1. Eastern Oregon June 19, 2015 Wildhorse Resort & Casino Pendleton, OR

3. Thank You www.bodylogic.net.au Welcome

4.  Self-Care  Introductions  Orientation

5. FOLDER

6. traumainformedoregon.org FOLDER

7. Plan  Introduce Trauma Informed Oregon traumainformedoregon.org Learn about your work Obtain your feedback  Offer Gathering Intra-agency and personal reflection Inter-agency and community reflection  Opportunity for Community Feedback  2:30 YouthMove YPx3 Training

8. Trauma Informed Oregon  State Sponsored Investment  Collaborative  Centralized Resource, Local Support, Coordination of Efforts  Evolving traumainformedoregon.org

9. TIO: State Sponsored Investment  Oregon Health Authority Children’s Mental Health Division & Adult Mental Health and Addictions  Awareness and System Change To reduce the impact of adversity and trauma in children, adults, and families AMH 1990s  2001 initial Trauma Informed Services Policy  Trauma White Paper (Apr 2013) Children’s System Advisory Council (CSAC): issue brief (Jan 2013), recommendations, and advocacy ACE Study data, growing local and national efforts Healthcare transformation

10. Trauma Informed Oregon  State Sponsored Investment  Collaborative  Centralized Resource, Local Support, Coordination of Efforts  Evolving traumainformedoregon.org

11. TIO: Collaborative

12.  2014  Leadership Team: Youth Family Lived Experience Culturally Specific Care Cross System Coordination Training and Education Public Health Social Work Physical and Mental Health care State Partners  Collaborative

13. Trauma Informed Oregon  State Sponsored Investment  Collaborative  Centralized Resource, Local Support, Coordination of Efforts  Evolving traumainformedoregon.org

14. TIO: Framework for Action Input from Stakeholders Informed Recommendations Consultation & Guidance Research & Evaluation Foundational Training Resources & Capacity Building Website & Newsletter State Forums Centralized Resources and Community Building Training and Education Policy and Investment Implementation and Accountability

15. TIO: Centralized Resources and Community Building  Website and newsletter: Compilation & Dissemination of Resources Providers: Tools for practice Agencies and systems: Tools for procedure change Adults, youth, and families: Resources Examples of implementation  Gatherings & Feedback October 2014: Kickoff Meeting Spring/Summer 2015: Regional Meetings Opportunities to share information and provide input

16. TIO: Training and Education  Foundational training TIC All service systems: public health, healthcare, social work, housing, education, early learning, child welfare, law enforcement, justice  Resources & referrals for specialized expertise  Training materials, protocols

17. TIO: Implementation and Accountability  Consultation and guidance Toolkits and models Practice and system change New policy requirements  Standards, benchmarks  Demonstration projects Leverage funds  Research and evaluation

18. TIO: Policy and Investment  Advocacy Share voices of youth, families, adults with lived experience, providers, community members Coordinate recommendations of stakeholders, state partners Disseminate outcomes of TIC projects

19. Trauma Informed Oregon  State Sponsored Investment  Collaborative  Centralized Resource, Local Support, Coordination of Efforts  Evolving traumainformedoregon.org

20. TIO: Evolving Your experience Your ideas Your feedback

21. Plan  Introduce Trauma Informed Oregon traumainformedoregon.org Learn about your work Obtain your feedback  Offer Gathering Intra-agency and personal reflection LUNCH Inter-agency and community reflection  Opportunity for Community Feedback  2:30 YouthMove YPx3 Training

22. “A cell is a machine for turning experience into biology.” Steve Cole Dobbs, The social life of genes. Pacific Standard, 2014 TIO: GATHERING

23. Emotional Connection Oxytocin Trust, Compassion, Care Hearing Stories Trauma-informed practice Resilience Sharing Stories Post-traumatic growth Epigenetic modification

24. FAMILY CULTURE COMMUNITY GEOGRAPHY POLITICAL SYSTEM ECONOMIC SYSTEM VALUES MORALS INSTITUTIONS FAITH SERVICE AGENCIES ECOLOGY EDUCATION JUDICIAL SYSTEM

25. Dopamine BDNF HOMEOSTATIC ATTEMPTS Anxiogenic: CRH-1 Cortisol NE 5-HT 2A Substance P FKBP5 Anxiolytic: CRH-2 DHEA 5-HT 1A Neuropeptide Y Galanin Testosterone Oxytocin Vasopressin K + channels in VTA GABA Glutamate Estrogen Substance P Cholecystokinin Voltage-gated Ca ++ channels CRH Mirror neurons STR ESS

26. Systemic Response  GENES  RECEPTORS, TRANSPORTERS  METABOLISM  ENDOCRINE SYSTEM  HPA Axis  Thyroid  IMMUNOLOGICAL SYSTEM  VASCULAR SYSTEM

27. RESILIENCE  Supportive relationships  Family and caregiver support  Low parental PTSD  Community support  Effective attachment  Social expressiveness  Ability to regulate emotions  Positive self-concept  Life purpose, moral code, spirituality, meaning  Altruism Catani 2010. Charney 2004. Feder 2009. Gillespie 2009. Golse 2006. Hansson 2008. JAACAP Practice Parameter for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder, 2010. Luthar 1991.  Creativity, flexibility, empowerment  Flexible adaptation, re- framing  Active, pragmatic coping  Self-determination  Humor, optimism and positive emotionality  Education  Stress inoculation

28. You may already be interacting in a trauma- informed way

29. Trauma-Informed Labels Trauma Informed Approach Principles versus specific practice 1.Safety 2.Trustworthiness and Transparency 3.Peer support 4.Collaboration and Mutuality 5.Empowerment, voice and choice 6.Cultural, Historical, and Gender Issues Trauma Specific Services, Trauma Recovery Programs  Promote healing  Reduce symptoms  Teach skills  Use psychoeducation, psychotherapy, empowerment strategies, mind-body practices, & other modalities Trauma Informed Care  Guides policy, practice, procedure based on understanding of trauma effects  Assumes every interaction with trauma survivor either activates a trauma response or does not  Strives for corrective emotional experiences  Attends to parallel process

30. Trauma-Informed Approach 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; and Seeks to actively resist re-traumatization. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION. SAMHSA’S CONCEPT OF TRAUMA AND GUIDANCE FOR A TRAUMA-INFORMED APPROACH. HHS PUBLICATION NO.(SMA) 14-4884. ROCKVILLE, MD: SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION, 2014.

31. TRAUMA-INFORMED APPROACH TRAUMA INFORMED  Awareness about prevalence of adverse effects & trauma  Universal prevention  Person centered  Determination of how an individual prefers to be addressed  Transparency  Collaboration  Prioritization of relationship & trust  Attempt to understand inexplicable reactions  Awareness of language, use of objective & neutral phrases  Goal of coping & function  Emphasis on strength, resilience, growth NOT TRAUMA INFORMED  Failure to consider influence of life experiences in current experience, interaction  Act on stereotypes  Provider Centered  Prioritization of compliance & control  Pejorative interpretation  Blaming or labeling language:  “Manipulative”  “Needy”  “Attention-seeking”  Goal of fixing & problem solving

33. Intra-agency and Personal Reflection  What are the strengths or resources of your organization?  What is your organization currently doing that you consider trauma informed? (write on COLORED index card)  What helps promote conversation in your organization? What would motivate you to share an experience?  What shuts down conversation and listening in your organization? What would it take to share something you have never shared?  How does or would a trauma-informed care model benefit your organization?  What are barriers to understanding trauma and trauma responses and/or implementing a trauma-informed care model in your organization?  What could your organization do to be more trauma informed?

34. NOURISHMENT

35. Plan  Introduce Trauma Informed Oregon traumainformedoregon.org Learn about your work Obtain your feedback  Offer Gathering Intra-agency and personal reflection LUNCH Inter-agency and community reflection  Opportunity for Community Feedback  2:30 YouthMove YPx3 Training

36. Inter-agency and Community Reflection  What are the strengths of your community and organizations you interact with? What are the assets or resources promote resilience and health?  What are the impacts of trauma among your community? What are your ideas for healing them?  What are barriers to understanding trauma and trauma responses and/or implementing a trauma-informed care model in your community?  What helps promote conversation in your community?  How can Trauma Informed Oregon help? (write on WHITE index card)

37. Adult Mental Health & Addiction Department of Human Services Justice System Housing & Community Based Support Public Health Health Care & CCO Healthy Together Project Education Early Learning Children’s Mental Health Eastern Oregon Trauma Informed Activities

38. National Trauma-Informed Projects The National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC) http://www.samhsa.gov/nctic ACES Too High http://acestoohigh.com/ace-concepts-in-action/ National Center for Domestic Violence, Trauma & Mental Health http://www.nationalcenterdvtraumamh.org National Child Traumatic Stress Network http://www.nctsn.org/ The National Institute for Trauma and Loss in Children https://www.starr.org/training/tlc National Council for Community Behavioral Healthcare- Trauma Informed BHC http://www.thenationalcouncil.org/wp-content/uploads/2012/11/NC-Mag- Trauma-Web-Email.pdf

39. National Trauma-Informed Projects National Association of State Mental Health Program Directors http://www.nasmhpd.org/TA/nctic.aspx Trauma-Informed Organizational Toolkit – The National Center on Family Homelessness http://www.familyhomelessness.org/media/90.pdf The National Association of States Directors of Developmental Disabilities Services http://www.nasddds.org/resource-library/behavioral-challenges/mental- health-treatment/trauma-informed-care/national-center-for-trauma- informed-care/ National Center for Social Work Trauma Education and Workforce Development http://www.ncswtraumaed.org/ Chadwick Center for Children and Families http://www.chadwickcenter.org/CTISP/ctisp.htm

40. And to make an end is to make a beginning. The end is where we start from.” T.S. Eliot  Be in touch Your work Your questions  Join the collaborative  Provide feedback Your ideas www.traumainformedoregon.org

41. Thank you