Principles of Trauma Informed Care and Crossroads for Women

Workshop Overview Define Trauma Define the Possible Impacts of Trauma Define Trauma Informed Care Putting Trauma Informed Care into Practice

What is your definition of Trauma?

“Individual trauma results from an event, 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 individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” (SAMSHA, 2014)

“DSM-5 , the diagnostic manual used by mental health providers states that…the exposure must result from one or more of the following scenarios in which the individual: Directly experiences the traumatic event(s) Witnesses the traumatic event(s) in person Learns that the traumatic event(s) occurred to a close family member or close friend Experiences first hand reported or extreme exposure to aversive details of the traumatic event(s) (not through media, pictures, television, or movies, unless work related (American Psychiatric Association. 2013, 271)

Symptoms of Trauma Hopelessness and powerlessness Low Self Esteem Trust Issues Sleep Disturbances Space and Touch Issues Fear and Anxiety Flashbacks and Panic Attacks Dissociation and “numbing” Depression and Suicidal Thoughts/Actions Self-Harm

Broad Impact of Trauma May affect ability to keep a job or care for children and family Can affect biological, psychological and social development Can have profound effects on health Can lead to criminal justice involvement Can disrupt an individual's view of the world and of themselves. Reinforce that everyone is effected by trauma differently.

The Importance of Understanding Trauma? Health Mental Health Substance Abuse Housing Justice Child Welfare Education Health: High Medical Utilization rates exist for : both male and female vets, survivors of war, political violence and terrorism, survivors of natural disasters, crime victims (especially women who have experienced sexual assault) and survivors of child abuse. Mental Health: The rate of nonfatal violent crimes against people with disabilities was more than twice the rate of people without disabilities last year. More than 33% of women and 37% of men with serious mental illness (SMI) had been sexually/physically assaulted in the last year alone. Substance Abuse: Men and women with PTSD and alcohol dependence are more likely to have all types of childhood adversities. Homelessness: Lifetime risk for violent victimization for homeless people is 97% (Goodman, Dulton, and Harris ) Of the homeless population who report to the VA, 39.7% of women and 33% of men reported being victims of military sex assault. Justice: Men in the criminal justice system have significantly higher rates of traumatic events than non-criminal men. Child Welfare: 86% of sex trafficking victims were in social service cases when they went missing. (National Center for Missing and Exploited Children, 2017) Education: Children with one or more aces missed school 2 weeks or more at almost double the rate of all U.S. children. (Child and Adolescent Health Measurement Initiative, 2013)

What is The ACE Study? http://www.acestudy.org/faqs The ACE Study is ongoing collaborative research between the Centers for Disease Control and Prevention in Atlanta, GA, and Kaiser Permanente in San Diego, CA. The Co-principal Investigators of The Study are Robert F. Anda, MD, MS, with the CDC; and Vincent J. Felitti, MD, with Kaiser Permanente. Over 17,000 Kaiser patients participating in routine health screening volunteered to participate in The Study.  Data resulting from their participation continues to be analyzed; it reveals staggering proof of the health, social, and economic risks that result from childhood trauma. http://www.acestudy.org/faqs

: The ACE Study uses the ACE Score, which is a total count of the number of ACEs reported by respondents. The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion: Alcoholism and alcohol abuse Chronic obstructive pulmonary disease (COPD) Depression Fetal death Health-related quality of life Illicit drug use Ischemic heart disease (IHD) Liver disease Risk for intimate partner violence Multiple sexual partners Sexually transmitted diseases (STDs) Smoking Suicide attempts Unintended pregnancies Early initiation of smoking Early initiation of sexual activity Adolescent pregnancy

What is Trauma Informed Care? TIC is a strengths-based service delivery approach “that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment” (Hopper, Bassuk, & Olivet, 2010, p. 82). It also involves vigilance in anticipating and avoiding institutional processes and individual practices that are likely to retraumatize individuals who already have histories of trauma, and it upholds the importance of consumer participation in the development, delivery, and evaluation of services. (SAMSHA, TIP 57) Vigilance to avoid re-traumatizing.

Guiding Principles of Trauma-Informed Care Safety  Trustworthiness and transparency  Peer support and mutual self-help  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, voice, and choice - Throughout the organization and among the clients served, individuals' strengths are recognized, built on, and validated and new skills developed as necessary. The organization aims to strengthen the staff's, clients', and family members' experience of choice and recognize that every person's experience is unique and requires an individualized approach. This includes a belief in resilience and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma. This builds on what clients, staff, and communities have to offer, rather than responding to perceived deficits. Cultural, historical, and gender issues - The organization actively moves past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, geography), offers gender responsive services, leverages the healing value of traditional cultural connections, and recognizes and addresses historical trauma.

Guiding Principles of Trauma-Informed Care Collaboration and mutuality  Empowerment, voice, and choice  Cultural, historical, and gender issues  Guiding Principles of Trauma-Informed Care 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, voice, and choice - Throughout the organization and among the clients served, individuals' strengths are recognized, built on, and validated and new skills developed as necessary. The organization aims to strengthen the staff's, clients', and family members' experience of choice and recognize that every person's experience is unique and requires an individualized approach. This includes a belief in resilience and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma. This builds on what clients, staff, and communities have to offer, rather than responding to perceived deficits. Cultural, historical, and gender issues - The organization actively moves past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, geography), offers gender responsive services, leverages the healing value of traditional cultural connections, and recognizes and addresses historical trauma.

Benefits of Trauma Informed Care creates a proactive approach to safety creates safer physical and emotional environments for clients, families, and staff creates and sustains opportunities for choice, power and control through increased therapeutic interactions reduces the possibility of re-traumatization improves the social environment in a way that improves all relationships creating environments that care for and support staff increases the quality of services, reducing unnecessary interventions, reducing costs reduces the number and types of negative encounters and events (e.g., seclusion and restraint) creating a resiliency and strengths-based focus increases client and family satisfaction increases success and job satisfaction among staff https://www.yourexperiencesm atter.com/learning/trauma-informed-care/benefits-of-being-trauma-informed/

Putting into Practice/ Trauma Responsive Environment Organizational Culture Values Leadership