moving forward in trauma awareness

MOVING FORWARD

BRINGING TRAUMA

OUT OF THE DARKNESS 2015, Chris Cavaliere

Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 1

Presented by Chris Cavaliere, CPST TRAUMAIf we share it together, we can bring its shadows to light.The Facing Forward ProgramChris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 2

How do we define trauma? Trauma results from an event, series of events or circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has a lasting effect on the individuals functioning and physical, social, emotional or spiritual well-being. From the experiences of war, natural disasters, violent assaults, serious accidents, continual exposure to violent environments and ongoing abuse, whether physical or emotional come the effects of trauma.( SAMHSA Trauma and Justice, 2012 )


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Many who experience trauma feel isolated and alone


It is possible to recover!Many have reached recovery.Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 5

90% 90% of people diagnosed with mental illness report experiencing traumatic events in their lives. * It is believed that everyone, if they live long enough, will experience some kind of potentially traumatic event in their lives. ( 1 in 4 *) Though two people may experience the exact same traumatic event, they will respond differently.


Why Different? Why would it be different if two people were in the same hurricane, but one was poor and one rich? What if one had family with them and one had no family?

Why would it be different if two siblings, one male, one female, both had been severely abused by their care giver, one had a M.I. diagnosis, the other didnt, or each had a different M.I. diagnosis?Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 7

How would it differ? How would it be different if two people were restrained by handcuffs, if one had been kidnapped as a child and one assaulted by a rival gang member?What would be different if one went to jail and the other to a hospital? Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 8

What are these numbers telling us?54% - women with depression experienced childhood trauma3 million + children witness domestic violence every yearEvery 35 seconds a child is abused or neglected1 child dies from violence every 3 hours

1 in 3 girls / 1 in 5 boys are sexually abused by the age of 1850% of women are more likely than men to have ACE scores of 5 or more. (?) The earlier in life trauma occurs, the more the effects will be long lasting. Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 9

Mental Health Challenges All people will have mental health challenges in their lifetime. The question is; How will they find ways to adapt to trauma? Some adaptations can come to us unbidden called mental illness. There are many paths to recovery. Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 10

The 3 EsWhat determines an individualstrauma experience?

The nature of the event or circumstances that occurred.How the person experiences the event.The lasting effects on the person.


Why Individual Experiences Differ The answer lies with how the person defines the event, their personal cultural beliefs and the availability of supports. These factors determine how their lives may or may not be disrupted physically and psychologically over time. Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 12

Did we get the story right? Is it possible that individuals who are not diagnosed with PTSD, but who are given other diagnosis, may be experiencing trauma effects? How closely have we listened to people to find the truth of their story?Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 13

Common Effects of Trauma Psychological EffectsDenialGuiltShameAngerFearAvoidanceDepressionDissociation

Physical EffectsNightmaresFlashbacksHypervigilanceSleep disturbancesStress headachesWeight fluctuationsIntestinal IrritationsHigh Blood Pressure


Loss of Control How would this be the first loss in experiencing a trauma event?

What inherent right does a trauma event take away from a person? Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 15

The Prevalence of Trauma inthe Co Occurring Realm

A 2012 study on alcohol conditions showed, 71.6% witnessed trauma, 30.7% experienced trauma injury and 17.3% experienced psychological trauma. * ( ? )Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 16

Trauma Adaptations Why do we fall into things like substance abuse, gambling, abusive relationships, self inflicted violence? Where do things such as eating disorders, emotional disorders, anxiety disorders, and altered states originate?Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 17

Challenges from Trauma Loss of Trust Emotional Disturbances Altered Thoughts Loss of Memory All affecting our actions and decisions Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 18

Did the chicken come before the egg or did the egg come before the chicken ? The Environmental Factor vsGenome Research


Resiliency


Moving Forward into Trauma Recovery


Recovery Factors

Developmental Stage Cultural Beliefs Available Support Integration of the Experience


Why is Grieving a Natural Process of Trauma Recovery? Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 23

Stages of Grieving Avoidance Denial Anger Guilt Shame

Numbing Weeping Acceptance Forgiveness Letting GoChris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 24

Safety Comes First Why is it important for a trauma survivor to FEEL safe? What causes a person to feel triggered when they hear, smell, taste, see, or touch something. What if they were triggered by something that someone said or did? Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 25

We need people who listen with understanding. People who can listen and see beyond diagnosis. People who can accept us as individuals who are resilient, competent and extremely creative. Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 26

Tools and Skills Relaxation Meditation Exercise Distractions Fun Activities Creativity Grounding Courage

Self Advocacy Self Awareness Communication Forethought Reflection Acceptance Mutual Support MindfulnessChris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 27

Trauma Specific Therapies C.B.T. - one of the first therapies for trauma. T.R.E.M. is a trauma education and processing group for men or women. C.P.T. is a trauma therapy that was first developed for Veterans, but has been integrated to create therapies to address other specific issues. E.M.D.R. This therapy is one of the most widely used and effective techniques for trauma.


A Peer Approach to Trauma Recovery FACING FORWARDA Peer Facilitated Trauma Recovery Workshop


Trauma-Informed CareSAMHSAs Joint Initiative Inclusive of all stake holders


Why Trauma-Informed Care In the 1800s, Dorothea Dix first witnessed the traumatization visited upon the mentally ill in the jails and poor houses across the US. It had been thought, since the Civil War through WWII, that traumatic stress was due to a character flaw.


Expanding the definition of Trauma In the dawn of the Industrial Age the civilian population experienced trauma through dramatic accidents and catastrophes. The 1960s social revolution recognized acts of interpersonal violence and crime violence as trauma. Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 32

Normal reactions to Abnormal circumstancesAdaptations and ResiliencyChris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 33

Progressive Change 1980s - the consumer movement voices trauma and re-traumatization in the M. H. system. 1990s - First national trauma conference is held, Dare to Vision becomes a catalyst for initiating trauma-informed care. 2000s - SAMHSA establishes centers on child trauma, disasters, seclusion and restraint, and trauma-informed care. 2010s - national professional associations and US media brings focus to trauma.


Education in Trauma-Awareness is just beginning


SAMHSA TIP 57 SAMHSAs TIP 57 is the treatment improvement protocol manual for implementing trauma-informed care into behavioral health services. The manual is focused in two parts, the first is a guide for building greater trauma awareness in all aspects of care, the second is a guide for program organization administrators to implement TIC into program policies, procedures and staff interaction with the individuals they serve. Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 36

TIP 57 PART I & PART II TIC a Sociocultural Perspective Trauma Awareness Understanding the Impact of Trauma Screening and Assessment Clinical Issues Across Services Trauma Specific Services Trauma-Informed Organization Building a Trauma-Informed Workforce


The Goals of TIP 57 Assume everyone you treat has a trauma history Become trauma aware and knowledgeable Evaluate and use appropriate trauma related tools for (diagnosis & care) Learn TIC Core Principles and Practices. Anticipate need for specific trauma-informed treatment ..to support the individuals recovery. Evaluate and build trauma-informed organizations.


Goals Implement interventions from a collaborative, strengths-based approach, appreciating the resilience of trauma survivors. Decrease.. re traumatization that can occur from implementing standard .. policies, procedures and interventions. Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 39

Goals NCTIC calls for the collaboration of all stake holders in TIC implementation in, programs, policies, procedures and reviews. How will consumers be represented? What role would you like to take part in? Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 40

Can we truly define a persons trauma experience? The factors relating to defining trauma experiences seem to be endless in possibilities. Never assume, yet be alert to re traumatization. Where we begin in being trauma-informed, is to ask what may or may not be comfortable for someone and if they wish to share, we must listen without judgment. As trauma survivors, as service providers, we can consider our own experiences and carefully relate in ways that will help, not harm. Chris Cavaliere, The Facing Forward Program, 2015. Do not reproduce without authors written permission. 41

moving forward in trauma awareness

Presentations & Public Speaking