Creating A Trauma Informed System Al Killen-Harvey,LCSW The Harvey Institute Al@theharveyinstitute.com 619-977-8569
Goals and Objectives 1.Describe the attributes of the various forms of trauma 2.Delineate the essential elements of a trauma informed system 3.Identify key elements of trauma informed screening, assessment and service delivery
A Trauma-Informed System Understands 1) The potential impact of traumatic stress on the individual s served by the system and how to promote factors related to resiliency 2) How the system can either help mitigate the impact of trauma or inadvertently add new traumatic experiences 3) The impact of vicarious trauma on a social service workforce and that exposure to trauma is inevitable when working in a social service agency 4) The need to fully integrates knowledge about trauma into policies, procedures, and practices Rule 1 of a Trauma-Informed System: Don t Make It Worse
What Is Trauma? An event, series of events or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual s functioning and mental, physical, social, emotional, or spiritual well-being Substance Abuse and Mental Health Services Administration(2014). SAMHSA s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD
Event vs. Experience
Acute trauma Types of Trauma (Event)
Types of Trauma (Event/Experience) Chronic trauma
Types of Trauma (Experience) Complex trauma
9 Historical Trauma
Historical Trauma Collective and cumulative emotional wounding across generations Cumulative exposure to traumatic events that not only affects an individual, but continues to affect subsequent generations The trauma is a psychological injury held personally and transmitted over generations
Situations That Can Be Traumatic (Events) Physical or sexual abuse/witnessing domestic violence Abandonment, betrayal of trust (such as abuse by a caregiver),or neglect The death or loss of a loved one Automobile accidents or other serious accidents Bullying Life-threatening health situations and/or painful medical procedures/life-threatening illness in a caregiver Witnessing or experiencing community violence (e.g., drive by shooting, fight at school, robbery) Witnessing police activity or having a close relative incarcerated Life-threatening natural disasters Acts or threats of terrorism
What Is Traumatic Stress? (Experience) The physical and emotional responses of a person to events that threaten their life or physical integrity or someone critically important to the them (such as a parent, child or sibling) Traumatic events overwhelm a person s capacity to cope and elicit feelings of terror, powerlessness, and out-ofcontrol physiological arousal Trauma is experienced as a series of traumatic moments each penetrating deep in the person s psyche
People Vary in Their Response to Traumatic Events The impact of a potentially traumatic event depends on many factors, including: Genetic makeup Age and developmental stage Perception of the danger faced Whether the individual was the victim or a witness Relationship to the victim or aggressor Past experience with trauma Adversities the individual faced following the trauma The response to the events of the individual s close friends/caretakers
Effects of Trauma Exposure Attachment: Traumatized individual s feel that the world is uncertain and unpredictable. They can become socially isolated and can have difficulty relating to and empathizing with others. Biology: Traumatized individual s may experience problems with movement and sensation, including hypersensitivity to physical contact and insensitivity to pain. They may exhibit unexplained physical symptoms and increased medical problems. Mood regulation: Individual s exposed to trauma can have difficulty regulating their emotions as well as difficulty knowing and describing their feelings and internal states.
Effects of Trauma Exposure Dissociation: Some traumatized individual s experience a feeling of detachment or depersonalization, as if they are observing something happening to them that is unreal. Behavioral control: Traumatized individual s can show poor impulse control, self-destructive behavior, and aggression towards others. Cognition: Traumatized individual s can have problems focusing on and completing tasks, or planning for and anticipating future events. Some exhibit learning difficulties and problems with language development. Self-concept: Traumatized individual s frequently suffer from disturbed body image, low self-esteem, shame, and guilt.
Adverse Childhood Experiences Abuse and Neglect (e.g., psychological, physical, sexual) Household Dysfunction (e.g., domestic violence, substance abuse, mental illness) Impact on Child Development Neurobiological Effects (e.g., brain abnormalities, stress hormone dysregulation) Psychosocial Effects (e.g., poor attachment, poor socialization, poor self-efficacy) Health Risk Behaviors (e.g., smoking, obesity, substance abuse, promiscuity) Disease and Disability Major Depression, Suicide, PTSD Drug and Alcohol Abuse Heart Disease Cancer Chronic Lung Disease Sexually Transmitted Diseases Intergenerational transmission of abuse Long-Term Consequences Social Problems Homelessness Prostitution Criminal Behavior Unemployment Parenting problems Family violence High utilization of health and social services 16 Source: Putnam, F.,& Harris, W. (2008). Opportunities to change the outcomes of traumatized children: Draft narrative. Retrieved from http://ohiocando4kids.org/outcomes_of_traumatized_children
CONTROL
SAFETY
Maximizing Physical and Psychological Safety for Children and Families 20
Psychological Safety
Psychological Safety What is it? What does it look like? How can you tell if a client feels safe? How can you tell if a client feels unsafe? 22
Maximizing Safety: Understanding Traumatic Responses They exhibit challenging behaviors and reactions When we label these behaviors as bad or good we forget that their behavior is a reflection of their experience Many challenging behaviors are strategies that have helped them survive in the past 23
Maximizing Safety: Understanding Trauma Reminders/Triggers When faced with people, situations, places, or things that remind them of traumatic events, individuals may experience intense and disturbing feelings tied to the original trauma. These trauma reminders can lead to behaviors that seem out of place, but were appropriate and perhaps even helpful at the time of the original traumatic event.
SCREENING Trauma Informed ASSESSMENT Trauma Informed SERVICE DELIVERY Trauma Informed
SCREENING
Adverse Childhood Experiences Emotional abuse Physical abuse Sexual abuse Emotional neglect Physical neglect Household dysfunction: Mother treated violently Household substance abuse Household mental illness Parental separation/divorce Incarcerated household member Source: Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V.,... Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.
ASSESSMENT
Assessment
Service Delivery
What can be done to help a traumatized client? Provide a safe place for the individual to talk about what happened. Set aside a designated time and place for sharing to help the individual know it is okay to talk about what happened. Give simple and realistic answers to the individual s questions about traumatic events. Clarify distortions and misconceptions. Be sensitive to the cues in the environment that may cause a reaction in the traumatized individual. For example, individual s may increase problem behaviors near an anniversary of a traumatic event. of the organization must be trauma informed/trained
Factors that Enhance Resilience 32 Sources: Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227-238. National Child Traumatic Stress Network, Juvenile Justice Treatment Subcommittee. (in preparation). Think trauma: A training for staff in juvenile justice residential settings. Will be available from http://www.nctsnet.org/resources/topics/juvenile-justice-system
Enhance the Well-Being and Resilience of Those Working 33 in the System
System Trauma The system itself can be a highly reactive, traumatizing experience without enough services and supports to assist the workforce in responding effectively. 34
Impact of Working with Victims of Trauma 35 Trauma experienced while working in the role of helper has been described as: Compassion fatigue Secondary traumatic stress (STS) Vicarious traumatization STS is the stress of helping or wanting to help a person who has been traumatized. Unlike other forms of job burnout, STS is precipitated not by work load and institutional stress but by exposure to clients trauma (acute or cumulative). STS can disrupt social service workers lives, feelings, personal relationships, and overall view of the world.
STS Signs and Symptoms Avoidance (including of certain clients) Preoccupation with clients/client stories Intrusive thoughts/nightmares/flashbacks Arousal symptoms Thoughts of violence/revenge Feeling estranged/isolated/having no one to talk to Feeling trapped, infected by trauma, hopeless, inadequate, depressed 36 Having difficulty separating work from personal life
What can a professional do to address STS? What can a supervisor or manager do to address STS? What can the agency do? 37
Self-Care for Responders 1. Recognize compassion fatigue as an occupational hazard. 2. Be aware of the signs. Professionals with compassion fatigue often exhibit signs that get overlooked or reframed. 3. Don t go it alone. Guard against isolation Don t judge yourself as weak or incompetent for having strong reactions to a trauma- it s the cost of caring!
Self-Care for Professionals (continued) 4. Seek help with your own traumas. Any social service worker who also has his or her own unresolved traumatic experiences, is more at risk for compassion fatigue. 5. If you see signs in yourself, talk to a professional. If you are experiencing signs of compassion fatigue for more than two to three weeks, seek counseling with a professional who is knowledgeable about trauma.
Contact Information Al Killen-Harvey, LCSW The Harvey Institute Al@theharveyinstitute.com 619-977-8569