kiersten parker, youth advocate tal curry, dph program administrator trauma informed care overview...
TRANSCRIPT
Kiersten Parker, Youth AdvocateTal Curry, DPH Program Administrator
Trauma Informed Care Overview
FRYSC Fall Institute 2012
When all she wants is…When all she wants is…
DiscussionDiscussion
In the absence of formal recognition or diagnosis for complex traumatic stress disorders, there is the potential mis- or overdiagnosis of severe disorders (e.g., bipolar, schizophrenia spectrum disorders, borderline personality disorder, conduct disorder).
(Christine Curtois and Julian Ford, “Treating Complex Traumatic Stress Disorders,” 2009)
In the absence of formal recognition or diagnosis for complex traumatic stress disorders, there is the potential mis- or overdiagnosis of severe disorders (e.g., bipolar, schizophrenia spectrum disorders, borderline personality disorder, conduct disorder).
(Christine Curtois and Julian Ford, “Treating Complex Traumatic Stress Disorders,” 2009)
Raise awareness about the often unrecognized prevalence of trauma history
Stimulate thinking around how to take trauma exposure history into account so that…� We don’t re-traumatize� We establish response styles and physical
surroundings that promote healing� We support a strength based perspective
To initiate a dialog which could transform service delivery toward a more trauma sensitive model of care
Raise awareness about the often unrecognized prevalence of trauma history
Stimulate thinking around how to take trauma exposure history into account so that…� We don’t re-traumatize� We establish response styles and physical
surroundings that promote healing� We support a strength based perspective
To initiate a dialog which could transform service delivery toward a more trauma sensitive model of care
Training Objectives
OverviewOverview
Definitions
Prevalence
Understanding Trauma: Its Consequences and Impact
Trauma Informed System of Care
Definitions
Prevalence
Understanding Trauma: Its Consequences and Impact
Trauma Informed System of Care
Imagine...Imagine...
A place where people ask ……. “what happened to you” instead of “what’s wrong with you?"
A place that understands that trauma can be re-triggered.
A place committed to supporting the healing process while ensuring no more harm is done.
A place where people ask ……. “what happened to you” instead of “what’s wrong with you?"
A place that understands that trauma can be re-triggered.
A place committed to supporting the healing process while ensuring no more harm is done.
Trauma is a Public Health ConcernTrauma is a Public Health Concern
“It has become more clear than ever psychological trauma is a primary — but often ignored or overlooked — factor of health (both physical and mental)... this presents a public health crisis in the United States that needs to be addressed immediately.”
From a letter (9-29-06) to President Bush the House Bipartisan Caucus on Addiction, Treatment, and Recovery
“It has become more clear than ever psychological trauma is a primary — but often ignored or overlooked — factor of health (both physical and mental)... this presents a public health crisis in the United States that needs to be addressed immediately.”
From a letter (9-29-06) to President Bush the House Bipartisan Caucus on Addiction, Treatment, and Recovery
What is Trauma Informed Care?
What is Trauma Informed Care?
Service delivery that is directed by
an appreciation for the high prevalence of traumatic experiences in persons 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)
Service delivery that is directed by
an appreciation for the high prevalence of traumatic experiences in persons 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)
What is System of Care?What is System of Care?
1. A philosophy or framework about the way services should be delivered to children and families
2. A community-specific design built:• within this philosophy/framework
• around local/state leadership, political context and funding
• to fit with other initiatives and partnerships
3. Not a model, program or single definable thing
1. A philosophy or framework about the way services should be delivered to children and families
2. A community-specific design built:• within this philosophy/framework
• around local/state leadership, political context and funding
• to fit with other initiatives and partnerships
3. Not a model, program or single definable thing
A Paradigm ShiftA Paradigm Shift
Not simply about trauma aware; but trauma informed
Shifts how we see our clients� What happened to you� Rather than what’s wrong
with you
Shifts how we see their symptoms� Instead of focusing on what w are not good
at, we focus on what we are good at
Shifts how we go about providing services—System of Care
Not simply about trauma aware; but trauma informed
Shifts how we see our clients� What happened to you� Rather than what’s wrong
with you
Shifts how we see their symptoms� Instead of focusing on what w are not good
at, we focus on what we are good at
Shifts how we go about providing services—System of Care
What is trauma?
DSM IV-TR ----PTSD
Defines “traumatic event” as one in which “a person experienced, witnessed or was confronted with an event(s) that involved actual or threatened death or serious injury or threat to the physical integrity of self or others”.
The person’s response involved intense fear, helplessness or horror
DSM IV-TR ----PTSD
Defines “traumatic event” as one in which “a person experienced, witnessed or was confronted with an event(s) that involved actual or threatened death or serious injury or threat to the physical integrity of self or others”.
The person’s response involved intense fear, helplessness or horror
What is Trauma?
Can you identify this picture?
Can you identify this picture?
How does this impact you?
How does this impact you?
What is trauma?What is trauma?“Traumatization occurs when both internal and external resources are inadequate to cope with the external threat” (Van der Kolk, 1989)
Trauma overwhelms the ordinary systems that give people a sense of control, connection and meaning.
Therefore...
“Traumatization occurs when both internal and external resources are inadequate to cope with the external threat” (Van der Kolk, 1989)
Trauma overwhelms the ordinary systems that give people a sense of control, connection and meaning.
Therefore...
Types of trauma resulting in serious persistent mental health
problems:
Types of trauma resulting in serious persistent mental health
problems:Complex trauma- “a psychiatric condition that officially does not exist, but which possibly constitutes the most common set of psychological problems to drive human beings into psychiatric care” (van der Kolk, 2009)Are usually not a “single blow” event e.g. rape, natural disasterAre interpersonal in nature: intentional, prolonged, repeated, severeOccur in childhood and adolescence and may extend over an individual’s life span
Re-victimization
(Terri, 1991; Giller, 1999)
Complex trauma- “a psychiatric condition that officially does not exist, but which possibly constitutes the most common set of psychological problems to drive human beings into psychiatric care” (van der Kolk, 2009)Are usually not a “single blow” event e.g. rape, natural disasterAre interpersonal in nature: intentional, prolonged, repeated, severeOccur in childhood and adolescence and may extend over an individual’s life span
Re-victimization
(Terri, 1991; Giller, 1999)
What prevalence data tells us?
What prevalence data tells us?
The majority of adults and children in psychiatric treatment settings have trauma histories A sizable percentage of people with substance
use disorders have traumatic stress symptoms that interfere with achieving or maintaining sobriety A sizable percentage of adults and children in
the prison or juvenile justice system have trauma histories
Victims of trauma are found across all systems of care
Trauma hx often goes undetected (Hodas, 2004, Cusack et al., 2005, Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)
The majority of adults and children in psychiatric treatment settings have trauma histories A sizable percentage of people with substance
use disorders have traumatic stress symptoms that interfere with achieving or maintaining sobriety A sizable percentage of adults and children in
the prison or juvenile justice system have trauma histories
Victims of trauma are found across all systems of care
Trauma hx often goes undetected (Hodas, 2004, Cusack et al., 2005, Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)
Juvenile and Criminal Justice
Juvenile and Criminal Justice
Kentucky, around 30,000 youth are charged with status or public offenses each year (KIDS COUNT Data Book)
Childhood abuse correlated with increased truancy, running away and homelessness (NASMHPD/NTAC, p. 55)
Childhood abuse or neglect increases the likelihood of arrest as a juvenile by 53% and as a young adult by 38%. The likelihood of arrest for a violent crime also increases by 38% (p.49)
PTSD in the juvenile justice population is 8 x’s as high as community samples of similar age peers (Wolpaw & Ford, 2004).
Kentucky, around 30,000 youth are charged with status or public offenses each year (KIDS COUNT Data Book)
Childhood abuse correlated with increased truancy, running away and homelessness (NASMHPD/NTAC, p. 55)
Childhood abuse or neglect increases the likelihood of arrest as a juvenile by 53% and as a young adult by 38%. The likelihood of arrest for a violent crime also increases by 38% (p.49)
PTSD in the juvenile justice population is 8 x’s as high as community samples of similar age peers (Wolpaw & Ford, 2004).
Trauma and Criminal JusticeTrauma and Criminal Justice
US leads the world in the rate of incarceration of its citizens
KY has the fastest growing prison population in the country
Yet, FBI crime reports indicate KY ranks 40th in violent crime
US leads the world in the rate of incarceration of its citizens
KY has the fastest growing prison population in the country
Yet, FBI crime reports indicate KY ranks 40th in violent crime
Prevalence Yields Pervasive
Consequences
Prevalence Yields Pervasive
Consequences
JeremyJeremyQuickTime™ and aH.264 decompressor
are needed to see this picture.
Jeremy Wade DelleJeremy Wade Delle
On January 8, 1991 in Richardson, Tx 16-year old Jeremy Wade Delle--a troubled, beaten, battered and bullied young man entered his english class and spokeHe pulled the trigger of a .357magnum and ended his life in front of his peersJeremy’s pain had spokenEarly childhood trauma is never without impact!
On January 8, 1991 in Richardson, Tx 16-year old Jeremy Wade Delle--a troubled, beaten, battered and bullied young man entered his english class and spokeHe pulled the trigger of a .357magnum and ended his life in front of his peersJeremy’s pain had spokenEarly childhood trauma is never without impact!
Consequences of TraumaConsequences of Trauma
Effects are neurological, biological, psychological and social in nature, including:
Changes in brain neurobiology
Social, emotional and cognitive impairment
Adoption of health risks behaviors as coping mechanisms (eating disorders, smoking, substance abuse, self-harm, sexual promiscuity, violence)--
Severe and persistent behavioral health, social problems, physical health and early death
•
Effects are neurological, biological, psychological and social in nature, including:
Changes in brain neurobiology
Social, emotional and cognitive impairment
Adoption of health risks behaviors as coping mechanisms (eating disorders, smoking, substance abuse, self-harm, sexual promiscuity, violence)--
Severe and persistent behavioral health, social problems, physical health and early death
•
Trauma occurs in layers, with each layer affecting every other layer. Current
trauma is one layer. Former traumas in one’s life are more fundamental layers. Underlying one’s own individual trauma history is one’s group identity or identities and the historical trauma with which they are associated. (Bonnie
Burstow)
Trauma occurs in layers, with each layer affecting every other layer. Current
trauma is one layer. Former traumas in one’s life are more fundamental layers. Underlying one’s own individual trauma history is one’s group identity or identities and the historical trauma with which they are associated. (Bonnie
Burstow)
Therefore...Therefore... 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, 2004)
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, 2004)
The Impact of Trauma
The Impact of Trauma
Importance of AttachmentImportance of Attachment
Traumatic Experience
Floods us w/ physical fear/helplessness
Colors the world as dangerous/unpredictable
Creates overwhelming emotional chaos
Threatens cohesive sense of self
Assaults self-efficacy and sense of control
Scrambles ability to engage fully in present/adapt to new situations
Traumatic Experience
Floods us w/ physical fear/helplessness
Colors the world as dangerous/unpredictable
Creates overwhelming emotional chaos
Threatens cohesive sense of self
Assaults self-efficacy and sense of control
Scrambles ability to engage fully in present/adapt to new situations
Secure Attachment
Soothes and comforts
Offers safe haven
Promotes affect regulation
Promotes personality integration
Promotes confidence/trust in self and others
Promotes openness to experience, and new learning
Secure Attachment
Soothes and comforts
Offers safe haven
Promotes affect regulation
Promotes personality integration
Promotes confidence/trust in self and others
Promotes openness to experience, and new learning
Emotionally Focused Couple Therapy with Trauma Survivors, Susan Johnson, (2002)
What’s the point?What’s the point?
When we are uninformed about trauma, we can accidently re-traumatize
Whether or not a given event evokes a trauma response, particularly with children, greatly depends on the response of caregivers
Each service provider a child/adolescent comes into contact with after a trauma event can either hinder, harm or help stimulate healing
When we are uninformed about trauma, we can accidently re-traumatize
Whether or not a given event evokes a trauma response, particularly with children, greatly depends on the response of caregivers
Each service provider a child/adolescent comes into contact with after a trauma event can either hinder, harm or help stimulate healing
Trauma exposure can re-organize a person around the traumatic event
Trauma exposure becomes both the defining and organizing experience that forms the core of a person’s identity
A whole new meaning system develops which informs and guides attempted coping strategies
Trauma changes the whole person not just in particulars
Trauma exposure can re-organize a person around the traumatic event
Trauma exposure becomes both the defining and organizing experience that forms the core of a person’s identity
A whole new meaning system develops which informs and guides attempted coping strategies
Trauma changes the whole person not just in particulars
Comprehensive Impact
Trauma changes your world view
Exposure to trauma is the rule rather than exception
Consider that many individuals bring a lifetime history of trauma (acute and chronic) which impacts the current precipitant situation
This history often results in alteration of brain structure and function
Exposure to trauma is the rule rather than exception
Consider that many individuals bring a lifetime history of trauma (acute and chronic) which impacts the current precipitant situation
This history often results in alteration of brain structure and function
Summary
Trauma Informed System of Care
Trauma Informed System of Care
Trauma Informed Care:Key Principles
Trauma Informed Care:Key Principles
Integrate philosophies of care that guide all clinical interventions
Are based on current literature
Are inclusive of the survivor’s perspective
Are informed by research and evidence of effective practice
Recognize that coercive interventions cause traumatization and re-traumatization and are to be avoided
(Fallot & Harris, 2002; Ford, 2003; Najavitas, 2003)
Integrate philosophies of care that guide all clinical interventions
Are based on current literature
Are inclusive of the survivor’s perspective
Are informed by research and evidence of effective practice
Recognize that coercive interventions cause traumatization and re-traumatization and are to be avoided
(Fallot & Harris, 2002; Ford, 2003; Najavitas, 2003)
Trauma Informed Care:Key Features
Trauma Informed Care:Key Features
Recognition of the high rates of PTSD and other psychiatric disorders related to trauma exposure in children and adults with SMI/SED
Early and thoughtful diagnostic evaluation with the focused consideration of trauma in people with complicated, treatment-resistant illness
(Fallot & Harris, 2002; Cook et al., 2002; Ford, 2003; Cusack et al.)
Recognition of the high rates of PTSD and other psychiatric disorders related to trauma exposure in children and adults with SMI/SED
Early and thoughtful diagnostic evaluation with the focused consideration of trauma in people with complicated, treatment-resistant illness
(Fallot & Harris, 2002; Cook et al., 2002; Ford, 2003; Cusack et al.)
Trauma Informed Care:Key Features
Trauma Informed Care:Key Features
Valuing the consumer in all aspects of care
Neutral, objective and supportive language
Individually flexible plans and approach
Avoid shaming or humiliation at all times
(Fallot & Harris, 2002; Cook et al., 2002; Ford, 2003; Cusack et al.; Jennings, 1998; Prescott, 2000)
Valuing the consumer in all aspects of care
Neutral, objective and supportive language
Individually flexible plans and approach
Avoid shaming or humiliation at all times
(Fallot & Harris, 2002; Cook et al., 2002; Ford, 2003; Cusack et al.; Jennings, 1998; Prescott, 2000)
Trauma Informed Care:Key Features
Trauma Informed Care:Key Features
Awareness/training on re-traumatizing practices
Institutions that are open to outside parties: advocacy and clinical consultants
Training and supervision in assessment and treatment of people with trauma histories
(Fallot & Harris, 2002; Cook et al., 2002; Ford, 2003; Cusack et al.; Jennings, 1998; Prescott, 2000)
Awareness/training on re-traumatizing practices
Institutions that are open to outside parties: advocacy and clinical consultants
Training and supervision in assessment and treatment of people with trauma histories
(Fallot & Harris, 2002; Cook et al., 2002; Ford, 2003; Cusack et al.; Jennings, 1998; Prescott, 2000)
Universal Precautions: A Core Concept
Universal Precautions: A Core Concept
Presume that every person in a treatment setting has been exposed to abuse,
violence, neglect or other traumatic experiences.
Presume that every person in a treatment setting has been exposed to abuse,
violence, neglect or other traumatic experiences.
Guiding Values of Trauma-Informed Care
“Healing Happens in Relationship”
Guiding Values of Trauma-Informed Care
“Healing Happens in Relationship”
Additional ResourcesAdditional Resources
www.nctsn.orgwww.nctsn.org
www.samhsa.gov/nctic/www.samhsa.gov/nctic/
www.nccp.org
What are three things you will take with you?What are three things you will take with you?
Contact InformationContact Information
Kiersten Parker,
Youth Advocate
&
Tal Curry, LCSW
Kiersten Parker,
Youth Advocate
&
Tal Curry, LCSW