health care for the homeless honolulu hawai’i june 28, 2013
TRANSCRIPT
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TRAUMA INFORMED EXCELLENCE:TRAUMA INFORMED CARE
Health Care for the Homeless
Honolulu Hawai’iJune 28, 2013
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DIVERSE MANAGEMENT SOLUTIONS, LLC
Stay positive
Informal
Interactive
diverse management solutions
www.DiverseManagementSolutions.com(303) 258-3523
Matt Bennett, MBA, [email protected]
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TIE LEARNING GOALS Have a basic understanding of the trauma informed
paradigm as it relates to: Self-care Leadership/Culture Trauma Informed Care Trauma Treatment
Conceptualize the impact of trauma on client functioning
Conceptualize how you can utilize this research change the way you and your programs interact with clients
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TRAUMA INFORMED CORE COMPETENCIESExcellence in care
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TRAUMA INFORMED EXCELLENCE: THE PATH
Trauma Specific
Treatment
Thrive: Self Care
Trauma Informed
Care
Leadership & Culture
The Goal: World Class Services
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TRAUMA INFORMED CARE
Science & Proven Methodologies
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DEFINING TRAUMA
Physical
SocialMind
Robustness Having or exhibiting strength or vigorous health
Capable of performing with success under a wide range of conditions
Resiliency The power or ability to return to the original form, position, etc.
Ability to recover readily from illness, depression, adversity, or the like.
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ACE FINDINGS
Acestudy.org, 2013
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TRAUMA VICTIM TO TRAUMA SURVIVORVictim
When you hear the term trauma victim what does it mean to you?
What role does trauma play in the life of the victim?
Survivor
When you hear the term trauma survivor what does it mean to you?
What role does trauma play in the life of the victim?
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Stress
& Trauma
Negativity & Survival
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Epigenetics!!!!
Caring Environment: • Genes are expressed that alter the
regulation of the nervous system • Qualities associated with emotional
resiliency are reinforced
Genes Proteins Cells Traits
EnvironmentAbusive Environment: • Stress inhibits proteins that lead to
the development & operation of brain areas associated with survival
• Decreases ability to manage stress in the future
Shenk, 2010
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Stress
& Trauma
Negativity & Survival
Inse
cure
/Dis
orga
nize
d Att
achm
ent
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Power of Attachment
• Attachment provides the template for how we see all relationships
• Think how Windows allows us to operate software like Word, ITunes and internet browsers
• Our emotional, cognitive and social functions operate from our attachment experience
• Trauma = Virus in the system
Bloom & Farragher, 2011
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Stress
& Trauma
Negativity & Survival
Inse
cure
/Dis
orga
nize
d Att
achm
ent
Automatic Response
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Brain Structure & Processing
•Brainstem – Basic processes• Limbic – Emotions & Survival•Cortex – Guides us in the
physical world•Prefrontal Cortex – Thinking &
Conceptualization Bottom-up information
(sensations) meet top-down information (memories) to create or experience of the world
Siegel, 2010
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Hypo-arousal
Habitual
Hyper-arousal
Fight/Flight
Freeze
Negativity & Survival
LifestyleStre
ss & Trauma
Inse
cure
/Dis
orga
nize
d Att
achm
ent
Automatic Response
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Retraumatization
•Mind’s attempt at integrating the experience into the personality
•As long as the trauma can not be put into words it will be relived through emotions and behaviors
•The emotions that are experienced are the emotions that need to be overcome in order to gain mastery over the trauma that they could not stop
Bloom & Farragher, 2011 & Herman, 1997
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Hypo-arousal
Habitual
Hyper-arousal
Fight/Flight
Freeze
LifestyleStre
ss & Trauma
Negativity & Survival
Inse
cure
/Dis
orga
nize
d Att
achm
ent
Automatic Response
Safety & Trust
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Relationship with Helper: Foundation for Focused Attention
“Recovery can take place only within the context of relationships; it cannot occur in isolation. In her renewed connections with other people, the survivor re-creates the psychological faculties that were damaged or deformed by the traumatic experience.”
– Judith Herman
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Your Impact
Client CharacteristicsRelationship HopeTechniques
Achor, 2010; Murphy, 2008
RelationshipHopeTechniques
Determinants of Successful Client Outcomes
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Steps to Prevent Re-traumatization•See the environment through the client’s eyes.
• Is the environment safe, calm and predictable or overly chaotic or rigid• Do your procedures and program rules treat clients as you would want to be
treated
•Help set client expectations of what their experience will be like in your program• New situation elicit fear that can be associated with the fear of the traumatic
experience• Boundaries that define the helping relationship• Program rules and expectations of the client• Introduction to staff
Bloom & Farragher, 2011; Rock, 2009 & Herman, 1997
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Steps to Prevent Re-traumatization•Build Safety
• Do what you say you will do• Do it to the best of your ability• Adhere to and model healthy boundaries• Provide honest reflection• Trust and respect client
•Go slow and go slower• Re-traumatization occurs most often when the helper or program pushes the
client beyond their sense of safety• Check in often
Bloom & Farragher, 2011; Rock, 2009 & Herman, 1997
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Hypo-arousal
Habitual
Hyper-arousal
Fight/Flight
Freeze
Lifestyle
Focused Attention
Emotional Regulation
F.A.C.E.S
BehaviorChange
Health & Wellness
Negativity & Survival
Inse
cure
/Dis
orga
nize
d Att
achm
ent
Safety & Trust
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Focus Strategies• Life Management
• Regain control of small aspects of life• Build self efficacy• Lowering stress not associated with trauma
• Reclaiming the Positive• Counterbalance negative worldview with small infusions of positive thought• Shift brain to the creation of new neuropathways• Improves outcomes of the helping relationship
• Techniques• Motivational Interviewing• Solution Focused Therapy• Mindfulness• Etc….
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TRAUMA TREATMENT
Strategies toward Post Traumatic Growth
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Hypo-arousal
Fight/Flight
Freeze
Focused Attention
Emotional Regulation
F.A.C.E.S
BehaviorChange
Health & Wellness
Post-Traumatic
GrowthHope
Negativity & Survival
Inse
cure
/Dis
orga
nize
d Att
achm
ent
Safety & Trust
Positivity & Logic
Hea
lthy
Rela
tions
hips
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Client’s Journey of Post Traumatic Growth
• Establishing Safety• Awareness & Management of Arousal States
Internal Regulation
Courtois & Ford, 2009
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QUESTIONS & COMMENTS
Thank You!
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REFERENCES & RESOURCES 1 Acestudy.org
Achor, S. (2010). The Happiness Advantage. New York, NY: Crown Business.
Bloom, S. L. & Farragher, B. (2011). Destroying Sanctuary: The crisis in human service delivery systems. New York: Oxford.
Ford, J. D.; Courtois, Christine A. (2009). Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide (p. 90). Guilford Press. Kindle Edition.
http://www.samhsa.gov/nctic/
J. Douglas Bremner. (2005). Does Stress Damage the Brain? W.W. Norton & Company: New York
Lewis, G. (2006). Organizational Crisis Management: The Human Factor. Boca Raton, FL: Auerbach Publications.
Miller, W. & Rollnick, S. (2002). Motivational Interviewing: Preparing People For Change.
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REFERENCES & RESOURCES 2
Ogden, P., Minton, K., Pain, C. (2006). Trauma and the Body. New York: W. W. Norton and Company.
Rock, D. (2009). Your Brain at Work: Strategies for overcoming distraction, regaining focus, and working smarter all day long. New York, NY: HarperCollins.
Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2007). Collaborative Treatment of Traumatized Children and Teens. New York: The Guiford Press.
Schwartz, T. (2010). The Way We Are Working Isn’t Working. New York: Free Press.
Shenk, D.. (2010). The Genius in All of Us. New York: Doubleday.
Siebert, A. (2005). The Resiliency Advantage. San Francisco, CA: Berrett-Koehler Publishers Inc.
Siegel, D. (2010). Mindsight: The new science of personal transformation. New York, NY: Random House.