Trauma Informed Excellence Trauma Informed Care

Transcription

1 Trauma Informed Excellence Trauma Informed Care 2012 HEALTH CARE FOR THE HOMELESS REGIONAL TRAINING ORLANDO FLORIDA NOVEMBER 1-2

2 Diverse Management Solutions, LLC Stay positive (303) Matt Bennett, MBA, MA Informal Interactive diverse management solutions

3 TIE Learning Objectives Understand the trauma informed paradigm as it relates to: Self-care Leadership/Culture Trauma Informed Care Trauma Treatment Conceptualize the impact of trauma on client functioning Utilize knowledge about the impact of stress/trauma in work with clients.

4 Defining Trauma and Stress ESTABLISHING THE NEED FOR A NEW PARADIGM

5 Robustness

6 Types of Trauma Active Trauma Intense stress that overwhelms our robustness resulting in a life dominated by the traumatic event. Passive Trauma Being overwhelmed by the trauma with no support to regain control. Attachment Trauma Threats to the availability of the attachment figure through illness (physical/emotional), substance abuse, imprisonment or other loss of meaningful contact. Betrayal Trauma Attachment figure is the perpetrator of the trauma. Complex Trauma Repeated systematic trauma that occurs over time. Bloom & Farragher, 2012 & Lewis, 2006

7 Trauma Informed Core Competencies EXCELLENCE IN CARE

8 Trauma Informed Excellence: The Path Excellence Trauma Treatment Trauma Informed Care Thrive: Self Care Leadership & Culture

9 TIE Leadership & Culture INDIVIDUAL & GROUP EXCELLENCE

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11 Thrive: Self Care A STRATEGIC APPROACH TO HEALTH AND EXCELLENCE IN LIFE AND WORK

12 Dangers in Helping Others Clients Trauma + Duration> Robustness = Compassion Fatigue Compassion Fatigue + Countertransference = Secondary Trauma Direct Witness to Another s Trauma > Robustness = Vicarious Trauma Stress + Duration> Robustness = Burnout

13 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

14 Trauma Informed Care BUILDING PRACTICE OFF SCIENCE & PROVEN METHODOLOGIES

15 ACE Findings Acestudy.org, 2012

16 Warning: Science Content Survival Road Amygdala Increased activation in traumatized people Survival Flight/Freeze/Fight reflex Thinking Road Sensory Cortex/ Hippocampus Smaller in traumatized people Controls negative emotional response of Amygdala Manages abstract and higher level thinking The Relay Thalamus Decides whether survival or thinking road addresses stimulus Environment and past impact how stimulus is processed

17 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

18 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

19 Processing Traumatized clients have less ability to limit survival reaction through top down processing Neuropathway development Experience lays down traces that permanently alter brain structure Intensity or repetition consolidates and strengths structure Cascading constraints emerge making it more difficult for new structures to develop and degrees of freedom limits potential of a consistent integrated self Ogden, Minton, & Pain, 2006

20 Dissociation Fragmentations of our personality and mind resulting from traumatic experience that we cannot integrate into our sense of self These fragmentations, memories or personalities remain separate from an integrated sense of self Brain processes no longer operates as an integrated whole Courtois & Ford, 2009

21 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

22 Retraumatization Mind s attempt at integrating the experience into the personality As long as the trauma can not be put into words it will be relived through emotions and behaviors The emotions that are experienced are the emotions that need to be overcome in order to gain mastery over the trauma that they could not stop Bloom & Farraagher, 2011 & Herman, 1997

23 Rattlers Everywhere

24 Client Rattlers What Rattlers (stress and trauma) depletes your client s Robustness What behaviors do you see when they are trigger

25 Trauma Treatment STRATEGIES TOWARD POST TRAUMATIC GROWTH

26 Phases of Trauma Treatment Internal Regulation Establish safety Awareness and management of arousal states Integration Finding meaning in the experience Integration of trauma into view of self and world Maintain safety in face of strong emotions Post Traumatic Growth Prevent future trauma Returning stronger and wiser Finding new meaning in life

27 Questions & Comments THANK YOU!

28 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.

29 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.