Trauma Informed Care: Improving the Way We Look at Caring for Kids & Families

Transcription

1 Trauma Informed Care: Improving the Way We Look at Caring for Kids & Families Patty Davis, MSW, LSCSW, LCSW Department of Social Work Children s Mercy April The Children's The Children's Mercy Mercy Hospital, Hospital, /14 03/14

2 Disclosures No disclosures 2 The Children's The Children's Mercy Mercy Hospital, Hospital, /14 03/14

3 Objectives Define psychological trauma and toxic stress Understand how trauma impacts health Delineate need for trauma-informed care Learn how to build resiliency The Children's Mercy Hospital, /14

4 What is Psychological Trauma? 4 The Children's The Children's Mercy Mercy Hospital, Hospital, /14 03/14

5 Psychological Trauma Any experience that overwhelms a persons ability to cope. 5 The Children's The Children's Mercy Mercy Hospital, Hospital, /14 03/14

6 Potentially Traumatic Events Serious accidents Child maltreatment Non-accidental physical trauma Traumatic grief Exposure to intimate partner violence (IPV) Complex trauma Gang Violence School/community shootings Bullying Serious illness Medical procedures Natural disasters (e.g. earthquake, tornado, hurricane) Terrorist attacks/war National Child Traumatic Stress Network, 2012

7 Variation in Outcomes The negative impact of childhood trauma, especially child abuse, is not universal. 20% to 40% of victims report experiencing little to no distress (Finkelhor, 1990). 7 The Children's The Children's Mercy Mercy Hospital, Hospital, /14 03/14

8 Toxic Stress Positive Stress Brief increases in heart rate, mild elevations in stress hormone levels. Normal part of healthy development Result of briefly distressing experiences Tolerable Stress Serious, temporary stress responses, buffered by supportive relationships Result of more severe, longer-lasting difficulty Loss of loved one, natural disaster Toxic Stress Prolonged activation of stress response systems in the absence of protective relationships Result of strong, frequent and/or prolonged adversity Abuse, neglect, family economic hardship

9 What Can Trauma/Toxic Stress Do? Can shape a person s basic beliefs about identity, world view and spirituality Can create symptoms that are ADAPTATIONS: What we see as the problem is the person s solution Can affect neurophysiological DEVELOPMENT The Children's Mercy Hospital, /14

10 Lateral Ventricles Measures in an 11-Year Old Maltreated Male with Chronic PTSD, Compared with a Healthy, Non- Maltreated Matched Control De bellis et al.,

11 Adverse Childhood Experiences The Children's Mercy Hospital, /14

12 If ACE score is If ACE Score is ACE = 0, 1% rate of suicide attempt, ACE = 1, 3%, ACE = 2, 5%, ACE = 3, 10%, ACE = 4, 19% rate of suicide attempts! If ACE score is ACE = > 4, 460% more likely to be suffering from depression than an individual with an ACE Score of 0. If Male with ACE = 6, 4,600% greater likelihood of becoming an IV drug user compared to male with ACE = 0 ACE = 4, 260% more likely to have COPD.

13 As the number of ACE s increase, the risk for the following health problems increases in a strong and Alcoholism and alcohol abuse, substance use/abuse Obesity Respiratory difficulties Heart disease Multiple sexual partners Poor relationships with others Smoking Suicide attempts Unintended pregnancies graded fashion: Anxiety problems and fears Avoiding people, places and things that are similar to or reminders of the traumatic event(s) Physical health problems Sleep problems Emotional problems such as feeling numb and/or disconnected from oneself or environment Memory problems Flashbacks

14 Additional ACE Study Results The Children's Mercy Hospital, /14

15 Why Trauma Informed Services? Trauma is pervasive and diverse Trauma s impact can be deep and life-shaping Trauma, especially interpersonal violence, is often self-perpetuating Trauma differentially affects the more vulnerable Trauma affects how people approach services The Children's Mercy Hospital, /14

16 A healthy experience A trauma survivor s experience Trauma Informed Florida The Children's Mercy Hospital, /14

17 The Challenge We don t know what we don t know Similar to standard precautions in medicine We don t know what kind of diseases/illnesses our patients have, so we treat everyone with caution. Trauma-Informed Care We don t know what kinds of experiences our patients have had when they present for services, so we need to approach them in a universally sensitive manner. The Children's Mercy Hospital, /14

18 Clarity of Purpose Trauma Specific Therapeutic Interventions and Clinical Services Child Life interventions EMDR, DBT, CBT, TF- CBT, PCIT etc. SAHF evaluations SCAN clinic Trauma-Informed Care (TIC Culture) Not the what, but the how, of compassionate service delivery Universal precautions and sensitive practices Organizational culture Pertains to all staff, including non-clinical

19 Core Principles in Trauma Informed Care Safety Physical Emotional Trustworthiness Choice Collaboration Empowerment Peer Engagement Resilience Social Responsibility Culture The Children's Mercy Hospital, /14

20 Staff Support and Well-Being Understanding trauma informed change as a cultural and systemic process means: Support and care for entire staff is essential, not an option or luxury Staff support is an organizational obligation as well as a personal or professional concern In stressed systems, trauma is a literal and figurative reality for many administrators and staff In such settings, we can apply much of what we know about trauma and recovery to the agency or program as a whole The Children's Mercy Hospital, /14

21 What Happens? Compassion Fatigue Empathy diminishes Vicarious traumatization Counter-transference issues Burnout 21 The Children's The Children's Mercy Mercy Hospital, Hospital, /14 03/14

22 Building Resilience Resilience: successful adaptation despite challenging or stressful experiences A process of development as opposed to an individual trait A system of traumainformed supports and services available to children across time promotes resilience Fairbank, J.A., Briggs, E.C., Carmody, K.A., Greeson, J.K.P. & Woods, B.A.. "Resilience & recovery in special populations: Children" Facilitating resilience & recovery following traumatic events. Ed. L.A. Zoellner & N.C. Feeny. New York: Guilford Press, The Children's The Children's Mercy Mercy Hospital, Hospital, /14 03/14

23 An MRI cannot detect it. BUT YOU CAN. The Children's Mercy Hospital, /14

24 Everyone has experienced previous trauma, to a certain degree. Previous trauma can shape the way we experience current environments. An environment might be comforting to one person, but uncomfortable to another For your Impact might be: What you can do: Patient and/or their caregiver Colleague, Peer, Manager, Staff Self Symptoms which aren t explained by tests, scans, and specialist consults Negative reactions/defensiveness to my recommendations or supportive services An over-proportional reaction to or discomfort with a seemingly unthreatening experience Uncomfortable memories or associated emotions triggered by an environment; you might be the only one discomforted by the environment, and those around you might not realize how uncomfortable 24 The Children's The Children's Mercy Mercy Hospital, Hospital, /14 03/14 Consider all possible culprits, including psychosocial triggers, rather than simplifying or allowing bias to influence clinical judgment Pass ideas and observations onto others in positive way Ask a question Avoid gossip. If you re a manager, ensure your staff members feel safe Talk to someone you trust Take a break, especially if you re in the middle of patient care or a highrisk task

25 Resources Initiative/Behavioral-Health/Trauma-Matters-KC The Children's Mercy Hospital, /14