SSHARED A TOOL FOR IDENTIFYING SIGNS SEQUELAE OF

SSHARED: A TOOL FOR IDENTIFYING SIGNS & SEQUELAE OF TRAUMA Created for Cal. SWEC’s Trauma Informed-Practice Resources March 2016 Holly Vugia, Ph. D, LCSW, PPSC California State University, East Bay

Objectives: 1. Be able to identify key signs (symptoms) of trauma 2. Be able to describe alternative contextual “meanings “ of such signs, most notably developmental stage & culture 3. Be able to describe the associated “lesson, result and help” for such symptoms, using the SSHARED handout 4. Gain an empathic understanding of the impact of trauma in the PCW context 5. Be able to apply SSHARED to a case example 6 It is recommended that students have a printout of the SSHARED handout

Human Responses to Trauma • People have SHARED & COMMON reactions to trauma, like: • Fight, flight, freeze • Fear, anxiety, denial, flashbacks, nightmares, distrust, etc. • Yet, at the same time, we have INDIVIDUAL reactions to trauma, influenced by: • MEANING: What does the experience means to us & our culture? • UNDERSTANDING: How do we explain the experience? • CONTEXT: What else was happening in our lives & our world? • DEVELOPMENT: What stage of human growth are we in? • COPING STRATEGIES: How do we cope with the trauma? • CONSEQUENCES: What were the results of the trauma?

Take a minute to discuss 1. What reactions do you have to the photo in the next slide? 2. What reactions do people in the room have in common? 3. What reactions are unique to the individuals?

An example of individual differences If this little one was in that car, could they talk about the trauma? How about this child? Their developmental stage will impact how they react to and process the trauma.

Discuss possible differences Adolescent detained by the US Border Patrol Adolescent with her dog, shot by police The meaning and socio-cultural context will impact how they process the trauma.

TIP: Remember that experiences of trauma can be unique and the perceived seriousness is relative to the individual. Try not to compare intensities of trauma based on YOUR definitions.

IN PCW, WE SEE TRAUMA … When people are in the midst of trauma, & we find this easy to recognize. We quickly feel their pain. Anguish ~ Anger ~ Anxiety Crying ~ Confusion ~ Crisis

AND WE SEE TRAUMA … Long after it has occurred. This can be harder to spot. TIP: Survivors of trauma often work very hard to keep their trauma experience, their symptoms or the sequelae a secret.

SSHARED: A Trauma Spotting Tool 1. Provides an ACRONYM to help you remember common trauma symptoms & sequelae 2. Articulates the “LIFE LESSON” the survivor has often learned 3. Describes common RESULTS of having learned that “life lesson” 4. Recommends evidenced informed HELP for specific types of symptoms & sequelae

THE ACRONYM (symptoms & sequelae) S ocial Challenges S ubstance Use H ypervigilance A nxiety & Depression R isky Behavior E motional Challenges D is-empowerment

REFER TO THE SSHARED HANDOUT “LIFE LESSON” is a phrase written in the voice of the survivor. It helps us understand the life perspective that can accompany the particular symptom or sequelae. Example: Trauma survivors who show social challenges often live from a world view that says: I do not understand people, and I am not understood. I am alone.

REFER TO THE SSHARED HANDOUT RESULT describes some behaviors & ways of being in the world that you may see. Example: Trauma survivors who show hypervigilance often display behaviors of: Seeking safety & survival; distractibility; expecting betrayal; heightened startle responses

When Using SSHARED to Assess & Plan for Trauma Survivors, Remember 1. Trauma’s mind-body connection 2. The importance of medical care & medications 3. The importance of safe housing 4. The importance of solid self-care for the survivor: nutrition, exercise, stress-reduction, sleep, mindfulness, structure 5. That psychoeducation, support, and/or spiritual interventions can be very effective 6. That there are many psychotherapy modalities: individual, couples, family, group

REFER TO THE SSHARED HANDOUT HELP offers suggestions of evidence informed interventions. Example: Trauma survivors who show risky behaviors often benefit from: A safety plan; coping plan; safety contracts; Dialectical Behavioral Therapy; otherapies; self-care; access to 24/7 resources; harm reduction

Let’s Try Two Case Examples 1. Read the cases on the next slides 2. Using the SSHARED Handout, discuss the questions that follow each case write-up.

Madelyn • Two weeks ago, due to severe neglect, CPS removed Madelyn’s 18 -month-old child from her home. Madelyn has been frantic and distraught according to front office staff. You are to work with 20 y. o. Madelyn. From reports, you know she drinks vodka heavily along with chronic use of weed; she is a survivor of Intimate Partner Violence (IPV) at the hands of the child’s father whose whereabouts are unknown; and in this crisis, she lost her part-time job as a clerk at the Dollar Store. 1. What SSHARED symptoms do you notice? 2. What life lessons do you think guide M. ’s life now? 3. What result might this have on M. ’s behavior? 4. What help would be most indicated?

Lemmie • At age 2, Lemmie’s mother was incarcerated (10 yr sentence for selling drugs). His paternal grandmother took him in, but has been hospitalized 5 times over the years related to sickle cell anemia; Lemmie stays with his aunt during these hospitalizations. Now 6 & in kindergarten, Lemmie has conflict with peers, gets upset easily, screams and hits the wall, & does not want to go to school. Grandmother is not sure she can continue to handle Lemmie with these behaviors. 1. What SSHARED symptoms do you notice? 2. What life lessons do you think guide Lemmie’s life? 3. What result might this have on Lemmie’s behavior? 4. What help do you think Lemmie needs?

Learning Check-In (please jot down your answers) 1 2 Which are two “H” in common SSHARED variables that can stands for: impact individual a) Hostility responses to b) Hypervigilance trauma? 3 Trauma can impact a person’s world view. In SSHARED this is called the: a) b) c) c) Context/Culture Personal Strength or Weakness Developmental Stage c) Health d) Hyperactivity The Result Risky behavior The Life Lesson

You have completed the learning portion of this presentation Contact Information Holly Vugia is an associate professor in the California State University, East Bay (CSUEB) Social Work Department Email: holly. vugia@csueastbay. edu Please indicate Cal. SWEC TIC in the email subject line (California Social Work Educational Consortium Trauma-Informed-Care)

References & Photo Citations • National Child Traumatic Stress Network http: //www. nctsn. org/resources/audiences/parents-caregivers/understandingchild-traumatic-stress#q 13 • http: //haliburtonlawfirm. com/practice • http: //www. whattoexpect. com/first-year/infant-car-seat-safety • http: //www. desumama. com/5 -tip-teaching-kids-buckle-car-seats-properly/ • http: //www. latinone. com/articles/7077/20140724/child-sex-trade-dirty-secrets- of-the-2014 -immigration-crisis. htm • http: //www. stuff. co. nz/national/pike-river-mine-disaster/4415669/Memorial- service-Rolling-coverage • • http: //www. adweek. com/news/advertising-branding/ad-day-how-netflix-will- and-wont-make-your-life-better-162447 • http: //www. catdumb. com/florida-cop-fatally-shoots-beloved-dog-717/