Hope After Trauma What we can do to respond in a sensitive way 1
What is Trauma Overview How it impacts the youth in our programs What does it mean to be Trauma Informed and Trauma Sensitive The 5 s How to have Trauma Sensitive Programs What is Vicarious Trauma and how it impacts the work we do Importance of Self Care 2
Trauma is Any dangerous, frightening, and overwhelming event witnessed or experienced by any member of a family. 3
Possible Examples of Traumatic Events Sexual Assault Sexual Abuse Fires Burns Dog Attacks Loss through Violent Death Witnessing Homicide Emotional abuse Witnessing Domestic Violence Witnessing Rape Physical Abuse Car Accidents Shootings Hurricanes Witnessing Violent Crime Medical Trauma 4
Difference Between Stress and Trauma Stress Can be an emotional and physical strain on one s coping resources. I m having a bad day. This is really difficult to deal with. I am really worried about what is going to happen today. Trauma Extremely frightening, life threatening, overwhelming and has lasting effects. I keep having bad dreams that it is happening again. I am always afraid and worried that I will die. 5
Trauma is made up of 3 parts There is an event. There is how we experience the event. There is an effect of the event. 6
Common Responses Triggers are when we hear, see, feel, taste, or smell something that reminds us of dangerous or frightening things that happened in the past. When these occur, the body may respond like it did when the trauma first happened (false alarms) or a person can react intensely to something that typically would not cause stress (overactive alarms). 7
How Child Experiences Affect Adult Health Adverse Childhood Experiences Multiple (unaddressed) ACES Increase the Risk for: Major Mental Illness Substance Abuse AIDS and Sexually Transmitted Diseases Academic Difficulties Impaired Physical Health (smoking, obesity, heart disease, cancer, early death) 8
Definition of Trauma Informed The 3 Rs A program, organization or system that is trauma informed 1) Realizes the widespread impact of trauma and understands the potential paths for healing; 2) Recognize the signs and symptoms of trauma in staff, clients and others involved with system, and 3) Responds by fully integrating knowledge about trauma into polices, procedures, practices, and settings. 9
Trauma Informed Programing All staff trained in trauma dynamics Trauma understanding built into staff responses Screen everyone for trauma exposures Policies and procedures should be reviewed with trauma awareness Discipline Awareness that traditional services and approaches may be triggering Incorporated into all activities Account for strengths, not just problems Achieve trust through collaboration and partnership 10
The 5 Ss 1. Safety 2. Supportive Adult Relationships 3. Self-Soothing/Self-Regulation 4. Strengths 5. Self-care 11
Create a safe environment Give choices and provide consistent rewards and consequences for behavior. Be predictable. Maintain routines and prepare youth for any changes in routine or schedule. Add ritual to the day. Maintain professional boundaries. Avoid the false promise of rescuing youth. Be the adult protective shield. 12
Support Every child needs three supportive adults in their lives as they grow up. Mentors are great but they must stay in a child s life at least six months to be effective. Be clear in your own mind about what your role will be in this young person s life and act appropriately. 13
Self-Soothing/Self-Regulation Recognize that these youth can be very challenging. Try to keep your emotional reactions in check and stay calm. When a young person is loosing control, they rely on you to provide the emotional glue they can t access. Praise young people for using appropriate coping strategies (even after a meltdown once they have regained control). 14
Strengths May have to start small. May have to search hard. Try to put yourself in his/her place. What you view as a challenge may be evidence of great strength on the part of a child. 15
Self-Care Youth and Families will have endless needs; pace yourself You will have some successes and some challenges, and sometimes you just won t know More to come about Self Care 16
History of Vicarious Trauma Researchers first began to examine secondary trauma in 1970s by looking at emergency workers who repeatedly exposed to trauma. Began to identify symptoms similar to PTSD. 17
What is Vicarious Trauma? It is the process of change that results from compassionately listening to and working with to trauma survivors. It happens because you feel committed or responsible to help, and at times are unable to fulfill the commitment. It is a process that happens over time when exposed repeatedly and it can deeply impact the way you see the world and your deepest sense of meaning and hope. 18
Research regarding personal trauma history is mixed, but those who have their own trauma history may be more vulnerable. Risk Factors for VT Personal Level Not having a spiritual connection that gives you a sense of meaning, purpose, and hope Added stress in current life (I.e., just lost a job, illness, family or social conflict, financial strain, etc) Limited social and professional support (sometimes family can t understand what you do and therefore have difficulties empathizing) Not managing limits appropriately or holding unrealistic expectations for oneself. 19
Personal Factors continued People who tend to avoid problems or difficult feelings, blame others for their difficulties, or withdrawn when things become hard Professions working with people can be affected by self-neglect, risk taking, and denial of one s own needs 20
Risk Factors for VT Situational Level Professional role (crisis worker, direct treatment, online, case management, etc) Being in a position of authority and responsible for large numbers of people Work setting Working longer engagements with less rest in between days/assignments 21
Risk Factors for VT Agency Level Agencies that have top-down structures (with little opportunity to communicate concerns, get info, influence decisions) Ignore the demanding nature of the work Do not provide adequate time off and overwork staff 22
Impact of Cultural Context on VT There are many broader cultural factors that influence one s experience of VT: Society s attitudes about traumatic events and those involved Society s values about different groups within society Society s attitudes about humanitarian workers Personal cultural values The way in which a person expresses distress and asked for support is influenced by culture, different communication styles, and different ways of conveying value and appreciation. 23
What does VT look like? Falls into three overall categories that all stem from difficulties managing your emotions and struggle with meaning: Physical and psychological signs Changes in behavior Changes in relationship signs 24
Physical and Psychological Signs Hyperarousal Intrusive images or thoughts Feeling numb Difficulty tolerating strong emotions Increased sensitivity to violence Cynicism Despair and hopelessness Guilt regarding your own survival Anger Disgust Fear 25
Behavior and Relationship Signs Behavior Difficulty setting limits and separating work from personal life Feeling like you never have time for self Feeling disconnected from loved ones Increased conflict in relationships Relationship: Social withdrawal Unable to pay attention to others distressing stories Decreased interest in activities Irritable, intolerant, agitated, impatient, needy Sexual difficulties Impulsivity 26
Ways Your Behavior Impacts Others Make more frequent mistakes Unable to fulfill commitments Excessive time off Blame others instead of seeking understanding Devalue or ridicule co-workers, family members, managers, youth Infect co-workers with own cynicism, depression, or lack of motivations 27
Impact on Change of World View VT changes the way you think about the world and yourself. Changes in spirituality - changes in beliefs regarding meaning, purpose, causality, connection, hope, faith). Changes in identity - the way you practice or think about identities as a professional, family or friend. Changes in beliefs related to major psychological needs (beliefs about safety, control, trust, esteem, intimacy). 28
Responses and Reactions When people are exposed to trauma directly or indirectly, they adapt. Often times when faced with violence or loss, people can engage in unhealthy coping styles. 29
Transforming VT Transforming VT is deeper than just coping with it. This is because over time VT changes your spirituality. Transforming VT means identifying ways to nurture a sense of hope and meaning and giving you a framework to grapple with the answers to difficult questions. Ultimately finding ways to stay connected to important sources of meaning and hope is what will help you transform your VT. 30
Why is it important to address these reactions? Close to 7% of professionals who work with traumatized individuals exhibits reactions that are similar to PTSD (Thomas and Wilson, 2004). Professionals who do not recognize and/or cope with their symptoms become challenged in their ability to provide effective services and maintain positive and professional relationships in their work contexts. We tend to neglect self-care. This will lead to burnout, problems in personal and professional relationships, and general dissatisfaction with life experiences. 31
Addressing VT Coping means to learn to live with the process so you can do you job. This includes: Preventing VT Managing VT 32
Strategies for Self-Care Caring physically for oneself eat balanced meals, take nutritional supplements Plenty of sleep/relaxation - meditation, coffee breaks, get a massage, lie on the grass Exercise Relaxation - mentally or physically (visualization, meditation, get away, talk about non-work subjects, watch movies) Recreation/play - share funny stories, join a sports team, get outside 33
Self-care Strategies continued Create self care plans and resource lists Positive self-statements Inspirational reading Journaling Talking with a safe person (supervisor or friend) Emotional release (crying, exercise) Be aware of negative coping strategies (drinking, excessive or restrictive eating, avoidance) what triggers these strategies. Remind self of the positive potential of the work you are doing (personal growth, challenges, respect for human resiliency) Understanding traumatic stress and having realistic expectations 34
Self-care strategies continued.. Relational Strategies: Developing and using support systems Natural (friends, family) School and workplace (supervisors, faculty, coworkers) Be aware of own trauma history Seek out help Peer to Peer Support Pets 35
Self-care strategies continued Spiritual Strategies: Knowing your values: where do you tend to find meaning and purpose. Participating in a community of meaning and purpose Regular times of prayer, reading, meditation Spiritually meaningful conversations Time with art, nature, music Solitude 36
While at Work Leave your office for lunch Keep a tennis ball or stress relieving ball to squeeze at your desk Learn how to stretch properly and do it at your desk Take a brisk 10 minute walk Listen to music through headphones Drink water Snack on dried fruit, nuts Talk to coworkers Leave your work at home Go to gym right after work 37
What does this mean for the Work Protectively larger picture? The way you think about your work and job has a significant influence on the impact of VT Important to examine how you think about your work. 38
It s all in your heart, what you want and what you can do. You can overcome anything. Estee Lauder 39
Resources/References Harris and Fallot, (2001): Using trauma theory to design service systems. New Directions In Mental Service, 89. San Francisco: Jossey- Bass. Hodas, Gordon. Responding to Childhood Trauma: The Promise and Practice of Trauma Informed Care. 2006. Pennsylvania Office of Mental Health and Substance Abuse Services. National Center for Trauma-Informed Care: http://mentalhealth.samhsa.gov/nctic/ National Child Traumatic Stress Network: http://nctsn.org Adverse Childhood Experiences http://acestudy.org/ 40
Jennifer McCraw, LCSW mccrawj@metrofamily.org 773-371-3626 9 th Annual Federation for Community Schools Forum November 15, 2013 41