1. Trauma Informed Care and Motivational Interviewing
Background and Theory

2. 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

3. 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

4. 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

5. 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

6. 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) % % % % %
5 or more %
Approximately two-thirds have at least one ACE
More than one-third have experienced 2 – 4 ACE categories

7. Childhood Experiences and Adult Alcoholism4+ 3 2 1

8. Childhood Experiences and Chronic Depression

9. Childhood Experiences and Suicide4+ 3 2 1

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

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

14. Trauma Histories
As many as 90% of people in psychiatric hospitals and % 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

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

16. 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

17. 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

18. Projects for Assistance in Transition from Homelessness (PATH)