Trauma Informed Care Ashley Steinberg MPH Outreach Community

Trauma Informed Care Ashley Steinberg, MPH Outreach Community Health Clinics

What is Trauma? � The word “trauma” is used to describe experiences or situations that are emotionally painful and distressing, and that overwhelm people’s ability to cope, leaving them powerless. Center for Nonviolence and Social Justice. (2014) What is Trauma? Retrieved from: http: //www. nonviolenceandsocialjustice. org/FAQs/What -is-Trauma/41/

What does it look like? � Anxiety, fear, and worry about a safety of self and others. � Increased distress � Distrust of others � A change in ability to interpret and respond appropriately to social cues � Difficulty with authority, redirection, or criticism � Hyperarousal � Emotional numbing National Child Traumatic Stress Network Schools Committee. (2008). Child Trauma Toolkit for Educators. Los Angeles, CA & Durham, NC: National Center for Child. Traumatic Stress.

Adverse Childhood Experiences The ACE Study identifies ‘adverse childhood experiences’ as growing up (prior to 18 years of age) in a household with: Recurrent physical abuse Recurrent emotional abuse Sexual abuse An alcohol or drug abuser An incarcerated household member Someone who is chronically depressed, suicidal, institutionalized or mentally ill ◦ Mother being treated violently ◦ One or no parents ◦ ◦ ◦ ACE Study. The Centers for Disease Control and Prevention reports on the Adverse Childhood Experiences (ACE) Study one of the largest investigations ever conducted on the links between childhood maltreatment and later-life health and well-being. www. cdc. gov/nccdphp/ace

ACE example question � Did a parent, guardian, or other household member yell, scream, or swear at you, insult or humiliate you MANY times OR � Did a parent, guardian, or other household member threaten to, or actually, abandon you or throw you out of the house MANY times http: //www. cdc. gov/violenceprevention/acestudy/questionnaires. html

Prevalence 56% of the population has experience 1 or more ACEs. 35% 30% 25% 20% 15% 10% 5% m em d ho l se ho u lln es ed li In ca rc er at ta M en be r bu se xu al a Se si n et w eb nc io le V se ho ld ho u ad ul ts ee n al ic Ph ys io n/ Se pa r at in ab us e ce D se ho u na l nc ea bu se io Su bs ta Em ot iv or ho l ab us d e 0% O’Connor, C. , Finkbiner, C. , & Watson, L. (2012). Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Madison, WI: Wisconsin Children’s Trust Fund and Child Abuse Prevention Fund of Children’s Hospital & Health System.

ACE continued ACE Study - effects are neurological, biological, psychological and social in nature, including: ◦ Changes in neurobiology ◦ Social, emotional and cognitive impairment ◦ Adoption of health-risk behaviors as coping mechanisms ◦ Severe and persistent behavioral health, physical health, social problems, and early death Perry, B. & Hambrick, E. (2008). The Neurosequential Model of Therapeutics. Retrieved from http: //childtrauma. org/nmt-model/references/

Re. Moved � https: //youtu. be/l. Oe. QUwd. Aj. E 0

Re. Moved cont. What number of evidenced ACEs did you find?

Physical Effects � Compared with people with zero ACEs, those with four categories of ACEs had ◦ A 240 percent greater risk of hepatitis ◦ A 390 percent more likely to have chronic obstructive pulmonary disease (emphysema or chronic bronchitis) ◦ A 240 percent higher risk of a sexually-transmitted disease ◦ Twice as likely to be smokers ◦ Twelve times more likely to have attempted suicide ◦ Seven times more likely to be an alcoholic ◦ Ten times more likely to have injected street drugs. The Adverse Childhood Experiences Study — the Largest Public Health Study You Never Heard Of, Part Two 10/08/2012 09: 19 am ET | Updated Dec 08, 2012

How can we do better?

Case study

What is trauma informed care? � Treatment that takes into account: ◦ An appreciation for the high prevalence of traumatic experiences in persons who receive mental health services. ◦ A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual. ◦ Care that addresses these effects, is collaborative, supportive, and skill based. http: //www. samhsa. gov/nctic/trauma-interventions

Regulation � Knowledge of the basic architecture of the brain provides both an understanding of the impact of trauma and a key toward effective treatment.

The brain cont. If there is no danger, the “doing” brain goes back to normal functioning. If there is danger the higher functioning brain shuts down, allowing the primitive brain to act. Traumatized children experience changes in brain structures, neurochemistry & genetic expression

Impact � Trauma contributes to difficulties in functioning socially, mentally, and physically.

Perspective shift �A shift in perspective can bring a new reality. Helping those charged with caring for people struggling with trauma by simply changing the question from “What is wrong with you? ” to “What has happened to you and how can I support you? ”

Hope � Reason to be creates a sense of purpose or direction for individuals. It is bolstered by resiliency – a combination of the individual’s internal attributes and the external resources that support them.

How you can help � Safe, calm, and secure environment with supportive care � System wide understanding of trauma prevalence, impact and trauma-informed care � Avoid retraumitization � Consumer voice, choice and advocacy � Recovery, consumer-driven and trauma specific services � Healing, hopeful, honest and trusting relationships

Vicarious Trauma

Vicarious trauma � Emotional residue of trauma exposure that caretakers of experience from working with people who have been traumatized. https: //www. youtube. com/watch? v=G_ht 2 v. AYPoc https: //www. counseling. org/docs/trauma-disaster/fact-sheet-9 ---vicarious-trauma. pdf? sfvrsn=2

Symptoms � Change � Anxiety in worldview � Depression � Lack of empathy for clients/patients � Isolated from friends and family � No longer satisfied with employer � Sleep disturbances � Changes in eating habits https: //www. counseling. org/docs/trauma-disaster/fact-sheet-9 ---vicarious-trauma. pdf? sfvrsn=2

Why is this important? � Professionals who are affected by vicarious trauma are at a higher risk of making poor professional judgments than those who are not affected � Healthcare providers may use defense mechanisms, such as detachment and nonempathic distancing to deal with client’s traumatic experiences

Ways to combat VT at work � Supervision-Keep in close communication with you supervisor � Coworker connection-Discuss difficult cases with your coworkers. � Be vocal-If you are feeling overwhelmed by a case/ situation, discuss this with your supervisor

References � � � � � Center for Nonviolence and Social Justice. (2014) What is Trauma? Retrieved from: http: //www. nonviolenceandsocialjustice. org/FAQs/What-is-Trauma/41/ Cole, S; Eisner, A; Gregory, M. ; Ristuccia, J. (2013). Creating and Advocating for Trauma. Sensitive Schools. Helping traumatized children learn. (2). Massachusetts Advocates for Children and Harvard Law School. Retrieved from: http: //tlpi. jacksonwhelan. netdna-cdn. com/wpcontent/uploads/2013/11/HTCL-Vol-2 -Creating-and-Advocating-for-TSS. pdf Matanick, N. (2014). Re. Moved. Retrieved from: http: //www. youtube. com/watch? v=l. Oe. QUwd. Aj. E 0 https: //www. counseling. org/docs/trauma-disaster/fact-sheet-9 ---vicarious-trauma. pdf? sfvrsn=2 National Child Traumatic Stress Network Schools Committee. (2008). Child Trauma Toolkit for Educators. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress. O’Connor, C. , Finkbiner, C. , & Watson, L. (2012). Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Madison, WI: Wisconsin Children’s Trust Fund and Child Abuse Prevention Fund of Children’s Hospital & Health System. Perry, B. & Hambrick, E. (2008). The Neurosequential Model of Therapeutics. Retrieved from http: //childtrauma. org/nmt-model/references/ http: //www. samhsa. gov/nctic/trauma-interventions The Adverse Childhood Experiences Study — the Largest Public Health Study You Never Heard Of, Part Two. 10/08/2012 09: 19 am ET | Updated Dec 08, 2012