Trauma Informed Care. Rick Edwards, LPC

Transcription

1 Trauma Informed Care Rick Edwards, LPC

2 FUNDAMENTALS OF TRAUMA 1. What are the types of Trauma? 2. What is a Traumatic Response? 3. What causes a Traumatic Response?

3 Post-Traumatic Stress Disorder The Diagnostic and Statistical (DSM) lists the key aspects of Post Traumatic Stress Disorder (PTSD): Re-experiencing Avoidance Emotional Dysregulation Loss of perspective Unable to interpret signals Loss of skills, functions and flexibility

4 Types of Trauma Type I PTSD: acute trauma

5 Types of Trauma Type I PTSD: acute trauma Type II Developmental trauma Abuse, neglect, violence Brain development

6 Types of Trauma Type I PTSD: acute trauma Type II Developmental trauma Abuse, neglect, violence Brain development Type III Both PTSD & Developmental

7 Types of Trauma Type I PTSD: acute trauma Type II Developmental trauma Abuse, neglect, violence Brain development Type III Both PTSD & Developmental Type IV PTSD plus Developmental Trauma plus ENVIRONMENTAL STRESS!

8 The Two Roads The Low road Prepares the body for emergency response Pathway is unconscious and does not contain contextual information. Tweet The High Road Provides context Insures accurate perception of the stimulus Helps prepare a response. News Article

9 Survival Circuits How one perceives stimuli makes the determination if a threat or not. Low road sensory processing is very fast and unconscious. Low road is only concerned with survival. Emotion hijacks reason

10 A moment in time Traumatized kids will not be able to see their futures if they are fighting for their lives in the present and if they have trouble making sense of the their past and seeing any likelihood of rewards or pleasure in future events.

11 ELEMENTS IN ACE STUDY Abuse Emotional Abuse Physical Abuse Sexual Abuse Neglect Emotional Neglect Physical Neglect Household Dysfunction Mother Treated Violently Household Substance Abuse. Household Mental Illness Parental Separation or Divorce Incarcerated Household Member

12 ACE PYRAMID

13 ANATOMY OF TRAUMA

14 Traumatic Stress Response Trauma activates a biological response in the brain. Norepinephrine (neurotransmitter) locks in the memory of the stress event. The brain processes the event in context to: Age Culture Development And other factors

15 Traumatic Stress Response The people we work with have been severely, negatively affected by trauma. Our approach can help restore hope Or Neglecting what we know about trauma can cause us to harm these patients further.

16 Traumatic Stress Response A MAJORITY of people served in public mental health and substance abuse systems have experienced REPEATED TRAUMA since childhood.

17 Traumatic Stress Response Exposure to traumatic experiences may result in a person staying stuck in: Fight Flight Freeze

18 What Activates A Traumatic Stress Response? TRIGGER words, sounds, posture PERCEPTION REACTION

19 What Activates A Traumatic Stress Response? Compliance Trigger Message: You are wrong; do this now;whether you like it or not. Guilt-based Performance Trigger Message: You failed; you will fail; you don t measure up; you don t know how to do this. Shame-based

20 What Activates A Traumatic Stress Response? Guilt Message versus Shame Message Guilt Your behavior is/was bad because of how it affected someone else. I can t believe you did that! Shame You are bad. You are bad/messed up/!

21 What Activates A Traumatic Stress Response? Compliance Trigger Message: You are wrong; do this now;whether you like it or not. Guilt-based Performance Trigger Message: You failed; you will fail; you don t measure up; you don t know how to do this. Shame-based

22 What Activates A Traumatic Stress Response? Reminder Trigger Sensory experiences (sights, sounds, tastes, smells, tactile) that feel like this happened before and it was bad! Evokes re-experiencing of a previous event

23 Traumatic Stress Response Loss of points of IQ This is not a good time to: Ask questions Teach life lessons Remind of past infractions Process.

24 Traumatic Stress Response Loss of points of IQ This IS a good time to: Step back and give some space Use non-verbal interventions Low doses of sympathy & reassurance Provide concrete help to meet a need

25 Sources of Triggers Local Sources of Triggers for Trauma Response Program: Schedules, rules, requirements Staff: Tone of voice, posture, facial expressions Self: Internal stimulation (delusions, paranoid symptoms, substance abuse)

26 Sources of Triggers External sources of Trauma Triggers Demands for compliance or performance Trauma reminders (sensory) Failure to deliver on promises, expectations

27 Considerations Trauma Informed Care (TIC) means treating every person with the care and sensitivity we would use for those with trauma. TIC is treating people who have special needs due to trauma history in a sensitive and respectful way.

28 Considerations We acknowledge that we could be a trigger to someone else and work to be very sensitive toward their needs. Allow as much self determination and self control as possible.

29 Clarity s Journey to Trauma Informed Care Sanctuary Open Arms Clarity Care Transactional approach: Fit is everything; goal of treatment is to maximize fit between the demands of the environment and the person s current abilities while promoting development of skills that are lacking. Values, Attitudes, Beliefs determine your interpretation Your interpretation guides your actions; believing is seeing

30 Clarity s Journey to Trauma Informed Care Transactional Approach (fit is everything) What happens if: The environment expects a child to behave/perform like an adult? A 10 year old acts with the stress and frustration tolerance of a 3 year old? Compatibility (degree of fit) is the best predictor of good behavioral outcomes.

31 Core Values Core Values (Values, Attitudes, Beliefs) Clarity Child Guidance Center Dignity for Children Respect for Children Understanding for Children

32 Tool box FOR TRAUMA INFORMED CARE

33 TOOLS FOR THE TOOL BOX The Transactional Assumption: Compatibility between expectations of the environment and the person s abilities(fit) is the best predictor of behavioral outcomes. Therapeutic goal: Match environmental expectations (as much as possible) to the individual s skills while promoting development.

34 TOOLS FOR THE TOOL BOX A core Clarity belief: Kids do well when they can. What does this mean? When they are NOT doing well There is a perceived or real demand they cannot accommodate

35 TOOLS FOR THE TOOL BOX When your clients are NOT doing well: What behaviors do you see Examples:

36 TOOLS FOR THE TOOL BOX Recognize a trauma response. Fight Behavior Escalation Flight Avoiding Freeze Shutting Down See the behavior for what it is

37 TOOLS FOR THE TOOL BOX How to respond to a trauma response? Empathy Reassurance Take a step back (check your IQ) Ask, How can I help? Ask for a person centered goal Leave the field if necessary And

38 TOOLS FOR THE TOOL BOX Do everything you can to avoid adding more triggers! So, avoid Compliance demands Performance demands Giving Reminders Teaching Life Lessons

39 TOOLS FOR THE TOOL BOX Clarity Staff Development Model Self Awareness Focus Model brings into awareness the role of our Values, Attitudes and Beliefs. Cognitive Flexibility Believing is Seeing? Emotional Attunement