Trauma Informed Care

1. Trauma Informed Care Laneita F. Williamson, R.N.

2. Objectives • To explain how behaviors are impacted by adverse childhood experiences, and how these behaviors increase the risk for adult health issues • To illustrate how adult health is impacted due to the biological changes from adverse childhood experiences, even without the conventional risk factors • Describe definition of TIC

3. Trauma Informed Care “What happened to this person” in place of “what’s wrong with this person”

4. Becoming Trauma Informed “Trauma informed care provides the foundation for a basic understanding of the psychological,neurological, biological, and social impact that trauma and violence have on many individuals we serve”

5. Adverse Childhood Experiences(ACE)Study Conducted by: Robert F. Anda, MD, MS, with the Center of Disease Control (CDC) Vincent Felitti, MD, with Kaiser Permanente

6. Adverse Childhood Experience Study • Retrospective and Prospective • 17,000 participant (initial phase 1995 – 1997) • Collaboration between CDC and Prevention and Keiser Permanente • Based at Keiser Permanente in San Diego Health and Appraisal Clinic • Used with over 440,000 patients

7. Ace Study Demographics

8. Ace Study Demographics

9. Ace Study Demographics

10. Categories of Trauma Identified Abuse • 28% Physical Abuse • 21% Sexual Abuse • 11% Emotional Abuse Neglect • 15% Emotional Neglect • 10% Physical Neglect

11. Categories of Trauma Identified Household Dysfunction • 27% Someone in household used drugs or alcohol • 23% Lost a parent to separation/divorce • 18% Member of the household was mentally ill • 13% Witnessed domestic violence against mother • 5% Member of household was in jail/prison

12. ACE Study • Common • Clusters • ACE Score • Cumulative (neuro)developmental Impact • Graded relationship to health, social, and behavioral problems • Co-morbid, Co-occurring

13. Aces Are Common

14. ACE Study 63% experience at least one category of childhood trauma

15. Areas Affected Brain

16. Dysregulation of Limbic System Toxic Stress Derails Healthy Development

17. Hippocampus • Controls emotional reactions • Constructing verbal memory • Constructing spatial memory Vulnerable to all forms of maltreatment in first 2-3 years of life

18. Corpus Callosum • Integrates hemispheres & facilitates: • Language Development • Proficiency in math • Processing of social cues – facial expression Vulnerable to neglect in infancy and sexual abuse in the elementary school years

19. Cerebellar Vermis • Regulating mental health, and movement through the physical environment • Reacting to peripheral details in the world around us Vulnerable to high levels of cortisol prior to puberty

20. Cortex • Thinking & Judgment; Executive Function; Long Term Memory; Vision Vulnerable to: Trauma in the first several years of life affecting pre-frontal cortex Witnessing domestic violence in the elementary school years affecting visual cortex Sexual abuse at 15-16 affecting executive function

21. Right Temporal Gyrus • Center for Spoken Language Vulnerable to emotional abuse, especially between ages 7 and 9

25. Diabetes • Unwanted sexual touching - 16% higher risk • Isolated sexual abuse -19% increased risk • Forced sexual activity before adulthood carried - 34% increased risk if it occurred once - 69% greater risk if it occurred more frequently • Moderate or severe physical abuse - 26% to 54%

26. Windows of Vulnerability - Teicher

27. COPD Risk A person with an ACE Score of 4 is 260% more likely to have COPD than is a person with an ACE Score of 0

28. Liver Disease A person with an ACE score of 4 is 240% more likely to have Hepatitis than a person with an ACE score of zero

29. Suicide Risk 6 or > ACE’s 46 times more likely to attempt suicide 4,600% increase in attempt of suicide compared to those with 0 ACE’s

31. ACE Study Toxic stress from trauma in early childhood has been shown to cause physiologic disruptions that persist into adulthood leading to frank disease, even in the absence of later health-threatening behaviors

32. Understanding We cannot always recognize a disability, but should not assume that someone doesn’t have one

33. Now What

34. Guiding Principles of Trauma-Informed Care Safety Trustworthiness and Transparency Empowerment, Voice, and Choice Collaboration and Mutuality Empowerment Cultural, Historical, and Gender issues

35. Understanding Triggers

36. Assess Individual Patient Actions

37. Simple Question • WHAT MAKES YOU FEEL UPSET OR UNCOMFORTABLE

38. Provide a Calm Environment

39. Trauma Informed Care Champions Trauma-Informed Care Champions: From Treaters to Healers

40. Supportive Tools for Patients

42. Strategy - HALT

43. The Impact of Diet and Exercise • Trauma deregulates cortisol levels (known as the stress hormone) in the body, but this can be corrected through good eating habits and consistent exercise

44. Nutritional Strategies

45. Community Resources

46. High-Resolution Relational Resonance Based Electroencephalic Mirroring (HIRREM) • Non invasive • Closed-loop • Acoustic Simulation • Monitored brainwaves are translated to audible tones • Brain resonance allows self-adjustment Dr. Charles Tegeler

47. Summarizing Thoughts

48. Trauma Informed Care Recognizes that trauma is NOT just an acute injury Trauma Informed Care understands that Adverse Childhood Experiences lead to adult internal health issues

49. Universal Precaution Trauma informed care is a cultural shift – Clinicians presume that every patient has been exposed to abuse, violence, neglect, or other adverse event

50. Universal PrecautionACE Study Video