Trauma Informed Excellence

Transcription

1 Trauma Informed Excellence Introduction of Presenter(s) Matt Bennett, MBA, MA Five Modules to Understand Trauma and How to Support Our Patients Five Module Trauma Series Trauma Rollercoaster 1 Impact of Trauma on Patient Functioning & Well Being 2 3 Traumatized Patient & HIV Medical Care Post Traumatic Growth & Healing Warning: You must be this positive to ride this ride! 4 Dangers in Helping Traumatized Clients & Self Care Strategies 5 Creating a Trauma Informed Clinic Impact of Trauma on Patient Functioning and Well Being Pre Assessment! The First of Five Modules 1 Impact of Trauma on Patient Functioning & Well Being 1

2 Objectives Section 1: The ACE Study Understand the impact of trauma on physical, social, and psychological health Conceptualize how the trauma informed paradigm focuses on patient issues in a different way than old paradigms The Paradigm Shift Paradigm Shift: A new way of thinking that challenges existing belief structures Section 2: Cup Analogy, & Trauma Utilize the Cup Analogy and to conceptualize how stress and trauma impact patient functioning Define trauma, passive trauma, and complex trauma Section 3: Homeostasis & Epigenetics Understand the impact our environment has on our genes and traits Recognize the opportunity for survival traits to change into FACES traits The Trauma Informed Challenge Challenge: Take a critical look at yourself, your services, and your organization and make the changes necessary to give your patients the maximum impact of the trauma informed paradigm Small Group Activity What is trauma? What impact does trauma have on patients and their ability to achieve strong health outcomes? The ACE Study Section 1: The Adverse Childhood Experience (ACE) Study Partnership: Center for Disease Control and Prevention and Kaiser Permanente 17,000 participants Early Death Disease, Disability & Social Problems Adoption of Health risk Behaviors Social, Emotional & Cognitive Impairment Disrupted Neurodevelopment Adverse Childhood Experiences Conception Death Mechanisms by Which Adverse Childhood Experiences Influece Health and Well being Throughout the Lifespan 2

3 Acestudy.org, 2013 Acestudy.org, Trauma Symptoms Psychological Biological Social Inability to focus Learning disrupted Memory problems Constipation or diarrhea Somatic pain Disrupted sleep patterns Risk for intimate partner violence Multiple sexual partners Limited volition Sexually transmitted Alcohol abuse & infections (STIs) Emotional instability dependence Unintended pregnancies Nightmares Illicit drug use Difficulty trusting others Diminished interest in Smoking everyday activities Concern about burdening Ischemic heart disease (IHD) others with problems Loss of positive point of view Fetal death Feelings of detachment Depression Chronic obstructive Attachment issues Suicide attempts pulmonary disease (COPD) Social withdrawal Deregulated emotional states Liver disease Isolation Disrupted personality Decreased immune function development Lack of awareness of social Decreased health related cues Fear & anxiety quality of life Anger & rage Acestudy.org, 2014, Levin, 2004, Herman, 1997 Acestudy.org, The 1990s: Decade of the brain Physical structure of brain develops differently The ACE Study Early Death Disease, Disability & Social Problems Adoption of Health risk Behaviors Social, Emotional & Cognitive Impairment Disrupted Neurodevelopment Adverse Childhood Experiences Conception Death Acestudy.org, 2013 Mechanisms by Which Adverse Childhood Experiences Influece Health and Well being Throughout the Lifespan 3

4 The ACE Study The Old Paradigm Focus on trauma symptoms & behaviors What did you do? Early Death Disease, Disability & Social Problems Adoption of Health risk Behaviors Social, Emotional & Cognitive Impairment Disrupted Neurodevelopment Adverse Childhood Experiences Mechanisms by Which Adverse Childhood Experiences Influece Health and Well being Throughout the Lifespan Conception Death Trauma Symptoms Psychological Biological Social Inability to focus Learning disrupted Memory problems Constipation or diarrhea Somatic pain Disrupted sleep patterns Risk for intimate partner violence Multiple sexual partners Sexually transmitted Limited volition Alcohol abuse & infections (STIs) dependence Emotional instability Unintended pregnancies Illicit drug use Nightmares Difficulty trusting others Smoking Diminished interest in Concern about burdening everyday activities Ischemic heart disease (IHD) others with problems Loss of positive point of view Fetal death Feelings of detachment Depression Chronic obstructive Attachment issues Suicide attempts pulmonary disease (COPD) Deregulated emotional states Liver disease Social withdrawal Disrupted personality Isolation Decreased immune function development Lack of awareness of social Decreased health related cues Fear & anxiety quality of life Anger & rage Acestudy.org, 2014, Levin, 2004, Herman, 1997 The ACE Study A Paradigm Shift Focus on trauma & root causes What happened to you? Early Death Disease, Disability & Social Problems Adoption of Health risk Behaviors Social, Emotional & Cognitive Impairment Disrupted Neurodevelopment Adverse Childhood Experiences Mechanisms by Which Adverse Childhood Experiences Influence Health and Well being Throughout the Lifespan Conception Death Small Group Activity How would shifting from the traditional, What did you do? to the trauma informed, What happened to you? change how patients are viewed in society: schools, services, policies, criminal justice, etc.? Robustness Defined Section 2: Cup Analogy, & Trauma Robustness: (Webster Defined) Having or exhibiting strength or vigorous health Capable of performing with success (without failure) under a wide range of conditions Goals Increase robustness patients have to bring to their lives Help manage levels and impact of stress and trauma 4

5 Robustness States Capacity of stress an individual can hold Increased by: Healthy lifestyle, healthy relationships, resiliency & self confidence Decreased by: Illness, diet, weather, time of day, bad relationships, trauma & constant stress Robustness Levels Level of stress and trauma within the state Cognitive and social capacity = space between water and top of cup Water overflowing = crisis Siegel, 2010 Siegel, 2010 : Flexible; adaptive; coherent; energized; stable : Flexible; adaptive; coherent; energized; stable Siegel, 2010 & Ogden, Minton, & Pain, 2006 Siegel, 2010 & Ogden, Minton, & Pain, 2006 Hyperarousal Zone (Flight/Fight): Increased sensation; emotional reactivity; hypervigilance; disorganized cognitive processing Hyperarousal Zone (Flight/Fight): Increased sensation; emotional reactivity; hypervigilance; disorganized cognitive processing : Flexible; adaptive; coherent; energized; stable : Flexible; adaptive; coherent; energized; stable Siegel, 2010 & Ogden, Minton, & Pain, 2006 Hypoarousal Zone (Freeze): Relative absence of sensation; numbing of emotions; disabled cognitive processing; reduction of physical energy Siegel, 2010 & Ogden, Minton, & Pain,

6 Trauma Defined Trauma: Intense stress that overwhelms our robustness state resulting in a life dominated by the traumatic event Types of Trauma Hyperstress: Stress that builds up and, without release, overwhelms robustness Lewis, 2006 Types of Trauma Hyperstress: Stress that builds up and, without release, overwhelms robustness Passive trauma: Being overwhelmed by the traumatic event without support to regain control Types of Trauma Hyperstress: Stress that builds up and, without release, overwhelms robustness Passive trauma: Being overwhelmed by the traumatic event without support to regain control Complex trauma: Repeated systematic trauma that occurs over time Section 3: Homeostasis & Epigenetics Homeostasis The tendency towards a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes. Google Dictionary Person Traits Change Neurobiology Relationships 6

7 The Old Argument: Nature vs. Nurture Nature Genes Proteins Cells Traits The Winner: Epigenetics!!!! Genes Proteins Cells Traits Nurture Relationships Traits Shenk, 2010 Shenk, 2010 Epigenetics FACES Traits Epigenetics Survival Traits Genes Proteins Cells FACES Traits Genes Proteins Cells Survival Traits Caring : Genes are expressed that regulate the nervous system Qualities associated with emotional resiliency are reinforced Shenk, 2010 Abusive : Stress inhibits proteins that lead to the development & operation of the brain Decreases ability to manage stress in the future Shenk, 2010 Impact of Trauma on Patient Functioning & Well Being Review Section 1: ACE Study Prevalence of Trauma Trauma Brain Behavior Poor Health Outcomes Focus on trauma & root causes What happened to you? Section 2: Cup Analogy, & Trauma Stress & Trauma Overflowing Cup Little or no Window of Tolerance Crisis Hyper/Hypo Arousal States (Flight, Fight or Freeze) Hyperstress, Passive Trauma & Complex Trauma Section 3: Homeostasis & Epigenetics Nature & Nurture Caring Environnent FACES Traits Trauma Environnent Survival Traits Genes & Traits Can Change! Small Group Activity How does this information impact how we look at our patients and the services we provide? 7

8 Objectives Section 1: The ACE Study Understand the impact of trauma on physical, social, and psychological health. Conceptualize how the trauma informed paradigm focuses on patient issues in a different way than old paradigms Section 2: Cup Analogy, & Trauma Utilize the Cup Analogy and to conceptualize how stress and trauma impact patient functioning. Define trauma, passive trauma, and complex trauma. Section 3: Homeostasis & Epigenetics Understand the impact our environment has on our genes and traits. Recognize the opportunity for survival traits to change into FACES traits. 2 THANK YOU! Any questions? Please complete & turn in the post assessment Next month s module Traumatized Patient & HIV Medical Care 8