Trauma-Informed Environments to Promote Healing Laurie Markoff, Ph.D. Institute for Health and Recovery URL: www.healthrecovery.org
What is Trauma?
Trauma Definition Extreme stress that overwhelms a person s ability to cope The experience of a threat to life, body or sanity as determined by the person A normal response to an abnormal event
Traumatic Events/Situations Physical assault Sexual abuse including sex work Emotional/psychological abuse Domestic violence War/genocide Accidents Natural or man-made disaster
Traumatic Events/Situations (2) Witnessing violence Living in a dangerous environment Historical trauma Oppression/stigma Institutional trauma Disability-specific trauma
Traumatic Events/Situations (3) May be experienced as an adult or child May occur repeatedly over time or one incident
Why Trauma Matters
Prevalence of Trauma for People with Disabilities Difficult to determine because of lack of comprehensive and effective screening tools (Curry, Powers and Oschwald, 2003) Women with disabilities experience abuse at similar or increased rates compared to women without disabilities (Plummer and Findley, 2012)
Failure to Understand and Address Trauma Can Lead to: Reminding people of their traumatic experiences (Harris and Fallot, 2001) Failure to engage (Farley, 2004) Increase in symptoms (eating disorders, self-harm) Increase in behavior problems Increase in relapse to substance use Withdrawal from the relationship Poor outcomes (Easton et al., 2000; Ouimette et al., 1999)
Impact of Trauma
Impact of Trauma (2) Body easily triggered fight, flight or hide response, longer recovery Mind loss of memory, flashbacks, difficulty concentrating Emotions difficulty managing emotions, numbing or becoming overwhelmed Beliefs damaged self, cannot tell who is trustworthy, no control over outcomes
Impact of Trauma for People with Disabilities May look different in people with certain disabilities Possible risk and protective factors Level of cognitive development Isolation Dependency Exposure to more perpetrators Difficulty naming and identifying abuse Cultural/societal barriers
What is Trauma-Informed Care?
Definitions Trauma-informed services Basic training/education for all staff from secretaries to high level administrators everything that happens includes an understanding of the impact of trauma Trauma-specific treatment Educating fewer, carefully selected staff/ clinicians to help people with trauma (Fallot & Harris, 2001; Najavits, 2006)
Principles of Trauma-Informed Care 1. Trauma is central to the development of multiple life problems 2. Universal precautions approach everyone as if they may be a trauma survivor 3. Symptoms and behaviors were developed as ways to cope with trauma or its impact 4. The goal of services is to return a sense of safety, independence and control
Establishing a Safe Environment
Establishing a Safe Environment (2) Reduce triggers Avoid strategies such as: Trying to control someone else Unnecessary rules Shaming Hard core confrontation Monitoring too closely, being in someone s space or face
Procedures or Situations that May Trigger Prior Experiences of Trauma Include: Lack of control-powerlessness Threat or use of physical force Observing threats, assaults, others engaged in self-harm Isolation Being in a locked room or space Interacting with authority figures Interacting with the opposite sex Lack of privacy
Procedures or Situations that May Trigger Prior Experiences of Trauma Include (2): Removal of clothing bathing, medical exams Being touched Being watched too closely Loud noises Fear based on lack of information Darkness Intrusive or personal questions Individual triggers from the original traumatic event(s)
Safe Crisis Intervention Staff are trained in creating calm Help people identify triggers and calming strategies Provide resources for calming (quiet space, fidget toys, music) Discuss conflicts that lead to abusive language or behavior, work together to establish and maintain safety
Establishing a Safe Environment Appropriate Crisis Management Planning ahead together Find out what actions or events cause distress Find out early warning signs of distress Find out what helps participants calm down Develop agreements about what staff will offer in a difficult situation
Establishing a Safe Environment (3) When an event is likely to be triggering Acknowledge Help the person to predict what will happen Give as much choice and control as possible Encourage use of calming strategies during the event Make space for recovery after event Encourage/provide self-soothing after the event
Establishing a Safe Environment Appropriate Crisis Management (2) Manage agitated people in a nonaggressive and non-threatening manner Stay calm Make eye contact Keep appropriate physical distance Be respectful and non-judgmental Offer options
Be a Trauma Detective Negative Events Before Environmental (events, time, place, social) Body Thoughts, feelings, behaviors Warning signs (internal, external) After Events in environment Body Thoughts, feelings, behaviors
Be a Trauma Detective Positive and Negative Aspects Calming strategies Strengths What makes them feel good? What do they like? Mental Core beliefs (I can t do anything right; I m unlovable) Attitudes (I deserve this pain) Assumptions (It will always be this way) Automatic thoughts (I can t stand this, need to act)
Building Healthy Coping Skills Emotional selfawareness Self-soothing Grounding Making safer choices
Trauma-Specific Treatments There are few studies of trauma-specific, evidence-based practices for people with disabilities other than substance use or mental health disorders. Some positive findings in case studies indicate possible benefits of Eye Movement Desensitization and Reprocessing, Cognitive Behavioral Approaches, Exposure Therapy, and/or Psychotherapy when conducted by individuals culturally sensitive to disability issues.
Trauma and Staff
Trauma and Staff (2) Staff may experience trauma in the workplace Staff my have prior histories of trauma which may be triggered by the workplace Staff may experience secondary trauma
Changes in the inner experience of people that come about as a result of being with people who have experienced trauma. Secondary Trauma
Impact of Secondary Trauma: Symptoms that Resemble Post-Traumatic Stress Reactions Flashbacks Nightmares Obsessive thoughts Difficulty managing emotions Numbing Over-reacting Physical symptoms Frequent illness
Impact of Secondary Trauma Changes in Beliefs about self, others, the world Sense of trust or sense of esteem in self or others Perception of safety of self or others Feeling connected Sense of control
Minimizing Secondary Trauma Organizational Culture Talks about the impact of trauma as normal Promotes and supports self-care Does not equate overwork with caring and commitment
What You Can Do to Minimize Secondary Traumatization Address the stress Self-care: Balance, limits, healthy habits, connection with others Nurturing activities: Gentleness, pleasure, comfort, relaxation play Escape: Activities that allow one to forget about work
What You Can Do to Minimize Secondary Traumatization (2) Manage your workload Pay attention to your own safety and comfort Find space and time away from participants and customers Bring personally meaningful items to your workplace Use available support