. Carl Bard

28 Information was provided by San Diego Trauma-Informed Guide Team (SDTIGT) SAMHSA: Assessing for and Addressing Trauma I Building Solutions Toolkit by Tracy L. Fried & Associates