Trauma and Gender: A Challenging Intersection

Transcription

1 Trauma and Gender: A Challenging Intersection Stephanie S. Covington, PhD, LCSW Center for Gender and Justice 7946 Ivanhoe Ave., Suite 201B La Jolla, CA (858) (858) FAX sc@stephaniecovington.com Utah Fall Substance Abuse Conference September 22, 2017 St. George, UT

2 Trauma and Gender: A Challenging Intersection Stephanie S. Covington, Ph.D., L.C.S.W. Center for Gender and Justice Institute for Relational Development La Jolla, CA Utah Fall Substance Abuse Conference September 22, 2017 St. George, UT 1 Two Themes Trauma Gender Content can be difficult 2 Safety Plan Six things you can do Breathing Safe place in your imagination Placing a call Counting backwards Massaging one s hands Prayer, meditation 3 Trauma and Gender, Sept 22, 2017 UT 1

3 Our World 4 Levels of Violence Childhood Adolescence Adult Street (workplace and community) Consumer Culture Media War Planet 5 Global Violence Violence is a leading cause of death among people aged (World Health Organization Centers for Disease Control and Prevention) 6 Trauma and Gender, Sept 22, 2017 UT 2

4 International Homicide Rates (Rate per 100,000) Austria Switzerland Norway Spain Netherlands Poland Italy Sweden United Kingdom New Zealand Germany Denmark Australia France Greece Ireland Canada Finland Israel United States (Global Study on Violence. UN Office on Drugs and Crime, ) 7 Two Kinds of Suffering Natural Created 8 Although the world is full of suffering, it is also full of the overcoming of it. ~Helen Keller 9 Trauma and Gender, Sept 22, 2017 UT 3

5 Gender 10 Gender 11 Gender Social Messages Socialization 12 Trauma and Gender, Sept 22, 2017 UT 4

6 Baby Showers Video Gender & Trauma Risks Responses 15 Trauma and Gender, Sept 22, 2017 UT 5

7 Gender and Abuse Childhood Girls and boys at equal risk from family members and people they know Adolescence Young men at risk from people who dislike or hate them. Boys at greater risk if they are gay, young men of color, or gang members. Young women at risk from lovers or partners people to whom they are saying, I love you. Adulthood Men at risk from combat or being victims of crime Women at risk from those they love 16 Differences in Risk Worldwide Worldwide, 1 in 4 women and 1 in 8 men experience psychological abuse from partner 38% of female homicides are committed by male partners, while 6% of male homicides are committed by female partners in 5 women will be raped, while 1 in 71 men will be raped Transgender population is at greater risk and has a higher rate of abuse 17 Gender-Responsive Treatment Creating an environment through: site selection staff selection program development content and material that reflects an understanding of the realities of the lives of women and girls (men and boys), and addresses and responds to their strengths and challenges. (S. Covington Women and Addiction: A Trauma-Informed Approach. Journal of Psychoactive Drugs, SARC Supplement 5, November 2008, ) 18 Trauma and Gender, Sept 22, 2017 UT 6

8 Trauma 19 Definitions Trauma informed Universal knowledge about trauma, adversity and its effects on individuality, communities, and society Trauma responsive Policies and practices in place to minimize damage and maximize opportunities for healthy growth and development in all populations at risk Creating an environment for healing and recovery 20 Definitions (cont.) Trauma specific Services designed to specifically address violence and trauma, the related symptoms, and to facilitate healing and recovery 21 Trauma and Gender, Sept 22, 2017 UT 7

9 Definition of Trauma The diagnostic manual used by mental health providers defines trauma as: exposure to actual or threatened death, serious injury or sexual violation. (American Psychiatric Assoc. [APA] DSM-5) 22 Definition of Trauma (cont.) The exposure must result from one or more of the following scenarios in which the individual: directly experiences the traumatic event; witnesses the traumatic event in person; (American Psychiatric Assoc. [APA] DSM-5) 23 Definition of Trauma (cont.) The exposure must result from one or more of the following scenarios in which the individual: learns that the traumatic event occurred to a close family member or close friend; experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related). (American Psychiatric Assoc. [APA] DSM-5) 24 Trauma and Gender, Sept 22, 2017 UT 8

10 Definition of Trauma (cont.) The disturbance, regardless of its trigger, causes significant distress or impairment in the individual s social interactions, capacity to work, or other important areas of functioning. (It is not the physiological result of another medical condition, medication, drugs or alcohol.) (American Psychiatric Assoc. [APA] DSM-5) 25 Definition of Trauma Trauma occurs when an external threat overwhelms a person s internal and external positive coping resources. (Van der Kolk, B., 1989) 26 Trauma is a normal reaction to an abnormal or extreme situation 27 Trauma and Gender, Sept 22, 2017 UT 9

11 Traumatic Events Trauma can take many forms: Emotional, sexual or physical abuse Neglect Abandonment (especially for small children) Extremely painful and frightening medical procedures 28 Traumatic Events (cont.) Catastrophic injuries and illnesses Rape or assault Muggings Domestic violence Burglary Automobile accidents 29 Traumatic Events (cont.) Immigration Natural disasters (hurricanes, floods, earthquakes, tornadoes, fires, volcanoes) Stigmatization Terrorism such as 11 th September 2001 Witnessing violence such as a parent harming another parent 30 Trauma and Gender, Sept 22, 2017 UT 10

12 Traumatic Events (cont.) The unexpected/violent loss of a loved one (even of a pet) Combat/war Torture Kidnapping Victim of trafficking Intergenerational (cultural) trauma 31 Historical Trauma Across generations Massive group trauma Examples include: Native Americans, African Americans, Holocaust survivors, Māori, First Nations, and others 32 Definition of Historical Trauma the cumulative emotional and psychological wounding spanning generations, which emanates from a massive group trauma. (Brave Heart, M.Y.H. (2005). From intergenerational trauma to intergenerational healing. Keynote address at the Fifth Annual White Bison Wellbriety Conference, Denver, CO, April 22, 2005) 33 Trauma and Gender, Sept 22, 2017 UT 11

13 34 35 Social Amnesia The study of psychological trauma has a curious history one of episodic amnesia. Periods of active investigation have alternated with periods of oblivion. Repeatedly in the past century, similar lines of inquiry have been taken up and abruptly abandoned, only to be rediscovered much later. ~ Dr. Judith L. Herman, Trauma and Recovery, 1992 p.7 36 Trauma and Gender, Sept 22, 2017 UT 12

14 Always Look For What is not being said What is being kept hidden What is being mocked and ridiculed What is too awful to know Whatever challenges the status quo Whatever challenges power 37 Why is this Important for all Human Services? Health Mental Health and Substance Abuse Housing Justice Child Welfare Education 38 Abuse is Pervasive Health High medical utilization rates exist for both male and female veterans; survivors of war, political violence and terrorism; survivors of natural disasters; crime victims (especially women who have experienced sexual assault); and survivors of child abuse. (Center for Substance Abuse Treatment, 2014). 39 Trauma and Gender, Sept 22, 2017 UT 13

15 Abuse is Pervasive Mental Health Over 33% of women and 37% of men with serious mental illness (SMI) had been sexually/physically assaulted in the last year alone (Rosenberg, Mueser, Jankowski, & Hamblen, 2002). 40 Abuse is Pervasive Substance Abuse Men and women with alcohol and/or drug dependence are more likely to have all types of childhood adversities. (Blanco, Brady, Perez-Fuentes, Okuda, & Wang, 2013) 41 Abuse is Pervasive Homeless Life-time risk for violent victimization for homeless people is 97% (Goodman, Dutton, & Harris, 1995). Of the homeless population who report to the Veteran Health Administration, 39.7% of females and 3.3% of males are victims of military sexual assault (Pavao et al. 2013). 42 Trauma and Gender, Sept 22, 2017 UT 14

16 Abuse is Pervasive Criminal Justice System Men and women in criminal justice system have significantly higher rates of traumatic events than non-criminal-justice men and women (Reavis et al., 2013). 43 Abuse is Pervasive Child Welfare 86% of sex trafficking victims were in the cases of social services when they went missing (National Center for Missing and Exploited Children, 2016). 44 Abuse is Pervasive Disability The rate of nonfatal violent crimes against people with disabilities was more than twice the rate of people without disabilities (Harrell, 2016). 45 Trauma and Gender, Sept 22, 2017 UT 15

17 Abuse is Pervasive Education Children with one or more adverse childhood experiences missed school two weeks or more at almost double the rate of all US children. (Child and Adolescent Health Measurement Initiative, 2013) 46 Reoccurring Themes Trauma & Abuse 47 Trauma and Abuse The more it happens... The longer it lasts... The earlier it starts... The more trust is betrayed... The more it s at the hands of other people... The more challenging its effects 48 Trauma and Gender, Sept 22, 2017 UT 16

18 Across the Lifespan Behavioral Problems Physical Illness Emotional Dysregulation Trauma & Loss Chronic Hyperarousal & Chronic Inflammation Adverse Childhood Experiences Family Dysfunction Social Dysfunction 49 Stress Adversity Trauma The Poison in Our Lives 50 Stress Normal Stress Positive stress Tolerable stress Destructive Stress Relentless stress Toxic stress Traumatic stress 51 Trauma and Gender, Sept 22, 2017 UT 17

19 Allostatic Load = Relentless Stress The wear-and-tear on the body and brain resulting from chronic over-activity of physiological systems that are normally involved in adaptation to environmental challenge 52 Relentless Stress Poverty Hunger Racism, sexism Parenting alone Multigenerational caregiving Children with multiple challenges Severe injury/illness in close family 53 Toxic Stress and Children Stress of adversity is toxic to the development of the brain Primary responses Emotions dysregulation Behavior unmanageable Relationships lack of connection, trust 54 Trauma and Gender, Sept 22, 2017 UT 18

20 Primary Issues (children) Attachment Relationships Regulation Feelings and behavior Competencies Learning 55 The Relationship of Adverse Childhood Experiences to Adult Health Status A collaboration effort of Kaiser Permanente and The Centers for Disease Control Vincent J. Felitti, M.D. Robert F. Anda, M.D. 56 The Adverse Childhood Experiences Study (ACEs Study) In 1998, largest study of its kind ever (almost 18,000 participants) Examined the health and social effects of adverse childhood experiences over the lifespan Majority of participants were 50 or older (62%), were white (77%) and had attended college (72%) 57 Trauma and Gender, Sept 22, 2017 UT 19

21 ACE Study (Adverse Childhood Experiences) Before age 18: Recurrent and severe emotional abuse Recurrent and severe physical abuse Contact sexual abuse Emotional neglect Physical neglect 58 ACE Study (Adverse Childhood Experiences) Growing up in a household with: Both biological parents not being present Your mother being treated violently An alcoholic or drug-user A mentally ill, chronically depressed, or family member attempting suicide A family member being imprisoned (N = 17,000) 59 ACE Study (Adverse Childhood Experiences) Results ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness. Smoking Alcoholism Injection of illegal drugs Obesity (Felitti, V.J.: Origins of Addictive Behavior: Evidence from the ACE Study Oct:52(8): German. PMID: (PubMed-indexed for MEDLINE). 60 Trauma and Gender, Sept 22, 2017 UT 20

22 Higher ACE Score Chronic Health Conditions Heart disease Autoimmune diseases Lung cancer Pulmonary disease Liver disease Skeletal fractures Sexually transmitted infections HIV/AIDS 61 ACE Study (cont.) Women 50% more likely than men to have a score of 5 or more. (Felitti & Anda, 2010) 62 ACE Study (cont.) If a male child has 6 or more yes answers, his risk of becoming an IV drug user increases by 4,600% compared to a boy with a score of zero. (Felitti & Anda, 2010) 63 Trauma and Gender, Sept 22, 2017 UT 21

23 ACE Study (cont.) One-third of the group had a score of Adverse Childhood Experiences Five-State Study 2010 Collaboration between CDC and state health departments of AR, LA, NM, TN and WA. 26,229 adults were surveyed 65 ACE Scores and Impact Adverse childhood experiences are underlying factors for: Chronic depression Suicide attempts Serious and persistent mental health challenges Addictions Victimization (rape and domestic violence) (Feleti and Anda, 2010.) 66 Trauma and Gender, Sept 22, 2017 UT 22

24 Adverse Childhood Experiences ( ( (Felitti, V.J., et. al.) 67 ACE Study (cont.) I see that you have Tell me how this has affected you later in your life. (Felitti & Anda, 2010) 68 Women in Prison Largest Effect-Mental Health Psychotropic medication Mental health treatment Attempted suicide Traumatic stress (Messina & Grella, 2005) 69 Trauma and Gender, Sept 22, 2017 UT 23

25 Women in Prison Largest Effect-Mental Health (cont.) 980% increase in odds if exposed to 7 CTE s (Messina & Grella, 2005) 70 Crittenton ACE Pilot (October 2012) Group Total Score All girls served by Crittenton (n=916) 53% 42% All young mothers served by Crittenton (n=253) Young mothers in juvenile justice and served by Crittenton (n=59) Young mothers in child welfare and referred to Crittenton (n=42) (Summary of Results: Crittenton Adverse Childhood Experiences (ACE) Pilot, October 24, 2012) 61% 48% 74% 69% 63% 48% 71 Process of Trauma Traumatic Event Overwhelms the physical and psychological coping skills Response to Trauma Fight, Flight, Freeze or Faint Altered state of consciousness, Body sensations, Numbing, Hyper-vigilance, Hyper-arousal, Collapse Sensitized Nervous System Changes in the Brain Brain Body Connection Physical and Psychological Distress Current stressors, Reminders of trauma (triggers) Sensations, Images, Behavior, Emotions, Memory Retreat Isolation Dissociation Depression Anxiety Emotional and/or Physical Responses Harmful Behavior to Self Substance abuse Eating disorders Self-injurious behavior Suicidal actions Harmful Behavior to Others Aggression Violence Rages Threats Physical Health Issues Lung Disease Heart disease Autoimmune disorders Obesity 72 Trauma and Gender, Sept 22, 2017 UT 24

26 Process of Trauma (Cont.) Traumatic Event Overwhelms the physical and psychological coping skills Response to Trauma Fight, flight, or freeze Altered state of consciousness, Body sensations, Numbing, Hypervigilance, Hyperarousal, Collapse Sensitized Nervous System Changes in the Brain Brain-Body Connection 73 Process of Trauma (Cont.) Psychological and Physical Distress Current stressors, Reminders of trauma (triggers) Sensations, Images, Behavior, Affect (emotions), Memory Emotional and/or Physical Responses Retreat Harmful Behavior to Self Harmful Behavior to Others Physical Health Issues Isolation Dissociation Depressive disorders Anxiety disorders Substance use disorders Feeding and eating disorders Deliberate selfharm Suicidal actions Aggression Violence Rages Threats Lung disease Heart disease Autoimmune disorders Obesity 74 Post-traumatic Stress Disorder (PTSD) Intrusive symptoms flashbacks, nightmares, intense or prolonged distress Avoidant symptoms avoiding people, places and situations which are triggers or reminders; disconnection (DSM-5) 75 Trauma and Gender, Sept 22, 2017 UT 25

27 Post-traumatic Stress Disorder (cont.) (PTSD) Negative emotions and thoughts blaming, excessive negativity, fear, anger, shame, diminished interests, feelings of isolation Arousal symptoms angry outbursts, reckless and dangerous behavior, hypervigilance, difficulty sleeping (DSM-5) 76 What does all this mean for the people we serve? 77 Mental Illness Substance Abuse HIV/ AIDS Other Health Problems Trauma Homelessness (Vivian Brown, Ph.D.) 78 Trauma and Gender, Sept 22, 2017 UT 26

28 Changes in Understanding: The Centrality of Trauma Incarceration Homelessness Violence and Trauma Substance Abuse Mental Health Problems 79 Areas of Separation Training Treatment Categorical Funding 80 Trauma Responsive What ALL organizations need to do to create or change policies that increase the likelihood of health and recovery for everyone. 81 Trauma and Gender, Sept 22, 2017 UT 27

29 Trauma-Responsive Services Take the trauma into account. Avoid triggering trauma reactions. Adjust organization so that trauma survivors can access and benefit from services. (Harris & Fallot) 82 Core Values of Trauma-Informed Environment Safety: Trustworthiness: Choice: Ensuring physical and emotional safety Maximizing trustworthiness, modeling openness, maintaining appropriate boundaries, and making tasks clear Emphasizing individual choice and control (adapted from Fallot & Harris, 2006) 83 Core Values of Trauma-Informed Environment (cont.) Collaboration: Empowerment: Providing equality in participation, sharing power, and creating a sense of belonging Striving for empowerment and skill building (adapted from Fallot & Harris, 2006) 84 Trauma and Gender, Sept 22, 2017 UT 28

30 Moving from Trauma Informed to Trauma Responsive Self-Assessment Create a Guide Team 85 Self-Assessment Five Core Values Safety, trustworthiness, choice, collaboration, empowerment Physical Environment Lighting, space, color, texture Safety Physical Psychological Moral Social 86 Guide Team 8 10 members Varied composition Chair Team members Trauma champion Message throughout organization Next meeting? 87 Trauma and Gender, Sept 22, 2017 UT 29

31 Staff Secondary traumatic stress (STS) Compassion fatigue Burnout Vicarious traumatization 88 Workplace Stress Paperwork Too much to do Demands Organizational change Office politics Funding Poor communication Unclear policies 89 Suicides Homicides Organizational Trauma Sexual abuse Media attacks Other patient or staff Other traumatic events deaths Loss of key staff Lawsuits Loss of key leaders Loss of funding Loss of programs Patient or staff injuries 90 Trauma and Gender, Sept 22, 2017 UT 30

32 Definitions Trauma informed Universal knowledge about trauma, adversity and its effects on individuals, communities, and society Trauma responsive Policies and practices in place to minimize damage and maximize opportunities for healthy growth and development in all populations at risk Creating an environment for healing and recovery 91 Trauma-Specific Interventions Services designed specifically: To address violence, trauma, and related symptoms and reactions; and To facilitate recovery and healing. 92 Definition of Gender-responsive Services/Approaches are those that intentionally allow research and knowledge on female/male socialization and development, and women s/girls /men s/boys risks, strengths and needs to affect and guide ALL aspects of program and system design, processes, and services (DCF/CSSD Guidelines 2008, Connecticut) 93 Trauma and Gender, Sept 22, 2017 UT 31

33 Gender-responsive Materials (trauma-informed) Women and Addiction: A Gender-Responsive Approach Helping Women Recover Helping Men Recover Beyond Trauma: A Healing Journey for Women Voices: A Program of Self-Discovery and Empowerment for Girls 94 Gender-responsive Materials (trauma-informed) Healing Trauma: A Brief Intervention for Women Exploring Trauma: A Brief Intervention for Men Women in Recovery A Woman s Way through The Twelve Steps 95 Gender-responsive Materials (trauma-informed) Beyond Violence: A Prevention Program for Criminal Justice- Involved Women Beyond Anger and Violence: A Program for Women Becoming Trauma Informed: A Training Curriculum for Correctional Professionals 96 Trauma and Gender, Sept 22, 2017 UT 32

34 Self-Help Books Leaving the Enchanted Forest: The Path from Relationship Addiction to Intimacy (relationships) Awakening Your Sexuality: A Guide for Recovering Women (sexuality) A Woman s Way through The Twelve Steps (addiction and recovery) 97 Treatment Strategies Cognitive-behavioral Relational therapy Guided imagery Mindfulness Expressive arts Mind-body (yoga) Emotional Freedom Technique (EFT) Eye Movement Desensitization and Reprocessing (EMDR) 98 Trauma-Specific Materials for Women Beyond Trauma (Stephanie Covington) Healing Trauma (S. Covington and E. Russo) Beyond Violence (Stephanie Covington) TREM (Maxine Harris) Trauma-Specific Materials for Men Helping Men Recover (Covington, Griffin & Dauer) Exploring Trauma (Covington and Rodriquez) M-TREM (Roger Fallot) 99 Trauma and Gender, Sept 22, 2017 UT 33

35 Materials for Adolescents Voices: A Program for Girls Beyond Trauma (adaptation for girls) A Young Man s Guide to Self-Mastery (in development) 100 Women s Integrated Treatment ( WIT ) This model is holistic, integrated and based on: The gender-responsive definition and guiding principles A theoretical foundation Interventions/strategies that are multidimensional (Covington, 2007) 101 Men s Integrated Treatment ( MIT ) This model is holistic, integrated and based on: The gender-responsive definition and guiding principles A theoretical foundation Interventions/strategies that are multidimensional (Covington, 2007) 102 Trauma and Gender, Sept 22, 2017 UT 34

36 One Hour Levels of Intervention Brief Conversation Six Sessions Exploring Trauma Healing Trauma Twelve Sessions Beyond Trauma Levels of Intervention (cont.) Eighteen to Twenty-Four Sessions Helping Men Recover (Covington, Griffin, & Dauer) Helping Women Recover (Covington) Beyond Violence (Covington) M-TREM (R. Fallot) TREM (M. Harris) One Thirty-six Sessions S.E.L.F. Psychoeducational Groups ( Research 105 Trauma and Gender, Sept 22, 2017 UT 35

37 Women-Only Treatment Long-Term Outcomes (10 year follow-up) Women-only (WO) treatment compared to mixed-gender (MG) WO increased odds of successful outcome by 49% Substance use Mental health Criminal justice (Evans, et. al., JSAT, 2013) 106 Prison Study (NIDA Funded) Randomized control group Gender-responsive vs. Therapeutic community Significant differences Greater reduction of drug use More likely to complete treatment Remained longer in aftercare Less recidivism (re-incarcerated) at 12 months (p.05) (Messina & Bond) 107 HEALING TRAUMA A BRIEF INTERVENTION FOR WOMEN 6 SESSIONS ON CD-ROM PRE AND POST TREATMENT CHANGES IN SYMPTOMS OF DEPRESSION AND POSTTRAUMATIC STRESS 27 October 1, 2012 through September 30, 2013 (N=53) Score 21 CESD (t=4.79, df=52, p PCL (t=2.96, df=52, p= Pre-Test Post-Test (September 2013 Annual Report: The Interpersonal Violence Project, Josephine M. Hawke, PhD) 108 Trauma and Gender, Sept 22, 2017 UT 36

38 Beyond Violence One Year Post Release Less recidivism Less relapse Beyond Violence Program TAU (Assaultive Offender Program) Arrest within the First Year Positive Drug Screen 15% 25% 47% 47% (Dr. Sheryl Kubia, MDOC Research Results 2015) 109 Pilot Project on Beyond Violence (California Department of Corrections and Rehabilitation CDCR) Phase 1: Phase 2: Phase 3: Training staff and peer educators Peer educators participate in Beyond Violence Peer educators co-facilitate Beyond Violence with four specific groups (Dr. Messina, UCLA) 110 CDCR Pilot Study Post Traumatic Stress Disorder PTSD Change over time Positive at Admission to BV Positive at McNemar s Graduation Chi Square from BV Peer Educators 55.2% 18.5% 8.33** Other Participants 72.1% 42.3% 7.35* (Nena Messina (2014). Beyond violence, final report, CDCR cooperative agreement no ) 111 Trauma and Gender, Sept 22, 2017 UT 37

39 Exploring Trauma Men in Prison Statistically significant decreases in: Depression PTSD Aggression Hostility Anger Anxiety Dissociation Sleep disturbance (Messina & Burdon, 2017) 112 When is Someone Ready? She/he is able to use some safe coping skills She/he has no major current crises or instability (e.g., homelessness or domestic violence) She/he is willing to do this type of work She/he can reach out for help when in danger She/he is not using substances to such a severe degree that emotionally upsetting work may increase her/his use 113 When is a Someone Ready? Her/his suicidality has been evaluated and taken into account She/he is in an ongoing system of care that is stable and consistent, with no immediate planned changes (e.g., discharge from inpatient unit or residential program) 114 Trauma and Gender, Sept 22, 2017 UT 38

40 What Makes a Good Facilitator? The following qualities in a facilitator will help to ensure a positive group experience: Trustworthy Credible Available Reliable, consistent Hopeful Warm, compassionate Emotionally mature Energetic 115 What Makes a Good Facilitator? (cont.) Healthy boundaries, respects confidentiality Committed to and interested in women s/men s issues Multi-cultural sensitivity and responsiveness Appropriate gender - a female should facilitate the all-female groups and a male should facilitate the all-male groups 116 What Makes A Good Facilitator? (cont.) If trauma survivor, she/he needs to feel confident that she/he is at a place in her/his own recovery that will allow for healthy and positive outcomes for herself/himself and the women/men in the group. Content expertise, if possible Skills as a facilitator 117 Trauma and Gender, Sept 22, 2017 UT 39

41 What Makes A Good Facilitator? (cont.) BE PREPARED! 118 What Makes a Difference? Creating a safe environment 119 Sanctuary 120 Trauma and Gender, Sept 22, 2017 UT 40

42 What is Sanctuary? Sacred place Place of refuge/protection Shelter Oasis 121 What Makes a Difference? Creating a safe environment Listening to her/his story Empathy 122 Upward Spiral Transformation Addiction & Trauma (constriction) Recovery & Healing (expansion) 123 Trauma and Gender, Sept 22, 2017 UT 41

43 About your presenter. Dr. Stephanie S. Covington is an internationally recognized clinician, author, organizational consultant, and lecturer. She is a pioneer in the field of women s issues, addiction, trauma and recovery. She has developed an innovative, gender-responsive, and trauma-informed approach that results in effective services in public, private, and institutional settings. Her presentations, staff-development seminars, and technical assistance focus on systems change and the development of caring, compassionate, and empowering therapeutic environments. They provide professionals an opportunity to learn new skills for dealing with personal, institutional, and societal changes and are always in demand, both nationally and internationally. Dr. Covington s clients include the Betty Ford Treatment Center, the Hanley Center, CeDAR (Center for Dependency, Addiction & Rehabilitation), the United Nations Office on Drugs and Crime, the Center for Substance Abuse Treatment in Washington, D.C., the California Department of Corrections and Rehabilitation, and numerous other treatment and correctional settings. Dr. Covington was a workshop chair for the women s treatment improvement protocol (TIP) published by SAMHSA. She is also the co-author of a three-year research project, Gender-Responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders, for the National Institute of Corrections. This publication received the University of Cincinnati Award for its outstanding contribution to the field of corrections in the U.S. and Canada. Educated at Columbia University and the Union Institute, Dr. Covington has served on the faculties of the University of Southern California, San Diego State University, and the California School of Professional Psychology, and she is a former chair of the Women's Committee of the International Council on Alcoholism and Addiction. She is a boardcertified Diplomate of the National Association of Social Workers and the American Board of Sexology and is a member of the American Association of Marriage and Family Therapy and the American Psychological Association. She has also served on the Advisory Council for Women s Services for the federal agency SAMHSA. She was the featured consultant and therapist on the Oprah Winfrey Network docu-reality show entitled Breaking Down the Bars. Dr. Covington is based in La Jolla, California, where she is co-director of the Institute for Relational Development and the Center for Gender and Justice, which seeks to expand gender-responsive policies and practices for females who are under criminal justice supervision. Among the many articles and books written by Dr. Covington are: Women and Addiction: A Gender-Responsive Approach Awakening Your Sexuality: A Guide for Recovering Women Leaving the Enchanted Forest: The Path from Relationship Addiction to Intimacy She has also published gender-responsive and trauma-informed program materials. The following curricula include training manuals for professionals and complementary materials for participants: Helping Women Recover: A Program for Treating Addiction (with a special edition for the criminal justice system) Beyond Trauma: A Healing Journey for Women Voices: A Program of Self-Discovery and Empowerment for Girls A Woman s Way through The Twelve Steps Beyond Violence: A Prevention Program for Criminal Justice-Involved Women Beyond Anger & Violence: A Program for Women Becoming Trauma Informed: A Training Program for Correctional Professionals (USA, Canadian, and UK versions) Healing Trauma: A Brief Intervention for Women (co-authored with Eileen Russo) Helping Men Recover (co-authored; also with a special edition for the justice system) Exploring Trauma: A Brief Intervention for Men (co-authored with Roberto Rodriquez) For a list of Dr. Covington s recent articles, and descriptions of her current seminars for professionals, visit: and About Your Presenter August 2016

44 STEPHANIE S. COVINGTON, PhD, LCSW Institute for Relational Development / Center for Gender and Justice, 7946 Ivanhoe Avenue, Suite 201 B, La Jolla, California Phone: (858) Fax: (858) info@stephaniecovington.com BOOK ORDER FORM PROGRAM DEVELOPMENT GUIDE PRICE QTY. TOTAL PRICE CLINICAL INNOVATOR SERIES WOMEN AND ADDICTION: A Gender-Responsive Approach Manual/DVD/CE Test $ $ Manual & CE Test $ $ MANUALIZED, TRAUMA-INFORMED TREATMENT CURRICULA A WOMAN S WAY THROUGH THE TWELVE STEPS Complete Set (10 books, 10 workbooks, 1 FG, 1 DVD) $ $ DVD $ $ 1 Facilitator s Guide, 10 workbooks $ $ Facilitator s Guide $ $ Set (1 Book, 1 Workbook in English) $ $ A Woman s Way through the Twelve Steps (Book in English) $ $ La Mujer Y Su Práctica de los Doce Pasos (Book in Spanish) $ $ Workbook (English) $ $ Libro de Ejercicios (Spanish) $ $ BEYOND TRAUMA: A Healing Journey for Women 2nd Edition (2016). A 12-session trauma-specific curriculum. Complete Set (FG, 20 workbooks, 3 DVDs) $ $ Facilitator s and Participant's DVDs $ $ Facilitator s Guide & 10 workbooks $ $ Facilitator s Guide $ $ Workbooks (pack of 10) $ $ Workbook $ $ BEYOND TRAUMA: A Healing Journey for Women 1st Edition (2003). 11-sessions. Available while supplies last. Workbooks (pack of 10) $ $ Workbook $ $ HEALING TRAUMA: A Brief Intervention for Women CD-Rom $ $ EXPLORING TRAUMA: A Brief Intervention for Men CD-Rom $ $ HEALING TRAUMA and EXPLORING TRAUMA set of CD-Roms $ $ Book Order Form, June 2017 Page 1 of 4 Stephanie S. Covington

45 STEPHANIE S. COVINGTON, PhD, LCSW Institute for Relational Development / Center for Gender and Justice BOOK ORDER FORM (continued) MANUALIZED, TRAUMA-INFORMED TREATMENT CURRICULA (continued) VOICES: A Program of Self-Discovery and Empowerment for Girls 2nd Edition (2017) Facilitator s Guide (includes 1 journal) $ $ Journal $ $ VOCES: Un Programa de Autodescubrimiento y Empoderamiento para Chicas 1st Edition (2004) Guía del Facilitador (Facilitator Guide in Spanish, includes 1 journal) $ $ Diario (Journal in Spanish) $ $ HELPING WOMEN RECOVER: A Program for Treating Addiction A 17-session program for treating women with addictive disorders Facilitator s Guide (includes 1 journal) $ $ Participant s Journal $ $ Special Edition for use in the criminal justice system Facilitator s Guide (includes 1 journal) $ $ Participant s Journal $ $ BEYOND ANGER AND VIOLENCE: A Program for Women Facilitator s Guide (includes 1 workbook and DVD) $ $ Participant s Workbook $ $ BEYOND VIOLENCE: A Prevention Program for Criminal Justice-Involved Women Special Edition for use in the criminal justice system Facilitator s Guide (includes 1 workbook and DVD) $ $ Participant s Workbook $ $ HELPING MEN RECOVER: A Program for Treating Addiction A 18-session program for treating men with addictive disorders Facilitator s Guide (includes 1 workbook) $ $ Participant s Workbook $ $ Special Edition for use in the criminal justice system Facilitator s Guide (includes 1 workbook) $ $ Participant s Workbook $ $ Book Order Form, June 2017 Page 2 of 4 Stephanie S. Covington

46 ALCOHOL AND DRUG EDUCATION WOMEN IN RECOVERY: Understanding Addiction English version $ 6.85 $ BOOKS Spanish version $ 6.85 $ AWAKENING YOUR SEXUALITY: $ $ A Guide for Recovering Women LEAVING THE ENCHANTED FOREST: $ $ The Path from Relationship Addiction to Intimacy - Continue to Next Page to Complete Your Order Request - Please review the processing options at the bottom of page 4 prior to submitting this form. Book Order Form, June 2017 Page 3 of 4 Stephanie S. Covington

47 STEPHANIE S. COVINGTON, PhD, LCSW Institute for Relational Development / Center for Gender and Justice, 7946 Ivanhoe Avenue, Suite 201 B, La Jolla, California Phone: (858) Fax: (858) info@stephaniecovington.com BOOK ORDER FORM (continued) SUBTOTAL (from previous pages): U.S. Shipping & Handling Add 10% before tax: Outside U.S. Shipping & Handling Add 25% before tax 1 : California Sales Tax Add 7.75% before shipping for California residents only 2 : TOTAL 3 : $ $ $ $ $ 1 International order payments by check/money order must be in U.S. currency and drawn from a U.S. affiliated bank 2 Only residents of California need to add California sales tax 3 Review the bottom of this page for processing options to place your order BILLING ADDRESS Name of Organization: Contact Name: Address: City: State: Zip: Country: Phone: Tax Exempt Number: Your Internal Order #: SHIPPING ADDRESS (please note, we are unable to ship to P.O. Box addresses) Same as Billing Address (check box):! Name of Organization: Contact Name: Address: City: State: Zip: Country: Phone: ADDITIONAL INSTRUCTIONS: PLEASE ALLOW DAYS FOR DELIVERY PLEASE CHOOSE ONE OF THE FOLLOWING METHODS TO SUBMIT YOUR ORDER: Mail this completed form with check/money order payable to Dr. Stephanie Covington to the La Jolla, California address Fax or this completed form with purchase order (obtained from your accounting department) to or info@stephaniecovington.com. We will process your order immediately and bill you under Net 30 terms. Credit cards may only be accepted via our online shopping cart and checking out via Paypal. We are unable to take credit cards over the phone. Visit and select Books and Curricula. Book Order Form, June 2017 Page 4 of 4 Stephanie S. Covington