Addressing Trauma in Our Communities Matters of the Mind: Addressing Trauma in Our Communities Nancy C. Lee, M.D. Deputy Assistant Secretary for Health-Women’s Health Office on Women’s Health U.S. Department of Health and Human Services April 22, 2013

Functional Definition of Trauma Trauma occurs whenever an external threat overwhelms a person’s coping resources.

What is Trauma? A Practical Definition Non-consensual Victim feels discomfort, fear, intimidated Bodily integrity, or that of someone else, is threatened

Prevalence of Trauma in the U.S. Rape and Sexual Assault One out of 6 U.S. women has been the victim of an attempted or completed rape in her lifetime 17.7 million U.S. women have been victims of attempted or completed rape. Source: RAINN

Intimate Partner Violence 1 out of 3 women experience at least one physical assault by a partner. Men who have witnessed their parents' domestic violence are twice as likely to abuse their wives. Girls who have witnessed domestic violence are more likely to stay in an abusive relationship as an adult. More than 50% of batterers also abuse their children or their victim’s children.

Prevalence of Trauma in the U.S. Childhood Sexual Abuse At least 2 of every 10 girls, and 1 of every 10 boys are sexually abused by the end of their 13th year.

Prevalence of Trauma in the U.S. Very common that an individual will have exposure to multiple traumatic events during their lives

Long Term Consequences Emotional Stress and Mental Illness Physical Illness, Disease and Disability High-Risk Behaviors The Impact of Trauma is Dramatically Underestimated

The Adverse Childhood Experience (ACE) Study Study analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behaviors later in life among 17,000 adult patients. Collaboration between the CDC and Kaiser Permanente Health System. The Co-principal Investigators - Vincent J. Felitti, MD, Kaiser Permanente Robert F. Anda, MD, CDC Over 17,000 Kaiser patients participated in routine health screening volunteered to participate in the study.  Data continues to be collected and analyzed. Study reveals staggering proof of the health, social, and economic risks that result from childhood trauma.

What is an ACE? Growing up experiencing any of the following conditions prior to age 18 Physical abuse Emotional abuse Sexual abuse Physical neglect An alcohol or drug abuser in home Someone who is mentally ill or suicidal in home Mother is treated violently One or no parents in home An incarcerated family member

ACE Score Prevalence 0 33% 1 25% 2 15% 3 10% 4 6% 5+ 11%* 0 33% 1 25% 2 15% 3 10% 4 6% 5+ 11%* *Women are 50% more likely to have a score >5.

ACE Study Findings As the number of ACEs increase, the risk for health problems increase in a strong and graded fashion.

ACE Study Findings Suicide At least 2/3 of all attempted suicides can be attributed to adverse childhood experiences. Sexually Transmitted Diseases There is a 250% increased risk of having an STD between individuals with an ACE Score of 4 vs. an ACE Score of 0.

ACE Study Findings An Individual with an ACE Score of 4 is: Chronic lung disease 260% more likely than someone with an ACE Score of 0. Depression 460% more likely to than someone with an ACE Score of 0.

ACE Study Findings IV Drug Use The relationship of ACE to IV drug use is particularly striking. A man with an ACE score of 6+ has a 4600% increased risk of becoming an IV drug user.

In Summary, the ACE Study indicates… ACEs are basic and long lasting determinants of: health risk behaviors mental illness social malfunction disease disability death healthcare costs

Secondary Victimization Also referred to as “Retraumatization” Victimization which occurs, not as a direct result of the traumatic event, but through the response of institutions and individuals to the victim

Examples Dental settings Ob-Gyn The supine position Can’t speak Ob-Gyn Pelvic exam Breast exams So what can be done to prevent Retraumatization?

Trauma-informed Care Take the trauma into account Avoid triggering trauma reactions Adjust the behavior of providers to support the individual’s coping capacity This will allow survivors to access and benefit from services Services that are provided for issues other than trauma but require knowledge about the impact of trauma to improve effectiveness Every part of an agency or institution from front desk staff, administrators, to care providers: Understand the effects of exposure to traumatic events Sensitively interact with trauma survivors Prevent re-traumatizing Engage in trauma screening as appropriate

Trauma-Informed Care Paradigm shift from… What’s wrong with you? to What happened to you?

Keep in Mind You are likely to encounter survivors of trauma who do not disclose Not all survivors are psychologically ready to discuss their experiences

Summary Traumatic events are prevalent in our society Trauma has negative physical, psychological and behavioral consequences Survivors may experience “secondary victimization” when they seek help You can help reduce some of these problems through trauma-informed practices

Substance Abuse Mental Health Services Administration (SAMHSA) SAMHSA's National Center for Trauma- Informed Care provides technical assistance to build awareness and promote implementation of trauma-informed practices.

Webinar Series provided by the Office on Women’s Health, in partnership with SAMHSA To Register for our upcoming webinars: https://services.choruscall.com/links/womenshealth.html

Thank you!