Trauma Informed Practice Shelley Gilbert BSW Legal Assistance of Windsor WEFIGHT Trauma Informed Practice Introduction Developing an understanding of the impact of trauma and then establishing direct practice and organizational strategies to assist allows our clients the opportunity to fully participate in the legal process and helps their representative to put their best case forward.

Introduction What is it? 4 Principles of Trauma Informed Practice Trauma Awareness Emphasis on Safety and Trustworthiness Opportunities for Choice, Collaboration and Connection Strengths Based and Skill Building We’re going to look real briefly at this idea of Trauma Informed Practice or TIP. Many people use these principles instinctively…..grass roots organizers in the migrant worker community, those working with people working in the sex trade industry, may already recognize and ensure choices are provided or the skills people bring to the table. But when these principles are employed together, they provide the best opportunity to reach out to individuals who have experienced trauma and support them in the most respectful and helpful manner.

Trauma Informed Services Embed an understanding of trauma in all aspects of service delivery Place priority on trauma survivor’s safety, choice and control Create a treatment culture of nonviolence, learning, and collaboration So TIP services are informed about trauma, and those services work at the client, staff, agency and system levels incorporating the core principles of trauma awareness, safety and trustworthiness, choice and collaboration, and building of strength and skills When these principles are employed, the connections between trauma, mental health & substance use are discussed in the course of work with all clients, trauma symptoms/adaptations are identified, and supports and strategies are offered that increase safety and support connection to services.

4 Key Principles 1. Trauma Awareness A trauma-informed approach begins with building awareness among staff and clients of: The high prevalence of trauma How the impact of trauma can be central to one’s development The wide range of adaptations people make to cope and survive The relationship of trauma with substance use, physical health and mental health concerns. BC Trauma-Informed Practice Guide, 2013 This knowledge is the foundation of an organizational culture of trauma-informed care

Trauma as an Event Individual Experiencing, witnessing, or being threatened with an event or events that involve serious injury, a threat to the physical integrity of one’s self or others, or possible death. The responses to these events include intense fear, helplessness, and/or horror. Women’s Co-occurring Disorders and Violence Study Intergenerational or multi-generational trauma Happens when the effects of trauma are not resolved in one generation. When trauma is ignored and there is no support for dealing with it, the trauma will be passed from one generation to the next. Many of us have experienced a traumatic event in our lives , but if we couple the event with factors such as length of time the event goes on, the age of the victim, the level of violence used and the amount of destruction in one’s family or community we begin to recognize that some events may cause life long responses…these responses may improve, they may change, they may be retriggered, but the memory of the even will not go away Aboriginal Healing Foundation, 1999:A5

What Does Trauma Look? Manifestations Post Traumatic Stress Disorder Physically showing fear, inability to follow conversation, looking distracted, exhaustion No shows, late, distractions during interviews, inability to take the bus, always accompanied Sleeping throughout the day, easily startled, no shows, unfocused Often childhood or compounded trauma Inability to maintain employment, stay in school, anger Intrusive recollection/re-experiencing – e.g. nightmares, flashbacks Avoidant/numbing – e.g. detachment, avoiding people and/or places Hyper-arousal – e.g. hyper-vigilance, difficulties with sleeping and/or concentrating Duration of disturbances is more than one month Causes significant problems with daily functioning APA, 2000 Physical unexplained chronic pain stress-related conditions (i.e. chronic fatigue) headaches sleep problems breathing problems digestive problems Emotional depression anxiety compulsive and obsessive behaviours overwhelmed with memories of the trauma difficulty concentrating fearful emotionally numb loss of time and memory problems suicidal thoughts Spiritual feelings of shame, guilt self-blame self-hate feel completely different from others no sense of connection feeling like a ‘bad’ person Interpersonal frequent conflict in relationships unable to trust difficulty establishing and maintaining close relationships experiences of revictimization trouble setting boundaries Behavioural drug and alcohol use shoplifting eating disorders self-harm high-risk sexual behaviours suicidal impulses gambling isolation justice system involvement

Key Principle 2. Emphasis on Safety and Trust-Worthiness Welcoming intake procedures Adapting the physical space Providing clear information and predictable expectations about programming Ensuring informed consent Creating crisis plans Providing culturally competent care/service BC Trauma-Informed Practice Guide, 2013 Trauma Survivors: Likely have experienced boundary violations and abuse of power Need to feel physical and emotionally safe May currently be in unsafe relationships Service Providers: The safety and mental health needs of service providers are also considered within a trauma-informed service approach. Key component of Service Provider safety: Education and support related to vicarious trauma. 2

Key Principles 3. Opportunity for Choice, Collaboration and Connection Service providers are encouraged to: Communicate openly Equalize power imbalances Allow the expression of feelings without fear of judgment Provide choices as to course of action Work collaboratively with both the client and supports Trauma-informed services create safe environments that foster a client’s sense of efficacy, self-determination, dignity, and personal control. Consider the following areas of choice: When, where and by whom services are provided Priorities and goals that will inform service plan Who attends appointments and meetings, e.g. support people Ask permission to ask a question; or engage in policy based practice, e.g. checking belongings at beginning of residential program Guarino et al. 2003; Fallot & Harris, 2009; Gender Matters, 2003

Key Principles 4. Strengths Based and Skill Building Service providers: Help clients identify their strengths Further develop resiliency and coping skills (could be related to culture/identity) Teach and model skills for recognizing triggers, calming, centering and staying present Support an organizational culture of “emotional intelligence” and “social learning” Maintain competency-based skills, knowledge, and values that are trauma informed BC Trauma-Informed Practice Guide, 2013

Systemically Trauma informed systems deliver and promote services that are culturally safe, take into account a socio-historical understanding of client/patient experiences and are informed by an awareness of the existence and impact of social inequities and systemic discrimination BC Trauma-Informed Guide, 2013

TRAUMA INFORMED INTAKE PRACTICES TIP can be seen in flexible intake and assessment processes that: Create safety (including cultural safety) Engage – establish a therapeutic relationship Do not “press for compliance.” Screen for present concerns Normalize client experience(s) Set boundaries Identify symptoms 2011 Focus Groups of BC Addictions and Mental Providers Staff collaboration can reflect on how to: Provide clear, practical information at initial contacts about what to expect, choices for being contacted and rationale for processes Provide opportunities for questions Respond to people who arrive in distress Guarino et al. 2003; Fallot & Harris, 2009; Gender Matters, 2003