Trauma Care and Developmental Disabilities: Trauma informed Care www.nhsonline.org

What is Trauma? Three key elements: Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as overwhelming or life-changing and that has profound effect on the individual’s psychological development or well-being, often involving a physiological, social, and/or spiritual impact. -SAMHSA experts 2012 The experience of violence and victimization including sexual abuse, physical abuse, severe neglect, loss, domestic violence and/or the witnessing of violence, terrorism or disasters DSM IV-TR (APA, 2000) Person’s response involves intense fear, horror and helplessness Extreme stress that overwhelms the person’s capacity to cope. The experience of interpersonal violence including sexual abuse, physical abuse, severe neglect, loss, and/or the witnessing of violence, terrorism, urban violence, war/combat, motor vehicles accidents and disasters Events that are shocking, terrifying and/or overwhelming to the individual Results in feelings of horror, fear, helplessness Trauma occurs when an external threat overwhelms a person’s internal and external positive coping resources Before moving to the next slide, ask participants to talk with their partner about what they think trauma is? Flipchart responses so they can see what they already know.

Why Trauma Informed Care? Under Reporting >Estimated 1 in 30 instances of sexual abuse against a person with a developmental disability are successfully reported >1 in 5 for the general population >Estimated only 3% of sex abuse cases are reported for this population James, 1988 Valenti-Hein and Schwartz, 1995 Higher Incidents of Abuse for People with Any Disability >1.2 to 2 times more likely to suffer from maltreatment than their nondisabled peers >3 to 4 times as likely to be neglected >4 times more likely to be the victims of crime Sobsey, 1996 Westat, Inc., 1993; Goldson, 2002 Higher Incidents of Abuse for People with Developmental Disabilities >Meta-analysis shows people with developmental disabilities suffer 2.5 to 10 times the abuse and neglect of non-disabled peers >More than 90% of adults reported sexual abuse within their lifetime >49% of that sample reported 10 or more abusive incidents Valenti-Hein & Schwartz 1995

SAMHSA’s Four R’s A program, organization or system that is trauma informed: Realizes the widespread impact of trauma and understands potential paths for recovery; Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; Resists re-traumatization, and Responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings.

Principles of a Trauma Informed Approach Safety Trustworthiness and Transparency Collaboration and mutuality Empowerment Voice and choice -Fallot 2008, SAMHSA, 2012 Safety: throughout the organization, staff and the people they serve feel physically and psychologically safe; the physical setting is safe and interpersonal interactions promote a sense of safety. Trustworthiness and transparency: organizational operations and decisions are conducted with transparency and the goal of building and maintaining trust among clients, family members, staff, and others involved with the organization. Trauma-informed peer support and mutual self-help are key vehicles for establishing safety, building trust, enhancing collaboration, and maximizing empowerment. Collaboration and mutuality: there is true partnering and leveling of power differences between staff and clients and among organizational staff from direct care staff to administrators; there is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making. The organization recognizes that everyone has a role to play in a trauma-informed approach; one does not have to be a therapist to be therapeutic. Empowerment: throughout the organization and among the clients served, individuals’ strengths are recognized, built on, and validated and new skills developed as necessary. The organization fosters a belief in resilience and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma; builds on what clients, staff and communities have to offer rather than responding to their perceived deficits. Voice and choice: the organization aims to strengthen the clients’, family members’, and staff’s experience of choice and recognize that every person’s experience is unique and requires an individualized approach. The organization addresses cultural, historical, and gender issues; the organization actively moves past cultural stereotypes and biases, offers gender responsive services, Promotes the value of cultural connections, and recognizes 5

Why is Trauma-Informed Care Important? We need to understand: The life situations that may be contributing to the persons current problems. That current problems faced by the people we serve may be related to traumatic life experiences. There is heightened sensitivity to situations that remind us of the people, places or things involved in our traumatic event. These reminders, also known as triggers, may cause a person to relive the trauma and view our organization as a source of distress and not as a healing and welcoming environment! And that: We might unintentionally cause harm by practices, policies and activities that are insensitive to the needs of individuals receiving services. Re-victimizing or re-traumatizing someone unintentionally is a real possibility None of us are immune from adverse experiences in the present or the past. Understanding trauma also means recognizing that our personal traumatic experiences or the stress associated with working in human services may impact our emotional and physical well-being as well as our work success and satisfaction.

National Council for Behavioral Health Learning Community National collaborative Year-long process Guided by TIC experts Social learning NHS is participating in the National Council for Behavioral Health’s Trauma-Informed Learning Community. The learning community is … National Collaborative – the learning community is a collaborative of approximately 30 providers nation wide interested in implementing trauma informed care. Year-Long process – the learning community is a year long process that is intended to help providers launch a successful trauma-informed care initiative. Although the learning community spans a year, it is understood that this is only the beginning of the transformation of becoming a trauma-informed organization. The transformation may take several years. Implementation Science – the National Council’s TIC Learning community is based on implementation science that outlines distinct methods and phases of a successful organizational change process. Guided by TIC Experts – The learning community is guided by national TIC experts. The national council has formed a trauma-informed care team to provide on-going consultation through monthly webinars, consultation calls, and other means such as the sharing of articles and tools. Social Learning – through the TIC Learning Community, NHS will be learning through collaboration with all other providers who are implementing, or who have implemented, trauma-informed care. NHS participates in events to learn/share about TIC implementation, group consultation calls, an e-mail list serve, etc.

NHS TIC Initiative Overview Core Implementation Team Pilot Sites Organizational Self- Assessment Goal Setting Progress Monitoring Sustain and Spread NHS is committed to a culture of compassion and safety where everyone thrives!

Locations – Adult Training Facilities NHS Northeastern PA (NEPA) – Carbondale, PA NHS Capital Region – Harrisburg, PA NHS Virginia – Richmond, VA NHS Cambrian Hills – Portage, PA These are licensed facility based service programs where people with ID come to learn daily living skills, pre vocational skills, have community inclusive opportunities Like size - 25 individuals, 6 – 7 staff

Kick-off Training Defining trauma Understanding ACES Resilience Trauma Informed care Compassion in our work and world overview of kickoff training Participants, Staff, Managers (all levels)** important they attended paradigm shift – not what is wrong but what happened, not what is wrong, but what is strong

Organizational Self-Assessment Distribute and review the OSA in its’ entirety. Or click on the link on the slide to view online in SurveyMonkey. The OSA is due by October 4th. Must be completed via Survey Monkey

The 7 Domains of Trauma-Informed Care Domain 1: Early Screening & Comprehensive Assessment of Trauma Domain 2: Consumer Driven Care & Services Domain 3: Trauma Informed, Educated & Responsive Workforce Domain 4: Trauma Informed, Evidence-Based and Emerging Best Practices Domain 5: Safe and Secure Environment Domain 6: Community Outreach and Partnership Building Domain 7: Ongoing Performance Improvement Provide a brief introduction to the 7 Domains of TIC. We will take a brief look at each of these now in turn. You will learn more about each domain when we review the Organizational Self Assessment. 12

Service Recipient Survey Distribute and review the Service Recipient Survey in its’ entirety. Or click on the link on the slide to view online in SurveyMonkey. Due by October 31st. Can be completed via hardcopy or SurveyMonkey

Staff Survey Distribute and review the TIC Staff Survey. Or click on the link on the slide to view online in SurveyMonkey. The staff survey is due by October 31st. Must be completed via Survey Monkey

Implementation Methods Local TIC Advisory Committee Routine meetings Variety of activities All local Advisory committees have staff, individuals and managers included Activities are being scheduled and having impact ton culture of the centers

NHS NEPA Domain 5 - A safe and secure physical and emotional environment Trauma Tree Worksheets with trauma related topics Community service

Staff and Individuals

NEPA Trauma Tree created by staff and individuals

The Tree blossoms

Inspirational quotes

NHS Capitol Region Domain 3 – Trauma Educated and Responsive Workforce Biweekly staff meetings Individual monthly supervisions Quarterly trainings relevant to trauma Creating fun activities

More activities

Monthly Supervisions

NHS Virginia Domain 5 - A safe and secure physical and emotional environment ID’s with safety plans Therapy ball Trauma tree – word of the day Use of ABLE link to find quotes and imagery

Virginia group

Therapy ball activity

Group activities

Therapy ball activity 1st each day!

NHS Cambrian Hills Domain 5 -A safe and secure physical and emotional environment Security system Begin the day with positive comments Inspirational words/quotes ID’s with safety plans Community outreach IDD Awareness Month activity

NEPA kick off group

Building wall of words

Holly leading the group discussion of the inspirational words

Advisory group and watching Inside out

Outcomes Culture change Satisfaction differences Measuring success of goals

Trauma-Informed Care Global KPIs – Turnover (Pilot Sites)

Trauma-Informed Care Global KPIs – Workers Comp (Total Net Incurred)

Trauma-Informed Care Global KPIs – Staff Satisfaction (Organizational Culture Survey)

TRAUMA INFORMED CARE IS FOR ALL OF US

Questions?