Goals and Objectives

1. Creating a Trauma Informed SystemAl Killen-Harvey, LCSWThe Harvey InstituteAl@theharveyinstitute.com619-977-8569

2. Goals and Objectives • Describe the attributes of the various forms of trauma • Delineate the essential elements of a trauma informed system • Identify current potential “trauma reminders” for clients in your organization/agency

3. What Is Trauma? Witnessing or experiencing an event that poses a real or perceived threat The event overwhelms the individual’s ability to cope

4. Event vs. Experience

5. Types of Trauma(Event) Acute trauma

6. Types of Trauma(Event/Experience) Chronic trauma

7. Types of Trauma(Experience) Complex trauma

8. Historical Trauma

9. 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

10. 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

11. 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-of-control physiological arousal • Trauma is experienced as a series of traumatic moments each penetrating deep in the person’s psyche

12. 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

14. Prevalence of Trauma in the United States

15. Cumulative Impact of Trauma • Traumas build upon one another creating a cumulative impact upon an individual’s: • Neurobiology • Physiological Responses • Response to his/her environment • Ability to regulate emotions • Judgment and cognitive processes used in learning and decision making • Self concept and self-esteem • Social relationships and ability to trust • Worldview

16. 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.

17. 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.

18. Maladaptive coping strategies can lead to behaviors including: Sleeping/eating disorders Substance abuse High activity levels, irritability, or acting out Emotional detachment, unresponsiveness, distance, or numbness Hyper-vigilance, or feeling that danger is present even when it is not Increased mental health issues (e.g. depression, anxiety) Overwhelming Emotion and Behavior

19. Adverse Childhood Experiences Household dysfunction: Mother treated violently Household substance abuse Household mental illness Parental separation/divorce Incarcerated household member • Emotional abuse • Physical abuse • Sexual abuse • Emotional neglect • Physical neglect 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.

20. Long-Term Trauma Impact–ACE Pyramid: CDC Death Conception Mechanisms by Which Adverse Childhood Experiences Influence Health and Well-being Throughout the Lifespan

21. 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) Long-Term Consequences • Social Problems • Homelessness • Prostitution • Criminal Behavior • Unemployment • Parenting problems • Family violence • High utilization of health and social services • Disease and Disability • Major Depression, Suicide, PTSD • Drug and Alcohol Abuse • Heart Disease • Cancer • Chronic Lung Disease • Sexually Transmitted Diseases • Intergenerational transmission of abuse 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

22. What is a Trauma-Informed Child-Serving System? Rule 1 of a Trauma-Informed System: Don’t Make It Worse A Trauma-Informed System understands: 1) The potential impact of traumatic stress on the individual’s served by the system How the system can either help mitigate the impact of trauma or inadvertently add new traumatic experiences How to promote factors related to resiliency after trauma

23. A Trauma-Informed SystemUnderstands That exposure to trauma is inevitable when working in a social service agency The impact of vicarious trauma on a social service workforce

24. 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.

25. Maximizing Physical and Psychological Safety for Children and Families

26. Psychological Safety

27. 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?

28. Maximizing Safety: Understanding TraumaticResponses • 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

29. 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. Maximizing Safety: Understanding Trauma Reminders/Triggers

30. Factors that Enhance Resilience Sources: Masten, A. S. (2001). Ordinary magic: Resilience processes in development. AmericanPsychologist, 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

31. Protective Factors 1 Benzies, K., & Mychasiuk, R. (2009). Fostering family resiliency: A review of the key protective factors. Child & Family Social Work, 14, 103-114. 2 Koball, H., Dion, R., Gothro, A., Bardos, M., Dworsky, A., Lansing, J., … Manning, A. E. (2011). Synthesis of research and resources to support at-risk youth. Retrieved from Administration for Children and Families Office of Planning, Research, and Evaluation website: http://www.acf.hhs.gov/programs/opre/fys/youth_development/reports/synthesis_youth.pdf Family characteristics:1 Family cohesion Supportive parent-child interaction Social support (e.g., extended family support) Cultural protective factors: Strong sense of cultural identity Spirituality Connection to cultural community Protective beliefs and values Cultural talents and skills Individual characteristics: • Cognitive ability • Self-efficacy • Internal locus of control (a sense of having control over one’s life and destiny) • Temperament • Social skills Community characteristics:2 • Positive school experiences • Community resources • Supportive peers and/or • Mentors

32. Enhance the Well-Being and Resilience of Those Working in the System

33. Enhance the Well-Being and Resilience of Those Working in the System Enhance the Well-Being and Resilience of Those Working in the System While behavioral health/social service support workers play an important role in supporting individuals, working with people who have experienced abuse, neglect, violence, and other trauma can cause staff to develop secondary traumatic stress reactions. Agencies/organizations should collect information about trauma and secondary trauma experienced by staff, implement strategies and practices that build resilience and help staff manage stress, and address the impact of secondary traumatic stress both on individuals and on the system as a whole.

34. System Trauma • The system itself can be a highly reactive, traumatizing system without enough services and supports to assist the workforce in responding effectively.

35. Impact of Working with Victims of Trauma • 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.

36. 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 Having difficulty separating work from personal life

37. What can a professional do to address STS? What can a supervisor or manager do to address STS? What can the agency do? Other resources/activities

38. Self-Care for Responders Be aware of the signs. Professionals with compassion fatigue may exhibit some of the following signs. Don’t go it alone. Guard against isolation Recognize compassion fatigue as an occupational hazard. Don’t judge yourself as weak or incompetent for having strong reactions to a trauma (it’s the cost of caring).

39. 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.

41. Al Killen-Harvey, LCSWThe Harvey InstituteAl@theharveyinstitute.com619-977-8569 Contact Information