Trauma & Trauma Informed Service Approach

Transcription

1 Trauma & Trauma Informed Service Approach I. Introductions II. Understanding trauma and the impact of trauma III. Concepts of trauma-informed care IV. Being and creating a trauma- informed provider and system Trauma is an event that overwhelms the person s perceived ability to cope, debilitates her/him through a central loss of control, and creates the necessity for psychological defenses. McCann and Pearlman define trauma as; 1) an event that is sudden, unexpected, or non-normative 2) exceeds the individual s perceived ability to meet its demands 3) disrupts the individual s frame of reference and other central psychological needs and related schemas Interpersonal Accidental Direct/Indirect Acute/Single incident Chronic & Complex Trauma Political/Cultural/ System Vicarious Trauma can be a life and death danger or a horrible physical injury, assault, pain or illness Trauma is a life altering violation, betrayal, abandonment Trauma immobilizes/overwhelms normal coping Pam Wright

2 Cortisol is produced and prevents neurons and synapses from firing and connecting causing parts of the brain to shut down The amygdala indicates danger (fight or flight) and is at the alarm center of the brain The alarm is activated during trauma and the filing center (hippocampus) and the thinking center (prefrontal cortex) shut down Depression Aggression/rage Lack of trust Anxiety Health problems Fearfulness Difficulty concentrating Substance abuse/addictions Flashbacks Risk taking & need for excitement Difficulty in relationships Hyper vigilance Impulsive/risk taking Hopelessness Poor social skills Anger Poor problem solving skills Poor memory Promiscuity Dissociation/numbing Pam Wright

3 Defensiveness Poor eating habits Low self-esteem Negative thoughts and feelings Withdrawn/passive Learning disabilities Brain development Neglecting self and putting others first Dysregulation Emotions- extremes or not at all Thinking- confused, disorganized, paranoid, dissociated Behavior- impulsive, self-destructive, violent, withdrawn, passive, substance abuse Identity- confused, empty, self-hating Dr. Vincent Felitti of San Diego Kaiser Permanente and Dr. Robert Anda from Center for Disease Control A study that looks at the effects of childhood trauma on a person s health and well being. Looks at childhood traumas that might include: Abuse: physical, emotional, sexual Neglect Dysfunction within the household: witnessing DV substance abuse within the home mental illness/suicidal member marital discord Crime/prison by someone in the home Ace score 0-10 As ACE scores go up so does the likelihood of the following: Heart disease Smoking Suicide attempts IV drug user High blood pressure Alcoholism Diabetes Pam Wright

4 Trauma Informed care is an approach to engaging people with a history of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their life. SAMSHA Negative behaviors are developed as a way to survive/cope 2. Programs and services are based on rules and should have them 3. Focus and goals of services is stabilization 4. Services offered clients are required to participate in and use 5. Trauma Survivors need service providers who are experts and can determine what is best for them to participate in 6. Consumers seek out services and are ready to do what is required or necessary to receive services 7. It is important to determine the problem and solve the problem A new way of looking at, approaching and organizing services. Moves from What s wrong with you? To What s happened to you? 8. We should respect and follow a person s choice Trauma is expected and pervasive Trauma is a life organizing event The whole person is seen within their trauma Safety is the primary focus Universal trauma training for all staff Shared power-partnership & collaboration Universal trauma screening Trust /trustworthiness is built, not expected, transparency, explanation and follow through Consumer has a voice and a choice Empowerment is a core value and is taught Pam Wright

5 Policies, procedures, structure, physical design ensure that trauma informed concepts are embedded and don t re-victimize Identify a Trauma Champion Ask What happened to you? Build on strengths Kindness promotes hope and resiliency Language demonstrates all these concepts Trauma-informed What happened? Collaboration Strengths based Goal educate, empower skill building (growth & change) Trust is earned and built Symptoms serve a purpose Both parties have something to offer Trauma is life organizing and pervasive Safety focused Traditional What is the problem? Power with provider/hierarchy Crisis driven Reduce symptoms & stabilize Trust & safety assumed Symptoms pathological Provider expert/decision maker Trauma a discrete experience There are five components of trauma informed service approach. 1. Safety- Includes both physical and emotional safety for survivor. 2. Trustworthiness- The development of boundaries, consistency and transparency. 3. Choice- The survivor has both a choice and a voice, She has the control. No one has the power or control over her decisions. 4. Empowerment a focus that prioritizes and recognizes strengths and builds skill of the survivor. 5. Collaboration- there is an equal partnership and a sharing of power between consumer and service provider. 6. Language- positive, conversational, offers choices Clients can and should be held accountable Non- punitive /non-judgmental manner Tell a client that their behavior/choice is not ok and isn t acceptable Offer a choice while stating your expectation We can determine that it is best to separate our partnership Pam Wright

6 Built on a understanding of trauma, research and evidence based models Creates Safety Listen, speak slowly, limit paperwork & questions Offer choices Validates, encourages and believes in the person Universal trauma screening/assessment Create guidelines for success and growth Transparency = Trust Language that supports trauma informed service approach Procedures and activities meet the consumers needs and not yours or the programs Not expecting or treating the person to be just like the last person Providing services in this manner is both respectful and welcoming. It follows the unique needs of the trauma survivor offering hope. Realistic expectations that are not punitive Pam Wright, LCSW South Bay Community Services pwright@csbcs.org ext Pam Wright