Trauma & The Trauma Informed Care Initiative

1. Trauma & The Trauma Informed Care Initiative Wisconsin Coalition Against Domestic Violence Oct 23, 2012 CJ Doxtater, Aging & Disability Specialist

2. Trauma & TIc • Brain Development • Psychological Trauma • Brain Effects • Trauma • Adverse Childhood Experiences • Trauma Informed Care (TIC) • Implementing Value Based Practice

3. Brain Development • Most neural development occurs after birth • A young brain is extremely elastic-realigning neurons at a rate no adult brain can match • Environment determines what neurons are pruned - basic brain architecture • Repetition is the technique used to prune neurons and develop the brain’s architecture

4. Stress Hormones • Increased heart rate & blood pressure • Blood sugar increases • Increased blood clotting • Tunnel vision • Memories come in “HD” • Increased cholesterol • Pain sensation dulled • Increased alertness & focus • Insulin increases • Memory loss from parts of the event • Increased strength, energy & aggression • Hearing may shut down • Time slows down or speeds up

5. Psychological Trauma • Trauma refers to extreme stress (i.e. threat to life, bodily integrity or sanity) that overwhelms a person’s ability to cope • The person’s subjective, individual experience determines whether or not an event is traumatic • Traumatic events result in a feeling of vulnerability, helplessness or fearfulness • Traumatic events often interferes with relationships and fundamental beliefs about oneself, others and one’s place in the world

6. Trauma Alters the Way the Brain Works • Hypersensitivity to even minor threats • Extremist thinking • Respond to many things as threats to life- aggression & impulse control • Attention to threat while ignoring less threatening but important information

7. Brain Development Patterns Brain Hormones, chemicals & cellular systems prepare for a tough life in an evil world • Individual • Edgy • Hot temper • Impulsive • Hyper Vigilant • Brawn over brains Traumatic stress Neutral Start Brain Hormones, chemicals & cellular systems prepare for life in a benevolent world • Individual • Laid back • Relationship oriented • Thinks things through • Process over power

8. Brain Development Patterns (cont.) • Outcome • Individuals & Species live peacefully in good timed; vulnerable in poor conditions Outcome Individuals & Species survive the worst conditions Dissonance between expectations & social reality fuels psychiatric disorders

9. Brain Effects by critical periods

10. Brain effects by critical periods (cont.)

11. 4 levels of Stress Reactivity

12. The “Onion Effect of Trauma” • PTSD • Complex • Inter-generational • Historical • Insidious • Vicarious • ACES Score

13. Adverse Childhood Experiences Study The ACE Study identifies ”adverse childhood experiences” as growing up in a household with: • Recurrent physical abuse • Recurrent emotional abuse • Sexual abuse • A person who abuses alcohol • A household who has a member who is incarcerated • A mother being treated violently • A caregiver who has an untreated mental illness, is chronically suicidal or repeatedly institutionalized • One or no parents

14. ACES Pyramid

15. Trauma-Informed Care: Guiding Values“Healing Happens in Relationship”

16. Implementing Value-Based Practice Understand the Prevalence and Impact of Trauma • Practice Universal Precautions: presume that every person in a human service setting has been exposed to abuse, violence, neglect or other highly adverse experiences. Examine all service delivery from this vantage point. • Provide early and thoughtful evaluation with focused consideration of trauma in people with complicated mental health and addiction issues • Learn about ‘triggers’ and coping strategies used by people impacted by trauma • Recognize that the majority of staff are uninformed about trauma and its sequelae, do not recognize it, and do not treat it. Staff receive ongoing training and supervision in how to assess for, support and provide effective treatment to people with trauma histories(Fallot & Harris, 2002, Cook et al, 2002, Ford, 2003)

17. Implementing Value-Based Practice Promote Safety • Create a service environment that is welcoming and calming • Develop spatial awareness, esp. regarding over-crowding • Provide confidential places to talk • Provide staff and consumer trainings that raise awareness re. re-traumatizing practices • Be open to outside parties, advocacy and clinical consultants • Ask about current abuse and address the current risks to safety • Give advance warning when something out of the ordinary may happen (Fallot & Harris, 2002, Cook et al, 2002, Ford, 2003)

18. Implementing Value-Based Practice (cont’d) • ) Share Power • Do not misuse or overuse displays of power such as keys, security and general demeanor • Provide opportunities for consumers to have valued roles such as leading initiatives, facilitating groups, training and advocating • Staff provide psychoeducation but do not claim to be experts; consumers are the experts regarding their own lives

19. Implementing Value-Based Practice (cont’d) Earn trust • Assign one person the role of asking sensitive trauma-related questions; do not require people to repeat their trauma histories to multiple staff • Provide training to staff on sensitive responses to disclosures of past abuse and trauma Communicate with compassion • Require all staff use ‘person-first language’ • Hold a training in Motivational Interviewing • Sponsor a staff/consumer training in ‘Non violent Communication’

20. Practice Based on ValuesValue: Communicate with compassion • Healing is contingent on the quality of a relationship • Relationships are communicated by the language we use • De-humanizing language creates unhealthy relationships and inhibits healing Examples of de-humanizing language: target populations, line staff, in the trenches, take downs, high level / low level, unmotivated, cutters, borderlines, non-compliant, manipulative, attention-seeking, case, etc…

21. Implementing Value-Based Practice (cont’d) Respect human rights • Learn how to respectfully ask all people about their trauma history (e.g., people who are psychotic and delusional can respond reliably to trauma assessments if questions are asked appropriately) • Participate on community action committees that address issues of social justice

22. Implementing Value-Based Practice (cont’d) Pursue the person’s strength, choice and autonomy • Focus on ‘what happened to you, and how did you survive?’ vs. ‘what’s wrong with you?’ • Create individualized treatment plans and approaches • Offer opportunities to learn new skills • Recovery goals encompass growth and change not just stabilization of symptoms

23. 5 Essential Ingredients for Healing • Relationships connecting to a deep set of values that provide a meaningful vision • Psycho educational experiences • Strength based guidance • Safe context • Workable realities