Trauma Informed Programing: Supporting Staff Exposed to Violence and Trauma

Identify the Image

WorkshopGuidelines Because family violence is

so prevalent, assume that there are survivors among us.

• Be aware of your reactions and take care of yourself first

• Respect confidentiality

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What is: Secondary Trauma?

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Secondary Trauma:

vicarious trauma, burnout, and compassion fatigue, describes how caring

for trauma survivors can have a negative impact on service

providers.

SECONDARY TRAUMACommon Reactions to Caring for Survivors of Trauma

• Helplessness• Depressive symptoms• Feeling ineffective with clients• Reacting negatively to clients• Thinking of quitting [contact with clients]

work• Fear• Recurrent thoughts of threatening situations• Chronic suspicion of others• Sleep disruptions

• Chronic lateness• Boundary Violation and

Transference• Taking excessive responsibility

for the client• Use of Alcohol and Drugs/Fries• Physical symptoms• Inability to relax or enjoy pleasurable

activities• Anger• Reacting angrily to clients/staff,

colleagues• Feelings of guilt• Detachment• Avoiding patients

Exposure toViolence and Secondary Traumatic Stress

• Lifetime exposure to violence is common • Working with clients who are experiencing domestic/sexual violence can trigger painful memories and trauma for staff• A personal history of exposure to violence increases the risk of experiencing secondary traumatic stress

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Self Care?

On a scale 0 (not at all) to 4 (Routinely)

How many of you actively take extra care of yourselves when it comes to this work?

On a scale 0 (not at all) to 4 (Routinely)

How many of you currently have the opportunity to formally debrief complicated DV cases?

Compliment Exercise

Pen and Paper needed

If you can’t think of an answer that’s ok, it is part of the exercise.

Think of the last time you gave a colleague (not friend or loved one) a compliment (could be personal or professional) and write it down.

Last time you received a compliment from a colleague what it was and write it down.

Last time you gave a compliment to a client andwhat it was?

Compliment Continued:

Think about the colleague who has driven you the most crazy in your work life, makes you think of nails on a chalk board and makes you ask yourself why they work here and how you can stand to work with them (Remember, it’s best not to write down names on your paper ) and write down a compliment for them.

Compliment Continued

Lastly, I want you to think about the compliment you bring to the world. What is your special gift? What write it down.

Why did we do this exercise?

Which was the easiest question to answer?

Why did we have you think about the person who drove you crazy?

What if you did the compliment exercise as an ongoing part of staff development?

We are reminded that the work has inevitable benefits and challenges, that we are stewards not just of those who allow us into their lives but of our own capacity to be helpful, and that a mindful and connected journey, both internally and externally, allows us to sustain the work.

— Jon R. Conte, Ph.D. Seattle, Washington•http://traumastewardship.com

Thank You Gifts: Polished Rocksand Sea Glass

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By Linda Chamberlain, PhD MPH and Rebecca Levenson, MA

Addressing the Bigger Picture: Adverse Addressing the Bigger Picture: Adverse Childhood Experiences Impact on ParentingChildhood Experiences Impact on Parenting

http://vimeo.com/71581118

Video Video DebriefDebrief

Connected Parents Video:• Meets parents where they are• De-stigmatizes ACEs• Normalizes using resources

(e.g. hotlines, apps, etc)• Primary prevention of child

abuse in a way that feels supportive of parents not punitive or judgmental

Resiliency is a Developmental Process

ResilienceResilience is the capacity to rise above difficult circumstances, allowing our children to exist in this less-than-perfect world, while moving forward with optimism and confidence.Kenneth Ginsburg, M.D., M.S.

Edwww.fosteringresilience.com

Card Card ReviewReview

Resiliency is for Parents Too!

• Building resiliency is a lifelong process

• Resiliency factors including self-esteem, ability to cope with stress, and sense of control reduce the likelihood of PSTD among adults who have experienced trauma (Wrenn et al, 2011)

• Social support is a resiliency factor for adults too

• 10 ways to Build Resilience” resource can be downloaded at: www.apa.org/helpcenter/road-resilience.aspx

Universal Universal Education Education ApproachApproach

Universal education plant a seeds for clients to understand that adverse childhood experiences can influence their parenting skills and how they react to stressful situations as adults.    

Question:Question: How might this video and safety card connect to conversations about DV?

By Linda Chamberlain, PhD MPH and Rebecca Levenson, MAPreventing ACEs by Enhancing Family SupportPreventing ACEs by Enhancing Family Support

Abuse, by CategoryAbuse, by Category Psychological (by parents) 11% Physical (by parents) 28% Sexual (anyone)Sexual (anyone) 22%22%

Neglect, by CategoryNeglect, by Category Emotional 15%

PhysicalPhysical 10%10%

Household Dysfunction, by CategoryHousehold Dysfunction, by Category Alcoholism or drug use in home 27% Loss of biological parent < age 18 23% Depression or mental illness in home 17% Mother treated violentlyMother treated violently 13%13% Imprisoned household member 5%

Prevalence of Adverse Childhood Experiences

Prevalence Prevalence (%)(%)

(Felitti et al, 1998)

ACEs have a dose-response relationship ACEs have a dose-response relationship with the following adult health outcomes:with the following adult health outcomes:

• Obesity

• Ischemic heart disease

• Cancer

• Chronic lung disease

• Autoimmune disease

• Skeletal fractures

• Liver diseases

• Premature death

(Anda et al, 2009; Dong et al, 2004; Dong et al, 2003; Dube et al, 2009; Felitti et al, 1998)

4-12 times greater 4-12 times greater

risk risk of alcoholism, drug abuse, depression, and suicide attempts

Adults with 4 or more ACEs:

(Felitti et al, 1998)

If any one ACE is present, there is an 87% chance87% chance at least one other category of ACE is present in that household

(Felitti et al, 1998)

ACEs Cluster

Effective Parenting Skills Can Mitigate Effective Parenting Skills Can Mitigate Effects of Trauma on ChildrenEffects of Trauma on Children

• Effective parenting skills and parental warmth promote resiliency among children exposed to domestic violence (Graham-Bermann et al, 2009)

• Parents’ ability to parent under stressful circumstances is a protective factor that buffers the effect of family violence on child adjustment (Davies et al, 2004; Margolin et al, 2004)

Thank You

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By providing By providing universal universal

education about education about ACEs and ACEs and

providing support providing support to parents you to parents you

can change lives.can change lives.