deborah borne, msw, md trauma-informed care. getting to know you
TRANSCRIPT
![Page 1: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/1.jpg)
DEBORAH BORNE, MSW, MD
Trauma-Informed Care
![Page 2: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/2.jpg)
Getting To Know You
![Page 3: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/3.jpg)
Our Goals
Expose you to the concept and principles of Trauma Informed Care
Plant the seeds for further conversation and implementation at your setting
Understand that trauma informed care is a long and ongoing process
Take something back for yourself…..
![Page 4: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/4.jpg)
Goals PART 1
Explain the nature of traumatic stress.Explore the relationship between
homelessness and trauma.Outline the body’s response to stress
and traumatic stress.Identify the impact of traumatic stress.Review the mechanisms of healing
from trauma
![Page 5: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/5.jpg)
Defining Stress and Trauma
![Page 6: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/6.jpg)
Why Trauma-Informed?
Misunderstood or ignored signs of trauma may:
Interfere with help-seekingLimit engagement into servicesLead to early “drop-out” Inadvertently re-traumatize people we are trying
to helpFailure to make appropriate referrals
![Page 7: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/7.jpg)
Homelessness & Trauma
Developmental trauma that predates becoming homeless
Becoming homeless as traumaExposure to trauma as part of being homelessHomelessness as increasing vulnerability to trauma
responseTrauma response as affecting access to services and
recovery
![Page 8: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/8.jpg)
Source: Poems, Pictures, and Other Great Stuff. (1996). Salem-Keizer Public Schools. Salem, Oregon.
![Page 9: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/9.jpg)
Traumatic stress is different from other kinds of stressors.
![Page 10: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/10.jpg)
What is Traumatic Stress?
Overwhelming experience.
Involves a threat.
Results in vulnerability and loss of control.
Leaves people feeling helpless and fearful.
Interferes with relationships and beliefs.
Source: Herman, J. (1992). Trauma and recovery. New York: Basic Books.
![Page 11: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/11.jpg)
Sources of Traumatic Stress
Loss of a loved oneAccidentsHomelessnessCommunity/school
violenceDomestic violenceNeglectPhysical abuseSexual abuseMan-made or natural
disastersTerrorismPhoto credit: K. Volk
![Page 12: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/12.jpg)
Trauma
Psychological
Complex
Historical
Sanctuary
Vicarious
![Page 13: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/13.jpg)
Impact of Trauma on the Helper
Constant stress and anxiety
Negative attitudeInability to focusFeelings of
incompetence and self doubt
Triggered PTSD reactions and other mental health issues especially if the worker has unresolved trauma
Compromised physical health
Disruption of relationships
Blurred boundariesHopelessnessDecrease in ability
to experience pleasure
Decreased productivity
![Page 14: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/14.jpg)
ACE STUDY
![Page 15: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/15.jpg)
Adverse Childhood Experiences(ACE; Anda & Felitti – www.acestudy.org)
1. Recurrent physical abuse
2. Recurrent emotional abuse
3. Contact sexual abuse
4. An alcohol and/or drug user in the household
5. An incarcerated household member
6. Household member who is chronically depressed, mentally ill, institutionalized, or suicidal
7. Mother is treated violently
8. One or no parents
9. Emotional or physical neglect
![Page 16: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/16.jpg)
ACE Study: Two Major Findings
ACE’s are vastly more common than recognized or acknowledged
ACE’s have a significant impact on later adult health and well-being
![Page 17: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/17.jpg)
ACE’s have a strong influence on…
Adolescent healthTeen pregnancySmokingAlcohol misuseIllicit drug misuseSexual behaviorMental healthRisk of re-victimizationStability of relationshipsPerformance in the workforce
![Page 18: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/18.jpg)
ACE’s increase the risk of…
Heart diseaseChronic lung diseaseLiver diseaseSuicideInjuriesHIV and STD’sOther risks for the leading causes of death
![Page 19: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/19.jpg)
Adverse Childhood ExperiencesACE score ≥ 4
Twice as likely to smokeSeven times as likely to have alcohol abuse/dependenceTwice as likely to have cancer or heart diseaseFour times as likely to have emphysema or COPDTwelve times as likely to have attempted suicide
Men with an ACE score ≥ 6 were 46 times more likely to have injected drugs
People with ACE score ≥ 7 had 360% higher risk of ischemic heart disease (and didn’t smoke, drink to excess, and were not overweight)
![Page 20: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/20.jpg)
The Neurobiology of
Traumatic Stress
![Page 21: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/21.jpg)
Goal of this section
Understand that the Brain and our experience shape how we think, feel, and behave
Trauma has an impact on the Brain
The brain, and clients can heal
![Page 22: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/22.jpg)
How we will Do it
Review the parts of the brain.Learn the physiological parts of the stress/trauma response
Understand how the brain is affected by trauma
Identify methods to help heal the brain
![Page 23: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/23.jpg)
![Page 24: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/24.jpg)
![Page 25: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/25.jpg)
![Page 26: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/26.jpg)
![Page 27: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/27.jpg)
The Brain……..
![Page 28: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/28.jpg)
![Page 29: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/29.jpg)
Right Brain/Left Brain
Left hemisphere better at math, judging time and rhythm, and coordinating order of complex movements Processes information sequentially
and is involved with analysis About 95 percent of our left brain
is used for language
Right hemisphere good at perceptual skills, and at expressing and detecting other’s emotions Processes information
simultaneously and holistically
![Page 30: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/30.jpg)
![Page 31: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/31.jpg)
The limbic system is a sort of “primitive core” of the brain strongly associated with emotion and memory.
Doing Brain
![Page 32: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/32.jpg)
![Page 33: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/33.jpg)
TWO TYPES OF STRESS RESPONSES:Nervous System and Endocrine System
Similarities: They both monitor stimuli and react so as
to maintain balance.Differences:
The Nervous System is a rapid, fast-acting system whose effects do not always persevere.
The Endocrine System acts slower (via blood-borne chemical signals called Hormones) and its actions are usually much longer lasting.
![Page 34: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/34.jpg)
Autonomic Nervous System
![Page 35: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/35.jpg)
Flight
Freeze
Fight
SYMPATHETIC NERVOUS SYSTEM
![Page 36: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/36.jpg)
How Does It all work together ?
![Page 37: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/37.jpg)
![Page 38: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/38.jpg)
TriggerTrigger
Amygdala Amygdala
Sympathetic Nervous System
Sympathetic Nervous System
Norepinephrine epinephrine
Norepinephrine epinephrine
Fight, flight or freeze
Fight, flight or freeze
HypothalamusHypothalamus
Stress Hormone (Cortisol)
Stress Hormone (Cortisol)
Regulates responseRegulates response
Slow Slow
FastFast
Memory
![Page 39: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/39.jpg)
![Page 40: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/40.jpg)
![Page 41: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/41.jpg)
![Page 42: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/42.jpg)
![Page 43: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/43.jpg)
TriggerTrigger
Amygdala Amygdala
Sympathetic Nervous System
Sympathetic Nervous System
Norepinephrine epinephrine
Norepinephrine epinephrine
Fight, flight or freeze
Fight, flight or freeze
HypothalamusHypothalamus
Stress Hormone (Cortisol)
Stress Hormone (Cortisol)
Regulates responseRegulates response
Slow Slow
FastFast
Memory
![Page 44: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/44.jpg)
![Page 45: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/45.jpg)
TriggerTrigger
Amygdala Amygdala
Sympathetic Nervous System
Sympathetic Nervous System
Norepinephrine epinephrine
Norepinephrine epinephrine
Fight, flight or freeze
Fight, flight or freeze
HypothalamusHypothalamus
Stress Hormone (Cortisol)
Stress Hormone (Cortisol)
Regulation response not work over timeRegulation response not work over time
Slow Slow
FastFast
Memory
![Page 46: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/46.jpg)
Brain Parts
THINKING, DOING and REPTILE BRAIN
RIGHT and LEFTFight/Flight/Flee vs. Rest/digest
STRESS RESPONSE: FAST and SLOW
![Page 47: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/47.jpg)
![Page 48: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/48.jpg)
Principles of Neurodevelopment
The brain is underdeveloped at birth
The brain organizes from the “bottom” up - brainstem to cortex and from the inside out
Organization and functional capacity of neural systems is sequential
Experiences do not have equal influence throughout development (sensitive periods)
![Page 49: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/49.jpg)
Altered cardiovascular regulationBehavioral impulsivity
Increased anxietyIncreased startle response
Sleep abnormalities
Trauma and Altered Neurodevelopment
![Page 50: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/50.jpg)
The Effects of Trauma on the BrainNeurological consequences of trauma
Manifestations
Reduction in the size of the Hippocampus
Decreased levels of Serotonin
Increased levels of “Stress”
Specific memory problems: - Declarative Memory (Facts, lists etc.) - Fragmentation of long-term memory - (Especially autobiographical and trauma related) - Dissociative amnesia (Gaps/black-outs) - Motor memories (activities learnt at the time of trauma)
Difficulties with concentration Problems with impulsivity and aggression Responses that are inappropriate to the situation
Anxiety and nervousness Numbing of responsiveness to environment Dramatic mood swings
![Page 51: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/51.jpg)
Stress results in decreased dendritic branching of neurons in the CA3 region of the hippocampus (Woolley et al. 1990)
Non-Stressed Stressed
![Page 52: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/52.jpg)
Academic tasks that are difficult when traumatized
Concentrate
Sit still
TalkBe Physical
Set Goals
Listen
![Page 53: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/53.jpg)
Neurogenesis and Plasticity
Neurogenesis: Production of new brain cells
Plasticity: Brain’s ability to change its structure and functions
![Page 54: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/54.jpg)
![Page 55: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/55.jpg)
TRIGGERS
![Page 56: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/56.jpg)
Triggers
Triggers include seeing, feeling, or hearing something that reminds us of past trauma.
Triggers activate the alarm system.
When the alarm system is activated, but there is no danger, it is a false alarm.
The response is as if there is current danger.
![Page 57: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/57.jpg)
What Determines How People React to Trauma?
Response to trauma depends on many “mediating factors.”
Identifying these factors is essential to understanding survivor responses and risk for long-term difficulties.
![Page 58: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/58.jpg)
Effects of Trauma
Every person’s response to a traumatic event is unique.
Both previous experiences and current beliefs shape a survivor’s reactions to abuse and traumatic stress
The trauma that happens in childhood at the hands of caregivers is doubly destructive — because it destroys the attachment relationship that the child would normally need to depend on to manage the trauma of abuse.
![Page 59: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/59.jpg)
Factors that Influence Responses to Trauma
1.History and current functioning.
2.Characteristics of the traumatic event.
3.Culture.
4.Stage of development.
5.Nature of relationships and social supports.
![Page 60: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/60.jpg)
Risk Factors for More Severe Trauma Responses
Poor current functioning and history of trauma.
Traumatic experiences across the lifespan are chronic and severe.
Trauma that begins early in development.
Insecure attachment/poor early relationships and limited current social support.
![Page 61: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/61.jpg)
![Page 62: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/62.jpg)
Nature of Relationships and Social Supports Influences Response to Trauma
“The interactive ‘dance’ [between caregiver and child] lays the foundation for the exchanges
that the baby, then child, then adult will echo throughout life…Adult relationships – be they between politicians or business people or a
shopper and the grocery clerk in the check out line – are all influenced by this, our first and
most profound relationship.”
- R. Karr-Morse & M. Wiley
Source: R. Karr-Morse & M. Wiley (1997) Ghosts from the nursery. New York: The Atlantic Monthly Press.
![Page 63: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/63.jpg)
![Page 64: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/64.jpg)
Attachment
Enduring emotional bond.
Biologically driven.
Determines future relationships and self-regulation.
![Page 65: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/65.jpg)
• Secure “container”
• Provides for basic needs and safety
• Gives the freedom to explore and learn
• Lack of availability and predictability
• Lack of safety and security
• Diminished ability to develop trusting relationships and coping skills
Secure Insecure
![Page 66: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/66.jpg)
Attachment in Adulthood
In adulthood, relationships expand beyond primary caregiver.
Early trauma makes forming adult relationships difficult. It decreases our ability to trust, seek out safe supports, etc.
Leads to decreased social supports.
![Page 67: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/67.jpg)
PHYSICAL + MIND + SOCIAL
Robustness
![Page 68: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/68.jpg)
Webster: Having or exhibiting strength or vigorous health Having or showing vigor, strength, or firmness Capable of performing without failure under a
wide range of conditions
Proactively addresses issues before they become crisis
Lessens or eliminates trauma associated with an event
Brings more resources to a crisis when it does happen
Robustness
Siebert 2005
![Page 69: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/69.jpg)
The Atoms of Robustness
Environmental Experience
Relational Experience
Genetic Expression
Physical HealthPhysical Health
Mind HealthMind Health
Social HealthSocial Health
![Page 70: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/70.jpg)
Physical Health
Physical Health is the foundation for Mind and Social Health
Key aspects of Physical Health Diet Exercise Sleep
A physically healthy person: Lowers stress/cortisol levels Increases brain functioning and growth Improves learning and memory Improves mental health and emotional capacity
![Page 71: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/71.jpg)
Mind Health
Mind Health is a combination of: Emotional Functioning Mental Functioning Spiritual Wellbeing
Role of Expectations
Role of Positive Thinking
![Page 72: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/72.jpg)
Social Health
Homelessness can lead to isolation Isolation leads to depression and other mental health issues
Assessment and attention should be paid to social support and the building of health relationships
Strong social bonds Increase well-being Lower stress Result in more stable mental health Increase cognitive performance Multiply our emotional, intellectual and physical resources Create a greater sense of purpose Recover faster from setbacks
Schwartz 2010
![Page 73: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/73.jpg)
Resiliency
Robustness
ResiliencyResiliency
Distress
![Page 74: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/74.jpg)
Definition of RESILIENCE1: the capability of a strained
body to recover its size and shape after deformation caused by compressive stress
2: an ability to recover from or adjust easily to misfortune or change
Re·sil·ience noun \ri-ˈzil-yən(t)s\
Siebert 2005
![Page 75: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/75.jpg)
The action taken to recover and grow from experiencing a stressful event
Tenacity in the face of distress
Surviving the trauma associated with a disruptive event
Resiliency
Siebert 2005
![Page 76: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/76.jpg)
![Page 77: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/77.jpg)
![Page 78: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/78.jpg)
QUESTIONS ?
![Page 79: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/79.jpg)
![Page 80: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/80.jpg)
Resources
National Health Care for the Homeless Councilwww.nhchc.org
Homelessness Resource Centerwww.homeless.samhsa.gov
The National Center on Family Homelessnesswww.familyhomelessness.org
National Child Traumatic Stress Networkwww.nctsn.org
T3 (Think. Teach. Transform.)www.ThinkT3.com
![Page 81: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/81.jpg)
Resources
CDC ACE Studyhttp://www.cdc.gov/ace/index.htm
SAMHSA: National Center for Trauma Informed Carehttp://www.samhsa.gov/nctic/
![Page 82: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/82.jpg)
Contact Information
Deborah Borne, MSW, MDSan Francisco Department of Public [email protected]
http://www.nhchc.org/
![Page 83: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/83.jpg)
History and Current Functioning Influences Response to Trauma
Prior exposure to trauma
Mental health concerns
Current living situation
Strengths/coping skills
History
Current Functioning
![Page 84: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/84.jpg)
Characteristics of Traumatic EventsInfluence Response to Trauma
What was the nature of the event?
How severe was it?
How long did it last?
![Page 85: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/85.jpg)
Culture Influences Response to Trauma
“A broad understanding of culture leads us to realize that ethnicity, genderidentity and expression, spirituality, race, immigration status, and a host of other factors affect not just the experience of trauma but help-seeking behavior, treatment, and recovery.”
- National Child Traumatic Stress Network
Source: National Child Traumatic Stress Network, Culture and Trauma Briefs. (2006). Volume 1(4). Available at www.NCTSN.org.
![Page 86: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/86.jpg)
Developmental Status Influences Response to Trauma
![Page 87: DEBORAH BORNE, MSW, MD Trauma-Informed Care. Getting To Know You](https://reader035.vdocuments.net/reader035/viewer/2022062718/56649e875503460f94b8bce7/html5/thumbnails/87.jpg)
Development and Trauma
Skills specific to each developmental stage build on learning from previous stages.
Children exposed to trauma invest energy into survival instead of developmental mastery.
Development in adulthood may continue to be impacted.