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

TRAUMA IS UNDER-REPORTED AND

UNDER-DIAGNOSED(NTAC,2004)

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

Trauma is when people live with more fear than HOPE

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

Trauma Recovery is when people live with

MORE hope than fear

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

Remember…..

IT’S NOT WHAT YOU SAY BUT HOW YOU SAY IT

Voice tone counts for 38% of the message sent….this increases to 90% when using the telephone

You may be the first contact with the agency so make it a GOOD experience

Smile Be Courteous, Attentive and Pleasant