Trauma Informed Care in the Community Pam Kasinetz Jeff DeSantis Resources for Human Development

Objectives 1. Describe the thinking behind and importance of Trauma-Informed Care in your own words; 2. Reflect critically about situations and challenges in your programs; 3. Create pathways to implementing community-based Trauma- Informed Care interventions back at your own programs.

Definition of Trauma An EVENT of series of events or set of circumstances that is EXPERIENCED by an individual as physically or emotionally harmful or life threatening and that has lasting adverse EFFECTS on the individuals functioning, ability to cope and well-being

Trauma Shapes our Beliefs

The Adverse Childhood Experiences Study (ACEs)

Key Findings: ACES ARE COMMON! 67% had at least 1 ACE 1 in 8 had 4 or more Four or more ACES: 2x’s – COPD 4 ½ x’s - Depression 2 ½ x’s – Hepatitis 12 ½ x’s – attempt suicide 7 or more ACES: Triple risk of lung cancer 3 ½ x’s - heart disease

Trauma Informed Care Is… A Shift in Thinking from.. What’s Wrong with You!? to What Happened to You? An appreciation for the high prevalence of traumatic experiences in person who receive services A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on an individual

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; RESPONDS by fully integrating knowledge about trauma into policies, procedures, and practices Seeks to actively RESIST RE-TRAUMATIZATION

Most Importantly… Recognizing that trauma related symptoms and behaviors originate from ADAPTING to Traumatic Experiences

Key Principles of Trauma-Informed Practices Safety Trustworthiness and Transparency Peer Support and Mutual Help Collaboration Empowerment, Voice and Choice Culture, Historical and Gender Issues Connection https://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_2/trauma_tip/guiding_principles.html

Key Principles of Trauma-Informed Practices Safety: ensuring physical and emotional safety Trustworthiness: maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries Choice: prioritizing consumer choice and control Collaboration: maximizing collaboration and sharing of power with consumers Empowerment: recognizing skills and strengths, skill building, validation Connection: Connection with others heals Key principles to support creation of TIC operations. When we implement these principles, we are focused on BOTH what service we are delivering and HOW we are delivering it When we are coming from this perspective, we understand our clients differently…gone are the days of: Client’s being compelled to treat us with “respect” Looking for compliance and an ‘easy’ shift Having control; proving that we’re “right” Feeling the need to teach the client’s about the “real world” SAFETY – as defined by the individual – waiting rooms, lighting, well lit exit signs, sign in books, door open or closed, defining terms/acronyms (ie DBT) so consumers are willing to participate and not embarrassed/ashamed to ask what it is CAN’T PROGRESS OR THRIVE WHEN YOU FEEL THREATENED TRUSTWORTHINESS – trust must be earned - clarity, consistency, transparency, boundaries, timeliness, honesty CHOICE – do we prioritize client experience of control and choice? Are options understandable? – fake choice v real choice COLLABORATION – collaborative documentation?, view client as the expert on what they need, satisfaction surveys, collaborate on goals EMPOWERMENT – recognize client strengths and skills, increase peer support services, skill building opportunities, validate and affirm as much as possible, emphasize resilience and growth over stability I add CONNECTION because healing occurs in the context of relationships (self, others, environment) and TIC enables positive relational experiences which research shows is the #1 predictor of positive outcomes.

Trauma Informed Implementation

Trauma Informed Care Domains Domain 1 Early Screening and Assessment Domain 2 Consumer Driven Care and Services Domain 3 Trauma Informed and Educated Workforce Domain 4 Trauma Informed, Evidenced Based Best Practices Domain 5 Safe and Secure Environment Domain 6 Community Outreach and Partnership Building Domain 7 Ongoing Performance Improvement Environment means something different in the community People were frustrated that many of the other providers were not trauma informed

What should Trauma Informed Care in the Community look like?

Challenges No established standards Can’t control the environment Can’t control the people who do control the environment Hard to evaluate competence

Facing the Challenges Networking Preparing Educating

How do we explain the concepts in layman’s terms? 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; RESPONDS by fully integrating knowledge about trauma into policies, procedures, and practices Seeks to actively RESIST RE-TRAUMATIZATION

Trauma Informed Care for the Caregiver

Trauma Informed Care is a parallel process for staff Safety Trustworthiness Choice Collaboration Empowerment Connection

Self -Care

Organizational Response to Self-Care Reflective Supervision Sharing Our Support (S.O.S) Team Staff Safety Plans Designated Self-Care Specialist Mindfulness Apps / Podcasts

Conclusions and Observations