Trauma-Informed Care/ Palliative Care Panel
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1 Building Hopeful Healing around Life s Most Challenging Times Trauma-Informed Care/ Palliative Care Panel Misty Boldt, LMSW Lifespan Tony Cotraccia, LCSW Syncopation Melissa Oakley, LMSW CareFirst Kim Evanoski, LMSW Care Manage for All, LLC Introduction by Barbara Ganzel, PhD, LMSW
2 Palliative Care ANY stage, ANY age, ANYwhere
3 Palliative Care ANY stage, ANY age, ANYwhere Trauma-Informed Care Behavioral health, Primary Care, Long-term Care
4 Trauma-Informed Care and the Trauma-Informed Organization Realizes the prevalence & impact of trauma
5 Trauma-Informed Care and the Trauma-Informed Organization Realizes the prevalence & impact of trauma Understands how to assess and treat the signs & symptoms of trauma
6 Trauma-Informed Care and the Trauma-Informed Organization Realizes the prevalence & impact of trauma Understands how to assess and treat the signs & symptoms of trauma Integrates this information into its policies and practices
7 Trauma-Informed Care and the Trauma-Informed Organization Realizes the prevalence & impact of trauma Understands how to assess and treat the signs & symptoms of trauma Integrates this information into its policies and practices To Prevent client re-traumatization To Promote client/staff empowerment in a culturally sensitive framework SAMHSA:
8 Trauma-Informed Care and the Trauma-Informed Organization Realizes the prevalence & impact of trauma Understands how to assess and treat the signs & symptoms of trauma Integrates this information into its policies and practices To Prevent client re-traumatization To Promote client/staff empowerment in a culturally sensitive framework SAMHSA:
9 Psychological Trauma: DSM-5 American Psychiatric Association (2013) Events that threaten death, serious injury, or sexual violence e.g., rape, serious accident, life-threatening illness (DSM-5) Self or other Directly experienced Personally witnessed Some indirect experiences qualify
10 PTSD in the DSM-5 Re-Experiencing (one symptom) Unwanted upsetting memories Nightmares Flashbacks Emotional trauma reminders Physical trauma reminders Trauma-Related Arousal/Reactivity (two symptoms) Risky or destructive behavior Hypervigilance/Heightened startle Difficulty concentrating Difficulty sleeping Irritability or aggression Lasts 30 days; Distress or Impairment Not due to illness or Rx Avoidance (one symptom) Trauma-related reminders Trauma-related thoughts or feelings Negative Thoughts/Feelings (two symptoms) Overly negative thoughts about oneself or the world Inability to recall key features of the trauma Exaggerated blame of self or others re trauma Negative affect Decreased interest in activities Feeling isolated Difficulty experiencing positive affect
11 Trauma Exposure is Pathogenic even w/o PTSD It is a predictor of immediate and lifetime increases in a wide array of mental and physical disorders Breslau et al. (1998); Kessler et al. (1995); Brown (1993); Bremner et al. (1993) There are significant psychophysiological effects of trauma exposure even w/o PTSD Impacts emotion processing, cognition, & mental health (PTSD, anxiety, depression ) Increases symptoms of PTSD & future vulnerability Ganzel, Morris, & Wethington (2010) Psych Review
12 Differences in grey matter volume Whole-brain ANOVA (Comparison > 9/11) Anterior Cingulate Medial PFC Insula Amygdala Anterior HC Ganzel et al., NeuroImage (2008) More than three years after 9/11, there were multiple areas with significantly lower mean gray matter volume in nonclinical 9/11-exposed adults (p <.001, w/control for total grey matter volume).
13 Differences in grey matter volume Whole-brain ANOVA (Comparison > 9/11) Anterior Cingulate Medial PFC Insula Amygdala Anterior HC All implicated in the evaluation and regulation of emotional stimuli in humans Ochsner et al. (2004) Phan et al. (2002)
14 Psychological Trauma IS COMMON More than 60% of men, and 50% of women in lifetime (ages years) More than half of these experience two or more traumas National Comorbidity Survey (N = 5,877) national, representative epidemiological survey of U.S. Kessler et al. (1995) Archives of General Psychiatry Pietrzak et al. (2012). Am. J. Geriatric Med.
15 Trauma-Informed Care and the Trauma-Informed Organization Realizes the prevalence & impact of trauma Understands how to assess and treat the signs & symptoms of trauma Integrates this information into its policies and practices To Prevent client re-traumatization To Promote client/staff empowerment in a culturally sensitive framework SAMHSA:
16 Trauma-Informed Care and the Trauma-Informed Organization Realizes the prevalence & impact of trauma Understands how to assess and treat the signs & symptoms of trauma Integrates this information into its policies and practices To Prevent client re-traumatization To Promote client/staff empowerment in a culturally sensitive framework SAMHSA:
17 Trauma Assessment Checklists: History & Symptoms National Center for PTSD Assessment Overview Trauma-Specific Treatment Eye Movement Desensitization & Reprocessing Trauma-Focused Cognitive Behavior Therapy Exposure Therapy
18 REACHING for Strong Palliative Care
19 REACHING for Strong Palliative Care ANY stage, ANY age, ANYwhere
20 REACHING for Strong Palliative Care ANY stage, ANY age, ANYwhere REACHING for Trauma- Informed Care especially for older adults
21 Building Hopeful Healing around Life s Most Challenging Times Trauma-Informed Care/ Palliative Care Panel Misty Boldt, LMSW Lifespan, Rochester, NY Tony Cotraccia, LCSW Syncopation, Ithaca, NY Melissa Oakley, LMSW CareFirst, Painted Post, NY Kim Evanoski, LMSW Care Manage for All, LLC
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