Connecting Best Practices: Trauma-Informed Motivational Interviewing

Disclosures

Pam Pietruszewski, MA - GSK: Employment

Presenters

Overview

• Trauma Overview• Motivational Interviewing Overview• Building Protective Factors

Trauma Overview

We begin to ask, “What happened to you?”

rather than“What is wrong with you?”

We have to ask, “What’s strong?”

rather than“What’s wrong?”

Paradigm Shift

What is Trauma?

Individual trauma results from an , series of events, or set of circumstances that is by an individual as overwhelming or life-changing and that has profound on the individual’s psychological development or well-being, often involving a physiological, social, and/or spiritual impact.

Definition (SAMHSA Experts 2012) includes

eventexperienced

effects

three key elements

The Adverse Childhood Experience Study Behavioral Heath at the Foundation of all Health

• Over 17,000 adults studied from 1995-1997

• Almost 2/3 of participants reported at least one ACE

• Over 1/5 reported three or more ACEs, including abuse, neglect, and other types of childhood trauma

• Major links identified between early childhood trauma and long term health outcomes,

• including increased risk of many chronic illnesses and early death "Major Findings," Centers for Disease Control and Prevention (CDC)

Life-Long Physical, Mental & Behavioral Health Outcomes Linked to ACEs

• Alcohol, tobacco & other drug addiction• Auto-immune disease• Chronic obstructive pulmonary disease &

ischemic heart disease• Depression, anxiety & other mental illness• Diabetes• Multiple divorces• Fetal death• High risk sexual activity, STDs & unintended

pregnancy

• Intimate partner violence—perpetration & victimization

• Liver disease• Lung cancer• Obesity • Self-regulation & anger management

problems• Skeletal fractures• Suicide attempts• Work problems—including absenteeism,

productivity & on-the-job injury

Survival Mode Response

Survival Mode Response

Inability to

• Respond

• Learn

• Process

Trauma Shapes our Beliefs

Worldview Spirituality

Identity

Impact of Trauma on Behavior Triggers

External reminders of traumatic event

• Smell• Sound• Sight• Touch• Taste

Internal reminders of traumatic event

• Emotions• Thoughts

Anger

Difficult concentrating

Physical Illness

Hyper arousal

Low self-esteem

Avoidant behavior

Traumatic grief

Mistrust Trauma re-enactment

Depression

Sensory sensitivity

Dissociation

AggressionShame

Need to control

Inattention

Persistent irritability

Defiance

Difficulty forming relationships

Disrupted MoodRegressive behavior Perfectionism

GuiltSleep problems

Fear

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Trauma is a risk factor for Substance Abuse

Substance Abuse is a risk factor for Trauma

Trauma-Informed Care

The 7 Domains of Trauma-Informed Care

• Domain 1: Early Screening & Comprehensive Assessment of Trauma

• Domain 2: Consumer Driven Care & Services• Domain 3: Trauma-Informed, Educated & Responsive Workforce• Domain 4: Trauma-Informed, Evidence-Based and Emerging Best

Practices• Domain 5: Safe and Secure Environment• Domain 6: Community Outreach and Partnership Building• Domain 7: Ongoing Performance Improvement

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w w w .T h e N a t i o n a l C o u n c i l. o r g

Motivational Interviewing Overview

Motivational Interviewing Overview

Motivational Interviewing (MI)

Motivational interviewing is a collaborative conversation style for strengthening a person’s

own motivation and commitment to change.

Miller & Rollnick, 2012Motivational Interviewing: Helping People Change

Common Tendencies When Facilitating Change

“That kid is doomed.”

“I can rescue her.” “He just doesn’t get it.”

Just do it!

MI is a Process of…

Engaging

Focusing

Evoking

Planning

Deficit Competenceq Insight & knowledge is lacking

q Telling

ü Capacity to change is within

ü Asking and listeningWhat is Your View?

Partnership

Evocation

Compassion

Acceptance

The Spirit of Motivational Interviewing

Building Protective Factors

We need to exercise…

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Ability to adapt well to stress, adversity, trauma or tragedy

Risk Factors• ACE’s• Poverty• Racism• Intergenerational trauma• Lack of support• Isolation• Hopelessness• Difficulty regulating

emotions• Poor self-confidence• Poor problem solving skills

Protective Factors• Optimism • Faith • Sense of meaning • Self-efficacy • Flexibility • Emotional regulation • Empathy • Close relationships • Spirituality • Effective problem solving

Honor voice and choicePartner with peopleRequest feedbackEnsure comfort

“Keep the Human in Human Services”-Dr. Pat Deegan

Build Relationships

Positive Psychology

Seligman, M. et al, American Psychologist, 2005.

Promoting people’s positive health assets - strengths that can contribute to a healthier, longer life.

• Positive emotions• Optimism• Social community• Meaning & purpose• Grit, determination• Gratitude

• Engaging in grateful thinking tampers the feelings of anxiety, fight or flight to increase our ability to rest and digest.

• Gratitude increases helping behaviors and motivation. Creates a “pay it forward” effect.

• Shifts the focus on what you are receiving, helps you feel more attached to the world and appreciative of what you have.

The Practice of Gratitude

Language Of Resilience

•• Vocabulary reinforces feelings and beliefsVocabulary reinforces feelings and beliefs•• Helps guide behaviorHelps guide behavior•• Leads to greater options for acting Leads to greater options for acting •• Allows us to be able to recognize resilience in Allows us to be able to recognize resilience in

self/othersself/others

Three Statements of Resilience

I Have…a recognition of what is available

I Am… a recognition of my value

I Can… a recognition of mastery, sense of the future

-Strengthening the Human Spirit by Edith Grotberg, PhD 1995

TIC-CARET

Take the time to introduce yourself, your role and explain what you will be doing. Set realistic expectations and goals for your time with them.

I Intently listen to their story and/or request. Be patient and persistent.

CConsistently and mindfully be aware of the language you use when responding to the client’s story and/or request.

CConnect the patient to others that may be able to meet any needs that are out of your scope of practice.

AAsk the patient for their story and try to anticipate their needs and questions. If applicable, provide ongoing choices and support.

RRespectfully respond and communicate at all times, e.g., use Mr./Mrs., be validating and affirming.

EEnsure all patient needs are met before exiting, make warm handoffs/referrals when possible. Follow through with what you say you will do.

Listening Style that Supports Change

Open-Ended Inquiry Seeking to understand “How… What…”

Affirmations Genuine testaments of character

Reflections What you hear, observe

Strengths-Oriented Open-Ended Questions

1. What does recovery look like for you?

2. What would you say are your strengths?

3. What coping skills have you learned from your (life experiences, cultural history, spiritual practices, athletic pursuits, etc.)?

4. What are some of your accomplishments that give you the most pride?

5. Imagine for a moment that a group of people are standing behind you showing you support in some way. Who would be standing there?

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Attributes of Successful ChangersAcceptingAdaptableAlertAmbitiousAssertiveBraveCarefulCommittedConsiderateCreative

DeterminedEagerFaithfulFlexibleFocusedForgivingHopefulIngeniousMatureOpen

PatientPersistentReasonableReliableSteadyStrongThoroughTrustingTruthfulWilling

"Affirmations are

our mental vitamins,

providing the supplementary

positive thoughts we need

to balance the barrage

of negative events and thoughts

we experience daily.“

—Tia Walker

What Can We Do Next?

What do we need to….üStart DoingüStop DoingüDo More of

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Paired Discussion

Contact Information

Linda Henderson-Smith, PhD, LPCDirector, Children and Trauma-Informed Services

lindahs@thenationalcouncil.org

Pam Pietruszewski, MAIntegrated Health Consultantpamp@thenationalcouncil.org