Trauma Informed-Care for the Adult Migrant Webinar · 2019. 10. 21. · Trauma Informed-Care for...
Transcript of Trauma Informed-Care for the Adult Migrant Webinar · 2019. 10. 21. · Trauma Informed-Care for...
Trauma Informed-Care
for the Adult Migrant WebinarOctober 18, 2019
Presenter―
FR. RAGAN SCHRIVER, PSYD, MSW
S P E C I A L A S S I S TA N T T O T H E P R E S I D E N T, C AT H O L I C C H A R I T I E S U S A ,A S S O C I AT E P R O F E S S O R , C O L L E G E O F S O C I A L W O R K , U N I V E R S I T Y O F T E N N E S S E E , K N O X V I L L E
Dear God, our journey through life is long and hard.
We cannot make this trip alone; we must walk together on the journey.
You promised to send us a helper, your Spirit. Help us to see your Spirit in those you
send to journey with us.
In the refugee family, seeking safety from violence, Let us see your Spirit.
In the migrant worker, bringing food to our tables, Let us see your Spirit.
In the asylum seeker, seeking justice for himself and his family, Let us see your Spirit.
In the unaccompanied child, traveling in a dangerous world, Let us see your Spirit.
Teach us to recognize that as we walk with each other, you are present.
Teach us to welcome not only the strangers in our midst but the gifts they bring as
well: the invitation to conversion, communion, and solidarity
This is the help you have sent: we are not alone.
We are together on the journey, and for this we give you thanks. Amen.
Let Us See
Source: Rev. Enock De Assis
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Q & A section at the end of the webinar.
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Trauma Informed-Care
for the Adult Migrant
Webinar
Goals for This Training:Attendees will be able to…
Define Trauma
Identify traumatic responses in clients
Describe how trauma impacts the human body
Understand traumatic reactions specifically in migrants
Recognize core principles for trauma informed care
Employ tools to help clients recover from traumatic experiences
Define steps toward self-care
Understanding the Needs of Displaced Persons
68.5 Million people in the world displaced from their homes◦Poverty ◦Persecution◦Natural disasters◦In search of security
Relationship between Migration and Trauma
Begin with understanding trauma
Trauma viewed from Differing Perspectives
Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster.
• American Psychological Association
Psychological trauma may set in after a distressing or life-threatening event
• Psychology Today
A very difficult or unpleasant experience that causes someone to have mental or emotional problems usually for a long time
• Merriam-Webster
Trauma DefinedTrauma is an event that is extremely upsetting and at least temporarily overwhelms internal resources.
It can be a single event
More often than not it is multiple events over time (complex, prolonged trauma)
An interpersonal violence or violation, especially at the hands of an authority/trust figure is especially damagingChild abuse experiences
Displacement
Traumatic Experience
“Being traumatized means continuing to organize your
life as if the trauma were still going on unchanged.”
-Bessel van der Kolk, MD
Traumatic Events
Individual Trauma◦ Assault
◦ Abuse
◦ Life threatening illness
Group Trauma◦ Displacement - Refugees/Asylees
◦ Military Activity
Community or mass trauma◦ Disasters
◦ Terrorist attacks
Trauma Impacts Everyone Differently
Trauma is common across cultures
A particular culture may not use the word “trauma” but a different word or term
In the Haitian culture, the term “seizisman” or “seized-up-ness” is used to describe traumatic responses
How is trauma described in your culture?
Effects of Trauma over the Lifespan
Possible Manifestations of Unresolved Trauma
Trauma Impacts the Brain
During traumatic events, as well as during flashbacks, thinking and reasoning are overpowered by emotional responses.
Left Brain & Right Brain
Trauma or sustained high stress damages the connection between the left brain and the right brain.
Neuronal Response
Stress & the Tiger
• Bodies are designed to respond to stress
• Adrenalin and cortisol help us run from the tiger or hide
• This threat is short in duration
BUT…when the tiger lives in your home, neighborhood or life…
A Story of Hope: Phineas Gage
What Does Trauma Look Like?
In Our Emotions?
• Difficulty managing feelings
• Easily frustrated
• Shame
• Chronic emptiness
In Our Thinking?
• Catastrophizing
• Concrete thinking/Black & white thinking
• Memory problems
What Does Trauma LookLike?
In Our Relationships?
• Difficulty assessing social cues
• Difficulty seeking attention
• Challenges in seeing another's point of view
• Difficulty in maintaining relationships
In Our Actions?
• Impulsive
• Suicidal
• Self-injury, chemical use/dependency
• Disordered eating
• Trauma re-enactment
What Does Trauma Look Like?
Outward Expressions
• Anger or defiance
• Violence towards others
• Truancy
• Criminal acts
• Perfectionism
Inward Expressions
• Withdrawal
• Substance use
• Numbing
• Violence to self
• Self-doubt
What does Trauma Look Like-Long Term?
Affects a Person’s:
•Perception of time
•Cognitive style
•Affective tone
•Problem-solving skills
•Ability to respond to/understand rules, regulations, and laws
Post-Traumatic Stress Disorder in Migrant Populations
• Real or perceived possibility of death, serious injury, or sexual assault
• Can include witnessing or other exposure
Exposure to the traumatic event
• Intrusion symptoms (e.g., memories, nightmares)
• Avoidance of trauma related thoughts, feelings, reminders
• Negative alterations in cognition and mood
• Trauma-related changes in arousal/activity (e.g., aggression, sleep disturbance, hypervigilance)
• Lasts a month or longer
Additional criteria:
Triggers & Flashbacks
Triggers
Stimulus that sets off a memory of a trauma
Explicit
Subtle and inconspicuous
Flashbacks•Re-experiencing a previous
traumatic experience
•After-effects linger for hours or longer
•Brief movie scene that intrudes on the client
/
Potential Triggers
Lack of controlThreats or feeling
threatened or attacked
Observing threats or assaults
IsolationInteracting with authority figures
Lack of information Lack of privacyRemoval of clothing
(medical exams)
Sensory experiences (smells, sounds,
touch, taste, body position)
Being touched
Loud noises DarknessIntrusive or
personal questionsBeing locked in a
roomBeing ignored
Condescending looks/Tone of voice
Transitions or disruptions in
routine
Feelings of vulnerability and
rejection
Sensory overload (crowded spaces,
loud sounds, powerful smells)
TraumaticWorldview
No place is safe Other people are unsafe and
cannot be trusted
My own actions, thoughts, and
feelings are unsafe
I expect crisis, danger, and loss
I have no worth and no abilities
Mediating & ExacerbatingFactors
Person
Age or developmental stage
Past experiences
Strengths and coping skills
Cultural beliefs
Environment
Supportive responses from significant others
Access to safety and resources
Event
Severity and chronicity
Interpersonal as opposed to an act of nature
Intentional or accidental
Trauma and the Migrant Experience
Migration: Opportunities and Stressors
• Can yield improved economic well-being and safety for migrants and family back home
• Yet… the migration process exposes adults & youth to multiple stressors that can lead to trauma/trauma reaction
(Capps, Castañeda, Chaudry, & Santos, 2007; Flores & Kaplan, 2009)
Migration Process
Pre-migration in home country
Migration journey
Post-migration
Sociopolitical Environment
DACA – Deferred Action for Childhood Arrivals
Temporary Protected Status
Reduction in accepted refugees – what does this mean for Latinx immigrants?
Enforced border control and local law enforcement
Accelerated deportations
Proposal – if use federal benefits (e.g., food stamps, Medicaid, or housing assistance, a tougher path to citizenship
Pre-migration:Trauma encountered “back home”
• Poverty
• Poor access to education/ medical care
• Discrimination
• Enslavement/exploitation
• Natural disasters
• Violence
Migration: Trauma during the journey
• Persistent and realisticfear
• Loss and Grief
• Violence
• Injury & Illness
Post-migration: Trauma
• Language and Cultural barriers
• Acculturation process; impact on youth
• Perpetual fear
• Loss/Family separation
• Discrimination
• Poverty
• Violence
Post-migration Hardship
Depression
Suicidal
Ideation
Anxiety
Any
psychiatric disorder
Discrimination AcculturationLanguage &
Cultural barriers
(Acevedo-Garcia, Bates, Osypuk, & McArdle, 2010; Carvajal et al., 2014; Cho, Frisbie, Hummer, &
Rogers, 2004; Held & Lee, 2016; Ornelas & Perreira, 2011)
Trauma-Informed Care’s New ParadigmFrom: To:
From: To:
What is wrong with you?
What happened to you?
Control Collaboration
Traditional vs. Trauma Informed ApproachesTraditional Approach◦ You are sick◦ You are a diagnosis◦ You are broken and need
to be fixed
Trauma Informed Approach◦ You are not sick or labeled◦ You are injured
Core Principles of Trauma Informed Care Awareness: Everyone knows the role of trauma
Safety: Ensuring physical and emotional safety
Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries
Choice: Respect and prioritize consumer choice and control
Collaboration: Maximizing collaboration and sharing of power with consumers
Empowerment: Prioritizing consumer empowerment and skill-building
Cultural Humility: Respecting diversity within programs, provide opportunities for clients to express culture
Safety
Meeting people where they are “at”
The person’s culture is respected
and incorporated into all stages
of intervention
Identification and on-going assessment of triggers
and plans to address these
Establish and maintain
predictable routines to
increase the sense of
safety
Maintain a calm
environment to decrease
hyper-arousal
Support and promote
positive and stable
relationships in the
person’s life
Ensure opportunities
for success
Trustworthiness
Provide clear information about when, where, and by whom services will be provided¢
Be on time Do what you say you will do, and if
you can’t do it, take responsibility
Talk about the good, the bad, and
the ugly
Avoid “tricking” or “catching” people
Choice
When and where will you meet?
How does the person prefer to communicate?
How does the person prefer to be addressed?
Who will be on the team?
What services does the person want?
Person decides which goals to work on first?
When does the person want to terminate services?
Collaboration
Ask about a client's goals or priorities
Service plans should be developed by the client, with the support of the case manager
Ongoing assessment of which services have been effective
Do goals and service plans need to be adjusted?
Shared expectations for the helping relationship
During emotional times ask, “How can I support you right now?”
Empowerment
Focus on empowerment instead of management and
control
Build upon strengths and promote resilience
Emphasize developing and practicing coping skills instead of
“gaining insight”
Tips for Practicing Trauma Informed Care Recognize behaviors probably serve a
purpose Why is a person chronically miss morning
appointments? Is the morning the only time she can sleep due to intrusive dreams?
Adjustment to support the person. Set appointment times for the afternoon.
Include everyone in your agency From receptionist to treatment staff Provide trauma training to every employee
How do we provide Trauma Informed Care?To the best of your ability and within your given time constraints:
Lose the labels
Give him/her time and space to tell the story
Let the survivor lead
Respect his/her voice and choice
Recognize the survivor’s comfort level
Consider the survivor’s perspective from the cultural context
How Do We Provide Trauma Informed Care?Listen◦ What is the survivor saying to you?
◦ What is the survivor not saying?
◦ How is the survivor saying it?
Inform◦ What information do you have that
may help him/her?
◦ What will happen next in the process?
◦ Why is the information important for him/her to have?
◦ How can your services help him/her?
Interfacing with Clients
Engagement & Assessment
Client Education about Trauma
Routines
Emotional Management
Attunement with Clients
Self and Identity
Modulation
Relational Connections
Executive Functions
Engagement and AssessmentConsider how you greet people...
Consider culture-specific communication styles...
Consider who you include and how...
Consider how you explain the assessment process...
Be aware of historical distrust of service providers by various populations...
Be aware of the stigma or taboo associated with various topics...
Consider how the assessment process is perceived...
Education
Normalize experiences
Biological information
(briefly)
Empowerment Understanding Client/system
RoutinesUse routine and structure to create comfort
Session structureBuild daily rhythm with clients
Explore comfortable daily routines
Mastery and safety
Engage the body
Planned times together
Affect Management
Normalize Validate Identify emotional situations
Build self-monitoring
skills
Enhance self care
Support resources
Relational Connections
Explore connections in relationship
Establish resources and methods to
access others
Build skills to support effective use of
resources
Executive Functions
Support active recognition of capacity to make choices
Build ability to evaluate situations
Build ability to inhibit emotional response
Build ability to generate and evaluate potential solutions
“The expectation that we can be immersed in suffering and loss daily and not be touched
by it is as unrealistic as expecting to be able to walk
through water without getting wet.”
(Remen, 2006)
Self-Care
What is Self-Care?
Self-care is what people do for themselves to establish and maintain health, and to prevent and deal with illness.
It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure, etc.), environmental factors (living conditions, social habits, etc.) socio-economic
factors (income level, cultural beliefs, etc.), and self-medication.’
Terminology About Self-Care
•Vicarious trauma
•Stress
•Vicarious traumatization
•Secondary traumatic stress
•Compassion fatigue
•Burnout
Vicarious Resilience
Involves the process of learning about overcoming adversity from the trauma
survivor and the resulting positive transformation and empowerment through
their empathy and interaction.(Hernandez, Gangsei, and Engstrom, 2007)
Self care planning
Questions and Discussion