Post on 27-Dec-2015
“People will forget what you said,
People will forget what you did,
But people will never forget how you
made them feel.”
Maya Angelou
Trauma Informed Engagement
• Acknowledges the significant prevalence of trauma in the world.
• Recognizes the profound effects of trauma on the thoughts, feelings, and behavior of survivors.
• Affirms the strengths and resilience of survivors.
Trauma: The Hidden Epidemic
• More than 50% of people in the United States are survivors of trauma.
• Many have experienced multiple traumatic events, often beginning in childhood.
• Rates of trauma increase with: poverty, homelessness, mental illness, substance abuse and developmental disability.
Public Mental Health and Trauma
• More than 90% of clients served in the public mental health system are survivors of trauma.
• It is reasonable to assume that trauma is a universal experience of the people we serve and adopt “universal precautions”.
Trauma: the Three E’s
• EVENT: Overwhelms ability to cope.
• EXPERIENCE: “In the eye of the beholder”.
• EFFECT: Attempts to cope and survive.
Traumatic Events Include:
• Neglect
• Witnessing Violence
• Physical, Sexual and Psychological Abuse
• Foster Care
• Absence of a Parent
• Familial: Mental Illness, Substance Abuse Incarceration
Traumatic Events Include:
• Poverty
• Bullying
• Incarceration
• Combat
• Disaster
• Accidents
• Traumatic Loss……………..ETC!!
ACES: Adverse Childhood Experiences Study
• Vincent Felitti, MD (Kaiser Permanente) and Robert Anda, MD (CDC) 1995
• Understanding the effect of childhood trauma on lifelong health and wellbeing.
• Initial study involved 17,000 middle class, insured individuals
ACES: Adverse Childhood Experiences Study
• Adverse Experience Categories: Abuse, Neglect, Family Dysfunction
• ACE Score: number of categories of adverse experiences in first 18 years of life.
ACES
• 2/3 of the participants had a score of 1 or higher.
• 12% of the participants had a score of 4 or higher
• The higher the ACE score the higher the risk of serious health issues as an adult.
Health Risks with High ACE Score
• Depression and suicide• Smoking and substance abuse• Teen parenthood• Impaired work performance• Heart disease, obesity and diabetes• Liver disease, lung disease and cancer• An ACE score of 6 or higher decreases life
expectancy by 20 years.
ACES in a Nutshell
• The greater the exposure to adverse experiences in childhood…
• The greater the neurobiological impacts and health risks…
• The greater the lifelong consequences for health and well-being.
The Experience of Surviving Trauma
• Trauma is a core life event around which subsequent development organizes.
• Trauma profoundly changes the experience of “being in the world”.
• Trauma changes how a person thinks, how they experience emotion and how they behave in the world.
Traumatic Events
• Disrupt the experience of CONTROL
• Disrupt the experience of CONNECTION
• Disrupt the process of MEANING MAKING
World View After Trauma
• The world is not a safe place.
• People cannot be trusted.
• Those I care about will hurt me the most.
• I have to defend myself.
• I am powerless.
• I am worthless.
• I am crazy.
Emotions after Trauma
• Fear and Anxiety
• Depression
• Numbing
• Anger and Rage
• Grief
• Guilt and Shame
• Rapid shifts in emotion
Behavior After Trauma
• Hyper-vigilance
• Avoidance and Isolation
• Aggression: “Hurt People Hurt People”
• Exhaustion
• Poor Sleep
• Difficulty with Boundaries
• Re-experiencing and Flashbacks
Trauma Triggers
• Symbols of past trauma which make us think we are in danger when we are not.
• Triggers can be : sounds, smells, sights, anniversaries, objects or movements.
• Triggers re-create the Trauma Dynamic.
• Fight-Flight-Freeze Response.
Neurobiology of Triggers
• Prefrontal Cortex: diminished activity to ensure instinctual response
• Thalamus: diminished ability to perceive new information
• Diencephalon and Brainstem: Fight, Flight, Freeze
An Important Differentiation
• Normal emotional states: Cognitive Processing is intact.
• Triggers: Cognitive Processing is disrupted.
• Provides a framework for effective intervention.
Healing and Recovery
• Survivors of Trauma do Recover and Thrive.
• Creating a “New Normal”
• Healing Happens in The Context of Relationships.
Trauma Informed Relationships
• Trauma Lens
• A shift from: What is wrong with you???
• A focus on: What has happened to you and how can I support you?
• “If you don’t get what happened to me you’re not going to get how I am happening to the rest of the world.”
Trauma Informed Relationships
• The concept of Re-Traumatization.
• Recreating the devastating dynamics involved in trauma.
• “One does not have to act with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Trauma Informed Relationships
• We all have stories.
• Our stories provide the meaning underlying our behavior.
• In trauma survivors, behavior is often an adaption which has allowed them to cope and survive.
• Trauma is an Explanation…not an Excuse.
Principles of a Trauma Informed Culture SAMHSA
• Safety
• Trustworthiness and Transparency
• Collaboration and Mutuality
• Voice and Choice
• Peer Support and Mutual Self-Help
• Resilience and Strength Based
• Intentional and Ongoing Change Process
“TI” TIPS
• You have great power and importance in the lives of the children and clients that you serve.
• You are planting seeds and creating experiences that will literally change the future.
“TI” TIPS
• Assume that people are doing the best that they can in the moment.
• When you see suffering…Lean In.
• When a client is struggling…Comfort First…Instruct Later.
• “I see that you are having a tough time…I want to help…How can I support you?
“TI” TIPS
• When you see anger, avoidance or apathy…Think Fear.
• Look at your workplace through a trauma lens: When I come in do I feel safe?...Do I feel hopeful?... Do I feel calm?
• Is there a space for clients to regroup and regain control?
• Consider a Comfort Kit.
“TI” TIPS
• Consistency and good boundaries promote trust and safety.
• Flexibility promotes empowerment and connection.
• Communicating with compassion, respect and honesty promotes growth.
• Your greatest tool is the exquisite gift of your presence.
“TI” TIPS
• Do not walk this path alone…this is a daily practice…not a destination.
• Come together for creative problem solving in working with clients.
• Come together for support.
• Come together for fun.
SELF CARE IS NOT SELFISH
• Put on your own oxygen mask before you assist the vulnerable person beside you.
• Working with trauma survivors can be tremendously gratifying but we must be aware of the “Cost of Caring”.
• What do we need to do to maintain our own resilience???
RESILIENCE
• Awareness of personal triggers, stressors and how the work is affecting us.
• Balance: Time and space for self care both DURING and after the workday.
• Connection and Healthy Coping.
• “Finish each day and be done with it…you have done what you could”