1. Trauma Informed Care Rebecca Kase, LCSW, RYT
Director – Heart Centered Counseling
Professional Trainer & Consultant

2. What is Trauma Informed Care?
A culture of care that promotes healing
Emphasizes a focus on safety and cultures of safety
Born from research and growing awareness of the vast impacts of trauma and common experience of trauma
A framework beneficial for anyone to understand – not just for clinicians
“Be nice”

3. What is Trauma? A common human experience.
Symptoms are a normal response to an abnormal life event.
The traumatized brain reacts as if the traumatic event were still occurring.
The past IS the present.
Behaviors, attitudes, perceptions and beliefs may be filtered through a trauma lens.
May negatively impact coping skills
What is Trauma?

4. What is Trauma? Defined by experience of:
A real or perceived threat to one’s emotional or physical integrity or well being, during which the individual experiences feeling:
Powerless
Helpless
Hopeless
Fear or terror
May be physical or psychological
What is Trauma?
NOTE: These are key experiences to look to avoid in your agency as you move towards a culture of trauma informed care. How can you avoid creating interactions, policies, procedures, processes, experiences that mirror the feelings of trauma.

5. “T” vs “t” trauma
Big “T” traumas are often acutely traumatic and easily identified as “trauma” by those experiencing trauma, professionals and non-professionals.
Big “T” traumas tend to negatively impact our sense of safety of the world.
Little “t” traumas may seem more subtle, may be ongoing, and may not appear so acutely traumatic to the survivor, professionals and non-professionals.
Little “t” traumas negatively impact our sense of self.
Multiple little “t” traumas are more disastrous than one or two big “T” traumas
The impact of a thousand paper cuts

6. Examples of “T” vs “t” “T” “t” Sexual assault A physical assault
Combat
A natural disaster
A mass shooting
Emotional abuse
Bullying
Neglect
Separation of primary attachment figures
Ongoing exposure to violence

7. Possible examples of trauma
Physical abuse
Sexual abuse
Poverty
Natural or person-made disasters
War & combat
Homelessness
Sexual assault
Auto accident
Having a family member with a mental illness as a child
Interpersonal violence
Physical attack by person or animal
Emotional abuse
Childhood neglect
Traumatic grief
Bullying
Feeling cut out of the herd
Witnessing something traumatic happen to someone else
Substance abuse in the home as a child
Medical conditions

8. What are psychological symptoms of trauma?
Depression
Anxiety
Panic
Exaggerated startle response
Sleep disturbance & nightmares
Avoidance of reminders of
trauma
Dissociation
Numbness
Negative beliefs and thoughts about self
Irritability and agitation
Flashbacks
Intrusive thoughts
Difficulties in relationships
Difficulties managing emotions
Elaborate

9. What is Trauma?
Those struggling with symptoms will attempt to find ways to cope and self soothe.
Coping may be considered adaptive or maladaptive vs. good or bad.
Survivors may vacillate between states of avoidance and flooding.
Common trauma response: fight, flight, freeze
We all attempt to cope with life throughout the day. Every behavior we engage in is likely, some way to cope.
Coping is not “good or bad”; rather consider it adaptive or helpful or maladaptive and unhelpful
We cannot take away a coping skill without replacing it with something else (ex: cannot tell someone to quit self harming without helping them find something else to do to cope in the times they self harm)
Avoidance and flooding- trauma survivors may pendulate between feeling completely overwhelmed and flooded to trying ot numb out- IT’S ALL COPING!
Fight, flight, freeze: many people know of these responses; these are basic survival responses that our brain decides in a moment’s time based on what it perceives is the best odds for our survival
Example of fight flight freeze: Think about a time in which you saw a car merging into your lane and you had a sudden reaction. Did you really think through this or was it an automatic reaction? This is an example of how automatic that survival system is.

10. Trauma & the Brain
Discuss parts of the brain

11. The ACE study
Partnership between the CDC and Kaiser, with 17,000 participants.
Examined how trauma impacts us later in life.
ACES:
Physical abuse
Sexual abuse
Emotional abuse
Neglect
Witnessing violence in the home
Substance abuse in the home
Mental illness
Criminal behavior
Separation/divorce

12. What the ACE study found
60% of the US population has experienced at least 1 ACE.
If you have experienced 1 trauma the likelihood of experiencing additional traumas increases
ACES increase your chance of suicidality anywhere from %.

13. Psychological Conditions:
Depression
Psychosis
PTSD
Personality Disorders
Suicidality
Self harm
Sexual assault
Emotion dysregulation
Difficulties in relationships
Substance abuse
Anxiety
Unintended pregnancy

14. Health Conditions: Heart Disease Lung Cancer Obesity Liver Disease
Chronic Pain
Chronic Fatigue
Diabetes
Skeletal fractures
Fetal Death
Auto-immune Diseases
Auto-Immune disease Examples: Rheumatoid arthritis, Lupus, Hashimoto’s, Graves Disease

15. Whole Life Perspective

16. What is Trauma Informed Care?
“Trauma informed care embraces a perspective that highlights adaptation over symptoms and resilience over pathology.”
Elliot, Bjelajac, Fallot, Markoff, & Reed, 2005
TIC is an approach to treating trauma. It is also an approach that supports the development of an environment that can foster healing, while also deterring and preventing re-traumatization.
Trainer notes:
From the ACE study, came the trauma informed care movement. With this information, we now understand that trauma is impacting most of those we work with in a profound way. Additionally, trauma impacts most care givers/healers as well.
Many in this field have their own trauma histories.
Key word here is “approach”- emphasize it is a process not a task that is checked off
Discussion point:
What do you think of when you hear the words “Trauma Informed Care”?

17. The 4 R’s of TIC:
Realizes the widespread impact of trauma and paths towards healing.
Recognizes the signs and symptoms of trauma in clients, families, staff and communities.
Resists re-traumatization.
Responds by integrating knowledge about trauma into policies, procedures, practices and settings.

18. Why TIC is important Many of us have our own trauma histories.
We may view interactions as threatening, intentionally hurtful, or as an attempt to provoke us.
At times we may judge an interaction as something someone is doing to us rather than someone interacting with us because something happened to them.
TIC asks us to change our lens from “What’s wrong with you” to “What happened to you”.
Asks that we treat everyone with compassion and understanding.
Positive impact on work culture, employee retention, improved clinical outcomes, better business, reduced risk

19. What helps Don’t take things personally.
Understand the difference between paradigms: “what’s wrong with you” vs. “what happened to you?”
There are layers of trauma, and our interactions can have the potential to be very healing or very harmful.
Trauma reactions impair our abilities to be logical and rational.
Ask “what may have happened to this person that would explain this behavior?”.
Anticipate trauma triggers and how experiences may be perceived

20. What helps Tips to resist re-traumatization:
Be mindful of your language, tone, making eye contact, and body language.
Provide as much choice as possible.
Be mindful of space & touch
Transparency
Focus on creating safe environments and experiences that feel safe

21. What helps Help ground someone who is having a trauma response:
Stay calm and speak gently.
Remind them where they are, that they are safe in this moment and you are here to help them.
Get them to a quiet and calming space.
Avoid sudden movements.
Ask them to take deep breaths, and breath with them. Praise them for their attempt.
Offer them something to drink. Have they eaten?

22. What hurts Lack of TIC awareness
Invalidation – “get over it, suck it up, move on, pick yourself up by your boot straps”
Stigmatizing language – “She’s so borderline”; “he’s manipulative”, “treatment resistant”, “attention seeking”
Not recognizing the impact of “T” and “t”
Forgetting everyone’s doing their best
Attributing behaviors and experiences to someone’s overall personality versus their past experiences
Us versus them mentality