Trauma Informed Care and Motivational Interviewing Background and Theory

STRESS! - Fight, Flight, Freeze In order to protect itself, the body uses increased energy to respond to danger in 1 of 3 ways: Fight Flight Freeze

Stress & the Brain Trauma: Allostatic load Frontal executive functioning areas are disengaged Subcortical fight or flight areas are engaged Trauma: Allostatic load The wear and tear that the body experiences due to repeated cycles of stressful events as well as the inefficient turning-on or shutting off of these responses

Toxic Stress and Trauma Adverse Childhood Experiences (ACE) Study 14 + year collaboration between the CDC and Kaiser Permanente in San Diego. Over 17,000 HMO Members – were interviewed and answered a series of questions about their childhood experiences. Middle Class; 80% White; 74% with Some College

Adverse Childhood Experiences 10 ACE Categories (score 1 for presence of each) Abuse of Child Emotional abuse Physical abuse Contact Sexual abuse Trauma in Child’s Household Chronically depressed, emotionally disturbed or suicidal household member Alcohol or Drug User Trauma in Child’s Household Mother treated violently Imprisoned household member Not raised by both biological parents (Loss of parent - Worst if by abandonment) Neglect of Child Physical neglect Emotional neglect

Number of categories of childhood experiences are summed Adverse Childhood Experiences Score Number of categories of childhood experiences are summed ACE Score Prevalence (after Wave 2) 0 33% 1 25% 2 15% 3 10% 4 6% 5 or more 11% Approximately two-thirds have at least one ACE More than one-third have experienced 2 – 4 ACE categories

Childhood Experiences and Adult Alcoholism 4+ 3 2 1

Childhood Experiences and Chronic Depression

Childhood Experiences and Suicide 4+ 3 2 1

ACE Score and Hallucinations Abused Alcohol or Drugs? Ever Hallucinated* (%) ACE Score *Adjusted for age, sex, race, and education.

ACE Score and Intravenous Drug Use N = 8,022 p<0.001

Trauma Histories As many as 90% of people in psychiatric hospitals and 92 - 97% of homeless women have histories of physical or sexual abuse. Between 75% and 93% of youth entering the juvenile justice system have experienced some degree of trauma Among males who experienced maltreatment prior to 12 years of age, 50-79% became involved in serious juvenile delinquency. “Implementing the New “Germ” Theory for the Public’s Health: A Call to Action” Andrea K. Blanch, Ph.D and David L. Shern, Ph.D., 2011

Meet individuals where they’re at. Social Work 101 Meet individuals where they’re at.

Stages of Change Assessing Motivation Pre-contempleation Contemplation Preparation Action Maintenance Termination Stages of Change Change is a process that is not always linear or direct. There are six stages that most people go through in changing problematic habits. Pre-contemplation (No intention to change, not even thinking about it, in denial) Contemplation (Starting to think about changing, looking at the pros and cons) Preparation (Ready to make a change, beginning to take the first steps) Action (Taking specific actions in reducing the problem behavior or acquiring new behaviors) Maintenance (Able to sustain the change for some time and working to prevent relapse) Termination (Completed the change and certain not to return to the old problematic habit) (Prochaska, Norcross, and DiClemente, 1994) Assessing Motivation

Action, Maintenance, Termination Homelessness is the absence of stable housing in a context of disaffiliation from social supports and resources that are normally available through the mainstream culture. L.L. Bachrach (1993) Homelessness and risk of homelessness can be minimized or prevented by: Providing emotional and practical support during the critical time of transition Strengthening the individual’s long-term ties to services, family, and friends

Projects for Assistance in Transition from Homelessness (PATH)