Trauma Informed Care and Peer Support Beth Filson, CPS Petra Robinson, CPS Nancy Jensen, CPS CPS Training Team of Wichita State University Center for Community Support & Research

Three Quotes – Three Perspectives on Trauma: “It’s not mental illness per se…It doesn’t have its roots in clinical understanding and brain chemistry science.” Mary Blake, Trauma Peer Expert Meeting July 2008 “I didn’t experience trauma, and not all the people I work with did either, so how is this relevant?” Certified Peer Specialist – Trauma Informed Peer Support, 2009 “Trauma is a social and community issue, not an individual issue; one that impacts community development and the quality of our communities…It confounds meaning of universal experience---love, hate, happiness, justice…how we see each other. Trauma and healing are profoundly social events.” Susan Salasan, CMHS Dare to Transform, 2008 So what isn’t a peer support group?

Refresher on Terms: Recovery: “Recovery is the process of gaining control over one’s life, and the direction on wants their life to go – on the other side of a psychiatric diagnosis, and all of the losses usually associated with a psychiatric diagnosis.” Appalachian Consulting Group, Inc. What is it we are saying we believe when we talk about recovery? List all the beliefs in this definition of recovery.

Refresher on Terms: Mental Illness: The combined impact of stigma, symptoms, and side effects of medications on one’s sense of self. Appalachian Consulting Group, Inc. Go through the Impact of Illness diagram on flip chart

What Is Trauma? Trauma shapes and informs our interactions with ourselves and others. It has a profound impact on our body, mind and spirit, often resulting in isolation, disconnection, learned helplessness, shame, rage, self-loathing and adverse physical conditions, including addiction. Traumatic events can be shocking, and terrifying. These events can include violence between people, abuse of any kind, neglect, institutionalization, disasters or war. Trauma often involved betrayal by a trusted person or institution. Healing from trauma is possible for all. The experience is transformative. The Transformation Center - www.transformation-center.org   1. (Non-coercive!) 2. (Great idea for new facilitators, especially!) 3. There’s never a “wrong” answer. ) 4. (We’re not often asked what we think as consumers, but all too often, what to think because we are consumers.)

The Adverse Childhood Experience Study (ACE) Led by Robert F. Anda, MD, MS, and Vincent J. Felitti, MD Center for Disease Control (CDC) and Kaiser Permanente. The largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life. For more information go to www.acestudy.org So what isn’t a peer support group?

ACE Findings: Compiled by Joan Gillece, PhD joan.gillece@nasmhpd.org Adverse Childhood Events (ACEs) have serious health consequences. Adoption of health risk behaviors as coping mechanisms: eating disorders, smoking, substance abuse, self harm, sexual promiscuity Severe medical conditions: heart disease, pulmonary disease, liver disease, STDs, GYN cancer and early death. (Felitti et al., 1998) So what isn’t a peer support group?

Adverse Childhood Experiences Defined: Recurrent physical abuse Someone who is chronically depressed, mentally ill or institutionalized, or suicidal Recurrent emotional abuse Contact sexual abuse Mother is treated violently An alcohol and/or drug abuser in the household One or no parents 9. Emotional or physical neglect An incarcerated household member Skip for time

Does Trauma Matter? Does it matter in the mental health system? Two (or maybe more) stories. So what isn’t a peer support group?

What’s Wrong with the Person? So what isn’t a peer support group?  

What happened to this person? So what isn’t a peer support group?  

What does this person need? So what isn’t a peer support group?  

Trauma Informed Systems of Care TIC changes the question from “What’s wrong with you?” to “What happened to you?” So what isn’t a peer support group?

What’s in a Name? The Behavioral Health Care System When behavior is seen as a symptom of the illness , the focus of services is on changing the way people act. But what happens if what I’m doing (how I behave) is how I am surviving?

A Mental Health System is Trauma Inducing When…. Trauma experience is not addressed – either staff’s or the person in services. Services and interventions are re-traumatizing – for staff and person receiving services. All or most of the person’s behavior is interpreted as symptom rather than adaptation or how a person has learned to live in the world, or survive. There are prominent and unrecognized symbols of power and authority throughout the center. Treatment programs are coercive , punitive, do not offer choice. 1. (Non-coercive!) 2. (Great idea for new facilitators, especially!) 3. There’s never a “wrong” answer. ) 4. (We’re not often asked what we think as consumers, but all too often, what to think because we are consumers.)

…Trauma Inducing when… The person receiving services is blamed for the behavior that is used to assert medical necessity. Disabling beliefs about what it means to live with a diagnosis - both staff and the person identified with a diagnosis are reinforced in program environments. Goals are not written by the person and do not relate to the needs the person has including the need for safety. The resources, supports, and skills that are being taught are not relevant to what the person wants to achieve. The community and other systems of support are not Trauma Informed. 1. (Non-coercive!) 2. (Great idea for new facilitators, especially!) 3. There’s never a “wrong” answer. ) 4. (We’re not often asked what we think as consumers, but all too often, what to think because we are consumers.)

Trauma Informed Systems of Care Defined – Trauma informed systems of care operate out of the awareness of the prevalence and the impact of trauma in the lives of most people receiving services in the public mental health system. TIC systems recognize that trauma is central to (not in addition to) the issues that impact a person in recovery. This awareness is reflected in all its policies, procedures and practices. Example: “Seclusion and restraint is treatment failure.” NASMHPD Position Statement on Seclusion and Restraint - www.nasmhpd.org So what isn’t a peer support group?

What Is Re-Traumatization? Let’s take a look at a trauma-inducing mental health system. If It’s creating new trauma, what is it doing for people who have already experienced trauma? 1. (Non-coercive!) 2. (Great idea for new facilitators, especially!) 3. There’s never a “wrong” answer. ) 4. (We’re not often asked what we think as consumers, but all too often, what to think because we are consumers.)

Trauma Specific Trauma specific services – deal directly with trauma experience – -examples TREM, DBT, EMDR, one –on- one or group therapy, etc. The focus is on the experience and the resulting impact. What happens when we try to do trauma-specific services within a trauma-inducing system? So what isn’t a peer support group?

What’s UP With That!!? Consumers, psychiatric survivors and ex- patients now talk openly and frequently about owning our own recovery from mental illness…. …But why don’t we talk openly and frequently about owning our recovery and healing from the impact of trauma? What happens when we try to do trauma-specific services within a trauma-inducing system? So what isn’t a peer support group?

When You Change the Question to: “What happened in your life..?” - you change the conversation- So what isn’t a peer support group?

What was seen as “maladaptive behavior” is often revealed to be how someone survived. What does this mean about “cure”? If we are only focused on changing people’s behaviors, we often take away survival strategies. Example: “Dissociation” is a great way to survive hours in restraints.

We are the Stuff of Our Own Transformation The process of personal transformation begins in the place of our greatest loss, our deepest grief, our most abject fear. It is rooted in the place we thought of as utterly useless, a total waste. But we affirm that we have always carried in us who we were intended to be, and what our lives are intended for. Transformation is the natural progression of Becoming; becoming never ends. It begins the moment we choose to engage in creating and re-creating the life we want to live – and we do this in relationship to one’s self, others, and to whatever we think of as our spirit. There is no room for regret in our transformed lives. We believe in personal transformation. Transformation takes place because we are using all that we are and all that we have ever been, and every one of our experiences. Transformation is what happens when we come together to engage in intentional relationships of healing and hope. B. Filson – GA Peer to Peer Trauma Initiative , 2005

National Center for Trauma Informed Care The National Center for Trauma Informed Care (NCTIC) is the technical support center of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. It is funded under contract to the National Association of State Mental Health Program Directors NASMHPD). http://mentalhealth.samhsa.gov/nctic/ So what isn’t a peer support group?

Prevalence of Trauma 90% of people served in the public mental health system have been exposed to trauma. (Mueser et al., 2004, Mueser et al., 1998) Most have multiple experiences of trauma. (Mueser et al., 2004, Mueser et al., 1998) 97% of homeless women with severe mental illness have experienced severe physical & sexual abuse – 87% experience this abuse both in childhood and adulthood (Goodman et al., 1997) American study of 100 adolescent inpatients; 93% had trauma histories and 32% had PTSD; 70-90% incarcerated girls – sexual, physical, emotional abuse. (DOC, 1998, Chesney & Sheldon, 1991)   So what isn’t a peer support group?

Prevalence of Trauma Up to two-thirds of men and women in SA treatment report childhood abuse & neglect. SAMSHA CSAT, 2000) Study of male veterans in SA inpatient unit - 77% exposed to severe childhood trauma, 58% history of lifetime PTSD. (Triffleman et al., 1995) 50% of women in SA treatment have history of rape or incest (Governor's Commission on Sexual and Domestic Violence, Commonwealth of MA, 2006) So what isn’t a peer support group?