1. Providing Trauma-Informed Care to the Homeless and MH Populations
Kristina Bechtel, CSW
WRIC CCS Social Worker
La Crosse County Integrated Support and Recovery Services

2. Today’s topic can be a heavy one so please practice self-care:
Breathe
Doodle
Take a Break

3. Trauma Defined
Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. - American Psychological Association
Psychological trauma may set in after a distressing or life-threatening event - Psychology Today
A very difficult or unpleasant experience that causes someone to have mental or emotional problems usually for a long time - Merriam-Webster

4. Trauma is different for everyone
Trauma Defined Cont'd...
Trauma is different for everyone
Often results in feelings of vulnerability, helplessness, and fear
Often interferes with relationships

5. Who can be affected by Trauma? Trauma is universal
Trauma happens regardless of:
age
culture
gender
class
Trauma is a life-shaping event

6. Types of Trauma Acute Complex Historical Sanctuary Vicarious
Psychological

7. Acute and Complex Trauma
Acute Trauma
Complex Trauma
Adult onset
Single incident
Adequate child development
Not linked to mental health disorder
Early onset
Multiple incidents
Extended over time
Highly invasive
Interpersonal
Highly stigmatizing
Vulnerable

8. Complex Trauma Cont'd Dysregulation:
Emotional: Difficulty managing feelings; low frustration tolerance; shame; chronic emptiness
Cognitive: Catastrophizing; concrete thinking; memory impairments
Interpersonal: Difficulty assessing social cues; difficulty seeking attention in appropriate ways; challenges in seeing another's point of view; difficulty in maintaining relationships
Behavioral: Impulsive; suicidal; self-injurous, chemical use/dependency; trauma
re-enactment

9. Complex Trauma Cont'd How it may get diagnosed:
Post-Traumatic Stress Disorder (PTSD)
Borderline Personality Disorder
Attention Deficit Hyperactivity Disorder (ADHD)
Oppositional Defiant Disorder (ODD)

10. Historical Trauma
Collective and cumulative emotional psychological wounding across generations, emanating from massive group trauma
Generates survivor guilt, depression, low self-esteem, psychic numbing, anger, and other physical symptoms

11. Sanctuary Trauma
The overt and covert traumatic events that occur in settings that are socially sanctioned as safe:
Medical, mental health and substance use disorder services
Corrections
Foster care
Home
School and boarding schools
Places or worship

12. Vicarious Trauma
The experience of learning about another person's trauma and experiencing trauma-related distress as a result of this exposure

13. Psychological Trauma Violence (physical, verbal, witnessing) Home
Personal Relationships
Workplace
School
Maltreatment or abuse
Emotional or spiritual
Verbal or physical
Exploitation
Sexual
Financial
Psychological
Abrupt change in health, employment, living situation over which people have no control

14. Trauma and Substance Use
Adults who experience trauma may self medicate; self medication may also increase risk for further abuse and traumatic experiences.

15. Adverse Childhood Experiences (ACE)
Early Relationships
Relationships are developed through the emotional bond between the child and caregiver. It is through this relationship that we learn to:
Regulate emotions
Develop trust in others
Freely explore our environment
Understand ourselves and others
Understand that we can impact the world around us
Begin to establish a worldview

16. ACE Abuse Psychological (by parents) Physical (by parents)
Sexual (by anyone)
Physical neglect
Emotional neglect
Household with:
Substance use
Mental illness Separation or divorce
Domestic violence
Imprisoned household member

18. Traumatic Experiences
Why the ACE is important…
Traumatic Experiences
Coping Skills
Consequence/Barrier
Shame
Make connections
To understand why barriers were made in the first place changes the perception that actions are simply behavioral
You can remove the barrier but if you don’t address the why, the barriers will continue to manifest

19. There is nothing we can do about what happened to them, but there is absolutely something we can do to make sure the cycle of trauma does not continue when they are with us!

20. Reminders or Triggers
Lack of control
Threats or feeling threatened or attacked
Observing threats or assaults
Isolation
Interacting with authority figures
Lack of information
Being told what to do
Lack of privacy
Removal of clothing (medical exams)
Sensory experiences (smells, sounds, touch, taste, body position)
Being touched
Being watched
Loud noises
Darkness
Intrusive or personal questions
Being locked in a room
Being ignored
Condescending looks/Tone of voice
Transitions or disruptions in routine
Feelings of vulnerability and rejection
Sensory overload (crowded spaces, loud sounds, powerful smells)
A trigger can be a person, place, thing, event time, date, smell, or texture

21. Explaining not Excusing Behaviors
Outward Expressions
Anger or defiance
Violence towards others
Truancy
Criminal acts
Perfectionism
Inward Expressions
Withdrawal
Substance use
Violence to self
Spacing out
Acknowledge the trauma but focus on the resiliency…

22. "We need to presume the clients we serve have a history of traumatic stress, and exercise "universal precautions" by creating systems of care that are trauma informed." (Hodas, 2005)

23. Taking it one step further…practice universal trauma informed care!
It’s important to treat everyone you come into contact with as though they could have experienced a trauma
Relatives
Friends
Coworkers
Cashier
Coffee Barista
Etc…

24. Trauma-Informed Approach
What it is:
A principal-based culture change process
It focuses how trauma may affect an individual's life and their response to behavioral health services
What it is not:
An intervention to address PTSD (not therapy)
A "flavor of the day" approach

25. “What’s
wrong with
you?”
“What happened to
you?”
Even if the story does not come out, work with people as if there is a story there.
“What’s
right with
you?”

26. A trauma informed approach incorporates four key elements:
Realizing the prevalence of trauma
Recognizing how trauma affects all individuals, including its own workforce
Responding by putting this knowledge into practice
Resisting re-traumatization

27. What does a trauma informed approach look like?
Avoid forcing eye contact
Be aware of your proximity
Avoid asking too many questions
Pay attention to your tone of voice
Pace client meetings by offering breaks
Draw upon past successes
Ask before touching or hugging
Provide choice when possible
Ask about a client's goals or priorities
During emotional times ask, "How can I support you right now?”
When the trauma story overwhelms or leaves you speechless, be willing to sit in supportive silence
Provide clear information about when, where, and by whom services will be provided
Be prepared to repeat information many times; repetition is commonly needed when clients are working with an overwhelmed nervous system

28. Safety Best practices: Avoid re-traumatization
Consider the role of shame in both addiction and trauma
Avoid judgements
Be genuine as you build rapport
Ask open-ended questions
Convey experience, strength, and hope

29. Trauma Informed Service is not something you "do" to people, it is how you approach people.

30. Any others Unacceptable terms when speaking to or about clients: Crazy
Cray-Cray
Cuckoo
B***chy
Nutty
Nutso
Nut Job
Frequent Flyer
Off his/her rocker
Piece of work
Batty
Bat S**t
Psycho
Any others

32. Questions? Kristina Bechtel La Crosse County – ISRS 300 4th St. N
La Crosse, WI 54601

33. Tonier Cain: Trauma Across the Lifespan