christine heyen, ma crime victims’ services division oregon department of justice association of...
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Trauma Informed Care & Effective Screening
Christine Heyen, MACrime Victims’ Services Division
Oregon Department of Justice
Association of Public Health Nursing Supervisors
Annual ConferenceMay 9, 2012
Imagine a place that…Asks “What happened to you?” instead of
“What is wrong with you?Understands past trauma can be triggered by
experiences in the presentIs committed to supporting people as they
healLeaves a person feeling edified
What is trauma?
“Trauma is an event that is extremely upsetting and at least temporarily overwhelms internal resources.”
Briere, J. (2006). Dissociative symptoms and trauma exposure: Specificity, affect dysregulation, and posttraumatic stress. Journal of Nervous and Mental Disease, 194, 78-82.
What is Trauma?It can be a single eventMore often than not it is multiple events over
time (complex, prolonged trauma)An interpersonal violence or violation,
especially at the hands of an authority/trust figure is especially damaging
What does trauma do to us?
Chronic trauma interferes with neurobiological development and the capacity to integrate sensory, emotional and cognitive information into a cohesive whole.
Developmental trauma sets the stage for unfocused responses to subsequent stress.
Bessel A. van der Kolk , MDhttp://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trauma_Disorder.pdf
ACE Studyhttp://www.cdc.gov/ace/index.htm
Adverse Childhood Experiences (ACE) Study
Traditional Approach vs. Trauma Theory
Traditional approachYou are sickYou are badYou are sick and bad
Trauma theoryYou are not sick or badYou are injured
Trauma Informed Care (TIC)“Trauma-Informed Care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors to rebuild a sense of control and empowerment.” (Hopper et al, 2010)
“Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization.” (SAMHAS)
What does TIC offer? Improves our desired outcomes Supports trauma recovery by
Reducing re-traumatization Providing “corrective emotional experience”
Decreases our own vicarious trauma or compassion fatigue
Core Principles of TIC
Awareness: Everyone knows the role of traumaSafety: Ensuring physical and emotional safetyTrustworthiness: Maximizing trustworthiness,
making tasks clear, and maintaining appropriate boundaries
Choice: Respect and prioritize consumer choice and control
Collaboration: Maximizing collaboration and sharing of power with consumers
Empowerment: Prioritizing consumer empowerment and skill-building
TIC Communication StyleTransactional
Focus on information exchangeTransactional with Social Talk
Mostly information exchange with some social talk (e.g. joking, comment on weather)
InteractionalFocus on rapport-building and interpersonal
relationship integrated with the information exchange
https://nchdv.confex.com/nchdv/2012/webprogram/Session2199.html
Tips for Practicing TICUse language the person recognizes
“Has your partner messed with your birth control?”
Meet the survivor “where they are”If a person is not ready to talk, do not
force the conversation. Rather keep the door open for a later time.
Consider the person’s cultural contextAvoid making assumptions – just ask!
Tips for Practicing TICRecognize adaptive behaviors serve a purpose
Why is a person chronically miss morning appointments? Is the morning the only time she can sleep? Does she have a traumatic brain injury that prevents her from remembering things?
Make adjustments to help that person succeed. Set appointment times for the afternoon.
Include everyone in your agency From receptionist to treatment staffProvide trauma training to every employee
How do we provide TIC?Listen
What is the survivor saying to you? What is the survivor not saying?How is the survivor saying it?
InformWhat information do you have that may help
her?What will happen next in the process?Why is the information important for her to
have?How can your services can help her?
How do we provide TIC?To the best of your ability and within your given time constraints:Lose the labelsLet her tell her storyGive her time and space to tell her storyLet the survivor leadRespect her voice and choiceRecognize the survivor’s comfort levelConsider the survivor’s perspective from
her cultural context
Quick & EasyOffer support and validation
Communicate care and concernAvoid passing judgement
Ask questions of the survivorFind out if she is experiencing some kind of violence or
coercion in her lifeListen to what she has to say
Resist interrupting herMake sure your body language is receptive
Offer information and assistanceGive her a resource card, a phone number, or a websiteRefer her to an advocate (warm hand-off)Tell her you are available to her in the future
Resources
Trauma and Trauma Informed Carehttp://www.trainingforums.org/lms/
Trauma Informed Care – PowerPoint presentation by Mandy A. Davis, LCSW, Portland State Universityhttp://www.doj.state.or.us/victims/pdf/trauma
_informed_care_presentation_outline.pdf
Futures Without Violencehttp://www.futureswithoutviolence.org/
Resources
Supporting health needs of women in shelter: Exploring traumatic brain injury and reproductive coercionhttps://
nchdv.confex.com/nchdv/2012/webprogram/Session2192.html
Violence and reproductive coercion: Assessment strategies for pregnant women, and client feedback to inform what workshttps://
nchdv.confex.com/nchdv/2012/webprogram/Session2199.html
The 6th Biennial National Conference on Health and Domestic Violence (March 29-31, 2012)https://
nchdv.confex.com/nchdv/2012/webprogram/meeting.html
ResourcesCommunity Connections – Creating Cultures of
Trauma Informed Carehttp://communityconnectionsdc.org/web/page/673/int
erior.htmlTrauma-Informed Organizational Toolkit
http://www.familyhomelessness.org/media/90.pdf Trauma-Informed Care; Best Practices and
Protocols for Ohio’s Domestic Violence Programs http://www.odvn.org/images/stories/FinalTICManual.
Creating Cultures of Trauma-Informed Care; A Self-Assessment and Planning Protocolhttp://www.annafoundation.org/CCTICSELFASSPP.pdf
ResourcesTrauma-Informed Care - PowerPoint
http://www.mhcc.org.au/ticp/research-papers/Risser-2008.pdf
Shelter from the Storm: Trauma Informed Care in Homelessness Services Settings - Articlehttp://homeless.samhsa.gov/ResourceFiles/cenfdthy.pdf
Adverse Childhood Experience Studyhttp://www.acestudy.org/
Community Re-Traumatization - Article http://
www.annafoundation.org/COMMUNITY%20RETRAUMATIZATION.pdf
Contact InformationChristine Heyen, MA
Oregon Department of JusticeCrime Victims’ Services Division
1162 Court Street NESalem, OR 97301(503) 378-5303