Trauma informed care and the intersection with brain injury · · 2015-11-23Trauma informed care...
Transcript of Trauma informed care and the intersection with brain injury · · 2015-11-23Trauma informed care...
Trauma informed care and the intersection with brain injury
Rohini Gupta, PsyD
October, 2015
Introduction
❖ Core faculty at University of Denver, Graduate School o Professional Psychology,
International Disaster Psychology Program
❖ Private Practice: Gupta Psychology that specializes in trauma treatment and cross cultural
counseling
❖ rohiniguptapsyd.com
❖ 303-675-7009
❖ Director of the Trauma and Disaster Recovery Clinic
❖ Training clinic that provides services to those who have experienced adversity
❖ Individual child and adults, couples, family, groups, outreach presentations, and program
❖ http://www.du.edu/gspp/services/tdrc.html
❖ 303-871-3087
Learning objectives
❖ Introduction to trauma and the overlap with TBI
❖ Understanding Trauma informed care and examples
that illustrate the concepts
❖ Challenges to implementing this approach
❖ Questions
What is trauma?
❖ “An event that overwhelms a person’s ability to cope (Herman, 1997)
❖ “Individual trauma results from an event, series of events, or set of
circumstances that is experience by an individual as physically or
emotionally harmful or life threatening and that has lasting adverse
effects on the individuals’s functioning and mental, physical, social,
emotional, or spiritual well-being (SAMHSA, 2014, pg. 7)
❖ DSM Definition:
❖ Stressor
❖ Intrusive symptoms, avoidance, negative alterations in cognitions
and mood, alterations in arousal and reactivity
Prevalence and impact (Harris and Fallot, 2009)
❖ Pervasive:
❖ National community based surveys reveal 55% to 90% have experienced 1 traumatic event
❖ Impact is broad reaches many domains
❖ Increase risk of MH problems, depression, anxiety, SA, health problems, eating disorders,
suicidality, and difficulty in relationships
❖ ACE Study (Felitti et al., 1998)
❖ Impact is deep and life shaping
❖ Can be life altering
❖ Neurological and psychosocial adaptions can occur
❖ Insidious and some are more vulnerable
❖ Ethnic minorities, low income, homelessness, severe mental heath, developmental disabilities,
substance abuse issues
Overlap of Trauma and TBI: Increased vulnerability
❖ Increased vulnerability to victimization (CDC, N.D)
❖ Exploitation (Oktay and Tompkins, 2004)
❖ Caregivers may respond with violence due to the
frustrations with caregiving (Kim, 2002)
❖ Demeaning and abusive behavior due to lack of
understanding (Sequeira and Halsted, 2001)
Overlap of trauma and TBI: comorbidity
❖ PTSD can occur after a TBI, even in severe cases where
there is little or no recall of the event that caused injury
(Taney et al., 2004)
❖ Prevalence rates
❖ Remains uncertain (McMillan et al., 2003)
Overlap of trauma and TBI: Symptomology
❖ Symptom overlap: insomnia, irritability, impaired
concentration (Sumpter et al., 2006)
❖ Memory impairment, social withdrawal, and difficulty
adjusting to TBI injury can look like PTSD symptoms
(Sumpter et al., 2006; Kennedy et al., 2007)
❖ Misattribution of symptoms can occur and/or misdiagnosis of
either condition (Sumpter et al., 2006; McMillian, 2001)
❖ Intrusive recollection is a symptom that distinguishes PTSD
from TBI (Stein et al., 2009)
What is Trauma informed care (TIC)?
❖ TIC involves a system focused framework of service
delivery (Kessler, 2014; Wolf et al., 2014)
❖ Organizational commitment to providing services that
are helpful to the special needs of trauma survivors
What is trauma informed care (TIC)?
❖ “What has happened to you?” NOT “What’s
wrong with you?” (Jennings, 2008)
Case example
Trauma informed care: a culture change
❖ TIC involves a culture change in the organization (Harris and Fallot,
2009; Kessler, 2014)
❖ Involves developing policies and working environments that are
organized around five principles (Harris & Fallot, 2009)
❖ Safety
❖ Trustworthiness
❖ Collaboration
❖ Empowerment
❖ Choice
Trauma informed care: safety
❖ Safety for consumer and staff
❖ Creating physical and emotional safety
❖ Examples for consumers and staff
Trauma informed care: Trustworthiness
❖ Trustworthiness for consumer and staff
❖ task clarity, consistency, and interpersonal
boundaries
❖ Examples for consumer and staff
Trauma informed care: Choice
❖ Choice for consumer and staff
❖ Maximizing choice and control
❖ Examples for consumer and staff
Trauma informed care: collaboration
❖ Collaboration for consumer and staff
❖ Creating collaborations and sharing power
❖ Examples for consumer and staff
Trauma informed care: empowerment
❖ Empowerment for consumers and staff
❖ Emphasizing empowerment and skill building
❖ Examples for consumers and staff
What can you do as an administrator (Harris & Fallot, 2009)
❖ Integration of knowledge abut violence and abuse into all
program practices
❖ Policy statement
❖ Develop a trauma initiative
❖ Consumer advisory group (has trauma survivors present)
❖ Collaborative and shared decision making style
❖ Provide resources and opportunity for learning
Trauma informed care: Does it work?
❖ TIC approaches can increase effectiveness of MH and SA
services (Harris & Fallot, 2009; Wesley & Power, 2005)
❖ Better outcomes have been found for TIC than traditional
treatment approaches (Cocozza et al., 2005; Morrissey & Ellis,
2005; Kammerer et al., n.d.)
❖ Improvement in daily functioning, decreased trauma
symptoms, decreased MH/SA symptoms
❖ No differences in cost to program with using TIC vs traditional
approaches and better clinical outcomes (Domino et al., 2005)
Challenges to Trauma Informed Care
❖ Staff attrition and high turnover (Bloom et al., 2003;
Rivard et al., 2004)
❖ Encouragement of flattened organizational hierarchy
(Bloom et al., 2003)
❖ Lack of time for communication and team building
(Rivard et al., 2004)
Challenges to Trauma Informed Care Continued (Wolf et al., 2014)
❖ Difficulty to agree on what emotional safety looks like
❖ Challenging to have choice and control for clients
❖ Concrete examples of collaboration can be difficulty
❖ TIC principles were applied to clients but many did not
include staff
Discussion
❖ Turn to the person next to you
❖ Are there ways your organizations are trauma informed?
❖ How can your organizations be more trauma informed?
Think of concrete examples
❖ What challenges might you have to implementing a TIC
approach and how can you respond to those challenges?
❖ When you go into the office on Monday, do you plan to
do anything differently?
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Bloom, S. L., Davis, M., Farragher, B., McCorkle, D., Martini, K, & Wellbank, K. (2003). Multiple
opportunities for creating sanctuary. The Psychiatric Quarterly, 74, 173-190.
Bryant, RA. (2001) Posttraumatic stress disorder and traumatic brain injury: can they co-exist?
Clinical Psychology Review, 21, 931-938.
Center for Disease Control (n.d). Victimization of persons with traumatic Brain injury or other
disabilities: a fact sheet for friends and families. Retrieved from
http://www.cdc.gov/traumaticbraininjury/pdf/VictimizationPerson_Fact
%20Sheet4FrdsFal-a.pdf
References
Cocozza, J.J., Jackson, E.W., Hennigan, K., Morrissey, J.B., Reed, B.G., & Fallot, R. (2005).
Outcomes for women with co-occurring disorders and trauma: Program-level effects.
Journal of Substance Abuse Treatment, 28(2), 109-119.
Domino, M. E., Morrissey, J. P., Chung, S., Huntington, N., Larson, M. J., & Russell, L.A. (2005).
Service use and costs for women with co-occurring mental and substance use disorders
and a history of violence. Psychiatric Services, 56, 1223-1232.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, et al.
(1998).The relationship of adult health status to childhood abuse and household
dysfunction. American Journal of Preventive Medicine, 14:245-258.
Harris, M., & Fallot, R. (Eds.). (2001). Using trauma theory to design services systems. New
directions for mental health services. San Fransisco, CA: Jossey-Bass
References
Harris & Fallot (2009). Creating cultures of Trauma-Informed Care (CCTIC): A self assessment
and planning protocol. Community Connections. Retrieved from http://
www.theannainstitute.org/CCTICSELFASSPP.pdf
Harvey, AG, Brewin CR, Jones C, Kopelman MD. (2003). Coexistance of postraumatic stress
disorder and traumatic brain injury: Towards a resolution of the paradox. Journal of the
international Neuropsychological Society, 9, 663-676.
Herman, J. L. (1997). Trauma and recovery. New York: BasicBooks
Jennings, A. (2008). Models for developing trauma informed behavioral health systems and
trauma specific services. National Center for Trauma Informed Care. Retrieved from
http://www.theannainstitute.org/Models%20for%20Developing%20Traums-Report
%201-09-09%20_FINAL_.pdf
References
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Morrissey, J.P., and Ellis, A.R. (2005). Outcomes for women with co-occurring disorders and
trauma: Program and person-level effects. Journal of Substance Abuse Treatment,
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Kessler, J. M. (2014). A call for the integration of trauma informed care among intellectual and
developmental disability organizations. Journal of policy and practice in intellectual
disabilities, 11(1), 34-42.
Kim E. (2002). Agitation, aggression, and disinhibition syndromes after traumatic brain injury. Neurorehabilitation, 17(4), 297–310
References
Machtinger, E. L., Cuca, Y.P., Khanna, N., Dawson Rose, C., Kimberg, L.S. (2015). From
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References
Rivard, J.C., McCorkle, D., Duncan, M.E., Pasquale, L.E., Bloom, S. L., & Abramovitz, R.
(2004). Implementing a trauma recovery framework for youths in residential treatment.
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SAMHSA (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed
Approach. Retrieved from http://traumainformedcareproject.org/resources/SAMHSA
%20TIC.pdf
Sequeira H, Halstead S. (2001). “Is it meant to hurt, is it?”: management of violence in women
with developmental disabilities. Violence Against Women, 7(4), 462–76.
Stein, MB., & McAllister, TW (2009). Exploring the convergence of postraumatic stress disorder
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References
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severe traumatic brain injury. Brain Injury, 20, 93–99.
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References
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