Truly trauma informed: creating safe environments

Transcription

1 Truly trauma informed: creating safe environments Gabriella Grant, Director California Center of Excellence for Trauma Informed Care, Santa Cruz CA

2 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.

3 Trauma Informed: Core values Safety Trustworthiness Choice Collaboration/connection Empowerment (Harris and Fallot, 2001)

4 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

5 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. Federal Partners Committee on Women and Trauma Report from the Federal Intergovernmental Partnership on Mental Health Transformation, auma.pdf

6 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.

7 Trauma lack of safety Safety = Empowerment and connection Trauma = disempowerment and disconnection

8 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

9 Complex trauma Unsafe home base (presence of harm, absence of safety) Unsafe outside the home relationships that feel safe and more accepting than home, self, or help 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

10 Complex domestic violence Unsafe homebase, abuse, chaotic home, instability unmet needs for safety, connection, Unsafe dynamics feel safer: Return to DV relationship, new DV relationship, suicide, chronic substance abuse, selfharm 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

11 Central trauma roles Bystander Perpetrator Integrated Self Rescuer Victim

12 Complex trauma = Trauma roles Unsafe home base: Perpetrator Unsafe out-of-home relationships and situations: Rescuer Unproductive behaviors: Victim Unsafe interventions: Bystander

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14 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

15 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.

16 Trauma Informed Intervention Safe base, safe housing, safe relationships Reconnection to social, work and family activities that promote safety and trustworthiness 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

17 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

18 Trauma-informed services are safety increase oriented An approach to services that looks at safety as the key to helping people who are struggling

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

20 Thank you! Gabriella Grant, Director CA Center of Excellence for Trauma Informed Care