Trauma-Informed Care

1. Trauma-Informed Care Deborah Borne, MSW, MD

2. Getting To Know You

3. Our Goals • Expose you to the concept and principles of Trauma Informed Care • Plant the seeds for further conversation and implementation at your setting • Understand that trauma informed care is a long and ongoing process • Take something back for yourself…..

4. Goals PART 1 • Explain the nature of traumatic stress. • Explore the relationship between homelessness and trauma. • Outline the body’s response to stress and traumatic stress. • Identify the impact of traumatic stress. • Review the mechanisms of healing from trauma

5. Defining Stress and Trauma

6. Why Trauma-Informed? Misunderstood or ignored signs of trauma may: Interfere with help-seeking Limit engagement into services Lead to early “drop-out” Inadvertently re-traumatize people we are trying to help Failure to make appropriate referrals

7. Homelessness & Trauma Developmental trauma that predates becoming homeless Becoming homeless as trauma Exposure to trauma as part of being homeless Homelessness as increasing vulnerability to trauma response Trauma response as affecting access to services and recovery

8. Source: Poems, Pictures, and Other Great Stuff. (1996). Salem-Keizer Public Schools. Salem, Oregon.

9. Traumatic stress is different from other kinds of stressors.

10. What is Traumatic Stress? • Overwhelming experience. • Involves a threat. • Results in vulnerability and loss of control. • Leaves people feeling helpless and fearful. • Interferes with relationships and beliefs. Source: Herman, J. (1992). Trauma and recovery. New York: Basic Books.

11. Sources of Traumatic Stress • Loss of a loved one • Accidents • Homelessness • Community/school violence • Domestic violence • Neglect • Physical abuse • Sexual abuse • Man-made or natural disasters • Terrorism Photo credit: K. Volk

12. Trauma Psychological Complex Historical Sanctuary Vicarious

13. Impact of Trauma on the Helper • Constant stress and anxiety • Negative attitude • Inability to focus • Feelings of incompetence and self doubt • Triggered PTSD reactions and other mental health issues especially if the worker has unresolved trauma • Compromised physical health • Disruption of relationships • Blurred boundaries • Hopelessness • Decrease in ability to experience pleasure • Decreased productivity

14. ACE STUDY

15. Adverse Childhood Experiences(ACE; Anda & Felitti – www.acestudy.org) • Recurrent physical abuse • Recurrent emotional abuse • Contact sexual abuse • An alcohol and/or drug user in the household • An incarcerated household member • Household member who is chronically depressed, mentally ill, institutionalized, or suicidal • Mother is treated violently • One or no parents • Emotional or physical neglect

16. ACE Study: Two Major Findings • ACE’s are vastly more common than recognized or acknowledged • ACE’s have a significant impact on later adult health and well-being

17. ACE’s have a strong influence on… • Adolescent health • Teen pregnancy • Smoking • Alcohol misuse • Illicit drug misuse • Sexual behavior • Mental health • Risk of re-victimization • Stability of relationships • Performance in the workforce

18. ACE’s increase the risk of… • Heart disease • Chronic lung disease • Liver disease • Suicide • Injuries • HIV and STD’s • Other risks for the leading causes of death

19. Adverse Childhood Experiences • ACE score ≥ 4 • Twice as likely to smoke • Seven times as likely to have alcohol abuse/dependence • Twice as likely to have cancer or heart disease • Four times as likely to have emphysema or COPD • Twelve times as likely to have attempted suicide • Men with an ACE score ≥ 6 were 46 times more likely to have injected drugs • People with ACE score ≥ 7 had 360% higher risk of ischemic heart disease (and didn’t smoke, drink to excess, and were not overweight)

20. The Neurobiology of Traumatic Stress

21. Goal of this section • Understand that the Brain and our experience shape how we think, feel, and behave • Trauma has an impact on the Brain • The brain, and clients can heal

22. How we will Do it • Review the parts of the brain. • Learn the physiological parts of the stress/trauma response • Understand how the brain is affected by trauma • Identify methods to help heal the brain

27. The Brain……..

29. Right Brain/Left Brain Left hemisphere better at math, judging time and rhythm, and coordinating order of complex movements Processes information sequentially and is involved with analysis About 95 percent of our left brain is used for language Right hemisphere good at perceptual skills, and at expressing and detecting other’s emotions Processes information simultaneously and holistically

31. The limbic system is a sort of “primitive core” of the brain strongly associated with emotion and memory.Doing Brain

33. TWO TYPES OF STRESS RESPONSES:Nervous System and Endocrine System • Similarities: • They both monitor stimuli and react so as to maintain balance. • Differences: • The Nervous System is a rapid, fast-acting system whose effects do not always persevere. • The Endocrine System acts slower (via blood-borne chemical signals called Hormones) and its actions are usually much longer lasting.

34. Autonomic Nervous System

35. SYMPATHETIC NERVOUS SYSTEM Flight Fight Freeze

36. How Does It all work together ?

38. Trigger Amygdala Slow Fast Hypothalamus Sympathetic Nervous System Stress Hormone (Cortisol) Memory Norepinephrine epinephrine Fight, flight or freeze Regulates response

43. Trigger Amygdala Slow Fast Hypothalamus Sympathetic Nervous System Memory Stress Hormone (Cortisol) Norepinephrine epinephrine Fight, flight or freeze Regulates response

45. Trigger Amygdala Slow Fast Hypothalamus Sympathetic Nervous System Memory Stress Hormone (Cortisol) Norepinephrine epinephrine Fight, flight or freeze Regulation response not work over time

46. Brain Parts • THINKING, DOING and REPTILE BRAIN • RIGHT and LEFT • Fight/Flight/Flee vs. Rest/digest • STRESS RESPONSE: FAST and SLOW

48. Principles of Neurodevelopment • The brain is underdeveloped at birth • The brain organizes from the “bottom” up - brainstem to cortex and from the inside out • Organization and functional capacity of neural systems is sequential • Experiences do not have equal influence throughout development (sensitive periods)

49. Trauma and Altered Neurodevelopment Altered cardiovascular regulation Behavioral impulsivity Increased anxiety Increased startle response Sleep abnormalities

50. The Effects of Trauma on the Brain