1. Presented by: Circuit 20 Trauma Informed Care Work Group

2. TRAUMA CAN OCCUR AT ANY AGE Trauma can affect any: RACE GENDER ETHNICITY SOCIO- ECONOMIC GROUP COMMUNITY WORKFORCE

3. Definition (NASMHPD,2006)  The experience of violence and victimization including sexual abuse, physical abuse, severe neglect, loss, domestic violence and/or the witnessing of violence, terrorism or disasters DSM IV-TR (APA, 2000)  Person’s response involves intense fear, horror and helplessness  Extreme stress that overwhelms the person’s capacity to cope

4. IT IS AN INDIVIDUAL’S EXPERIENCE OF THE EVENT…… not necessarily the event itself that is traumatizing.

5. Trauma can be: Trauma can occur from : A single event A connected series of events Chronic lasting stress Being in a car accident or other serious incident Having a significant health concern or hospitalization Sudden job loss Losing a loved one Being in a fire, hurricane, flood, earthquake or other natural disaster Witnessing violence Experience emotional, physical or sexual abuse

7.  Mental health Treatment that incorporates:  An appreciation for the high prevalence of traumatic experiences in person who receive mental health services  A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual (Jennings, 2004)

8. The APA’s DSM IV defines a “traumatic event” as one in which a person experiences, witnesses, or is confronted with actual or threatened death or serious injury, or threat to physical integrity of oneself or others. A person’s response to trauma often includes intense fear, helplessness or horror. Trauma can result from experiences that are “private”: Sexual assault Domestic violence Child abuse/neglect Witnessing interpersonal violence Trauma can also result from “public” experiences: War Terrorism Natural disaster

9. Trauma is becoming increasingly recognized as a significant factor in a wide range of health, behavioral health & social problems Trauma is a central mental health concern and the one “common denominator” of all violence & disaster victims

10.  Slightly more than ½ of all women in the U.S. will be exposed to at least one traumatic event in their lifetime (Kessler et al, 1995)  The lifetime prevalence of trauma exposure revealed that 51% of women & 61% of men had experienced at least one traumatic event in their lifetime (Kessler et al, 1995)  Women report exposure to a range of traumatic events. Although estimates vary, finding suggest that between 17% & 34% of women will experience a rape at some point in their lifetime (Brener et al, 1999;Tjaden et al, 2000)  Women are also at higher risk for sexual molestation, childhood parental neglect, childhood physical abuse, domestic violence and the sudden death of a loved one (Kessler et al, 1995;Norris et al, 2002)

11. “WHAT IS WRONG WITH YOU?” “WHAT HAS HAPPENED TO YOU?” FROM TO

13.  The majority of adults & children in psychiatric treatment settings have trauma histories  A sizable % of people with substance use disorders have traumatic stress symptoms that interfere with achieving or maintaining sobriety  A sizable % of adults & children in the prison or juvenile justice system have trauma histories ( Hodas, 2004, Cusack et al., Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)

14.  National survey of 5,877 people aged 15-54 concluded that trauma is very common  60.7% of men and 51.2% of women reported experiencing a traumatic event at some point in their lives  10% of men and 6% of women reported experiencing four or more types of trauma (kessler, et al,1995)

15. Tolin & Foa conducted an analysis in 2006 of existing research on prevalence of traumatic events and severity of PTSD, looking specifically at sex differences. They found the following:  Females were significantly more likely to report experiencing adult sexual assault and child sexual abuse  Males were significantly more likely to report accidents & non-sexual assault, regardless of age. Male adults, war- related events, disaster or fire, witnessing death or injury and illness were more common  For childhood experiences, no differences were found for: child abuse/neglect, war-related events, disaster or fire, witnessing death or injury, or illness

16. *UNIVERSAL PRECAUTIONS* Presume that EVERY person in a treatment setting has been exposed to abuse, violence, neglect, or other traumatic events

17. We need to presume the clients we serve have a history of traumatic stress and exercise “Universal Precautions” by creating systems of care that aretrauma-informed (HODAS, 2005)

18. Trauma InformedNon Trauma Informed  Recognition of high prevalence of trauma  Recognition of primary and co- occurring trauma diagnoses  Assess for history and symptoms of trauma  Recognition of culture and practices that are re-traumatizing  Lack of education on trauma prevalence & “universal precautions”  Over diagnosis of Schizophrenia, Bipolar, Conduct Disorder & Addictions  Cursory or no trauma assessment  “Tradition of Toughness” valued as best care approach

19. Trauma Informed Non Trauma Informed  Power/control minimized-constant attention to culture  Caregivers/supporters -COLLABORATION  Address training needs of staff to improve knowledge, sensitivity and understanding  Keys, security uniforms, staff demeanor, & tone of voice  Rule enforcers- COMPLIANCE  “Patient blaming” as fallback position without training

21. Recovery is… “ a process, an outcome and a vision. We all experience recovery at some point in our lives from injury, from illness, from loss or from trauma. Recovery involves creating a new personal vision for one’s self ( Spaniol, Gagne, & Koehler, 1997)

22. …a common human experience and a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills or roles toward our understanding of mental illness (Anthony, 1993)

23.  EMPOWERMENT  INDEPENDENCE  RESPONSIBILITY  CHOICE  RESPECT & DIGNITY  HOPE

24.  Peer delivered services  Self-help techniques  Emphasis on recovery  Understanding the relationship between trauma and mental illness  Cognitive Behavioral Therapy (individual therapy)  Medication Management- new medications  EMDR: Eye Movement Desensitization & Reprocessing

25. Staff members provide:  Encouragement  Support  Education  Acceptance  Choices  Information  Understanding  Respect  HOPE

26.  You have come a long way  You are a strong person  I admire your courage in dealing with this pain  I encourage you  Don’t give up  I can’t promise, but I will do my best to help  I don’t understand. Please tell me what you mean  You are doing well  How can I help you  I am here for you  We can work together through this  It is OK to feel like that  I accept you the way you are  What do you need at this time

27.  The most important person in any business  Is not dependent on us…..We are dependent on them  Is not the interruption of work, but the purpose of it  Customers do us a favor when they come…..We aren’t doing them a favor by waiting on them

28.  Stay calm  Show empathy  Show respect  LISTEN  Reflect what they have said  DON’T ARGUE  Think  Know your procedure (get Supervisor if needed)  Explain policy and procedure  Be willing to “go the extra mile”  Keep customers’ best interest in mind

29.  IT’S NOT WHAT YOU SAY BUT HOW YOU SAY IT  Voice tone counts for 38% of the message sent….this increases to 90% when using the telephone  You may be the first contact with the agency so make it a GOOD experience  Smile  Be Courteous, Attentive and Pleasant