Trauma Informed Excellence H E A L T H C A R E F O R T H E H O M E L E S S R E G I O N A L T R A I N I N G J U L Y 1 3 TH,

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1 Trauma Informed Excellence H E A L T H C A R E F O R T H E H O M E L E S S R E G I O N A L T R A I N I N G J U L Y 1 3 TH,

2 Diverse Management Solutions, LLC Stay positive (303) Matt Bennett, MBA, MA Informal Interactive Let s have some fun! diverse management solutions

3 TIE Learning Objectives Understand the components of the trauma informed paradigm Assess your work and work environment in terms of trauma informed core competencies Understand the impact of trauma on client functioning

4 Trauma Informed Core Competencies E X C E L L E N C E I N C A R E

5 SAMSHA s Definition When a human service program takes the step to become trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services. Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization.

6 Trauma Informed Excellence: The Path Excellence! Practice Integration Trauma Foundations Thrive: Self-Care Leadership

7 TIE Leadership AFFECTIVE LEADERSHIP + INTELLECTUAL LEADERSHIP = INDIVIDUAL & GROUP EXCELLENCE

8 Affective Leadership Drivers Contagious Nature of Emotions Emotional Labor Parallel Processes Leader s Emotional Power Safety Client s Rights Components Integrity Honesty Humility Trust Positive Regard Positive Outlook Caring Growth Mindset Shared Power Open Communication Democracy

9 Intellectual Leadership Drivers Components Ambiguity Focus Change Lack of Motivation Dangers of Stress Failure of Modern Work Practices Client Involvement Engagement Fit Needed Resources Shared Values Shared Vision Accelerators Accountability Recognition

10 Thrive A STRATEGIC APPROACH TO HEALTH AND EXCELLENCE IN LIFE AND WORK

11 We MUST Care for Ourselves First!!! Helping Trauma Loss of positive worldview Feeling of incompetence and self doubt Negative attitude & hopelessness Inability to engage in relationships Blurred boundaries Constant anxiety Decreased productivity Compromised physical health PTSD & Mental Health Issues Burnout Heart disease Cancer Increase in turnover (40%) Absenteeism Poor productivity Mental illness Job dissatisfaction Cognitive impairment Increase in aggressive and violent behavior Difficulty adjusting to change

12 Trauma Foundations BUILDING PRACTICE OFF SCIENCE & PROVEN METHODOLOGIES

13 Thrive! Physical Health Mind Health Social Health R o b u s t n e s s Distress Hyperstress Challenge Resiliency Focus Eustress

14 Robustness Defined Robustness (Webster Defined): Having or exhibiting strength or vigorous health Having or showing vigor or strength Capable of performing without failure under a wide range of conditions

15 Distress: Stress Leading to Trauma Distress: Bad stress caused by a specific event or related events Stress Intensifiers Importance, Uncertainty & Duration (Distress + Intensity) > Robustness = Trauma Trauma Support = Passive Trauma Trauma + System Triggers = Re-traumitization Trauma + Intensity (Duration) + Simultaneous/Sequential Occurrence = Complex Trauma (Clients Trauma + Intensity) > Robustness = Compassion Fatigue Compassion Fatigue + Countertransference = Secondary Trauma Direct Witness to Another s Trauma > Robustness = Vicarious Trauma Hyperstress can increase the impact of distress and vice versa

16 Warning: Science Content Low Road Amygdala Developed early in our evolution Survival Flight/Freeze/Fight reflex High Road Hippocampus/ Cortex Developed later in our evolution Manages abstract and higher level thinking The relay Thalamus Decides whether Amygdala or Hippocampus addresses stimulus Environment and past impact how stimulus is processed

17 Brain Structure & Processing Brainstem Basic processes Limbic Emotions & Survival Cortex Guides us in the physical world Prefrontal Cortex Thinking & Conceptualization Bottom-up information (sensations) meet top-down information (memories) to create or experience of the world Siegel, 2010

18 How the Brain Views Trauma Trauma Threat to survival When threatened the brain resorts to intense primitive responses to survive which the brain believes is keep it alive Trauma is survived but brain becomes organized around being ultra alert to other dangers even if illogical

19 Trauma & Memory Explicit Memory (Conscious Memory) During trauma massive amounts of cortisol are released Cortisol slows or shuts down the hippocampus Explicit memories are blocked leading to blackouts and dissociation Implicit Memory (Unconscious Memory) During trauma the amygdala massive amounts of adrenaline is released Adrenaline heightens the formation of implicit memories The implicit memories of fear, terror, perceptual details and bodily feeling are remembered all throughout the body Bremner, 2005

20 Triggers Can be triggered by specific objects or sensations in the environment that are similar to the original traumatic event When implicit memories are trigger the survivor reexperiences the same intense fear and terror associated with the trauma These memories often force survivors out of normal life and more towards physical and social isolation Bremner, 2005 & Ogden, Minton, Pain, 2006

21 Window of Tolerance Hyperarousal Zone (Flight/Fight): Increased sensation; emotional reactivity; hypervigilance; disorganized cognitive processing Window of Tolerance: Flexible; adaptive; coherent; energized; stable Hypoarousal Zone (Freeze): Relative absence of sensation; numbing of emotions; disabled cognitive processing; reduction of physical energy Siegel (2010) & Ogden, Minton, & Pain (2006)

22 Phases of Emotional States Regulating State Fully engaged in the environment Reading State Encounters trigger stimulus Coping skills are utilized to calm and sooth Seek help and regulation from others Increased anxiety, disorientation and confusion Reexperiencing State Flood of traumatic memories Everything becomes about survival in the moment Becomes disoriented to time and place Consciousness is being taken over by emotion Reconstituting State Transitioning back to emotion regulation Time is needed to re-orientates to surrounding Again can attempt to utilize coping skills Saxe, Ellis & Kaplow, 2007)

23 Rattlers Everywhere

24 Client Rattlers In small groups Talk about the Rattlers (stress and trauma) that depletes your client s Robustness Talk about the behaviors you see when they are trigger

25 Practice Integration STRATEGIES TOWARD POST TRAUMATIC GROWTH

26 Goals of Trauma Treatment Regulate emotional distress. Selectively engage with and trust others. Inhibiting risky or ineffective behaviors. Effective problem-solving and life management tactics. Rethinking the false notion that one is defective, failing, incompetent, dependent, or damaged. Sense of self as whole, integrated, worthy, and efficacious. Prevention of reenactments of the trauma and revictimization. Restoration of an existential sense of life as worth living.

27 Phases of Trauma Treatment Safety & Stabilization Safety necessary for any healing Manage arousal states Managing triggers Client education on trauma Focus on sense of self and relationship capacities Processing of Traumatic Memories Integration of trauma into autobiographical narrative Work on maintain functioning in face of strong emotions Reintegration Integrating the trauma into a positive view of self and world Integrating new self into the world

28 Please Complete an Evaluation! T H A N K Y O U!

29 References & Resources 1 Acestudy.org Achor, S. (2010). The Happiness Advantage. New York, NY: Crown Business. Bloom, S. L. & Farragher, B. (2011). Destroying Sanctuary: The crisis in human service delivery systems. New York: Oxford. Ford, J. D.; Courtois, Christine A. (2009). Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide (p. 90). Guilford Press. Kindle Edition. J. Douglas Bremner. (2005). Does Stress Damage the Brain? W.W. Norton & Company: New York Lewis, G. (2006). Organizational Crisis Management: The Human Factor. Boca Raton, FL: Auerbach Publications. Miller, W. & Rollnick, S. (2002). Motivational Interviewing: Preparing People For Change.

30 References & Resources 2 Ogden, P., Minton, K., Pain, C. (2006). Trauma and the Body. New York: W. W. Norton and Company. Rock, D. (2009). Your Brain at Work: Strategies for overcoming distraction, regaining focus, and working smarter all day long. New York, NY: HarperCollins. Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2007). Collaborative Treatment of Traumatized Children and Teens. New York: The Guiford Press. Schwartz, T. (2010). The Way We Are Working Isn t Working. New York: Free Press. Shenk, D.. (2010). The Genius in All of Us. New York: Doubleday. Siebert, A. (2005). The Resiliency Advantage. San Francisco, CA: Berrett- Koehler Publishers Inc. Siegel, D. (2010). Mindsight: The new science of personal transformation. New York, NY: Random House.