Trauma Informed-Care

for the Adult Migrant WebinarOctober 18, 2019

Presenter―

FR. RAGAN SCHRIVER, PSYD, MSW

S P E C I A L A S S I S TA N T T O T H E P R E S I D E N T, C AT H O L I C C H A R I T I E S U S A ,A S S O C I AT E P R O F E S S O R , C O L L E G E O F S O C I A L W O R K , U N I V E R S I T Y O F T E N N E S S E E , K N O X V I L L E

Dear God, our journey through life is long and hard.

We cannot make this trip alone; we must walk together on the journey.

You promised to send us a helper, your Spirit. Help us to see your Spirit in those you

send to journey with us.

In the refugee family, seeking safety from violence, Let us see your Spirit.

In the migrant worker, bringing food to our tables, Let us see your Spirit.

In the asylum seeker, seeking justice for himself and his family, Let us see your Spirit.

In the unaccompanied child, traveling in a dangerous world, Let us see your Spirit.

Teach us to recognize that as we walk with each other, you are present.

Teach us to welcome not only the strangers in our midst but the gifts they bring as

well: the invitation to conversion, communion, and solidarity

This is the help you have sent: we are not alone.

We are together on the journey, and for this we give you thanks. Amen.

Let Us See

Source: Rev. Enock De Assis

QUICK HOUSEKEEPING:

The webinar is being recorded.

The phone lines and computer speakers are being

muted at this time.

Please use the chatbox feature to send your

questions.

Q & A section at the end of the webinar.

Please make sure you have connected to the audio, using your computer or telephone: 415) 930-5321 Attendee access code: 469-081-901

Trauma Informed-Care

for the Adult Migrant

Webinar

Goals for This Training:Attendees will be able to…

Define Trauma

Identify traumatic responses in clients

Describe how trauma impacts the human body

Understand traumatic reactions specifically in migrants

Recognize core principles for trauma informed care

Employ tools to help clients recover from traumatic experiences

Define steps toward self-care

Understanding the Needs of Displaced Persons

68.5 Million people in the world displaced from their homes◦Poverty ◦Persecution◦Natural disasters◦In search of security

Relationship between Migration and Trauma

Begin with understanding trauma

Trauma viewed from Differing Perspectives

Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster.

• American Psychological Association

Psychological trauma may set in after a distressing or life-threatening event

• Psychology Today

A very difficult or unpleasant experience that causes someone to have mental or emotional problems usually for a long time

• Merriam-Webster

Trauma DefinedTrauma is an event that is extremely upsetting and at least temporarily overwhelms internal resources.

It can be a single event

More 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 damagingChild abuse experiences

Displacement

Traumatic Experience

“Being traumatized means continuing to organize your

life as if the trauma were still going on unchanged.”

-Bessel van der Kolk, MD

Traumatic Events

Individual Trauma◦ Assault

◦ Abuse

◦ Life threatening illness

Group Trauma◦ Displacement - Refugees/Asylees

◦ Military Activity

Community or mass trauma◦ Disasters

◦ Terrorist attacks

Trauma Impacts Everyone Differently

Trauma is common across cultures

A particular culture may not use the word “trauma” but a different word or term

In the Haitian culture, the term “seizisman” or “seized-up-ness” is used to describe traumatic responses

How is trauma described in your culture?

Effects of Trauma over the Lifespan

Possible Manifestations of Unresolved Trauma

Trauma Impacts the Brain

During traumatic events, as well as during flashbacks, thinking and reasoning are overpowered by emotional responses.

Left Brain & Right Brain

Trauma or sustained high stress damages the connection between the left brain and the right brain.

Neuronal Response

Stress & the Tiger

• Bodies are designed to respond to stress

• Adrenalin and cortisol help us run from the tiger or hide

• This threat is short in duration

BUT…when the tiger lives in your home, neighborhood or life…

A Story of Hope: Phineas Gage

What Does Trauma Look Like?

In Our Emotions?

• Difficulty managing feelings

• Easily frustrated

• Shame

• Chronic emptiness

In Our Thinking?

• Catastrophizing

• Concrete thinking/Black & white thinking

• Memory problems

What Does Trauma LookLike?

In Our Relationships?

• Difficulty assessing social cues

• Difficulty seeking attention

• Challenges in seeing another's point of view

• Difficulty in maintaining relationships

In Our Actions?

• Impulsive

• Suicidal

• Self-injury, chemical use/dependency

• Disordered eating

• Trauma re-enactment

What Does Trauma Look Like?

Outward Expressions

• Anger or defiance

• Violence towards others

• Truancy

• Criminal acts

• Perfectionism

Inward Expressions

• Withdrawal

• Substance use

• Numbing

• Violence to self

• Self-doubt

What does Trauma Look Like-Long Term?

Affects a Person’s:

•Perception of time

•Cognitive style

•Affective tone

•Problem-solving skills

•Ability to respond to/understand rules, regulations, and laws

Post-Traumatic Stress Disorder in Migrant Populations

• Real or perceived possibility of death, serious injury, or sexual assault

• Can include witnessing or other exposure

Exposure to the traumatic event

• Intrusion symptoms (e.g., memories, nightmares)

• Avoidance of trauma related thoughts, feelings, reminders

• Negative alterations in cognition and mood

• Trauma-related changes in arousal/activity (e.g., aggression, sleep disturbance, hypervigilance)

• Lasts a month or longer

Additional criteria:

Triggers & Flashbacks

Triggers

Stimulus that sets off a memory of a trauma

Explicit

Subtle and inconspicuous

Flashbacks•Re-experiencing a previous

traumatic experience

•After-effects linger for hours or longer

•Brief movie scene that intrudes on the client

/

Potential Triggers

Lack of controlThreats or feeling

threatened or attacked

Observing threats or assaults

IsolationInteracting with authority figures

Lack of information Lack of privacyRemoval of clothing

(medical exams)

Sensory experiences (smells, sounds,

touch, taste, body position)

Being touched

Loud noises DarknessIntrusive or

personal questionsBeing locked in a

roomBeing ignored

Condescending looks/Tone of voice

Transitions or disruptions in

routine

Feelings of vulnerability and

rejection

Sensory overload (crowded spaces,

loud sounds, powerful smells)

TraumaticWorldview

No place is safe Other people are unsafe and

cannot be trusted

My own actions, thoughts, and

feelings are unsafe

I expect crisis, danger, and loss

I have no worth and no abilities

Mediating & ExacerbatingFactors

Person

Age or developmental stage

Past experiences

Strengths and coping skills

Cultural beliefs

Environment

Supportive responses from significant others

Access to safety and resources

Event

Severity and chronicity

Interpersonal as opposed to an act of nature

Intentional or accidental

Trauma and the Migrant Experience

Migration: Opportunities and Stressors

• Can yield improved economic well-being and safety for migrants and family back home

• Yet… the migration process exposes adults & youth to multiple stressors that can lead to trauma/trauma reaction

(Capps, Castañeda, Chaudry, & Santos, 2007; Flores & Kaplan, 2009)

Migration Process

Pre-migration in home country

Migration journey

Post-migration

Sociopolitical Environment

DACA – Deferred Action for Childhood Arrivals

Temporary Protected Status

Reduction in accepted refugees – what does this mean for Latinx immigrants?

Enforced border control and local law enforcement

Accelerated deportations

Proposal – if use federal benefits (e.g., food stamps, Medicaid, or housing assistance, a tougher path to citizenship

Pre-migration:Trauma encountered “back home”

• Poverty

• Poor access to education/ medical care

• Discrimination

• Enslavement/exploitation

• Natural disasters

• Violence

Migration: Trauma during the journey

• Persistent and realisticfear

• Loss and Grief

• Violence

• Injury & Illness

Post-migration: Trauma

• Language and Cultural barriers

• Acculturation process; impact on youth

• Perpetual fear

• Loss/Family separation

• Discrimination

• Poverty

• Violence

Post-migration Hardship

Depression

Suicidal

Ideation

Anxiety

Any

psychiatric disorder

Discrimination AcculturationLanguage &

Cultural barriers

(Acevedo-Garcia, Bates, Osypuk, & McArdle, 2010; Carvajal et al., 2014; Cho, Frisbie, Hummer, &

Rogers, 2004; Held & Lee, 2016; Ornelas & Perreira, 2011)

Trauma-Informed Care’s New ParadigmFrom: To:

From: To:

What is wrong with you?

What happened to you?

Control Collaboration

Traditional vs. Trauma Informed ApproachesTraditional Approach◦ You are sick◦ You are a diagnosis◦ You are broken and need

to be fixed

Trauma Informed Approach◦ You are not sick or labeled◦ You are injured

Core Principles of Trauma Informed Care Awareness: Everyone knows the role of trauma

Safety: Ensuring physical and emotional safety

Trustworthiness: 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

Cultural Humility: Respecting diversity within programs, provide opportunities for clients to express culture

Safety

Meeting people where they are “at”

The person’s culture is respected

and incorporated into all stages

of intervention

Identification and on-going assessment of triggers

and plans to address these

Establish and maintain

predictable routines to

increase the sense of

safety

Maintain a calm

environment to decrease

hyper-arousal

Support and promote

positive and stable

relationships in the

person’s life

Ensure opportunities

for success

Trustworthiness

Provide clear information about when, where, and by whom services will be provided¢

Be on time Do what you say you will do, and if

you can’t do it, take responsibility

Talk about the good, the bad, and

the ugly

Avoid “tricking” or “catching” people

Choice

When and where will you meet?

How does the person prefer to communicate?

How does the person prefer to be addressed?

Who will be on the team?

What services does the person want?

Person decides which goals to work on first?

When does the person want to terminate services?

Collaboration

Ask about a client's goals or priorities

Service plans should be developed by the client, with the support of the case manager

Ongoing assessment of which services have been effective

Do goals and service plans need to be adjusted?

Shared expectations for the helping relationship

During emotional times ask, “How can I support you right now?”

Empowerment

Focus on empowerment instead of management and

control

Build upon strengths and promote resilience

Emphasize developing and practicing coping skills instead of

“gaining insight”

Tips for Practicing Trauma Informed Care Recognize behaviors probably serve a

purpose Why is a person chronically miss morning

appointments? Is the morning the only time she can sleep due to intrusive dreams?

Adjustment to support the person. Set appointment times for the afternoon.

Include everyone in your agency From receptionist to treatment staff Provide trauma training to every employee

How do we provide Trauma Informed Care?To the best of your ability and within your given time constraints:

Lose the labels

Give him/her time and space to tell the story

Let the survivor lead

Respect his/her voice and choice

Recognize the survivor’s comfort level

Consider the survivor’s perspective from the cultural context

How Do We Provide Trauma Informed Care?Listen◦ What is the survivor saying to you?

◦ What is the survivor not saying?

◦ How is the survivor saying it?

Inform◦ What information do you have that

may help him/her?

◦ What will happen next in the process?

◦ Why is the information important for him/her to have?

◦ How can your services help him/her?

Interfacing with Clients

Engagement & Assessment

Client Education about Trauma

Routines

Emotional Management

Attunement with Clients

Self and Identity

Modulation

Relational Connections

Executive Functions

Engagement and AssessmentConsider how you greet people...

Consider culture-specific communication styles...

Consider who you include and how...

Consider how you explain the assessment process...

Be aware of historical distrust of service providers by various populations...

Be aware of the stigma or taboo associated with various topics...

Consider how the assessment process is perceived...

Education

Normalize experiences

Biological information

(briefly)

Empowerment Understanding Client/system

RoutinesUse routine and structure to create comfort

Session structureBuild daily rhythm with clients

Explore comfortable daily routines

Mastery and safety

Engage the body

Planned times together

Affect Management

Normalize Validate Identify emotional situations

Build self-monitoring

skills

Enhance self care

Support resources

Relational Connections

Explore connections in relationship

Establish resources and methods to

access others

Build skills to support effective use of

resources

Executive Functions

Support active recognition of capacity to make choices

Build ability to evaluate situations

Build ability to inhibit emotional response

Build ability to generate and evaluate potential solutions

“The expectation that we can be immersed in suffering and loss daily and not be touched

by it is as unrealistic as expecting to be able to walk

through water without getting wet.”

(Remen, 2006)

Self-Care

What is Self-Care?

Self-care is what people do for themselves to establish and maintain health, and to prevent and deal with illness.

It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure, etc.), environmental factors (living conditions, social habits, etc.) socio-economic

factors (income level, cultural beliefs, etc.), and self-medication.’

Terminology About Self-Care

•Vicarious trauma

•Stress

•Vicarious traumatization

•Secondary traumatic stress

•Compassion fatigue

•Burnout

Vicarious Resilience

Involves the process of learning about overcoming adversity from the trauma

survivor and the resulting positive transformation and empowerment through

their empathy and interaction.(Hernandez, Gangsei, and Engstrom, 2007)

Self care planning

Questions and Discussion