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Psychological Intervention

TRAINING OF TRAINERS ON VICTIMOLOGY AND VICTIM ASSISTANCE Lembaga Perlindungan Saksi Dan Korban 18 - 28 Maret 2013. Psychological Intervention. KIERAN GRAHAM MUNDY Tokiwa International Victimology Institute. OVERVIEW. Review Exposure to Psychological Trauma

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Psychological Intervention

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  1. TRAINING OF TRAINERS ON VICTIMOLOGY AND VICTIM ASSISTANCE LembagaPerlindunganSaksi Dan Korban 18 - 28 Maret 2013 Psychological Intervention KIERAN GRAHAM MUNDY Tokiwa International Victimology Institute

  2. OVERVIEW Review Exposure to Psychological Trauma Posttraumatic Stress Disorder (PTSD) Acute Stress Disorder (ASD) Awareness of Presence of PTSD and ASD Assessment & Treatment of Psychological Disorders in Children and Juveniles

  3. PATHWAYS TO PROGRESS PREVENTION PROSECUTION PROTECTION RECOVERY If trauma is untreated, it will prevent recovery and lead to revictimization WORLDWIDE 4P PARTNERSHIPS PARADIGM Diplomatic, economic, political, legal and cultural

  4. TOP-DOWN APPROACH Definitions (e.g., the UN Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power) aim to give victims the freedom to exercise their human rights What actually is happening? A victim centered approach aims to heal and restore ISSUES TO CONSIDER VICTIM CENTERED APPROACH

  5. Less than 1 in 10 victims of serious crimes who reported to the police received specialized help (IVS Survey 2005) O’Connell, M. (2013, March 22). Victims and the Police. Presented at the TRAINING OF TRAINERS ON VICTIMOLOGY AND VICTIM ASSISTANCE LembagaPerlindunganSaksi Dan Korban 18 - 28 Maret 2013 THE VICTIMS? ( ≅ < 10%) POPULATION Total Impact = SURVIVORS Resilient + VICTIMS Non-Resilient

  6. To help survivors (& victims) re-stabilize their lives and become healthy again – to be healed and restored • To help survivors (& victims) prevent further victimization from the criminal justice system or other agencies the victim may come into contact with following the victimization • This is the initial period of recovery for the victim, and may require considerable time, effort and resources before the victim resolves long-term issues associated with the victimization FRIDAY’S CLASS

  7. EXPOSURE TO PSYCHOLOGICAL TRAUMA

  8. EXPOSURE TO A TRAUMATIC EVENT IS COMMON A majority of people report at least one trauma-inducing event in their lives • Fear, sadness, guilt and anger are common • There is also pain, a sense of loss, a loss of trust and security • In natural disasters, there is often a total loss of community

  9. Most (about 80%) recover over time with the help of family , friends, and community • A few (<3% to 20%) develop ASD or PTSD and need professional help

  10. Most (≅ 80%) people exposed to intense stress are RESILIENT • No observable disruption in close relationships at work or daily life • Relatively healthy levels of psychological functioning maintained A minority (< 20%) are NOT RESILIENT • Moderate to severe initial elevations in bio-psycho-psychological symptoms that significantly disrupt normal functioning • Symptoms decline gradually over weeks, months, or years before returning to pre-trauma levels RESILIENCE

  11. Most people want to be left alone once basic needs met • Able to identify the risk early enough. • Are aware that environmental assaults (like tsunamis) are deadly. • Have the options available to avoid death or injury SURVIVORS (RESILIENT)

  12. Identification Awareness Options available Threat of Environmental assault

  13. A small minority of high-risk (vulnerable) people • Women, children or the elderly, but not necessarily so • Those unable to identify the threat • Those unaware of the VICTIMIZING FORCE of the unexpected event • Those who not have the personal and other resources to cope TARGET THE HIDDEN VICTIMS

  14. Threat of Environmental assault What Threat? Awareness I have no idea that I risk dying of hunger if it doesn’t rain! Identification Why are you all looking at me? This is my home – I like it here! My brothers left ages ago! Options available If you come too close, I will run back to my mother! I’m hungry anyway so I might just go soon!

  15. PTSD

  16. Despite low risk, some people develop Posttraumatic Stress Disorder (PTSD) or Acute Stress Disorder (ASD) • The psychological reactions following a trauma-inducing event are TRAUMA-IDENTIFIED. The victim identifies with the critical event. • Trauma-specific means the type of trauma is not specific to the unexpected personal event TRAUMA IDENTIFIED

  17. Reactions from any threat(real or perceived), to the life or physical safety of a person, their loved ones or those around them leads to intense fear, and helplessness • More than 250,000 Australians experience PTSD in any one year • About 5% have had PTSD at some point in their lives • Prevalence rises to about 18% in adults who have been physically abused in childhood

  18. Safety Needs Safety and Security • Protection • Stability • Pain Avoidance • Routine/Order Attributed to Claudia Hannah University of Phoenix Online MADL 117C - EDTC 560

  19. Diagnosing PTSD

  20. Before a diagnosis of PTSD can be made Anumber of symptoms in each of three categories (re-experiencing, avoidance & emotional numbing and hyperarousal) must be present for at least a month These symptoms must lead to significant distress or impairment in functioning PTSD

  21. While symptoms often develop in the days and weeks following exposure to trauma, the onset of PTSD can be delayed for years for a significant number of people. Figure adapted from Dussich, J., Hall, B., Nobukazu, N., Rauch, S., Tuerk, P., & Yodder, M. The Psychological Effects of Trauma and Posttraumatic Stress Disorder (PTSD). TIVI Crisis Response Team Work Group, Mito, Ibaraki. April 18-19, 2011. PTSD

  22. DIAGNOSING ACUTE STRESS DISORDER

  23. ASD ASD is diagnosed between two days and one month following a trauma-inducing event There is significant overlap in the diagnostic criteria of ASD and PTSD The diagnosis of ASD requires the experience of several dissociative symptoms not included in PTSD (e.g., detachment, reduced awareness of surroundings, depersonalization, and dissociative amnesia) PTSD places greater emphasis on avoidance symptoms The main difference between PTSD and ASD is the duration of symptoms required for a diagnosis to be made

  24. BEING AWARE OF PSYCHOLOGICAL TRAUMA

  25. Awareness of PTSD/ASD Most people experience some level of stress after a traumatic event and recover using their own resources. Professional help is only necessary when a person’s distress is persistent or severe enough to cause significant impairment. Athorough clinical assessment includes physical, psychological, and social functioning. Some people may still face ongoing threat &be at risk of further exposure to trauma[e.g., emergency personnel/ victims of domestic violence may have to return to unsafe environments]

  26. VULNERABILITY Some sub-populations are more at risk of this type of victimization than others Prisoners, IDPs, refugees and asylum seekers, military and emergency personnel, survivors of motor vehicle accidents, crime, sexual assault, natural disasters, and terrorism Hidden vulnerability: intellectual disability, relative age (juveniles with adults), Asperger’s Syndrome (an autistic spectrum disorder)…..(being female, or a child is not necessarily a risk factor!)

  27. ASSESSMENT & TREATMENT OF COMPLEX TRAUMA IN CHILDREN AND JUVENILES

  28. REFER FOR CLINICAL ASSESSMENT IF YOU SUSPECT PTSD/ASD • Family members should be included in the assessment process, education and treatment planning • The needs for care of family members should also be met. • Everything should be done with the person’s consent.

  29. Attachment • Biology • Affect Regulation • Dissociation • Behavioural control • Cognition • Self concept DOMAINS OF IMPAIRMENT EXPOSED TO COMPLEX TRAUMA

  30. Your therapeutic goal is to resolve the impact of a single or series of traumatic experiences on the victim • Therapeutic decisions emerge from clinical and standardized assessment. CREATE A UNIQUE CLIENT PICTURE

  31. Assessment • Create a Unique Client Picture • Triage • Treatment PSYCHOLOGICAL INTERVENTION

  32. Psychosocial Assessment • Medical Assessment general/ forensic • What does the child/juvenile/family need? • Safety? • Stabilization? • Services [referrals, legal information/assistance with reporting, liaison with CPS and other systems] • What are the ‘helps’ required for those needs? • Crisis response • Advocacy • Case management • Psychoeducation CREATE A UNIQUE CLIENT PICTURE

  33. Multidimensional approach • Areas of competence and vulnerability are assessed in overlapping biological, emotional, social and cognitive domains • Individual functioning is considered in the context of the child’s relationships and the family’s ecological niche ASSESS BEFORE TREATING TO MATCH INTERVENTION TO NEEDS

  34. Clinical Interviews • Behavioral Observation • Standardized Measures UNIQUE CLIENT PICTURE

  35. What treatments do you have available? • What treatments are you as a therapist able to provide? • Funding? • Client Issues? …BE REALISTIC! TREATMENT TRIAGE

  36. LUAR BIASA

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