Trauma Informed Systems

1. Trauma Informed Systems Creating Hope & Resilience!

4. Sources of traumaEffect the Witness, Victim, Perpetrator • Sexual, Physical, or Emotional Abuse • Neglect, whether physical, medical, emotional, educational • Traumatic grief, loss, or abandonment of a loved one • Natural Disasters • Manmade Disasters • Medical Trauma • Interpersonal or Domestic Violence • Community or School Violence • Terrorism or Refugee Trauma • Military Combat • Serious Accidents • Emotional/Psychological Maltreatment • Human events……

5. Trauma Informed vs. Specific Trauma informed organizations, programs, and services have a basic understanding of how trauma affects the life of the person seeking services. It applies to all parts of an organization, including management and methods of service delivery. It is about culture, philosophy, and perceptions of the organization. From the way the chairs are positioned in the lobby to understanding how certain behaviors are linked to traumatic experiences, a trauma informed culture creates a safe environment for people to journey towards recovery. Regardless of position within the organization, anyone can provide trauma informed services. From the person who answers the phone, to the CEO, to the custodian, to the practitioner, everyone in the organization should know basic trauma informed principles. Because as with all cultural change, it begins in us and with us. Trauma specific services are interventions and models created to directly address the symptoms and consequences of trauma. Trauma specific services should be offered throughout the service delivery system. From validated trauma screening and assessment, to evidenced based or promising practices, to crisis intervention, there are multiple options for providing trauma specific services.

6. The ACE Study

7. ACE Study(adverse childhood experiences) www.acestudy.org The ACE Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente.  Led by Co-principal Investigators Robert F. Anda, MD, MS, and Vincent J. Felitti, MD, the ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.

14. ACE IMPACT ACE impacts • A child with 4 or > ACEs: • 250% increase of sexually transmitted disease, which increase with score • 390% more likely to develop COPD • 460% more likely to suffer from depression • 1,220% increase in suicide attempts, with higher ACE scores that went up 3,000-5,100% • A male child with 6 ACEs has a 4,600% increased risk of adult IV drug use. www.acestudy.org

15. Healing Neen

16. Effects of Trauma

17. Fight, Flight, Freeze

18. Stress symptoms: Effects on your body, feelings and behavior By Mayo Clinic staff Stress symptoms may be affecting your health, even though you might not realize it. You may think illness is to blame for that nagging headache, your frequent forgetfulness or your decreased productivity at work. But sometimes stress is to blame. Indeed, stress symptoms can affect your body, your thoughts and feelings, and your behavior. When you recognize common stress symptoms, you can take steps to manage them….

19. DSM – 5 Trauma and Stress Related Disorders 313.89 Reactive Attachment Disorder 313.89 Disinhibited Social Engagement Disorder 309.81 Post Traumatic Stress Disorder (includes PTSD for children 6 years and younger 308.3 Acute Stress Disorder 309.___ Adjustment Disorders 309.89 Other Specified Trauma and Stressor Related Disorders 309.9 Unspecified Trauma and Stressor Related Disorders

20. Trauma Symptoms • Intrusion Symptoms • Negative Mood & Cognitions • Dissociative Symptoms • Avoidance Symptoms • Arousal Symptoms

21. Intrusion or Re-experiencing Symptoms • Intrusion: • Re-experiencing • Distressing Memories and Intrusive thoughts • Nightmares or recurrent dreams • Dissociative symptoms like Flashbacks where recurring • Distress & reactivity at exposure to reminders, internal or external • Psychological Reactivity to reminders • Physiological Reactivity to reminders

22. Avoidance Symptoms • Avoidance: • Avoidance, Emotional Numbing, Addictions • Avoidance of thoughts, memories, feelings • Avoidance of external reminders

23. Arousal Symptoms • Arousal Symtoms • Increased Arousal • Irritability and Angry Outbursts • Reckless or Self Destructive Behaviors • Hypervigilance • Exaggerated startle response • Problems with Concentration • Sleep Disturbances

24. Dissociation Symptoms • Dissociation: • Dissociation Continuum • Depersonalization • Derealization

25. Negative Alterations in Cognition and Mood Symptoms • Mood and Cognition: • Inability to remember • Negative personal and world view • Negative emotional state – fear, horror, anger, guilt, shame • Diminished interest or participation • Feelings of detachment of estrangement • Inability to feel positive emotions

26. Neurodevelopmental implications

27. Summarizing Effects of Trauma • The effects of trauma depend on developmental level, resiliency, and other predisposing factors • Brain development and learning difficulties • Emotional problems • Behavioral problems :Self-injury ; Revictimization; Substance abuse ; Dangerous sexual behavior ; Responding impulsively to stressful situations, which can lead to increased risk for JD and later adult criminal offenses • Disrupted attachment relationships – being capable of being involved in safe and trusting relationships

28. Trauma Informed- Create Safety, Instill Hope, Build Resilience

29. Creating Cultures Of Safety and Resilience What it is NOT What it IS Breaking the Cycle Not Personal If I can’t tell you, I will show you Sandra Bloom – Hurt People…can hurt People Want change? Healed people, can help people • Not an Excuse ~ Everyone is still accountable, they still face the consequences of actions

30. Creating Culture

31. Creating Cultures Of Safety, Hope, and Resilience It always begins with US! • What role does our own background trauma play in our current helping mode? • How does being aware of our experiences, perceptions, and beliefs help our work with others? • Are we helping?

32. Tips for checking YOUR culture • Language: • It’s NOT “what’s wrong with you?” • It’s “what happened to you?” • “What didn’t happen to/for you?”

33. Taking Care of You www.nctsn.org/nctsn_assets/pdfs/cwt3_sho_inventory.pdf www.seekingsafety.org

34. You can always test for self care and resilience using a CAT SCAN

35. Free Online Resources National Child Traumatic Stress Network The mission of the National Child Traumatic Stress Network is to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States. This website offers resources for parents, counselors, teachers, and communities.www.nctsnet.org This is also the location of the child welfare trauma training toolkit. Child Trauma Academy The Child Trauma Academy is a unique collaboration of individuals and organizations working to improve the lives of high-risk children through direct service, research, and education. The .com site offers free online courses, while the .org site offers a myriad of educational resources. www.childtraumaacademy.com and www.childtraumaacademy.org Trauma Focused Cognitive Behavioral Therapy Offers a free web-based training for Trauma Focused – Cognitive Behavioral Therapy. www.musc.edu/tfcbt Cognitive Processing Therapy Offers a free web-based training for Cognitive Processing Therapy http://cpt.musc.edu • CEBC: California Evidenced-Based Clearing House for Child Welfare http://www.cebc4cw.org/

36. HopeHealingSafetyResilience Trauma Informed Gwendolyn Downing LPC Manager of Hope and Resilience Oklahoma Department of Mental Health And Substance Abuse Services 1200 NE 13th Oklahoma City, OK 73152 405-522-8117 gjdowning@odmhsas.org