Module 1

Tippi Watson. MPH, BCHS

2014

ObjectivesBy the end of this class students will be able to

recognize:

The prevalence of trauma

Identify the key steps to TIC

Define trauma and identify the types of trauma

Understand the concept of resiliency and its importance

Identify the characteristics of a trauma informed organization

Identify the three R’s of TIC

Overview Trauma-informed care is…..

Strengths based approach

Based on an understanding of the impact of trauma

Responsive to the impact of trauma

Creates opportunities for individual control and empowerment.

Addresses service provision on all levels of safety

Physical

Psychological

emotional

What is Trauma Informed Care?SAMHSA defines trauma informed care as “a strengths based service delivery approach that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors to rebuild a sense of control and empowerment.” (SAMHSA, 2014, p.xix)

Trauma Informed Care “It involves diligence in anticipating and avoiding institutional processes and individual practices that are likely to retraumatize individuals who already have histories of trauma, and it upholds the importance of consumer participation in the development, delivery, and evaluation of services.” (SAMHSA, 2014, p.xix)

Why is TIC important?Many individuals who seek treatment

in a behavioral health setting have a history of trauma.

Most of those people do not draw a connection between the trauma and their maladaptive behavior.

SAMHSA endorses adherence to 6 key principles in a trauma informed approach Safety

Trustworthiness and Transparency

Peer support

Collaboration and mutuality

Empowerment, voice and choice

Cultural, Historical, and Gender Issues

Statistics….. In surveys of adolescents receiving treatment for substance abuse,

more then 70% of patients had a history of trauma exposure. (NCTSN.org,

2014)

NCS data shows that 60.7% of American males and 51.2% of females age 15 – 24 reported exposure to one or more traumatic events (Kessler et al.,

1995).

GSMS found that by age 16 - 67.8% of the children studied were exposed to one or more traumas (Copeland et al., 2013)

Up to two thirds of men and women in substance use disorder treatment report childhood abuse and neglect (SAMSHA, CSAT, 2000).

Study of male veterans in an inpatient unit found that 77% were exposed to severe childhood trauma and 58% had a history of lifetime PTSD (Triffleman et al., 1995).

Key elements of TIC Meet clients needs in a safe, compassionate, and

collaborative manner.

Prevent treatment practices that re-traumatize people

Treatment is built on the strengths and the resilience of the client

Treatment is transferable to the community setting.

Support the ideas of TIC in agencies through support, consultation, and supervision of staff.

What is trauma? SAMHSA defines trauma as:

“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 in the persons functioning and physical , social, emotional or spiritual well being.”

(SAMHSA, 2012, p.2)

How are we traumatized?Direct experience of the trauma

Witness the event

Feel threatened by someone or something

Hear about an event that effects someone you know

What kind of events?Human made wide scale disasters

(World Trade Center Bombing, Oklahoma City Bombing, Roswell school shooting).

Human made individual events (sexual assault, mugging, domestic violence.)

Natural disasters (flood, tornados, hurricanes)

Why do some people develop maladaptive behaviors and not others?

Resiliency - The ability to rise above the circumstances or to meet the challenges with fortitude.

Stage of development when the trauma occurred.

Support system in place

Trauma experience

Previous outcomes that were successful

Characteristics of a Trauma Informed Organization Invested in their staff and its development

Promote TIC in training of all staff

Adopt trauma informed principles of care

Address secondary trauma issues

Implement processes that reinforce the safety of their staff.

Resiliency and its impactResiliency - The ability to thrive despite negative life experiences and heal from traumatic events. It is directly related to the internal strengths and environmental supports of an individual.

We must make a shift from a ‘pathology’ mindset to one of resilience… a mindset that views clients’ presenting difficulties, behaviors, and emotions as responses to surviving trauma.

We must view traumatic stress reactions as normalreactions to abnormal situations.

Factors that contribute to resilience include…. Close relationships with family and friends A positive view of yourself and confidence in your strengths and

abilities The ability to manage strong feelings and impulses Good problem-solving and communication skills Feeling in control Seeking help and resources Seeing yourself as resilient (rather than as a victim) Coping with stress in healthy ways and avoiding harmful coping

strategies, such as substance abuse Helping others Finding positive meaning in your life despite difficult or

traumatic events

Key Elements to a Trauma-Informed Approach1. Realizing the prevalence of trauma

2. Recognizing how trauma affects all individuals involved with the program, organization, or system including its own workforce.

3. Responding by putting this knowledge into practice.

(SAMHSA, 2012, p.4)

1. Realizing the prevalence of trauma

According to the National Comorbidity Study 61% of men and 51% of women report experiencing at least one traumatic event in their lifetime.

Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions 71.6% of the sample reported witnessing trauma, 30.7 % experienced a trauma that resulted in injury, and 17.3 % experienced psychological trauma.

(SAMHSA, Tip 57: Trauma-Informed Care in Behavioral Health Services, 2014)

Prevalence of Trauma American study of adolescent inpatients found that 93% had

histories of trauma and 32% had PTSD (Lipschitz et al, 1999)

According to the National Survey of Adolescents, (1997) 8% of all children age 12 to 17 report a lifetime prevalence of sexual assault, 17% reported physical assault, and 39% reported witnessing violence.

Gabby et al, (2004) reports from review of research that up to 63% of survivors of childhood abuse, 53% of the children who were medically ill, and 95% of disaster survivors suffered from PTSD.

97% of homeless women with SMI have experienced severe physical and sexual abuse – 87% experience this abuse both in childhood and adulthood (Goodman et al, 1997).

Prevalence continued…. Up to two-thirds of men and women in substance use disorder

treatment report childhood abuse and neglect (SAMHSA. CSAT, 2000)

55-99% of women with substance abuse disorders have a lifetime history of trauma; 50% of women in treatment have a history of rape or incest (Navjatis et al., 1997; Gov. Commission on Sexual and Domestic Violence, Commonwealth of MA, 2006)

Being abused or neglected as a child increases the likelihood of arrest as a juvenile by 59% (widom, 1995).

70% - 92% of incarcerated girls reported sexual, physical, or severe emotional abuse in childhood. (DOC, 1998, Chesney & Sheldon, 1997).

Studies suggest that 49 percent of people with intellectual disabilities will experience 10 or more sexually abusive incidents in their lifetime(Sobsey & Doe, 1991).

Between 75 and 95% of people with an intellectual or developmental disability will be sexually assaulted in their lifetime (ADC, Rights and Advocacy,

1996).

2. Recognizing how trauma affects all individuals involved.The consumer of services

The family of the person receiving services

The staff members supporting the person receiving services.

The community service providers

Schools, employers, and other agencies

3. Responding Using this knowledge to create individualized services

Acting on the needs of the individual

Strengths based approaches are vital to success

Consumer driven care

Quality services

TIC begins with the first contact a person has with an agency.

Recognizing that Trauma-Related Symptoms and Behaviors Originate from Adapting to Traumatic Experiences

Trauma related symptoms and behaviors are an individuals best and most resilient attempt to manage, cope with, and rise above his/her experience of trauma.

Individuals do the best they can with what they have.

Traumatic stress reactions are individual specific reactions. No two people will be the same.

People do not wake up and say “I am going to be dysfunctional today.”

Trauma is never and excuse, but it is an explanation.

Universal PrecautionsTreat individuals with care and assume that trauma may have likely happened in their lives. Just as you would treat all biological fluids as if they contained a contagion.

What is a strengths based approach?Strengths based approach is based on six key principles according

to the research of Saint-Jacques (2009): Every individual, family, group and community has strengths.

Focusing on these strengths instead of the pathology is of prime importance.

The community is a rich source of resources Interventions are consumer driven and self–determination is

respected. Collaboration is the central goal between the practitioner and

the client and is primary and essential. Outreach is the preferred mode of intervention. Treatment in

the community should be the goal. Providing that support is critical for sustained success.

All people have an inherent capacity to learn, grow and change.

What is different about a Trauma Informed Program? Program policies, procedures and practices protect the

vulnerabilities of the trauma survivor.

Program policies, procedures and practices protect the vulnerabilities of the support staff.

Practices are designed with consumer input.

First do no harm is at the core of TIC.

The organization is committed to building competence among staff.

Establishes program standards and clinical guidelines that support delivery of trauma sensitive services.

What questions do you have?

References SAMHSA, Trauma Informed Care in Behavioral Health

Services, Tip 57, 2014.

Turner, T. National Association of State Mental Health Program Directors, SAMHSA, retrieved June 2014.

Journal of Family Violence, ISSN 0885-7482.