What Does Trauma Have To Do With ALGEE?

Transcription

1 What Does Trauma Have To Do With ALGEE? Cheryl S. Sharp, MSW, ALWF November 6, :00 2:00 PM EST Mental Health First Aid USA is coordinated by the National Council for Behavioral Health, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health.

2 Introductions

3 Cheryl S. Sharp, MSW, MWT, is the Senior Advisor for Trauma-Informed Care for the National Council for Behavioral Health. She serves as project coordinator and faculty lead for the National Council s 2011, 2012, 2013, and 2014 Adoption of Trauma-Informed Approaches Learning Community. She holds the unique perspective of a person with lived experience both as a family member and as an ex-consumer of services as well as a provider of services. She is an ordained minister, Master WRAP Trainer and serves as an international trainer/consultant for the Copeland Center for Wellness & Recovery, a Mental Health First Aid Trainer, and a trainer of Intentional Peer Support (Shery Mead). Cheryl has worked with over 600 organizations to support their work in trauma-informed practices. She most recently became project director for the National Council s Crisis and Suicide Response initiatives.

4 Learning Objectives Webinar participants will learn: 1. Identify the need for Mental Health First Aiders and instructors to understand the relationship between trauma and mental health 2. Understand the physical, mental and emotional impact of trauma across the lifespan 3. ALGEE in action when considering trauma

5 What We Will Cover Today Defining Trauma Understanding Adverse Childhood Experiences (ACEs) Neuro/Bio/Psychosocial Impact of Trauma Using Trauma Sensitive Approaches to Provide Support

6 Mental Health First Aid Action Plan Assess for risk of suicide or harm Listen nonjudgmentally Give reassurance and information Encourage appropriate professional help Encourage self-help and other support strategies

7 What is Trauma? Definition (SAMHSA Experts 2012) includes three key elements: Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as overwhelming or life-changing and that has profound effects on the individual s psychological development or well-being, often involving a physiological, social, and/or spiritual impact.

8 What is Trauma? Trauma is pervasive Trauma s impact is broad and diverse Trauma s impact is deep and life-shaping Trauma, especially interpersonal violence, is often self-perpetuating Trauma is insidious and differentially affects the more vulnerable Trauma affects how people approach services The service system has often been re-traumatizing Healing is possible

9 What Does Trauma Do? Trauma shapes a child s basic beliefs about identity, worldview, and spirituality Symptoms are adaptations A person often gets stuck in a vicious loop of reexperiencing events and keeps them from being able to move forward in their lives Using a trauma framework, the effects of trauma can be addressed and a person can go on to lead a normal life

10 Prevalence in the General Population In the general population, 61% of men and 51% of women reported exposure to at least one lifetime traumatic event, but majority reporting more than one traumatic event.(kessler, et al, 1995) 2012 numbers show that 59% of the general population has experience adverse childhood events

11 Prevalence in Substance Abuse, Mental Health and Justice Involved 93% of children in detention report significant exposure to adverse events. (Abram et al., 2004); Ford et al., 2007) 50% of women in SA treatment have history of rape or incest (Governor's Commission on Sexual and Domestic Violence, Commonwealth of MA, 2006) 90% of public mental health clients in have been exposed to trauma, (Mueser et al., 2004, Mueser et al., 1998)

12 Universal Precautions We need to presume the clients we serve have a history of traumatic stress and exercise universal precautions by creating systems of care that are trauma-informed. (Hodas, 2005)

13 Adverse Childhood Experiences Study Center for Disease Control and Kaiser Permanente (an HMO) Collaboration Over a ten year study involving 17,000 people Looked at effects of adverse childhood experiences (trauma)over the lifespan Largest study ever done on this subject

14 ACE Score Increases Suicide Attempt 1 of 100 people with 0 ACEs attempt suicide 10 of 100 people with 3 ACEs attempt suicide 20 of 100 people with 7 ACEs attempt suicide

15 Childhood Experiences Underlie Chronic Depression

16 Childhood Experiences and Adult Alcoholism

17 Lateral Ventricles Measures Two 11 Year Old Males (De Bellis et al., 1999)

18 Stress and the Brain Unpredictable Severe Predictable Moderate Vulnerability Resilience

19 Play Stress & Pleasure (Panksepp, 1998)

20 Play & Fear (Panksepp, 1998)

21 Survival Mode Response Stressed Brains Brain cannot effectively: Respond Learn Process Allow time to calm & return to higher brain functioning

22 w w w. T h e N a t i o n a l C o u n c i l. o r g Plasticity of the Human Brain Cortex Limbic Plasticity Diencephalon Cerebellum Brainstem Complexity 22

23 Effective Supports Effective supports must account for: A dysregulated nervous system A social environment that cannot contain this dysregulation

24 Impacting the Lower Brain w w w. T h e N a t i o n a l C o u n c i l. o r g Rhythmic Respectful Repetitive Rewarding Relational Relevant

25 Activating the Lower Brain Music

26 Activating the Lower Brain Movement

27 Activating the Lower Brain Touch

28 Stress Hormones Cortisol - Stress management response hormone. Too much cortisol: Slows down healing and normal cell regeneration Co-opts parent molecules needed to make other vital hormones Impairs digestion, metabolism and mental function Interferes with healthy endocrine function Weakens our immune system

29 Stress Hormones Norepinephrine: Stress hormone & neurotransmitter Affects the amygdala Along with epinephrine, underlies the fight or flight response Directly increases heart rate and impacts the release of glucose High levels can cause a continuous feeling of hyper arousal Individual might experience prolonged bouts of anxiety, restlessness and sleeplessness

30 The Anti-Stress Hormone Oxytocin Women s bodies produce to stimulate labor and milk flow for breastfeeding Men have it, too; released during sex and is associated with cuddling behavior Bonding hormone Connected virtuous actions like responsibility, trust and generosity Motivates us to bond together to raise offspring and treat strangers like family

31 Resilience Resilience is the ability to adapt well to stress, adversity, trauma or tragedy. It means that, overall, you remain stable and maintain healthy levels of psychological and physical functioning in the face of disruption or chaos PEACE: It does not mean to be in a place where there is no noise, trouble, or hard work. It means to be in the midst of these things and still be calm in your heart. - Anonymous

32 Three Statements of Resilience I Have = Safety & Security: Core for Developing Resilience I Am = Safety & Security: Core for Developing Resilience I Can = Mastery, Sense of Future Strengthening the Human Spirit by Edith Grotberg, PhD 1995

33 What Do We Do? Set up calm and nurturing environments Meticulously observe for triggers Train to caring and compassion Adjust the environment Adjust what we do

34 Ultimately, what determines how children survive trauma, physically, emotionally or psychologically, is whether the people around the particularly the adults they should be able to trust and rely upon, stand by them with love, support and encouragement. Dr. Bruce Perry The Boy Who Was Raised as a Dog The same applies to adults!

35 But What Exactly Does Safety Mean? We always recognized the importance of physical safety. Our refusal to tolerate violence of any sort constituted our best defense against any breach in physical safety. But a physically safe environment, although necessary, was not sufficient. So there had to be other kinds of safety, which I have termed psychological safety, social safety, and moral safety. (Sandra L. Bloom, Creating Sanctuary, 2013)

36 Principles of a Trauma-Informed Approach Safety Trustworthiness and transparency Collaboration and mutuality Empowerment Voice and choice (Fallot 2008, SAMHSA, 2012) 36

37 Mental Health First Aid Action Plan Assess for risk of suicide or harm Listen nonjudgmentally Give reassurance and information Encourage appropriate professional help Encourage self-help and other support strategies

38 Having The Conversations It s o.k. to ask What happened to you? rather than what s wrong with you? The ACE Study shows that people are often relieved at finally being asked. You can also ask, Has something like this happened to you in the past? or Does this remind you of something that has happened in the past? Listening nonjudgmentally requires that we suspend judgment regarding what we may hear. A person may disclose things that make you uncomfortable. Take care of yourself.

39 What You Can Do If a person discloses a trauma history and you have encouraged them to get professional help; encourage them to seek support from a therapist or doctor who knows how to work with trauma survivors or offers trauma-focused or trauma-specific therapies. Peer support is especially helpful for those with a trauma history. Peers are being trained to work with trauma survivors. It is often more comfortable sharing your story with others having similar experiences.

40 How to Help Adults Affected by Traumatic Events Encourage the person to: Tell others what he or she needs Identify sources of support Take care of himself or herself Use coping strategies that have helped in the past Spend time in a safe and comfortable place Seek professional help if needed

41 Trauma Informed Non Trauma Informed Recognition of high prevalence of trauma Recognition of primary and cooccurring trauma diagnoses Assess for traumatic histories & symptoms Recognition of culture and practices that are re-traumatizing Lack of education on trauma prevalence & universal precautions Over-diagnosis of Schizophrenia & Bipolar D., Conduct D. & singular addictions Cursory or no trauma assessment Tradition of Toughness valued as best care approach

42 Trauma Informed Power/control minimized - constant attention to culture Caregivers/supporters collaboration Address training needs of staff to improve knowledge & sensitivity Non Trauma Informed Keys, security uniforms, staff demeanor, tone of voice Rule enforcers compliance Patient-blaming as fallback position without training

43 Questions?

44 Resources SAMHSA Concept Paper 2014 Child Trauma Academy National Child Traumatic Stress Network National Council for Behavioral Health ACEs Connection

45 Contact Information Cheryl S. Sharp, MSW, ALWF Senior Advisor for Trauma-Informed Services National Council for Behavioral Health , ext

46 Mental Health First Aid Team National Council for Behavioral Health ( ) Team Member Title Ext. Meghan Bragg Program Associate 264 Bryan Gibb Director of Public Education 243 Margaret Jaco Mental Health First Aid Associate 263 Susie Morrison Program Associate 268 Laira Roth Project Manager 256 Betsy Schwartz VP Public Education & Special Initiatives 259 Jessica Steltzriede Program Associate Tramaine Stevenson Mary Wichansky Director of Program Development/Operations Mental Health First Aid-Instructor Curriculum Support Mgr

47 Next Instructor Webinar >Violence, Mental Illness and Substance Use Disorders - Myths and Facts >Thursday, December 4 th, pm ET