Presented by: Circuit 20 Trauma Informed Care Work Group.
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Transcript of Presented by: Circuit 20 Trauma Informed Care Work Group.
Presented by:Circuit 20
Trauma Informed Care Work Group
TRAUMA INFORMED
CARE: Recognizing and understanding
the effects of traumatic experiences
TRAUMA CAN OCCUR AT ANY AGE
Trauma can affect any:
• RACE•GENDER
•ETHNICITY•SOCIO-
ECONOMIC GROUP
•COMMUNITY •WORKFORCE
WHAT IS TRAUMA?
Definition (NASMHPD,2006)
The experience of violence and victimization including sexual abuse, physical abuse, severe neglect, loss, domestic violence and/or the witnessing of violence, terrorism or disasters
DSM IV-TR (APA, 2000)
Person’s response involves intense fear, horror and helplessness
Extreme stress that overwhelms the person’s capacity to cope
EXPOSURE TO TRAUMA
IT IS AN INDIVIDUAL’S EXPERIENCE OF THE EVENT……
not necessarily the event itself that is
traumatizing.
Trauma can be: Trauma can occur from:
• A single event• A connected series of
events• Chronic lasting stress
• Being in a car accident or other serious incident
• Having a significant health concern or hospitalization
• Sudden job loss• Losing a loved one• Being in a fire, hurricane,
flood, earthquake or other natural disaster
• Witnessing violence• Experience emotional,
physical or sexual abuse
Exposure to Trauma
Definition of Trauma Informed Care (TIC)
Mental health Treatment that incorporates: An appreciation for the high prevalence of
traumatic experiences in person who receive mental health services
A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual
(Jennings, 2004)
Trauma: The “Common Denominator”
• The APA’s DSM IV defines a “traumatic event” as one in which a person experiences, witnesses, or is confronted with actual or threatened death or serious injury, or threat to physical integrity of oneself or others. A person’s response to trauma often includes intense fear, helplessness or horror.
• Trauma can result from experiences that are “private”:• Sexual assault• Domestic violence• Child abuse/neglect• Witnessing interpersonal violence
Trauma can also result from “public” experiences:• War• Terrorism• Natural disaster
Trauma is becoming increasingly
recognized as a significant factor
in a wide range of health, behavioral
health & social problems
Trauma is a central mental health concern
and the one
“common denominator”
of all violence & disaster victims
National Comorbidity Survey indicates….
Slightly more than ½ of all women in the U.S. will be exposed to at least one traumatic event in their lifetime (Kessler et al, 1995)
The lifetime prevalence of trauma exposure revealed that 51% of women & 61% of men had experienced at least one traumatic event in their lifetime (Kessler et al, 1995)
Women report exposure to a range of traumatic events. Although estimates vary, finding suggest that between 17% & 34% of women will experience a rape at some point in their lifetime (Brener et al, 1999;Tjaden et al, 2000)
Women are also at higher risk for sexual molestation, childhood parental neglect, childhood physical abuse, domestic violence and the sudden death of a loved one (Kessler et al, 1995;Norris et al, 2002)
Trauma Informed Care provides a new model under which the basic
premise for organizing services is transformed:
“WHAT IS
WRONG WITH YOU?”
“WHAT HAS
HAPPENED
TO YOU?”
FROM TO
What does the data tell us?
The majority of adults & children in psychiatric treatment settings have trauma histories
A sizable % of people with substance use disorders have traumatic stress symptoms that interfere with achieving or maintaining sobriety
A sizable % of adults & children in the prison or juvenile justice system have trauma histories
( Hodas, 2004, Cusack et al., Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)
How common are traumatic events?
National survey of 5,877 people aged 15-54 concluded that trauma is very common
60.7% of men and 51.2% of women reported experiencing a traumatic event at some point in their lives
10% of men and 6% of women reported experiencing four or more types of trauma
(kessler, et al,1995)
Gender Differences in Traumatic Events
Tolin & Foa conducted an analysis in 2006 of existing research on prevalence of traumatic events and
severity of PTSD, looking specifically at sex differences. They found the following:
Females were significantly more likely to report experiencing adult sexual assault and child sexual abuse
Males were significantly more likely to report accidents & non-sexual assault, regardless of age. Male adults, war-
related events, disaster or fire, witnessing death or injury and illness were more common
For childhood experiences, no differences were found for: child abuse/neglect, war-related events, disaster or fire,
witnessing death or injury, or illness
Trauma Informed Systemsuse:
*UNIVERSAL PRECAUTIONS*
Presume that EVERY person in a treatment setting has been exposed to abuse, violence, neglect, or other
traumatic events
For this reason…
We need to presume the clients we serve have a history of
traumatic stress and exercise“Universal Precautions”
by creating systems of care that are
trauma-informed(HODAS, 2005)
Trauma InformedNon Trauma
Informed
Recognition of high prevalence of trauma
Recognition of primary and co-occurring trauma diagnoses
Assess for history and symptoms of trauma
Recognition of culture and practices that are re-traumatizing
Lack of education on trauma prevalence & “universal precautions”
Over diagnosis of Schizophrenia, Bipolar, Conduct Disorder & Addictions
Cursory or no trauma assessment
“Tradition of Toughness” valued as best care approach
Trauma InformedNon Trauma
Informed
Power/control minimized-constant attention to culture
Caregivers/supporters-COLLABORATION
Address training needs of staff to improve knowledge, sensitivity and understanding
Keys, security uniforms, staff demeanor, & tone of voice
Rule enforcers-COMPLIANCE
“Patient blaming” as fallback position without training
Recovery Model
Recovery is…“ a process, an outcome and a
vision. We all experience recovery at some point in our lives from injury, from illness, from loss or from trauma. Recovery involves creating a new personal vision for one’s self
( Spaniol, Gagne, & Koehler, 1997)
Recovery is……a common human experience
and a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills or roles toward our understanding of mental illness
(Anthony, 1993)
Understanding Values of Consumer Self Help & Recovery include:
EMPOWERMENT INDEPENDENCE RESPONSIBILITY CHOICE RESPECT & DIGNITY HOPE
Recovery oriented treatment approaches
Peer delivered services Self-help techniques Emphasis on recovery Understanding the relationship between
trauma and mental illness Cognitive Behavioral Therapy (individual
therapy)
Medication Management-new medications
EMDR: Eye Movement Desensitization & Reprocessing
What is the Staff Involvement in the Recovery Process?
Staff members provide: Encouragement Support Education Acceptance Choices Information Understanding Respect HOPE
What Consumers want to hear from Staff
You have come a long way
You are a strong person I admire your courage
in dealing with this pain
I encourage you Don’t give up I can’t promise, but I
will do my best to help I don’t understand.
Please tell me what you mean
You are doing well How can I help you I am here for you We can work together
through this It is OK to feel like that I accept you the way
you are What do you need at
this time
What is a customer?
The most important person in any business Is not dependent on us…..We are
dependent on them Is not the interruption of work, but the
purpose of it Customers do us a favor when they
come…..We aren’t doing them a favor by waiting on them
CUSTOMER
SERVICE
Resolving Conflict Stay calm Show empathy Show respect LISTEN Reflect what they have said DON’T ARGUE Think Know your procedure (get Supervisor if needed) Explain policy and procedure Be willing to “go the extra mile” Keep customers’ best interest in mind