Understanding Trauma The Mind Body Spirit Connection and
Understanding Trauma: The Mind, Body, Spirit Connection and Recreational Therapy Treatment Intervention 1
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Learning Objectives Participants will be able to: 1) Identify three impacts of trauma on mental and physical health 2) Identify the impact of lifelong wellness techniques needed for recovery and integrated wellness 3) Explain the aspects of the Adverse Childhood Experiences Scale 4) Develop at least three RT Program/Intervention Strategies
SELF CARE This session shows the various ways that trauma can impact youth and adults. The video shown today contains adult language and includes scenes with family violence and sexual assault, which may be upsetting to watch. Please take measures to care for yourself, if needed.
EXERCISE
If 20 million people were infected by a virus that caused anxiety, impulsivity, aggression, sleep problems, depression, respiratory and heart problems, vulnerability to substance abuse, antisocial and criminal behavior, developmental delays and school failure, we would consider it an urgent public health crisis. Yet, in the United States alone, there are more than 20 million abused, neglected and traumatized children vulnerable to these problems. Our society has yet to recognize this epidemic, let alone develop an immunization strategy. B. D. Perry
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WHAT IS WELLNESS…. Wellness means overall well-being. It incorporates the mental, emotional, physical, occupational, intellectual, and spiritual aspects of a person's life. Each aspect of wellness can affect overall quality of life, so it is important to consider all aspects of health. This is especially important for people with mental health and substance use conditions because wellness directly relates to the quality and longevity of one’s life.
WHAT ABOUT TRAUMA? WHAT IS A TRAUMATIC EVENT? Ø Trauma comes in many forms. Traumatic experiences can include: abuse and/or neglect, witnessing violence, abandonment or the loss of a loved one, traumatic grief, bullying, a traumatic event such as a natural disaster or car accident, painful medical treatment, school violence and more. Ø Trauma can be cumulative with the impact building or can be episodic. Exposure to trauma often impacts development. Ø Trauma can change an individual’s sense of safety and how they perceive the actions of others – even those trying to help them. Ø Trauma impacts development and mental wellness. Ø Poverty is the single best predictor of child abuse and neglect
PREVALENCE OF TRAUMA: CHILDREN & ADOLESCENTS IN MENTAL HEALTH SETTINGS Canadian study of 187 adolescents Ø reported 42% had PTSD Ø American study of 100 adolescent inpatients Ø 93% had trauma histories Ø 32% had PTSD Ø A point in time medical record review of 154 children/adolescents in MA psychiatric hospitals revealed that 98% of the youths had clear, documented histories of trauma Ø (Kotlek, Wilkes, & Atkinson, 1998), (Lipschitz et al, 1999), (Massachusetts DMH, 2007)
PREVALENCE OF TRAUMA: CHILDREN AND ADOLESCENTS - JUVENILE JUSTICE SETTINGS Ø Being abused or neglected as a child increases the likelihood of arrest as a juvenile by 59% Ø Arrest rates of trauma-exposed youth are up to 8 times higher than community samples of same-age peers Ø 70% - 92% of incarcerated girls reported sexual, physical, or severe emotional abuse in childhood Ø A 2003 OJJDP survey of youth in residential placement found that 70% had some type of past traumatic experience, with 30% having experience frequent and/or injurious physical and/or sexual abuse. (Widom, 1995), (Saigh et al, 1999; Saltzman et al, 2001), (DOC, 1998; Chesney & Sheldon, 1997), (Sedlak & Mc. Pherson, 2010)
IMPACT OF TRAUMA EXPOSURE ON CHILDREN (NATIONAL CHILD TRAUMATIC STRESS NETWORK) Ø The world is uncertain and unpredictable; creates problems with boundaries and distrust; can cause social isolation. Ø Increases stress hormones changing the brain chemistry. Can cause hypersensitivity to physical touch. May cause unexplained physical health problems. Ø Causes difficulty in regulating emotions, difficulty in describing feelings, wishes and desires to others. Ø Creates feelings of detachment, withdrawal, amnesia-like state.
IMPACT ON CHILDREN Ø Causes poor impulse control, self-destructive behavior, aggression, sleep disorders and eating disorders. Ø Causes problems with focusing and completing tasks, difficulty with planning, learning difficulties and language development. Ø Instills a lack of predictable sense of self, low self-esteem, shame and guilt. Ø Causes problems with emotional regulation and over-controlled or under-controlled behavior.
IMPACT ON CHILDREN Ø Inability to articulate even the most basic of feelings, as if they are numb Ø Physical immobility Ø Loss of curiosity Ø Responding to minor irritations with tremendous fear and anger Ø Mood swings Ø Loss of creativity Ø Increase in aggression and anxiety "We now know that their behaviors are not the result of moral failings or signs of lack of willpower or bad character, " "They are caused by actual changes in the brain. ” (van der Kolk MD, Bessel (2014 -09 -25). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (Penguin Publishing Group. Kindle Edition. )
PREVALENCE OF TRAUMA IN ADULTS WITH MENTAL HEALTH CONDITIONS 97% of homeless women with serious mental illness (SMI) experienced severe physical and sexual abuse Ø 87% experienced abuse in both childhood and adulthood Ø 90% of public mental health clients have been exposed to trauma; most had multiple experiences of trauma Ø 34 -53% report childhood sexual or physical abuse Ø 43 -91% report some form of victimization Ø 81% of adults diagnosed with bipolar disorder or dissociative identity disorder (DID) were sexually or physically abused as children Ø 29 -43% of people diagnosed with SMI have post-traumatic stress disorder (PTSD) Ø (Huckshorn, 20122)
PREVALENCE OF TRAUMA IN ADULTS WITH SUBSTANCE USE DISORDERS Ø 66% of men and women in substance abuse treatment report childhood abuse and neglect Ø 77% of male veterans in substance abuse inpatient units were exposed to severe childhood trauma Ø 58% had a history of lifetime PTSD Ø 50% of women in substance abuse treatment have a history of rape or incest (Huckshorn, 2012)
WHY IS BEING TRAUMA INFORMED IMPORTANT TO INDIVIDUALS WITH IDD AND THOSE SUPPORTING THEM? Ø High rates of abuse and neglect including physical, sexual and emotional Ø High rates of bullying Ø Victims of violent crimes Ø Family stress can turn into family violence Ø Institutionalization Ø Abandonment and isolation Ø Restraint and seclusion
ADVERSE CHILDHOOD EXPERIENCES STUDY Ø To understand the impact of trauma on people’s health, the Centers for Disease Control and Prevention and Kaiser Permanente health plan conducted a study, called the Adverse Childhood Experience (ACE) study, which was the largest scientific study of its kind. Ø First conducted between 1995 and 1997, 17, 000 members of the Kaiser Permanente health plan who were already undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction
ACE STUDY FINDINGS Ø In the study of 17, 000 members of the Kaiser Permanente health plan, adverse childhood experience (ACE) of abuse, neglect, and family dysfunction were found to be common. Ø Almost two-thirds of study participants reported at least one ACE, and more than one of five reported three or more ACE. Ø Findings demonstrated that as the ACE score increased, the physical and mental health problems increased. The short- and long-term outcomes of these childhood exposures include a multitude of health and social problems
WHAT ARE ACES? ADVERSE CHILDHOOD EXPERIENCES Ø ACEs are experiences in childhood that are unhappy, unpleasant, hurtful Ø Sometimes referred to as toxic stress or childhood trauma.
ACEs http: //acestoohigh. com /got-your-ace-score/ /Separation
ACE SCORE VS. SMOKING AS AN ADULT
ACE SCORE VS. ADULT ALCOHOLISM
ACE SCORE VS. INTRAVENOUS DRUG USE
ACE SCORE VS. LIKELIHOOD OF > 50 SEXUAL PARTNERS
ACE SCORE VS. UNINTENDED PREGNANCY OR ELECTIVE ABORTION
CHILDHOOD EXPERIENCES UNDERLIE CHRONIC DEPRESSION
CHILDHOOD EXPERIENCES UNDERLIE LATER SUICIDE
ACE SCORE VS. SERIOUS JOB PROBLEMS
ACES IMPACTS LEARNING 51% of children with 4+ ACE scores had learning and behavior problems in school Compared with only 3% of children with NO ACE score Source: Burke, N. J. , Hellman, J. L. , Scott, B. G. , Weems, C. F & Carrion, V. C. (June 2011). “The Impact of Adverse Childhood Experiences on an Urban Pediatric Population, ” Child Abuse and Neglect, 35, No. 6.
YOUTH RISKS ASSOCIATED WITH TRAUMA Ø Ø Ø Ø risk for intimate partner violence multiple sexual partners sexually transmitted diseases (STDs) smoking obesity suicide attempts unintended pregnancies poor health-related quality of life Ø illicit drug use Ø ischemic heart disease (IHD) Ø liver disease Ø Ø School Absenteeism —tardiness & truancy Ø Dysregulated eating (under & overeating) Ø Self-injurious behaviors (e. g. , cutting)
ACE & SCHOOL PERFORMANCE Ø Traumatized Ø 2. 5 x children are: more likely to fail a grade in school Ø score lower on standardized achievement tests Ø more likely to have struggles in receptive & expressive language Ø suspended Ø more & expelled more often frequently placed in special education
IMPACT ON LEARNING Ø Organizing narrative material Ø Cause & effect Ø Taking another's perspective Ø Attentiveness Ø Regulating emotions Ø Executive Functioning Ø Engaging in curriculum
IMPACT ON CLASSROOM BEHAVIOR Ø Reactivity & impulsivity Ø Aggression Ø Defiance Ø Withdrawal Ø Perfectionism
THE ACE COMPREHENSIVE CHART Adverse Childhood Experiences Neurobiological Impacts and Health Risks Long-term Health and Social Problems The more types of adverse childhood experiences… The greater the The more serious the neurobiological impacts and lifelong consequences to health risks, and… health and well-being 38
WHY? THE SCIENCE OF TRAUMA Ø All behavior has meaning Ø Symptoms are ADAPTATIONS Ø We build on success not deficits
THE SCIENCE OF TRAUMA Ø When trauma occurs or past traumas are triggered, the brain reverts to its reptilian stage of survival. Ø Fight Ø Flight Ø Freeze Ø Person perceives that he/she is in danger. Ø Rational mind shuts down and reverts to survival mode. This is not a teachable moment!
TRAUMA-MIND/ TRAUMA RESPONSE Ø Activation of Fight, Flight or Freeze trauma response Ø Janine Fischer also discusses activation of attachment issues – neediness, withdrawal, etc. Ø Dan Siegel - People will revert to the age that trauma first occurred when in trauma response mode! Ø Rational Mind Shuts Down Ø If people are in trauma response and we treat them as though they are “being manipulative” - we will lose their trust and they will become further alienated. This is not the “Teachable Moment!”
PSYCHOLOGICAL TRAUMA – PAST IS PRESENT HOW DID THE BRAIN REACT? Neocortex The rational brain: Intellectual tasks Limbic The intermediate brain: Emotions Reptilian The primitive brain: Self preservation, aggression The Triune Brain
EFFECTS OF ENLARGED AMYGDALA Ø Working memory is impaired Ø New information and concepts are not easily translated into skills Ø Emotional Labiality is High Ø Overall Cognition is Impaired Ø Heightened Fear Responses Ø Heightened Emotion
CHEMISTRY WHEN SYMPATHETIC NERVOUS SYSTEM IS TRIGGERED Cortisol goes from Amygdala to Frontal lobe Adrenaline is released and floods the system Regions of Brain do not communicate and Integrate
High ACE scores and the Body Adverse Childhood Experiences have been linked to Ø risky health behaviors Ø chronic health conditions Ø low life potential Ø early death
When someone scores FOUR or higher: The likelihood of: Ø Chronic pulmonary lung disease increases 390 percent Ø Hepatitis increases 240 percent Ø Depression increases 460 percent Ø Suicide increases 1, 220 percent
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, 1998 ØA questionnaire about adverse childhood experiences was mailed to 13, 494 adults who had completed a standardized medical evaluation at a large HMO; 9, 508 (70. 5%) responded. ØThe number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. ØLogistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0– 7) and risk factors for the leading causes of death in adult life.
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study ØPersons who had experienced four or more categories of childhood exposure, compared to those who had experienced none Ø 4 -to 12 -fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; Ø 2 - to 4 -fold increase in smoking, poor self-rated health, 50+ sexual intercourse partners, and sexually transmitted disease Ø 1. 4 - to 1. 6 -fold increase in physical inactivity and severe obesity. Ø The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including: Ø Ischemic heart disease Ø Cancer Ø Chronic lung disease Ø Skeletal fractures Ø Liver disease. Ø The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
The Bottom Line: Study findings repeatedly reveal a graded doseresponse relationship between ACEs and negative health and wellbeing outcomes across the life course
WHAT IS PTSD –DSM 5 Ø Criterion A- Stressor Ø Criterion B- Intrusive Symptoms Ø Criterion C- Avoidance Ø Criterion D- Negative alterations in cognitions and mood Ø Criterion E- Alterations in arousal and reactivity Ø Criterion F- Persistence in above Criteria for > 1 month Ø Criterion G- Functional significance
3 AREAS OF SYMPTOMS OF PTSD 1. Re-experiencing ( interfering with present to different degrees) – Ø Intrusive Memories Ø Nightmares Ø Flashbacks- Person can disconnect from reality and be convinced he or she is being attacked, hurt or threatened due to a memory that becomes present 2. Avoidance – Ø Blunted emotions/ Ø Shut down responses Ø Person can become obsessive about details concerning self and safety Ø Disconnection and withdrawal
SYMPTOMS OF PTSD CONTINUED 3. Arousal – Ø Easy to startle Ø Agitated – can lead to property destruction Ø Periodically Combative Ø Impulsive Ø Also associated with reckless or self-destructive behavior
TRIGGERS Abused kids are often very sensitive to changes in voices and faces, but they tend to respond to them as threats rather than as cues for staying in sync. Dr. Seth Pollak of the University of Wisconsin showed a series of faces to a group of normal eight-year-olds and compared their responses with those of a group of abused children the same age. Looking at this spectrum of angry to sad expressions, the abused kids were hyperalert to the slightest features of anger. (van der Kolk MD, Bessel (2014 -09 -25). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (p. 114). Penguin Publishing Group. Kindle Edition. )
TRAUMA RESPONSES DUE TO “BUTTONS PUSHED” Trigger Response – Something happens in the present that reminds the person of the negative past - person goes into fight, flight or freeze mode: Thinking he or she is in Danger! Trauma Trigger Fight Freeze Flight
COMMON EXTERNAL PTSD TRIGGERS Ø Sights, sounds, or smells associated with the trauma Ø People, locations, or things that recall the trauma Ø Significant dates or times, such as anniversaries or a specific time of day Ø Nature (certain types of weather, seasons, etc. ) Ø Conversations or media coverage about trauma or negative news events Ø Situations that feel confining (stuck in traffic, at the doctor's office, in a crowd) Ø Relationship, family, school, work, or money pressures or arguments Ø Funerals, hospitals, or medical treatment
COMMON INTERNAL PTSD TRIGGERS Ø Physical discomfort, such as hunger, thirst, fatigue, sickness, and sexual frustration Ø Any bodily sensation that recalls the trauma, including pain, old wounds and scars, or a similar injury Ø Strong emotions, especially feeling helpless, out of control, or trapped Ø Feelings toward family members, including mixed feelings of love, vulnerability, and resentment
WHAT TO DO WHEN SOMEONE IS TRIGGERED Symptoms of Trigger Cool Down System (Activation of Sympathetic nervous( Activation of Parasympathetic nervous system) Fight Calming Flight Breathing Freeze Getting Being away from trigger Safe
HOW DO WE SEE THESE INDIVIDUALS? Uninformed view Trauma-informed view Anger management problems Maladaptive responses (in school setting) May have ADHD/BPD/ODD/CD/BAD Seeking to get needs met Choosing to act out & cause disruption disrespectful or manipulative) Difficulty regulating emotions Lacking necessary skills Negative view of world (e. g. , adults cannot be trusted) Trauma response was triggered Uncontrollable, destructive Non-responsive (e. g. , Uninformed response Individual needs consequences to correct behavior or maybe a ADHD evaluation Adapted from Daniel & Zarling (2012) Trauma-informed response Individual needs to learn skills to regulate emotions & we need to provide support
The Risk & Protective Factors Model Social Skills Supportive School & Community Environment Family Cohesion Secure Attachment Adaptive Coping Skills Self Efficacy Mentors Healing & Protective Environment Social Support 62
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EXERCISE
Trauma Informed Care changes the question from “What’s wrong with you? ” to “What happened to you? ” BECOMING TRAUMAINFORMED
“If you think you’re too small to make a difference, try sleeping in a room with a mosquito. ” African Proverb
Now I know…. . now what…. . Therapeutic Recreation Specialist Recreational therapy, also known as therapeutic recreation, is a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological and physical health, recovery and wellbeing.
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Guiding Principles of Trauma Informed Care: According to SAMHSA’s concept of a trauma-informed approach, “A program, organization, or system that is trauma-informed”: 1. Realizes the widespread impact of trauma and understands potential paths for recovery 2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; 3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and, 4. Seeks to actively resist re-traumatization. Neal Creative © Neal Creative | click & Learn more
Ø The Intervention promotes skill development in one or more of the 8 Wellness Dimensions Ø The Facilitation of the Intervention promotes the Guiding Principles of Trauma Informed Care Neal Creative © Neal Creative | click & Learn more
Ø 15 Minutes to Plan an Intervention that Promotes at least one of the Guiding Principles of Trauma Informed Care/Development of one of the 8 Dimensions of Wellness while Encouraging the Participants to Engage in Recovery Focus Services using the supplies given ØEach group will select one member to Explain the Intervention ØWhat wellness skill the activity promotes, develops, and/or maintains ØWhat guiding principles of a Trauma Informed Care is utilized to promote recovery ØIf desired, the group can demonstrate the activity Neal Creative © Neal Creative | click & Learn more
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Session Evaluation Please take a few moments to complete the session evaluation 1. Utilize http: //sgiz. mobi/s 3/SRTS-Session-Eval-2018 - Link available on SRTS 2018 Homepage – srts. info 2. Select session being evaluated from drop down box - Session number is found in Program 3. Answer each question (note rating scales differ throughout) and then select Next to advance 4. Hit Submit button to send the results Neal Creative © Neal Creative | click & Learn more
CONTACT INFORMATION David Crooke, LPC dcrooke@cpga 180. com Katie Durden, RN Katie. Durden@beaconhealthoptions. com Kathy Durden, CAC II, CPRP carepartnersinc@bellsouth. net
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