NOPH Orientation for Trauma Informed Care. (SAMHSA, 2012)Individual trauma results from an event,...
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Transcript of NOPH Orientation for Trauma Informed Care. (SAMHSA, 2012)Individual trauma results from an event,...
NOPH Orientation forTrauma Informed Care
(SAMHSA, 2012)Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being.
What is trauma?
• Safety
• Trustworthiness and Transparency
• Peer Support
• Collaboration and Mutuality
• Empowerment, Voice, and Choice
• Cultural, Historical, and Gender Issues
SAMHSA’s Six Key Principles of Trauma Informed Care
High percentage of public health clients have trauma history; prevalence
Will help you to better understand our patients and how to treat them more effectively
Why is it important to be informed about trauma at NOPH?
Adverse Childhood Experiences Provided research linking trauma experiences
to later high risk behaviors and emotional and physical health problems i.e.- Anxiety, depression, diabetes, drug use,
heart disease, pulmonary disease, liver disease, STDs, gynecologic cancer
This research provided awareness of funding for training and interventions
ACE Questionnaire- 10 questions
ACE Study
Resilience- an individual's ability to adapt to stress and adversity
Research has shown Top 5 resilience factors are: Having power over one’s own life Having a sense of self and self worth Having external supports Being affiliated with a group Having positive experiences with safe adults,
esp adults in positions of authority. (Show resilience questionnaire)
We’ve all been through bad experiences, how come we have coped
better than some of the patients?
Effects of Trauma
Thinking
Feeling
Acting
Thinking Feeling ActingDistrust of others, self, worldGuilt, shameLow self-worth; lack of identityDissociationLoss of hope
Feeling UnsafeDepression, AnxietyDys-regulated EmotionsReactive, ImpulsiveHallucinations/Intrusive Memories
Cutting, self injuryAggressivenessInterpersonal difficultiesImpulsiveHyper-vigilance, alertKeyed up, excitable
What are the effects of trauma?
Neurobiologic Effects of TraumaToxic Stress Derails Healthy Development
1:52 YouTube videoTrauma during developmental period produces an
overactive stress response system (fight/flight/freeze)
Brain is always on high alert, impulsive and reactive, in protective mode due to perceived dangers
Less able to develop positive coping responses, problem solving skills and communication skills
What are the effects of trauma?
Even treatment can be triggering/traumatic: Loss of freedom Loss of privacy Loss of coping techniques (smoking, using,
support system) Intrusion from other patients Restraint/Seclusion
Hospitalization can address precipitating crisis and re-stabilize; outpatient treatment best for long-term trauma treatment
Hospitalization and Trauma
Powerlessness/Lack of Control Feeling Unsafe loud noise, fighting, threats, getting too
close, people coming up behind them, patients’ scary symptoms
Lack of Predictability Specific reminders
Triggers
Know the patient’s triggers Know your triggers Know team member triggers
INTERVENE
Know Triggers
During hospitalization- we can help contain emotional reactions and work to improve coping skills
Seeking Safety is a great resource for teaching skills and for core groups.
Recovery from Trauma
Behind Closed Doors
Video Time!
He’s being manipulative. She just wants attention. There’s no reason for him to get upset. She doesn’t want to change. He is resisting. She’s too needy. He’s just playing games. I’ve tried what works for everyone else, it should
work for them. It isn’t fair to the other patients, they shouldn’t get
special treatment.
Blaming the VictimActual Staff Statements
Reminder
“We take away everything they would use to handle the world and ask them to behave like angels.”
Think… “What happened to you?” Not “What is wrong with you?”
Understand maladaptive behavior from a faulty coping style (sick) perspective rather than from a volitional (bad) perspective.
You do NOT “understand” “I’m trying to better understand you.” “Thank you for sharing that with me.” “How can I support you?”
Recognize their difficulties, AND THEIR STRENGTHS! Acknowledge their truth in what they are saying/experiencing
How do we understand maladaptive behaviors we see in
patients from a Trauma Perspective?
Help patient to develop and use their Comfort Plan and comfort items available on the unit
Meet the patient’s needs/Be present and attentive Good staff/team communication to minimize
splitting Set limits in a firm but kind manner; be consistent Work with team/unit staff to develop a unified
Safety Plan for high risk situations Allow the opportunity for the patient to re-gain
control without coercive measures
How do we respond in a trauma-sensitive manner?
Do NOT assume we “know what’s best.” Give choices and alternatives Ask their opinions Emphasize what IS allowed Reevaluate practices if they are always
challenged
Share Power
Model healthy/adaptive interactions, emotional stability, good coping skills, problem solving skills
Unit milieu is very important – a functional team models teamwork, good unit dynamics
Debriefings are important – debrief staff and the patient after a code
Do not take verbalizations/actions personally- keep a professional empathic boundary
How do we respond in a sensitive manner?
Comfort Plan- Review with patient, clarify what may help, encourage use of safe coping strategies
Comfort Box materials- explore comfort box/weighted blanket
Safety Plans – being aware and preventative, anticipatory Headphones Distraction items such as Sudoku, Crosswords, Word
Search Talking/Venting Sensory items, lotions Respectful Communication with each other and the patient Good utilization of Bad News Protocol, pre-planning and
foresight
Tools to use for early escalation, pre-crisis
intervention
Pay attention to personal emotional well-being and coping
Understand what secondary trauma is, burnout, and compassion fatigue
Learn to process with supervisor/colleagues – debrief
Take advantage of coaching options
Staff Self-Care and Wellness
Trauma causes long-lasting problems Do not blame the victim. Not everyone charged of a crime
is a criminal. Everything you do either helps or hurts Ask “What happened to you?” not “What’s wrong with
you?” Validate and accept them while supporting change They are trying to cope. We want to teach them healthier
coping. Remember to give choices and control whenever you can. Know yourself: check in regularly with your self, colleagues,
friends and family. Patients First. Patience First.
Take-Aways
Thank you!