FIRST 5 SACRAMENTO COMMISSION ADVISORY COMMITTEE 2750 Gateway Oaks Drive, Suite 330 Sacramento, CA 95833 AGENDA FRIDAY April 10, 2015 2:00 P.M. Members: Ernie Brown, Carolyn Curtis, Dr. Le Ondra Clark Harvey, Dr. Lee Turner-Johnson, Trish Lindvall, David Mana-ay, Dr. Warren McWilliams, Barbara Payne, Ashley Rosales, Robert Silva (Chair), Cid Van Koersel, Trinh Vu, Judy Walker (Vice-Chair), Walter Wyniarczuk Staff: Toni Moore, Executive Director Cheryl Rookwood, Clerk of the Commission 1. Call to Order and Roll Call (5 minutes) 2. Approval of March 13, 2015 Draft Action Summary (5 minutes) 3. Recognition of Ashley Rosales Six Year Term on this Committee (5 minutes) 4. Executive Director: Commission Report (10 minutes) 5. Program Presentation: Trauma Informed Practice (45 minutes) 6. Announcements/Comments a. Future Agenda Items/Presentations: May: West Ed: Early Education Effective Exchange (E-4) 7. Public Comments The meeting is voice recorded in its entirety. A CD will be available for checkout from the First 5 Sacramento Commission offices at 2750 Gateway Oaks Dr., Suite 330, Sacramento, the day after the meeting. The on-line version of the agenda and associated materials are posted for your convenience at http://www.first5sacramento.net/default.html. Some documents may not have been posted on-line because of their size and/or format. As they become available, hard copies of all documents are available from the Clerk of the Commission at the First 5 Sacramento Commission offices.
TRAUMA Informed Care And Beyond Carolyn Rich Curtis, Ph.D. 1
What is trauma informed care 1. Appreciate high prevalence of trauma 2. Program, organization or system realizes widespread impact of trauma 3. Recognizes signs and symptoms of trauma in staff, clients, and others 4. Recognizes paths for healing with trauma informed, evidenced based and emerging best practices 5. Responds by fully integrating knowledge about trauma into policies, procedures, practices and settings. 6. Recognizes individual differences & no one method works with all people 2
1. Appreciate high prevalence of trauma Abuse, Neglect & Exposure to other Traumatic Stressors are COMMON Adverse Childhood Experiences Almost two-thirds of participants reported at least one ACE incident, and more than one in five reported three or more ACE. 3
Adverse Childhood Experiences Recurrent physical abuse Recurrent emotional abuse Contact sexual abuse An alcohol and/or drug abuser in the household An incarcerated household member Someone who is chronically depressed, mentally ill, institutionalized, or suicidal Mother is treated violently One or no parents Emotional or physical neglect 4
By the numbers: 1 in 6 men experienced trauma 1 in 5 Americans sexually molested 1 in 4 beaten by a parent 1 in 3 couples engages in physical violence 25% grow up with alcoholic relatives 1 in 8 witnessed their mother being beaten or hit 50% of Head Start children have 3 ACE s 5
Pyramid 6
2. Program, organization or system realizes widespread impact of trauma 3. Recognizes signs and symptoms of trauma in staff, clients, and others 7
Trauma Changes our Brain This generation & The next 8
Trauma Response Neo cortex becomes overwhelmed and shuts down memory is encoded with sensory memory Neo-cortex constricts ; altered state; implicit memory encodes trauma 9
Trauma Response: Two Memories Narrative or declarative memory (chronological encoded with language Eric Gentry Implicit memory (in matrix and connected to events) 10
The Cook, Smoke Detector & The Watchtower The Cook- sensations are examined in dissociated segments Smoke Detector: stimulus relevant or not (Danger signal) Watch Tower: further analysis with calmness and objectivity. Shut down of Broca areaspeech Activate right hemisphere, shut left hemisphere Nerves that fire together wire together Bessel Van der Kolk 11
Perceived Threat Physiological Brain Mechanics Other Effects Heart Rate Basal Ganglia & Obsession Thalamic Fx Breathing Rate Neo-cortical Fx Compulsion Breathing Volume Frontal Lobe activity Speed & Agility Executive Fx Centralized Circulation Fine motor control Emotional regulation Muscle Tension Temporal Lobe Activity Strength Language (Werneke' s ) Speech (Broca' s ) Energy Anterior Cingulate Constricted thoughts & behaviors DIS-EASE Fatigue Fight or Flight or Freeze Eric Gentry 12
Symptoms - Behaviors Event Arousal & Reactivity Intrusive Thoughts Negative Cognitions & Moods Avoidance Eric Gentry 13
Continuum of Posttraumatic Responses Assimilation Generalized Anxiety/ Dissociative Dissociative & Growth Depression Disorder NOS Identity Disorder All posttraumatic responses are adaptive and make GOOD SENSE No Effect Acute Stress/ PTSD Disorders of Extreme Stress NOS Trauma and posttraumatic stress can affect the individual in many ways from growth to extreme debilitation. Eric Gentry 14
4. Recognizes paths for healing with trauma informed, evidenced based and emerging best practices 5. No one method works with all people 15
Meta Analysis: 54 Trauma Experts Paths for Healing Emotion regulation strategies Narration of trauma memory Cognitive restructuring Anxiety and stress management Interpersonal skills Meditation and mindfulness interventions 16
Treating Trauma Simple Not Easy Narrative Relaxation/ Self-Regulation Building & Maintaining RELATIONSHIP @ Eric Gentry 17
Distinguish between Am Safe and Feel Safe 18
Scott Miller- Feedback Informed Therapy Formalizing measures of progress and the therapeutic alliance to guide care. Doubles the effectiveness of behavioral health services, Decreases costs Reduces deterioration and dropout rates 19
Recognize individual differences No one method works with all people 3-2-1 Sensory grounding Safe-place visualization Flashback Journal Athletics, music, dancing Emotional Freedom Techniques Light Stream Icon in envelope EMDR Yoga Mindfulness Cognitive Behavioral Therapy DBT Progressive Relaxation Anchoring Transitional Object Postural grounding Internal vault Timed/metered expression Neurofeedback Communal Rhythms Theater Art Group Therapy Internal Family Systems 20
Immediate Self Regulation Body Awareness + Softening Muscles Peripheral vision Pelvic floor relaxation Soft-palate relaxation Diaphragmatic breathing 21
LOVE Interpersonal Skills Attunement Empathy Love from your significant other New permanent object The partner is a healing source for trauma 22
6. Responds by fully integrating knowledge about trauma into policies, procedures, practices and settings. 23
Key Principles of Trauma Informed Care Safety Trustworthiness & transparency Collaboration & mutuality Empowerment Resilience & strengths based Cultural, historical & gender issues Change is a process 24
It s the little things Interactions that express kindness, patience, reassurance, calm, acceptance and listening An Environment Comfortable Calming Clean Messages are pleasant, inspiring, hopeful PLEASE and THANK YOU 25
Why is trauma informed care important We might unintentionally cause harm The need to recognize our own traumatic experiences 26
Trauma from one generation to another: It s for our children & grandchildren Carolyn Rich Curtis, Ph.D. 2747 Julie Ann Court, Sacramento, CA 95608 carolynrichcurtis@gmail.com 916-995-6846 27