August 15th 2014, Jacobs Center.

Trauma Informed Presentation 10:15AM to 12:15 PM

SDSU School of Social Work Annual Field Instructor’s Orientation Meeting,

8.00 am to 12:30 pm

Trauma Informed Care: Implications for Field Instruction,

Kimberly Beckstead LCSW

Learning Objectives:

O Apply the core principles of Trauma Informed Care in field instruction O Define trauma and understand its impact on the brain O Express the basic tenants of Trauma Informed Care and its importance in

practice O Demonstrate an understanding of both risk and protective factors

Outline:

O Defining trauma and understanding its impact on the brain O Vincent Felitti and Adverse Childhood Experience Study O Understanding ACE Score – personal and professional application O Risk and Protective Factors O Express the basic tenants of Trauma Informed Care and its importance in

practice O Impact of Trauma on Physical Health O Juggling “Kai” Small Group Activity O 10 Principles of Trauma Informed Care in Institutional and Direct Practice O Group Activity - Trauma Informed Lens for Interns – Lucy the Intern O Questions and Answer – Discussion

Kimberly Beckstead LCSW

Kimberly is a Licensed Clinical Social Worker (LCSW) currently working as the Clinical Program Manager at Marine Corps Air Station Miramar, providing supervision to AOD Counselors as well as direct care for active duty Marines and Sailors. Her focus and professional passion are aimed providing trauma informed clinical individual and group therapy to various populations in both private practice and as a DOD employee. Kimberly graduated UCSD with a BA in Communication. She went on to pursue her MSW at SDSU, Graduate School of Social Work, where she was awarded the Mental Health Stipend. Kimberly began working for Mental Health Systems Inc. in 2008 as a Clinical Case Manager. In 2009 she became one of the founding members of the San Diego Trauma Informed Guide Team (SDTIGT), a grass roots, integrated community based group, focusing and disseminating core competencies of systemic trauma informed services. In addition, Kimberly provides private consulting and trainings in the San Diego and Riverside Counties with specialty in Trauma Informed Care, Trauma Informed evidence based practices and mental health.

References / Bibliography

• Covington, S. (2003). Beyond Trauma: A healing journey for women. United States. Hazelden Foundation.

• Harris, M. & Fallot, R. (Eds.). (2001). Using trauma theory to design service systems. San Francisco, CA. Jossey-Bass.

• Herman, J. (1997). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. New York, NY. Basic Books.

• Perry, B. & Szalavitz, M. (2006). The boy who was raised as a dog: And other stories from a child psychiatrist's Notebook—what traumatized children can teach us about loss, love, and healing. New York, NY. Basic Books.

• www.apbspeakers.com/speaker/vincent-felitti

• www.biology.about.com/od/humananatomybiology/a/anatomybrain.htm

Updated References on Trauma Informed Care

Covington, S. (2003). Beyond trauma: A healing journey for women. United States. Hazelden Foundation. Harris, M. & Fallot, R. (Eds.). (2001). Using trauma theory to design service systems. San Francisco, CA. Jossey-Bass. Herman, J. (1997). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. New York, NY. Basic Books. Perry, B. & Szalavitz, M. (2006). The boy who was raised as a dog: And other stories from a child psychiatrist's Notebook—what traumatized children can teach us about loss, love, and healing. New York, NY. Basic Books. www.apbspeakers.com/speaker/vincent-felitti www.biology.about.com/od/humananatomybiology/a/anatomybrain.htm Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS PublicationNo. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

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Trauma Informed Care

Kimberly Beckstead LCSWKimberlysd23@yahoo.com

Learning Objectives

O Apply the core principles of Trauma Informed Care in field instruction

O Define trauma and understand its impact on the brain

O Express the basic tenants of Trauma Informed Care and its importance in practice

O Demonstrate an understanding of both risk and protective factors

Housekeeping

O Silence Cell PhonesO BreaksO “Parking Lot”

Introductions

O Please share with neighbor:O Your name and agencyO Is there something specific you are

hoping we cover today?O Share one word you associate with

TraumaO Fields of Service here today? –

Show of hands – Feedback to group

Common Definition of Trauma

The experience, threat, or witnessing of physical harm, that overwhelms a person’s

ability to cope.

Keep this in mind…

•How do you define trauma?

•Awareness that definition is subjective

•Based on individual experience

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What is Trauma?•Neglect•Domestic Violence •Witnessing DV•Childhood Sexual Abuse•Childhood Physical Abuse

What is Trauma?

•Sexual Assault•Human Trafficking •Criminal Victimization•Extreme Economic Depravation•Natural Disasters•War

Complex TraumaO Is a term now being used to define the

profound effects of trauma on a developing child that can affect cognitive, language and emotional development, behavioral control, self-concept, affect regulation, relational intimacy, and physical health.

“The Boy Who Was Raised as a Dog”. Perry, B and Szalavitz, M. (2006).

PTSD as Cognitive Disability

•Trauma interferes with:• Interpretation •Ability to correctly receive and

communicate information•Understanding of the world around them

The “Hand Brain”

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Break“Time doesn’t heal, time conceals.”

Dr. Vincent FelittiACE Principal Investigator

Felitti VJ, Anda RF, Nordenberg D, et al: Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine 14:245–258,1998

Adverse Childhood Experiences

(ACE)ACE Before Age 18

• Recurrent physical abuse

• Recurrent emotional abuse

• Contact sexual abuse• An alcohol and/or drug

abuser in the household• An incarcerated

household member

•Someone who is chronically depressed, mentally ill, institutionalized, or suicidal•Mother is treated violently•One or no parents•Emotional or physical neglect

ACES have a strong influence on:

•If the ACE score is 4+• Adolescent health• Teenage pregnancy• Smoking• Alcohol abuse• Illicit drug abuse• Serious physical health issues

ACE Questionnaire 

O Break into groups at your tableO Review the ACE questionnaire

O Multigenerational DiscussionO Think of a child on your caseloadO Think about the ACE score of the

childO ACE score of one of their parentsO Present to the rest of the group

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COLEVA.NETTrauma Specific vs. Trauma 

Informed• Trauma Specific

• Treating the actual trauma• Trauma resolution as the ultimate goal

• Trauma Informed• Accommodating trauma survivors• Creating sense of safety as the goal

• Scope of Practice- Do No Harm• Ex: Americans With Disabilities Act (1990)

"Using Trauma Theory to Design Service Systems." Harris & Fallot. (2001)

Juggling Exercise“Kai”

“Traumatized Individuals live in an unsafe world, doing

unsafe things in an attempt to be safe.”-Gabriella Grant

ACESSelf Inventory

O What is the importance of knowing your own ACE score?

O Important Internal Questions to AskO What were some of your protective

factors contributing to your resilience

O What biases are you bringing into the room?

Putting this into Practice

O Agency assessmentO Identifying Trauma Informed

ChampionO Environmental AssessmentO Paradigm Shift

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Emphasize Early Screening

O Make early screening for trauma, assessment of the impact of trauma, and referral for integrated trauma services common practice.

Adapted from The National Council for Community Behavioral Healthcare. http://www.thenationalcouncil.org/cs/traumainformedcare a call to arms

Develop Your Workforce

O Create workforce orientation, training, support, competencies and job standards related to trauma.

O Don’t just train clinical staff-train and educate everyone who comes into contact with consumers, from the receptionist to the maintenance staff.

Adapted from The National Council for Community Behavioral Healthcare. http://www.thenationalcouncil.org/cs/traumainformedcare a call to arms

Institute Practice Guidelines

O Centralize clinical practice guidelines for working with people with trauma histories.

O Develop policies, practices, and standards to support access to evidence-based and emerging best practices in trauma treatment.

Adapted from The National Council for Community Behavioral Healthcare. http://www.thenationalcouncil.org/cs/traumainformedcare a call to arms

10 Principles of TIC in Direct Practice

1. Recognize impact of violence and victimization on coping skills

2. Establish recovery from trauma as primary goal

3. Employ empowerment model4. Maximize choice and control over

treatment 5. Based on relational collaboration

10 Principles of TIC in Direct Practice

6. Environment designed to ensure safety, respect and acceptance7. Highlight strengths and resiliency 8. Minimize possibility of re-traumatization9. Culturally competent and understand the client from context of their life experience10.Solicit customers input and feedback in design and evaluating services.

Group Activity

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Lucy the InternLooking through the TI Lens

Group Discussion

1. What should this intern have explored with this client first?

2. What part of the brain was this intern’s client most likely operating in?

3. How would advise your intern to you create a sense of safety with this client?

4. How can you prepare your intern for a situation like this in the future?

Stages of Trauma Recovery

O Stage One: ESTABLISHING SAFETY- (Trauma Informed)O -Securing safetyO -Stabilizing symptomsO -Fostering self-care

O Stage Two: REMEMBRANCE & MOURNING- (Trauma Specific)O -Reconstructing the traumaO -Transforming traumatic memory

O Stage Three: RECONNECTION-(Trauma Specific)O -Reconciliation with selfO -Reconnection with othersO -Resolving the trauma Judith L. Herman, 1992

TIC Wrap Up

Questions and Feedback

Thank you!

References• Covington, S. (2003). Beyond Trauma: A healing journey for women. United States.

Hazelden Foundation.• Harris, M. & Fallot, R. (Eds.). (2011). Using trauma theory to design service

systems. San Francisco, CA. Jossey-Bass.• Herman, J. (1997). Trauma and recovery: The aftermath of violence—from domestic

abuse to political terror. New York, NY. Basic Books.O Perry, B. & Szalavitz, M. (2006). The boy who was raised as a dog: And other stories

from a child psychiatrist's Notebook—what traumatized children can teach us about loss, love, and healing. New York, NY. Basic Books.

• www.apbspeakers.com/speaker/vincent-felitti• www.biology.about.com/od/humananatomybiology/a/anatomybrain.htm

Contact Information

Kimberly Beckstead, LCSWE-mail: kimberlysd23@yahoo.com

Phone: 760 504-1967

Lucy the Intern

Lucy Jones is a first year intern at your field site, a county contracted youth program in City Heights. She is in her first year MSW Program at SDSU School of Social work and has been interning at this site for the last 4 weeks. Lucy shares her experience in a recent individual session she had with a student named Jose, a 16 year old participating in the substance abuse counseling intensive outpatient program at the field placement.

She explains that while in session she brought up his relationship with his father and any “bad memories” he had of him growing up. She further reported that she observed this client, growing flushed, losing eye contact, complaining his hands were going numb and eventually laying in the fetal position on the ground unresponsive. Lucy reported that she got up and approached Jose, tapping him on the shoulder asking if he was okay. At this time, he jumped up and yelled at her, storming out of the room. Lucy is unsure as to what happened and what to do, since he has not returned her phone call since the session took place 1 week ago. Lucy is shaken up and is worried she has caused this client damage.

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Administration Concentration Expands: Administration and Community Development

There are emerging needs and opportunities in the communities and the larger human services systems in which social workers operate.

Working with grassroots communities and agencies is again gaining prominence in social work

The School's Consensus Organizing Center is playing a growing role in advancing this trend in San Diego.

The School's growing international programs go beyond traditional administration settings to incorporate community development methods.

Required courses for both Admin and CD

SW 720: Civic Engagement and the Social Environment

SW 740: Advanced Seminar In Social Work Administration and Community Development

SW 755: Field practicum in Administration/Community Development

SW 791 or 797: Advanced Evaluation/Research or thesis

SW 702: Advanced Social Policy

Administration Specialization

Goal: educate students who can upon graduation assume positions as supervisors, program managers, or staff workers such as analysts or program specialists in public and not-for-profit human service agencies.

Administration = management + leadership Management: planning, program design, information

systems, program evaluation, financial management, human resource management, and supervision.

Leadership: visioning, inspiring and motivating staff, strategic management, and organizational change.

Administration Courses(Electives)

SW 745: Leadership and Organizational Change SW 758: Financial Management & Resource

Development SW 758: Information Systems & Knowledge

Management (alternatives: NUSR 648 Information Systems for Nursing or MIS 688: Information Systems in Organizations)

Other departments: Business, Public Administration, Public Health, Psychology

CERTIFICATE IN SOCIAL WORK ADMINISTRATION

Available for current or graduated MSW Administration students

Specifically deigned for Direct Practice/ Clinical MSWs who are entering or planning to enter administration

Courses: Social Work courses on the previous slide plus SW 740: Advanced Seminar In Social Work Administration and Community Development

Questions? Contact Tom Packard at tpackard@mail.sdsu.edu

Community Development Specialization

Goal: educate students who want to apply their administrative, policy, and organizing skills in a community setting with a focus on developing local communities and institutions

Community Development = the economic (income, assets), physical (housing, transportation, commercial, public

spaces, environment), and social (social bonds and involvement) revitalization of a community led by the people who live in that community

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Community Development Courses(Electives)

SW 758: Community Organizing and Problem SolvingSix units of electives selected from: SW 780: International Social Work and Social Welfare SW 745: Leadership and Organizational Change SW 758: Financial Management & Resource

Development SW 758 Information Systems & Knowledge Management SW 758: Immigration Issues in SW

Integration with Advanced Field Practicum

Internships in community development settings arranged through the Consensus Organizing Center

Examples: Libraries, Neighborhood Associations, Financial Institutions

Non-MSW supervision at the site and MSW supervision through the Consensus Organizing Center