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Secondary  Trauma3c  Stress  Saprina  Matheny,  MSW,  LICSW  

Ambit  Network  

Ambit  Network,  University  of  MN  Naviga&ng  Research  and  Prac&ce  in  Child  Trauma    

 •  Established  in  2005  as  an  NCTSN  Community  Treatment  and  

Services  Center  through  SAMHSA  funding.  Project  Co-­‐Directors:  Drs.  Abi  Gewirtz  and  Chris  Bray  

   •  The  MN  Na6onal  Child  Trauma6c  Stress  Network  site  

(www.ambitnetwork.org  and  www.nctsn.org.    

•  Purpose:  to  raise  the  standard  of  care  and  improve  access  to  services  for  trauma3zed  children,  their  families,  and  their  communi3es.  

 •  A  university-­‐community  partnership  including  a  variety  of  

nonprofit,  government,  and  community  agencies    

Ambit  Network  Naviga&ng  Research  and  Prac&ce  in  Child  Trauma  

•  Ambit/DHS  train  mental  health  organiza3ons  across  the  con3nuum  of  care  in  evidence-­‐based  treatments  for  trauma    

•  Connect  “front  door  agencies”  to  trauma  trained  clinicians  

•  Assist  in  developing  trauma-­‐informed  child-­‐serving  agencies    

•  Emphasize  subpopula3ons  of  trauma3zed  children—those  affected  by  parental  military  deployment,  refugee  and  immigrant  children,  and  American  Indian  children  

•  Expect  to  serve  more  than  4,100  children.    

 There  is  a  cost  to  caring.  

Charles  Figley  

Working  with  trauma-­‐exposed  children  can  evoke  distress  in  providers  that  makes  it  more  difficult  for  them  to  provide  good  care.  

– Providers  must  deal  with  personal  and  professional  challenges  

– The  work  may  evoke  strong  memories  of  personal  trauma  and  loss  related  experiences  

– Proper  self  care  is  important.  

Core  Concept  #12   Secondary  Trauma&c  Stress  

Refers  to  the  reac3on  a  person  has  as  a  result  of  exposure  to  a  trauma3zed  person’s  story  and  trauma3c  stress  

reac3ons.    

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12  Core  Concepts:  Impact  of  Trauma  on  Staff  Wellness    

Prior  Trauma  

Trauma3c  Grief/Loss  

Direct  Exposure  

Secondary  Trauma  

Compassion  Fa3gue  

Burnout  

1. Traumatic experiences are inherently complex  

What  are  some  sources  of  secondary  trauma8c  stress  in  

your  work?  

Core Concept 2

Trauma occurs within a broad context that includes personal characteristics, life

experiences, and current circumstances.

The Adverse Childhood Experiences Study

 

Adverse  Childhood  Experiences  and  Maladap3ve  Coping  Strategies  

 

Dr. Felitti – Kaiser Permanente Dr. Anda – Center for Disease Control and Prevention

Adverse  Childhood  Experiences    

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•  Emo3onal  abuse  

•  Physical  abuse  

•  Sexual  abuse  

•  Emo3onal  neglect    

•  Physical  neglect  

•  Household  dysfunc3on:  •  Mother  treated  violently  

•  Household  substance  abuse  

•  Household  mental  illness  

•  Parental  separa3on/divorce  

•  Incarcerated  household  member  

Source: Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... Marks, J. S. (1998). 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.

What  is  your  ACE  Score?  

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Adverse  Childhood  Experiences  are  Common  

                           

(www.acesstudy.org)

Household dysfunction: % of sample

Substance Abuse 27% Parental Sep/Divorce - Absence 23% Mental Illness 17% Battered Mother 13% Criminal Behavior 6%  

Adverse  Childhood  Experiences  are  Common  

2. Abuse: % of sample Psychological 11% Physical 28% Sexual 21%

3. Neglect: Emotional 15% Physical 10%    

 

(www.acesstudy.org)

Important  Adverse  Childhood  Experiences  NOT  Covered  in  the  ACE  Study  

Community Violence  •         Witnessing  a  shoo3ng/bombing  or  riot    •         Being  shot  at    

       •         Being  jumped  or  beaten    

     •         Being  stabbed    •         Having  lost  someone  close  to  you  to  murder  

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Long-­‐Term  Trauma  Impact–ACE  Pyramid:  CDC    

Early    Death  

Disease,  Disability,  and  Social  Problems  

Adop3on  of  Health-­‐risk  Behaviors  

Social,  Emo3onal,  and  Cogni3ve  Impairment  

Disrupted  Neurodevelopment  

Adverse  Childhood  Experiences  

Mechanisms  by  Which  Adverse  Childhood  Experiences  Influence    Health  and  Well-­‐being  Throughout  the  Lifespan    

Concep3on  

Death  

Core Concept 2

What  are  the  ecological  factors  (intrinsic/extrinsic)  that  affect  how  you  respond  to  our  work?  

Person

al  Histo

ry  

Coping

 Style  

Invisib

le  Suitc

ase   Caseload  

Personal  Family  Circumstances  

Job  Sa6sfac6on  

Co-­‐Worker  Dynamics  

Core Concept 3

Trauma3c  events  oben  generate  secondary  adversi3es,  life  changes,  and  distressing  reminders  in  daily  life.      How  has  your  work  changed  you?    What  are  your  own  triggers?  

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Secondary  Trauma&c  Stress  can  change  our  interac&ons  with  the  world,  our  families,  our  friends.  

 

What’s  in  your  suitcase?  

“Since I started this

job my wife has said

that I have changed.

She says I have

become cold

hearted. I know I

have changed,

comes with the job.”

 

(From  “Secondary  Trauma&c  Stress  :  What  is  it”    Leslie  Ross  and  James  Henry,  2012).  

•  What are the ways you feel your work has had a negative influence on what matters to you in life?

•  What are the ways you feel

your work has had a negative influence on the way you see the world?

•  What are the ways you feel

your work has had a negative influence on the way you see yourself or the ways others in your life see you?

Core  Concept  4  

• We  can  exhibit  a  wide  range  of  reac3ons  to  trauma  and  loss.  

 

What  are  the  signs  that  you  may  be  experiencing  Secondary  

Trauma3c  Stress?  

STS  Signs  and  Symptoms  •  Avoidance  (including  of  certain  clients)  •  Preoccupa3on  with  clients/client  stories  •  Intrusive  thoughts/nightmares/flashbacks  

•  Arousal  symptoms  

•  Thoughts  of  violence/revenge  •  Feeling  estranged/isolated/having  no  one  to  talk  to  •  Feeling  trapped,  “infected”  by  trauma,  hopeless,  inadequate,  depressed  

•  Having  difficulty  separa3ng  work  from  personal  life    

Sound  familiar?  23

Signs  of  STS  

Physiological  reac3ons:        sleep  disturbances      headaches,  stomach  aches      impaired  immune  system  

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What  are  the  signs?  

Emo3onal  reac3ons:      irritability      uncontrolled  emo3ons      anxiety  or  fear      anger,  rage,  hos3lity      detachment,  shugng  down      boredom      feeling  incompetent  

What  are  the  signs?  

Cognitive reactions:!!!diminished concentration!!!confusion!!!intrusive traumatic imagery!!!self doubt!!!preoccupation with others’!

!traumas !!!!perfectionistic thinking!

What are the signs?!Behavioral  reac3ons:      impa3ence  with  others      sleep  disturbances      nightmares      startle  response      hypervigilance      use  of  nega3ve  coping  !!losing things!

What  are  the  signs?  

Spiritual  reac3ons:      loss  of  purpose      sense  of  meaninglessness      anger  at  God      ques3oning  prior  spiritual  

           beliefs      pervasive  hopelessness  

What are the signs?!Interpersonal reactions:!!!withdrawing/isolating!!!decreased interest in sex or intimacy!!!mistrust of others!!!impact on parenting!!!projection of anger or blame!!!intolerance of others‘ behaviors!

Vicarious  Trauma  Warning  Signs  

Chronic

Exhaustion Disconnection

Social Withdrawal

Insensitivity to Violence or Injustice

Loss of

Creativity

Avoidance

Poor

Boundaries

Anger/Cynicism

Diminished Self-Care

Illness

Survival Coping

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•  Increase  sense  of  helplessness  •  Reduced  perspec3ve  taking    •  Reduce  ability  for  cri3cal  thinking  •  Difficulty  recognizing  and  monitoring  emo3ons  and  reac3vity  

•  Over  or  under  react  to  poten3al  hazards  •  Can  be  contagious  

If  Unaddressed,  STS  can   Effects  of  Vicarious  Trauma  •  Dreaming, reexperiencing, or continually

thinking about the event •  Trouble sleeping •  Being frequently reminded of the event •  Being avoidant •  Feeling anxious or fearful •  Feeling depressed

Core  Concept  5  Danger  and  safety  are  core  concerns    when  

we  are  exposed  to  trauma    

 What  makes  a  physically  and  psychologically  safe  work  environment?     What  do  you  need  from  your    supervisor?  What  do  your  supervisees  need  from  you?  

Organiza8onal  Stress  Organiza3ons,  like  individuals,  are  living,  complex,  adap3ve  systems.  They  are  vulnerable  to  stress,  par3cularly  chronic  and  repe33ve  stress.    

Organiza&onal  Stress    

What  do  you  think  are  some  events  that  can  contribute  to    

organiza3onal  stress?  

When  our  organiza3on  is  stressed,  we  

are  all  stressed.    

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How Staff Stress Impairs Organizational Functioning

Increased Absenteeism

Impaired Judgment

Unwillingness to Accept Extra Work

Low Motivation

Low Productivity

Increased Staff Friction Higher Staff Turnover

Impact  of  Organiza3onal  Stress    

Stuck Missionless Crisis Driven

Punitive Unsafe

http://youtu.be/oXCuGvsThEw

Impact  of  Organiza3onal  Stress    

Stuck Missionless Crisis Driven

Punitive Unsafe

http://youtu.be/oXCuGvsThEw

Core  Concept  6  

•  Trauma3c  experiences  affect  our  family  and  broader  caregiving  system  

How  impact  does  our  work  have  on  our  rela3onships  with  our  friends  and  family?  How  do  we  maintain  posi3ve  rela3onships  with  coworkers  or  collaborators  during  3mes  when  they  see  us  as  contribu3ng  to  STS?  

Core  Concept  7  

Protec3ve  and  promo3ve  factors  can  reduce  the    adverse  impact  of  trauma  

 

Vicarious  Trauma:  Risk  and  Resiliency  Factors  

Personality

and Coping

Style

Past Trauma History

Current Life Circumstances

Social Support

Spiritual Resources

Work Style

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Core  Concept  8  

Trauma  and  post-­‐trauma  adversi3es  can  strongly  influence  development  

What  beliefs  do  you  hold  that  may  make  you  more  vulnerable  to  secondary  trauma3c  stress?  

Core  Concept  9  

• Culture is closely interwoven with traumatic experiences, response, and recovery  

What  are  some  of  the  organiza3onal  cultural  issues  that  impact  secondary  trauma3c  stress?  

Core  Concept  10  • Neurobiology  underlies  reac3ons  to  trauma3c  experiences    

How  does  empathic  engagement  and  secondary  trauma3c  stress  reac3ons  impact  our  neurobiology?  

Workplace  Strategies  Wellness  ac6vi6es  

Mindfulness  exercises    

Team  building  ac6vi6es  

Celebra6ons  

Use  Vaca6on    Leave  Time  

Buddy  System  

Organiza6onal  support  

Resiliency  Building  Ac6vi6es  

Core  Concept  11  

Challenges  to  the  social  contract,  including  legal  and  ethical  issues,  affect  trauma  response  and  recovery  

• What  are  the  system  issues  that  increase  your  risk  of  a  sense  of  hopelessness,  helplessness,  or  anger?  

Core  Concept  12  

Working  with    trauma-­‐exposed  children  can  evoke  distress  in  providers  that  makes  it  more  difficult  for  them  to  provide  good  care.    How  do  we  take  care  of  ourselves?  How  do  our  organiza3ons  support  us?  

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Steps  to  Stress  Reduc&on    

•  Engage in self-care.

•  Accept organizational limitations.

•  Uphold organizational responsibilities.

Steps  to  Stress  Reduc&on:  Engage  in  Self  -­‐Care  

Self-care is the ability to engage in helping others without sacrificing other important parts of one’s

life.

The  A-­‐B-­‐C’s  of  Self-­‐-­‐Care   Awareness  

Balance

Physical

Psychological

Emotional

Spiritual

Professional

Connection…

with your family

with your partner

Silence of the

Lambs

with your friends

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It is unethical not to attend to your self care as a practitioner,

because self care prevents harming those we serve.  

 Charles Figley

Balance

Physical

Psychological

Emotional

Spiritual

Professional

Top  10  signs  you’re  too    stressed  

•  You  fake  calls  from  your  child’s  school  so  you  have  an  excuse  to  go  home.  •  When  you  pull  out  your  Blackberry  for  the  tenth  3me  your  child  threatens  to  

throw  it  out  the  window.  •  You  listed  Starbucks  as  your  emergency  contact.  •  You  pencil  in  your  bathroom  breaks.    •  Case  files  have  become  “light  bed3me  reading.”  •  Your  best  friends  think  you  have  moved  away  because  they  have  not  heard  from  

you  in  so  long.  •  You  consider  Red  Bull  part  of  a  balanced  diet.  •  You  fall  asleep  during  trips  to  the  den3st’s  office  because  it’s  the  only  3me  you  put  

your  feet  up.  •  It  takes  you  six  days  of  vaca3on  to  begin  to  relax  and  six  minutes  in  the  office  to  

forget  you  took  one.  

3 current mentors

3 joy or beauty

3 people not in immediate

3  people  immediate    

3  friends—no  work  

3  ac3vi3es  

Every  Day   Every  Week  

Every  Month   Every  Year  

It is unethical not to attend to your self care as a practitioner,

because self care prevents harming those we serve.  

 Charles Figley

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Just  as  despair  can  come  to  one  only  from  other  human  beings,  hope,  too,  can  be  given  to  one  

only  by  other  human  beings.        

Elie  Wiesel  Author,  Ac&vist  

Holocaust  Survivor  

Trauma Resources

Na3onal  Child  Trauma3c  Stress  Network  • www.nctsn.org  Na3onal  Center  for  Trauma-­‐Informed  Care  •   www.samhsa.gov/nc3c  DHS  Trauma-­‐Informed  Care    • www.  www.dhs.state.mn.us  Na3onal  Registry  for  Evidence-­‐Based  Prac3ces  • www.nrepp.samhsa.gov    

Trauma Resources Trauma  Focused-­‐Cogni3ve  Behavioral  Therapy  •  ncbt.musc.edu  

ACE  Study    •  www.cdc.gov/nccdphp/ace  

Crea3ng  Sanctuary  in  Schools  Bloom,  S.  •  www.  Sanctuaryweb.com  

Child  Trauma  Academy  •  www.childtraumeaacademy.com  

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 Saprina  Matheny,  MSW,  LICSW  

Ambit  Network  smatheny@umn.edu