addressing invisible wounds: helping students manage trauma & achieve success in college

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Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College College campuses who are “Trauma informed” can help victims manage trauma symptoms and succeed in post secondary education. ~ Roger P. Buck, Ph.D.

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Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College. College campuses who are “Trauma informed” can help victims manage trauma symptoms and succeed in post secondary education. ~ Roger P. Buck, Ph.D. Six Goals of this Presentation. - PowerPoint PPT Presentation

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Page 1: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Addressing Invisible Wounds: Helping Students Manage

Trauma & Achieve Success In College

College campuses who are “Trauma informed” can help victims manage trauma symptoms and succeed in post secondary education.~ Roger P. Buck, Ph.D.

Page 2: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

1. Define and understand the concept “trauma informed”. 2. Explore complex variables associated with normal human

responses to traumatic events and their potential long-term impact on the individual.

3. Identify three specific categories of trauma, the associated traumatic events and unique characteristics that impact traumatic responses and symptom development.

4.Learn specifics about military trauma and its potential impact on student veterans and their academic success.

5. Identify positive proactive supports that help traumatized individuals.

6. Considering the Adverse Childhood Experiences (ACE) study and other trauma research: create a clear and concise trauma informed protocol for faculty and staff (campus-wide).

Six Goals of this Presentation

Page 3: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Goal 1: Trauma Informed?

Trauma occurs in all walks of life

Education and Awareness is key

What is “trauma informed”?

Why is it important to understand trauma?

How does being trauma informed enhance my ability to provide services to students?

Does being trauma informed actually help in producing better outcomes for students with significant trauma histories?

Page 4: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

All supports and interventions are based on the recognition that symptoms exhibited by survivors are directly related to the traumatic experience.

These experiences are the cause of many mental health, substance abuse and behavioral health problems.

Understanding trauma and the human responses associated with that trauma are key to improving program effectiveness, educational success, individual adjustment, transition success and/or recovery.

What is Trauma Informed?

Page 5: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Establishment of the National Center for Trauma-Informed Care. (www.mentalhealth.samhsa.gov/nctic)

Improvement in program effectiveness through evidence based best practice/trauma informed principles.

Across all areas of society: Mental Health Systems, Criminal Justice, Substance Abuse, Victims Assistance, Education, Primary Medical Care etc.

Childhood trauma is rapidly becoming recognized as a public health issue due to the lifelong negative effects associated with early trauma experiences (Adverse Childhood Experiences “ACE” study).

Why A Trauma Informed Approach Matters

Page 6: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Understanding the immediate and long term impact that campus violence has on a student, faculty and staff.

Understanding that privacy and respect are more effective than seclusion or restraint for those traumatized victims in residential care facilities (re-traumatized).

Recognize the long term negative impact early childhood trauma experiences causes on child development. (depression, personality disorders, antisocial behavior etc).

Understanding that military war veterans must learn to cope with a myriad of physical, cognitive, emotional, behavioral and spiritual/existential (PCEBS) symptoms that plague them daily.

Examples of Being Trauma Informed

Page 7: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Enhanced awareness and sensitivity of the issues and concerns that veterans and other trauma victims bring to campus will increase your ability to effectively serve and respond to their special needs or provide added accommodations.

Creating an environment with compassionate, empathic and aware faculty and staff will foster internal support networks that potentially enhance performance and retention of traumatized students.

Awareness of other “appropriate” professional supports (both internal and external to the institution) that you can refer individuals to will go a long way in retaining traumatized students with additional needs.

How you and your campus can benefit

Page 8: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Trauma Informed campus: Does it really help students succeed in secondary education?

Trauma-Informed Trauma-Specific interventions

◦ FACT: Those with chronic histories of domestic violence, physical and sexual abuse and other trauma experiences often develop Co-occurring disorders such

as chronic health conditions Substance abuse Eating disorders HIV/AIDS Criminal justice

involvement

Page 9: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Trauma informed campus: Does it really help students succeed in secondary education?

Trauma Informed FACT

FACT: Military combat veterans are permanently changed by traumatic war experiences that potentially cause Physical, Cognitive, Emotional, Behavioral, and Spiritual (PCEBS) symptoms to develop

Page 10: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Trauma informed campus: Does it really help students succeed in secondary education?

ACUTE TRAUMA CHRONIC TRAUMA

FACT: Acute trauma experiences will make an immediate impact on the victim and PCEBS symptoms will develop

Most people (80%) will successfully adjust on their own through resilience and social supports within approximately 3 months (Depending on intensity, severity, type of trauma, individual factors, social supports and other factors)

FACT: Chronic (long term or repeated exposure to danger) trauma experiences will have a cumulative impact on the individual causing more severe PCEBS symptoms and other more holistic effects

Page 11: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Goal 2: Explore the Complex Anatomy of Trauma Responses

Factors that determine trauma responses

Factors that determine trauma responses

Individual characteristics

Nature of the event/events

Social supports Psycho-physiology

Page 12: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

1. The specific type of traumatic event. (war, rape, domestic violence, natural disasters)

2. The individual’s characteristics. (Age, gender, culture, previous trauma, mental illness)

3. Environmental supports. (Social support systems – family, friends, shared experiences group)

4. Treatment/intervention strategy effectiveness. 5. Psycho-physiological aspects of trauma

responses.

Five Primary Areas of Trauma Research

Page 13: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Nature of the crisis event

Nature of the crisis Nature of the crisis

Single event vs. recurring

Solitary vs. shared experience

Presence of loss factor Separation from family

members Trusted family as

perpetrator (betrayal) Death of family member

Page 14: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Nature of the Crisis Event

Nature of the crisis Nature of the crisis

Loss of familiar environment

Loss of status or body function

Physical injury/pain Presence of violence Element of stigma Presence of life threat

Page 15: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Individual Characteristics

Individual Characteristics

Individual Characteristics

The age/developmental stage

Pre-crisis adjustment Past experience with

crisis The gender of trauma

victim Moral/spiritual beliefs Cultural background Cognitive level Biology

Page 16: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Individual characteristics

Individual Characteristics

Individual Characteristics

Perception/meaning of crisis event

Previous behavioral health issues

Physical disability Subjective world view

or interpretation style Personality type

Page 17: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Factors in the Support System

Support system Support system

Nuclear family Extended family School Friends Peers Local community Supportive others Non-supportive others

Page 18: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Psycho-physiology

Psycho-physiology Psycho-physiology

Physiological responses to stress are well documented in the literature

Individuals with PTSD show a variety of changes in memory, emotion, attention and concentration

Individuals with PTSD experience changes in brain structure, chemical functioning that impacts memory, emotions and executive thought processes

Page 19: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Specific Responses to Traumatic Events (ACUTE RESPONSES)

Acute Trauma Acute Responses

Acute responses occur during and immediately following crisis events.

These are normal responses to abnormal events.

The duration of these symptomatic responses are usually short lived lasting just a few days up to approximately 3 months.

Symptoms may vary and persist over a longer period of time depending on the type event, individual factors and supports in the environment.

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Page 21: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

There are five general categories of acute responses (P.C.E.B.S.) (refer to handout):

◦ A. Physical responses◦ B. Cognitive responses◦ C. Emotional responses◦ D. Behavioral responses◦ E. Spiritual responses

Acute Responses

Page 22: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Examples of Acute Trauma

Acute Trauma Acute Responses

Natural disasters (tornado, flood, fire)

Man made disasters (plane or car crashes, bridge collapse, building fire)

Criminal victimization (campus violence, murder, rape)

Page 23: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Natural and man-made disasters are usually acute traumas

Page 24: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Chronic Trauma

Page 25: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Long term trauma experiences to consider:◦ Long-term domestic violence (adult)◦ Long-term severe physical abuse (adult)◦ Long-term severe sexual abuse (adult)◦ Childhood severe domestic violence, physical

abuse, sexual abuse and neglect◦ Repeated tours of military duty in a combat zone◦ Prostitution Brothels◦ Concentration camps◦ Prisoner of war camps

Examples of Chronic Trauma

Page 26: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Additional Chronic and Acute Trauma Experiences to Consider

Chronic and Acute Trauma

Chronic and Acute Trauma

Trauma Survival and Disability

Elder Abuse Criminal victimizations Aftermath of homicide

and/or suicide Racial and Ethnic

Intolerance Sexual and Gender

Prejudice and victimization

Community based violence School violence, bullying,

and trauma Workplace bullying,

harassment, and violence Natural disasters

(prolonged or multiple) Genocide, Ethnic conflict

and political violence Impact of war on civilian

populations Other

Page 27: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Due to the chronic nature of the trauma the following potentially occurs:◦ Central Nervous System:

Brain memory centers (amygdala, hippocampus) increased reactivity to stimuli with potential for structural brain damage manifesting in: increased heart rate, blood pressure and anxiety responses such as panic, mood disturbance, tremors, nervousness, agitation, sleep disturbance, hyper-vigilance, and heightened memory and thought processing.

◦ CNS may cause re-experiencing events◦ CNS may result in avoidance behaviors◦ CNS may cause prolonged hyper-arousal which ultimately

results in distraction, confusion, attention deficits, concentration inconsistency, memory lapse and memory processing/recall difficulties

Chronic Nature of Responses (Physiological)

Page 28: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

P.C.E.B.S. – Will be similar to the Acute trauma responses but lead to labeling or diagnosing of the following:

◦ Post Traumatic Stress Disorder (PTSD).◦ Depressive Disorders.◦ Various Anxiety Disorders.◦ Substance Abuse Disorders

Chronic Effects of Trauma

Page 29: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Attention Deficit Bipolar disorder Sleep disorders Personality disorders Anti-social behaviors Criminal behaviors (Domestic violence, child

abuse, workplace violence, driving infractions etc.)

Traumatic Brain Injury Symptoms

Additional Diagnoses and Disruptive Behaviors

Page 30: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Chronic Trauma

Chronic Trauma Chronic Responses

Additional Issues:◦ Person repeatedly abused is

often mistaken as someone who has a “weak character”

◦ Survivors of chronic trauma are often misdiagnosed as Borderline, Dependent, or Masochistic personality disorder.

◦ Survivors who are “faulted for their symptoms” as a result of victimization are unjustly blamed.

Page 31: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Chronic trauma

More complex symptoms

Isolation both physical and emotional

Avoid talking and thinking about trauma

Alcohol and substance abuse to avoid nightmares/night terrors, sleeplessness and numb feelings

Self mutilation and other forms of self harm social isolation

Suicide

Page 32: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

1.Trauma and Loss, Vulnerability and interpersonal violence

2. Intolerance and the Trauma of Hate

3. Community Violence, Crisis Intervention, and Large Scale Disaster

Goal 3: Identify three specific categories of trauma and the associated trauma events

Page 33: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Responses unique to three specific types of traumatic experiences

Type I, II, III Trauma Type I, II, III Trauma

Type I: Trauma of Loss, Vulnerability, and interpersonal violence:◦ Issues of loss and grief◦ Trauma survival and disability◦ Sexual trauma◦ Childhood trauma◦ Adolescent trauma◦ Adult trauma◦ Intimate partner violence◦ Elder abuse◦ Criminal victimization◦ Aftermath of homicide/suicide

Type 2: Intolerance and trauma of hate:◦ Racial and ethnic intolerance◦ Sexual and gender prejudice

and victimization

Type 3: Community Violence, large scale disaster:School violenceWork and campus violenceNatural disasters

◦ Political violence◦ War impact military and civilian

Page 34: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I: Trauma of loss, vulnerability and interpersonal violence

Type I Trauma Type I Trauma

Issues of loss and grief Survival and disability Sexual trauma Life stage trauma: childhood,

adolescent and adult Intimate partner abuse Elder abuse Criminal victimization Aftermath of homicide or

suicide

Page 35: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Trauma of Loss, Vulnerability, and interpersonal Violence

Type I Trauma Type I Trauma

Stage theory suggests: loss leading to grief may include denial, numbness, separation anxiety, despair, and disorganization

Struggles with “meaning making” to resolve grief or making sense of senselessness

Restoration orientation may not occur easily - unable to create new relationships

Disenfranchised Grief the grieving individual doesn’t receive social support from others necessary for effective adjustment

Page 36: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

◦ Disenfranchised Grief includes grief not recognized, validated or supported by the social world of the mourner Grief where relationship is not recognized such as

extramarital relationships, gay and lesbian relationships, other relationships that lack social sanction

Grief where loss is not acknowledged by societal norms as “legitimate” loss such as abortion, pet loss, amputation, others not worthy of sympathy

Grief where griever is excluded such as children, elderly, developmentally disabled and others who are believed to not really experience grief

Circumstances of death cause stigma or embarrassment such as AIDS, crime, alcoholism

Disenfranchised grief

Page 37: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Ambiguous Loss

Type I Trauma Type I Trauma

Two types of disenfranchised grief

Physically present but psychologically absent–loved one with Alzheimer’s disease or traumatic brain injury

Physically absent but psychologically present – someone is kidnapped or missing in action in war

Note: Social supports are confused and perplexed about sympathy expression

Confusing because it is unclear how one is to adjust to them

◦ Physically present with no death suggests premature to grieve

◦ Physically absent suggests to grieve is to give up hope of return of missing person Uncertainty means adjustment

cannot occur Rituals are not available nor are

social supports Grief is unending as uncertainty

drags on with no resolution

Page 38: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Disability trauma is profoundly distressing. Two types of disability/impairment: congenital and acquired. Theory and research based literature is limited. Lack of access to health and rehabilitation services, education,

employment and high cost of medical care hinders ability to fully participate in society

Persons with an impairment become a person with disability (PWD) due to societal, systemic and environmental barriers.

Four dimensions of the Multidimensional model: impairments, activity limitations, participation restriction and environmental barriers, and facilitators.

PWD face attitudinal, environmental and institutional disability discrimination, which may last longer and feel worse than the physical trauma of loss of a limb, sight, hearing or other physical impairments.

Type I trauma: Trauma Survival and Disability

Page 39: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Attitudinal: Stereotypes and stigma exists and creates obstacles such as – women with disabilities often experience abuse which causes worse trauma than the physical disability itself (raped in their homes, communities and institutions – two times more likely to be sexually or physically assaulted or exploited than non-disabled – seen as easy targets by perpetrators)

Environmental: Two types of environmental barriers include physical environment inaccessibility (building or structure access)

and social inaccessibility (limited access occurs when families don’t include the person due to certain disabilities also public health information that is not available to hearing or visually impaired ie., AIDS/HIV awareness and condom marketing campaigns)

Type I Trauma: Trauma Survival and Disability (Cont’d)

Page 40: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Institutional: Legal discrimination such as not being permitted to marry or have children, exclusion from employment or school, and non-compliance with fair voting practices

Trauma linked to disability discrimination:◦ PWD experience a stress pileup from accumulation of a lifetime of

traumatic events◦ PWD may be vulnerable due to childhood trauma◦ PWD experience stressors in adulthood leading to depression, substance

abuse, memories of previous traumas and PTSD◦ PWD (children and young adults of college age) may be susceptible to

attachment trauma which includes physical abuse, sexual abuse, rejection, psychological abuse (cruelty), emotional neglect (unresponsiveness to emotional states), and physical neglect (failure to provide for basic needs)

Type I Trauma: Trauma Survival and Disability (Cont’d)

Page 41: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Sexual violence creates a plethora of mental health problems including but not limited to:

◦ Post Traumatic Stress Disorder (PTSD)(17%-65%)◦ Anxiety and panic disorders◦ Depression◦ Substance abuse◦ Normal and expected reactions (refer to PCEBS handout)◦ Responses are individual and a complex interaction between the

individual and their environment◦ Other variables to consider: perpetrator assault characteristics ie.,

spousal, partner, date, acquaintance, stranger and incest (over 50% report knowing the perpetrator) also was alcohol or drugs involved (15% rapes involved GHB slipped to victim)

Type I Trauma: Sexual Trauma

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Research studies on re-victimization concentrate on:◦ Interpersonal factors such as high risk activities that increase

exposure to potential perpetrators (binge drinking, two or more current sexual partners)

◦ Intrapersonal factors including psychological distress, relationship insecurity, low self-esteem, self-blame, low self-efficacy, use of avoidant coping styles, and deficits in risk appraisal and situational coping (avoidant coping strategies: denial, numbing or detachment increases PTSD symptoms over time by avoiding memories and feelings associated with trauma event)

◦ These factors reduce an individual’s ability to assess, assertively cope with and escape from potentially dangerous situations and reinforces more aggressiveness by the perpetrator

Type I Trauma: Sexual Trauma

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Type I Trauma: Life-stage trauma

Life-Stage Trauma Life-Stage Trauma

Early Childhood Trauma

Adolescent Trauma

Adult Trauma

Page 44: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Life Stage Trauma

Early Childhood Early Childhood

Early Childhood:◦ Critical time for brain

development (brain is 75% adult size by age 2)

◦ Positive early experiences are associated with increased synaptic connections

◦ Negative, adverse or traumatic early experiences are associated with decreased synaptic connections

Page 45: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Life-Stage Trauma

Early Childhood Early Childhood

Early Childhood:◦ 3 phases of attachment:

1. orientation and signals with limited discrimination of figure (8 weeks)

2. orientation and signals toward one or more discriminated figure (12 weeks)

3. maintenance of proximity to a discriminated figure (12 weeks to 18 months)

Consistent and sensitive caregiver responses are positively associated with creation of a secure attachment (safety and security is established through successful attachment & gaining confidence)

Inconsistent, adverse, and unpredictable responses result in formation of insecure attachment characterized as (avoidant, ambivalent, resistant, disorganized, or disoriented)

Page 46: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Life-Stage Trauma

Early Childhood Early Childhood

Other developmental competencies (infant to pre-

school)◦ Begin gross motor regulation◦ Self regulation (eat & sleep)◦ Development of trust ◦ Language◦ Gross motor development◦ Autonomy◦ Continued self-regulation◦ Egocentrism◦ Cause-effect thinking◦ Initiative

Trauma in Early Childhood◦ 50% of children who

experience maltreatment (physical, sexual, emotional abuse and neglect) are younger than age 7

◦ Caregiver is the source of both support and threat resulting in a child with approach - avoidance relationship and disorganized attachment

◦ Witnessing domestic violence resulted in numbing, increased arousal, fear, aggression, re-experiencing and hyper-arousal

Page 47: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Life-Stage Trauma

Early Childhood Early Childhood

Trauma in Early Childhood:◦ Repeated exposure to

threatening and traumatic situations results in decrease size of developing brain.

◦ Inhibits parts of the brain responsible for learning, managing behavior and emotional reaction, social reasoning and social skill development. (essential for success in school, employment and relationship)

◦ Causes physiological changes: increases anxiety/depression

Strong relationship between childhood trauma and:

Subsequent mental disorders Higher suicide rate Mood disorders Substance abuse Visual, auditory and tactile

hallucinations Other psychotic symptoms

may also be found in trauma survivors

Page 48: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Life-Stage Trauma

Early Childhood Early Childhood

Trauma in Early Childhood

◦ Infants and children who witness violence show excessive irritability, immature behavior, sleep disturbances, emotional distress, fears of being alone and regression in toileting and language also increased likelihood of arrest as a juvenile and adult.

Page 49: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Life-Stage Trauma

ACE Study ACE Study

Adverse Childhood Experiences (ACE) Study:◦ Shows 10 different types of

traumatic or violent childhood experiences contributed to mental illness, adult health problems, health risk behaviors (smoking, substance abuse, obesity etc) higher use of health care services.

◦ For other research refer to the National Child Traumatic Stress Network (www.nctsn.org)

Adverse Childhood Experiences (ACE) Study:◦ Those with 4 or more of the 10

traumatic experiences demonstrate: twice as likely to smoke cigarettes,

◦ 5 times more likely to use illicit drugs

◦ 7 times more likely to be alcoholic◦ 11 times more likely to use injection

drugs ◦ 19 times more likely to attempt

suicide◦ Vulnerable to early mortality due to

health problems◦ Suffer more chronic health problems

diabetes, heart disease, and cancer

Page 50: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Life-Stage Trauma

Adolescent Trauma Adolescent Trauma

Adolescent Trauma:◦ Approximately 4 million

adolescents have been victims of a serious physical assault

◦ Nine million have witnessed serious violence during their lifetime

◦ School age children and adolescents experience the full range of post trauma stress reactions that are seen in adults

Adolescent responses to Trauma:◦ When trust is damaged by

adults failing to protect them the adolescent’s basic worldviews and foundational aspects of relationships change

◦ Inability to trust caretakers, or God makes it difficult to feel safe

Page 51: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Life-Stage Trauma

Adolescent Trauma Adolescent Trauma

Adolescent responses to trauma:◦ Fear and anxiety, guilt,

shame, re-experiencing the trauma, increased arousal, avoidance, anger and irritability, negative self-image, abuse of substances

◦ Female adolescents are more likely to experience PTSD symptoms than male adolescents who tend to suppress these symptoms

◦ Additional trauma responses may be determined by family disruption by the traumatic event (family breakup, relocation of family, family conflict, poverty, parental un-employment, parental substance abuse, and psychopathology)

◦ Life stressors become cyclical

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Women’s rights are often nominally granted by male dominated society even in our industrialized Western culture

Women’s rights continue to be ignored by some male groups and are ignored in the homes of their partners

Types of IPV events and related issues:◦ Homicide, rape, sexual assault, robbery, aggravated assault and simple

assault◦ IPV makes up approximately 22% of violent crime against women and 3%

against men ◦ IPV in gay men, lesbians, bisexuals, and transgendered people report 9%

current relationships but 32% in previous relationships◦ Victims of deliberate cruelty such as IPV represents victimization more than

trauma response – distinction recognizes the perpetrator’s behavior as the source of deleterious effects more so than the victim’s reaction – which are primarily shame, self-blame, subjugation, morbid hate, paradoxical gratitude, defilement, sexual inhibition, resignation, secondary injury, socioeconomic downward drift

Type I Trauma: Intimate partner violence (IPV)

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Page 54: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Intimate Partner

Violence (IPV)

IPV IPV

Cycle of Violence:53% of habitually violent offenders had observed their parents engaged in physical combat79% of violent children reported extreme violence between parentsThree phases of actual cycle of violence involves; tension, abuse, relief (honeymoon) phases

Page 55: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Criminal victimization

Criminal Victimization Criminal Victimization

Annually 25 million Americans are victimized by some form of crime

Rapes, robberies and assaults number 2.2 million injuries with more than 700,000 hospital stay

Sexual assault has major negative affects on one fourth of women and up to 7% men victims resulting in increased risk of anxiety, depression, substance abuse and PTSD

Women who perceive negative events as uncontrollable tend to have more severe PTSD symptoms than women who perceive negative events as controllable and/or predictable

Theft from a person constitutes a fundamental violation of a person’s dignity and shows a callous disregard for one’s rights as a person – so we respond with outrage

Page 56: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type I Trauma: Criminal Victimization

Criminal Victimization Criminal Victimization

Psychology of victimization:◦ Several layers property

crime hurts a person at outer most level of the self; armed robbery invades a deeper level of the self due to direct contact with the robber and threatens physical harm; assault and battery injures the victim deeper physically and psychologically

Rape goes to the core of the person and causes a loss of sense of safety and intimacy that sexual contact is supposed to have & impacts victim’s basic beliefs, values, emotions and sense of safety

Society response to crime victim may determine how supported or abandoned victim feels which impacts psychological responses to the event

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Type I Trauma: Aftermath of suicide or homicide

Suicide Suicide

Sudden and often violent death leaves surviving family members in turmoil and needing to reconstruct their world without the victim

Simultaneously family members are experiencing extreme shock, and are often struggling emotionally, physically, socially and financially

Psychological and emotional experiences that survivors left behind by suicide experience

◦ Self-blame◦ Shame◦ Stigma◦ Rejection◦ Abandonment◦ Guilt◦ Anger ◦ Perceive suicide as aggressive act

toward the survivor

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Type I Trauma: Aftermath of Homicide or Suicide

Suicide Suicide

Psychological and emotional experiences that survivors left behind by suicide experience (Cont’d)

◦ Spiritually/meaning – make sense - why

◦ Intrusive images◦ Disorganized thinking◦ Increased vulnerability◦ Need to assign blame◦ Attempt to regain control◦ Feelings of victimization and

unfairness

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Type I Trauma: Aftermath of homicide and Suicide

Homicide Homicide

Six “R’s” Grieving Process:

Recognize loss

React to separation

Recollect and re-experience

Relinquish old attachments

Readjust to new without forgetting the old

Reinvest

Psychological and emotional experiences that survivors left behind due to homicide experience:◦ Attempt to make sense of the death◦ Self-blame gives them some

psychological control ◦ Blame criminal justice system◦ Internalized feeling◦ Hyper-arousal◦ Withdrawal◦ Somatic complaints◦ Anxiety◦ Depression◦ PTSD symptoms◦ Existential crisis◦ Complicated grief reactions

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Type I Trauma: Aftermath of Homicide and Suicide

Homicide Homicide

Death of loved one will impact relationships, academic functioning and developmental process of survivors:◦ Difficulty socially with friends◦ Difficulty socially at work◦ Difficulty socially at school◦ Difficulty socially with family◦ Old relationships may falter◦ New relationships may form

Other potential losses after murder include: ◦ Intrapersonal – questioning faith,

values, and deepest beliefs

◦ Interpersonal – family structure breaking apart under the stress (especially if murderer was a family member ie., husband – wife – once stable extended family breaks apart)

◦ Extra-personal – loss of victim’s income or financial security due to medical bills could lead to loss of home or accustomed life style

Page 61: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type II: Intolerance and trauma of hate

Type II Trauma Type II Trauma

Racial and ethnic intolerance

Sexual and gender prejudice and victimization

Page 62: Addressing Invisible Wounds: Helping Students Manage Trauma & Achieve Success In College

Type II Trauma: Racial ethnic intolerance

Racial Intolerance Racial Intolerance

Three conditions for racism to flourish:

◦ Groups must be distinguishable for each other

◦ Culturally different

◦ One group must already be in a position of institutionalized inequity (educational inequality, financial discrimination)

Four categories of racism:◦ Individual – an individual against

another or group

◦ Institutional – organization or institutional practices

◦ Cultural – those in control use cultural differences of “others” to prove inferiority

◦ Liberal – profess equality but a ploy to have the “others” merge into the dominant culture

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Type II Trauma: Sexual and gender prejudice

LGBT Community LGBT Community

Hate crimes:◦ Cause physical and

psychological wounds consistent with violent victimization

◦ Communicate unique messages of fear for LGBT community

◦ Are perpetrated frequently with ferocious brutality

◦ Offenders appear to be attempting to wipe out the existence of homosexuality, gender atypical behavior, and the life of their victim

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Type III: Community violence

Community Violence Community Violence

School Work Campus Natural disaster Political War both military and

civilian

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Type III Trauma: School, work, and campus violence

School violence Reactions to trauma events

School environment:◦ Buildings that are clean

and well cared for have lower levels of violence

◦ Social environment that fosters safety include: Skills instruction Expected student behavior Engagement in the

community Student self/other

awareness Positive adult interaction

Responding to school violence:◦ Children age 5 and under

exhibit anxiety and fear◦ Children age 6-11 likely will get

in trouble at school more frequently, truant, inattentive and disruptive in class, irrational fear, nightmares and sleep problems

◦ Adolescents may exhibit emotional numbing, nightmares, flashbacks of the trauma all of which are normal responses to traumatic events

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Type III Trauma: Workplace Trauma

Workplace trauma Workplace trauma

Workplace violence◦ 2 million acts of violence occur

in the workplace every year in the U.S.

◦ 16 million acts of verbal aggression occur in the workplace annually

◦ Categorized as either physical, verbal or psychological

◦ Context of violence as criminal, client or co-worker

Workplace violence◦ Homicides account for 12% of

all workplace deaths◦ Suicides account for 5% of all

workplace fatal injuries◦ Assaults/violent acts are

second leading cause of death of American workers

◦ In 2009 homicide was the leading cause of death for women in the workplace

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Type III Trauma: Workplace Trauma

Workplace trauma Workplace trauma

Workplace aggression:◦ Harassment – ◦ Bullying –◦ Mobbing – ◦ Emotional abuse –◦ Workplace incivility –◦ Victimization –◦ Social undermining –◦ Identity threat –◦ Abusive supervision◦ Petty tyrant -

Causes of workplace aggression:

Individual factors◦ Trait factors (personality)◦ Gender◦ Negative emotions◦ Type A behavior◦ Self-monitoring ability◦ Hostile

Social factorsInjusticeInterpersonal conflictFrustration & job dissatisfactionLosing jobEnvironmental conditionsDrug and alcohol use

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Type III Trauma: College Campus Trauma

College campus trauma College campus trauma

College trauma◦ 2009 more than 23 million

students enrolled in 4500 colleges & Universities

◦ Approximately 15% -20% female college students raped in their lifetime

◦ Approximately 5% to 15% college males admit committing an act of rape

◦ Two thirds of all violent campus crimes are simple assault

◦ Only 5% of rapes and attempted rapes are reported to police

College trauma◦ In 41% of violent crimes the

perpetrator under influence AOD

◦ Men are twice as likely to be victims of campus crime

◦ 36% of LGBT students experienced some form of harassment in the past 12 months

◦ Underreporting of campus crimes leads these stats. suspect

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Type III Trauma: College Campus Trauma

College campus Trauma College Campus Trauma

Psycho-social development◦ Emotional management◦ Autonomy◦ Developing purpose◦ Increasing tolerance of others◦ Difficulty with these

developmental tasks may result in prone to violent and aggressive behavior

◦ Alcohol and drug abuse as pre-cursor to aggression and violence

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Type III Trauma: Natural Disasters

Natural Disasters Natural Disasters

Types of disasters to consider:◦ Weather

◦ Climate related

◦ Earth movement

◦ Biological/ecological

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Goal 4: Learn specifics about military trauma and its impact on student veterans

Military trauma Military trauma

Military Culture

Military Training & Deployment

Transition Issues

Trauma Reactions

Five Aspects of Recovery

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Goal 5: Identify positive proactive supports that help trauma victims

Holism Holism

Extensive research in treatment modalities

Holistic approaches that address:◦ Cognitive problems◦ Relationship problems◦ Affective problems◦ Family problems◦ Traumatic symptom problems◦ Somatic problems◦ Other considerations: Grief

and bereavement, anniversaries, ceremonies, memorials, and rituals

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Trauma Informed : Does it really help students to succeed in secondary education?

Trauma-Specific interventions

Trauma-Specific interventions

Trauma-Specific interventions are designed to address the consequences of trauma in the individual and to facilitate healing/success and recognize:

1. Survivor’s need to be respected, informed, connected, and hopeful regarding their own recovery/success

2. The interrelation between trauma and symptoms of trauma

3. The need to work collaboratively with survivors, family and friends, and other support services to empower survivors

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Trauma Informed: Does it really help students to succeed in secondary education

Trauma-Specific interventions

Trauma-Specific interventions

Trauma-Specific interventions:

1. Addiction and Trauma Recovery Integration Model

2. Risking Connection

3. Seeking Safety

4. Trauma, Addiction, Mental Health, and Recovery

5. Trauma Affect Regulation: Guide for Education and Therapy

6.Trauma Recovery and Empowerment Model

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Positive Proactive Supports

Intervention Characteristics

Intervention Characteristics

Interventions share the following characteristics:◦ Emphasizes concepts of

empowerment, connection and collaboration

◦ Various settings already include: residential treatment settings, public schools, domestic violence shelters, homeless shelters, group homes, juvenile justice programs, substance abuse programs, parenting support programs, acute care settings, psychiatric hospitals, and prisons

Interventions share the following characteristics:

◦ Peer support/healthy relationship promotion

◦ Psycho-education◦ Interpersonal skills training◦ Meditation◦ Creative expression◦ Spirituality ◦ Community action and supports◦ Safety◦ Practical de-escalation skills◦ Intrusive memory management◦ Restore capacity for information

processing and memory

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Trauma informed: Does it really help students succeed in secondary education?

Trauma-Specific Interventions

Trauma-Specific Interventions

Trauma-Specific interventions: ◦ Human services

organizations will: Assess their organization,

management, and service delivery system

Modify to include basic understanding of how trauma affects the life of individuals seeking services

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Goal 6: Create a clear and concise trauma informed protocol for campus-wide use Protocol for establishing a

“Trauma informed” campus◦ Institutional commitment to

being trauma informed◦ Identify your target population

(trauma victims by type I, II, III)◦ Identify what your target

population wants and need◦ Assess your ability to provide for

those needs & possible roadblocks to your effort

◦ Create an action plan, steps, milestones and outcomes you expect to achieve

◦ Establish a timeline

Specific Focus: Campus Culture Change◦ Public health issue◦ Integrate into campus culture

awareness of trauma, compassion and caring for student victims

◦ Focus on strengths and resiliency vice pathology

◦ Focus on education and training◦ Normal responses to abnormal events◦ Early action and consistent supports◦ Peer supports and resources◦ Thorough awareness training across

campus – all staff and faculty◦ Ensure “trauma informed” level of

care treatment is available either on campus or in the local community

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National Center for Post Traumatic Stress Disorder (NCPTSD) www.ncptsd.va.gov

National Child Traumatic Stress Network (NCTSN) www.nctsn.org

National Center for Trauma Informed Care (NCTIC) www.mentalhealth.samhsa.gov/nctic/

Textbook: Trauma Counseling: Theories and Interventions Editor: Lisa Lopez Levers., Springer Publishing Co., New York

Resources

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Roger P. Buck Ph.D. Director Counseling Center Hocking College 3301 Hocking Parkway Nelsonville, Ohio 45764 Phone: 740-753-6133/6095 Email: [email protected]

Contact Information