trauma-based assessment & treatment for children &...
TRANSCRIPT
In Summary Childhood abuse and trauma:
• Causes serious and chronic health, behavioral health and social problems
• Impacts brain and nervous system, perception of self and others
• Epidemic proportions – a major public health issue
• Often unrecognized, ignored or denied (Jennings, 2004)
Trauma-Informed is MUCH more that
trauma treatment!
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There is an important difference
between “Trauma Informed”
care and delivering “Trauma
Specific” treatment.
Trauma Specific
Treatment
A trauma specific service is
designed to treat the “actual
sequelae” of trauma Harris, M., Fallot, R., 2001 E.g. Trauma Focused Cognitive Behaviour
Therapy
The Science of
Trauma Informed
Services
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Roots in the United States
• 2001 – 12 States formed and informal
network – State Public System Coalition on
Trauma (SPSCOT)
– Formed a listserv for ongoing communication
• 2004 - Produced “Trauma Services
Implementation Toolkit for State Mental
Health”. (Jennings, 2004)
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Roots in the United States
• 2004 – Dare to Act Conference
(National)
• 2005 – National Centre for Trauma
Informed Care formed.
• 2007 – Update to the toolkit
(SAMHSA)
• 2008 - Dare to Transform Conference,
Substance Abuse and Mental
Health Services Administration
(SAMSHA) 2011
• Overview: Reducing the pervasive, harmful, and costly
health impact of violence and trauma by integrating trauma-informed approaches throughout health, behavioural health, and related systems and addressing the behavioural health needs of people involved in, or at risk of involvement in the criminal and juvenile justice system.
Strategic Initiative #2 Trauma and Justice
“Trauma Informed” - Definition
…means that individuals in organizations
are educated on the causes and effects of
trauma and understand the potential to
retraumatize individuals by providing
services and/or interacting in a manner
that is not sensitive to their experiences
and needs.
(Thrive, Trauma Informed System of Care, Portland, Maine)
Trauma Informed Philosophy
• Value the person with lived experience in
all aspects of care
• Use neutral, objective and supportive
language
• Individually flexible plans and
approaches
• Avoid shaming or humiliation at all times
(Fallot & Harris, 2002; Ford, 2003; Najavits, 2003)
Trauma Informed Philosophy
“Trauma-informed strategies ultimately seek to do no further harm; create and sustain zones of safety for children, youth and families who may have experienced trauma; and promote understanding, coping, resilience, strengths-based programming, growth and healing.”
(Cooper, Masi, Dababnah, Aratani and Knitzer, 2007; Strengthening Policies to Support Children, Youth and Families Who Experience Trauma, National Centre for Children in Poverty, Columbia University, pg. 17)
Trauma Informed Principles
• Integrate philosophies of care that guide all clinical interventions
• Are based on current literature
• Are inclusive of the survivor's perspective
• Are informed by research and evidence of effective practice
• Recognize that coercive interventions cause traumatization and re-traumatization are to be avoided
(Fallot & Harris, 2002; Ford, 2003; Najavits, 2003)
Safety; Trustworthiness; Choice; Collaboration; Empowerment
Trauma Informed
Organizations
1. Every part of a TI organization, its management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services.
2. The whole organization understand the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization.
Substance Abuse And Mental Health Services Administration (SAMHSA)
Universal Precautions as a
Core Trauma Informed Concept
Presume that every person in a
treatment setting has been exposed to
abuse, violence, neglect or other
traumatic experiences
Carlos Neves, MSW, RSW
kidsLINK Intake Social Worker
Re-examination
“What happened to you?”
“What is
wrong with
you”
12 Criteria
“Blueprint for Action” Jennings, 2007
• State Accomplishments, Activities
and Resources Toward Meeting
Criteria for Building Trauma
Informed Mental Health Service
Systems
• Reviewed action across the U.S.
• 12 Criteria
12 Criteria
1. A designated trauma function and focus in the state
mental health department.
2. State trauma policy or position paper.
3. Workforce recruitment, hiring and retention.
4. Workforce orientation, training, support,
competencies and job standards related to trauma.
Ann Jennings, 2008 Update, Models for Developing Trauma-Informed Behavioural Health Systems and Trauma Specific Services, National Centre for Trauma Informed Care, funded by SAMHSA
12 Criteria
5. Consumer/Trauma Survivor/Recovering person
involvement and trauma informed rights.
6. Financing criteria and mechanisms to support
development of trauma-informed service systems and
implementation of evidence based and promising practice
trauma treatment models and services.
7. Clinical practice guidelines for working with children and
adults with trauma histories.
8. Policies, procedures, rules, regulations and standards to
support access to trauma treatment, to develop a trauma-
informed system, and to avoid re traumatization.
12 Criteria con’t
9. Needs assessment, evaluation, and research to explore prevalence and impacts of trauma; assess trauma survivor satisfaction, service utilization and needs; and to monitor and make adjustments in trauma-informed and trauma-specific service approaches.
10. Universal trauma screening and assessment.
11. Collaborations amongst trauma-informed services and service systems.
12. Trauma-specific services, including evidence based and promising practice treatment models.
U.S. – States’ Actions
#1 - TI Focus and Function at the State Level – 32 States
Maine – Thrive Initiative – First in the U.S. 9 Million $
#2 – State policy or position paper – 15 States
Oregon - State Policy on TI Services
#8 – P&P to prevent re victimization - 33
States
Colorado – State Rules on TI Services
Fallot & Harris
1. Program Procedures and Settings: Safety; Trustworthiness; Choice; Collaboration; Empowerment.
2. Formal Service Policies
3. Trauma Screening, Assessment and Service Planning
4. Administrative Support for Program-Wide Trauma-Informed Services
5. Staff Trauma Training and Education
6. Human Resource Practices
Self Assessment and Planning Protocol (2009)
Six Domains
Group Discussion
Self Assessment
Toolkit
• A Long Journey Home: A Guide for Creating Trauma–Informed Services for Mothers and Children Experiencing Homelessness (2008)
• The National Center on Family Homelessness
Search “trauma informed toolkit”
www.kidslinkcares.com
Traditional Services & Systems Trauma-informed Services & Systems
Traumatic stress is not viewed as a primary
defining event in people’s lives
Traumatic and violent events are the central,
primary events impacting everything else in the
lives of women and children
Problems/Symptoms are discrete and separate Problems/Symptoms are inter-related
responses to or coping mechanisms to deal
with trauma
Hierarchical Shares Power/Decreases Hierarchy
People providing shelter and other services are
the experts
Homeless families are active experts & partners
with people providing services:
Primary goals are defined by service providers
and focus on symptom reduction
Primary goals are defined by homeless families
and focus on recovery, self-efficacy and, healing
Reactive Proactive
Sees clients as broken, vulnerable, damaged and
needing protection from themselves
Understands providing clients with the
maximum level of choices, autonomy, self-
determination, dignity, and respect is central to
healing
Reference: A Long Journey Home: A Guide for Creating Trauma-Informed Services for Mothers and Children Experiencing Homelessness
Canada
kidsLINK -
Ontario • 2009 - Visit Thrive (Maine),
Andrus/Sanctuary (New York)
• 2009/10 Explore/implement trauma
specific service - TFCBT
• 2010 – Implement universal trauma
screen at Front Door (Joint
Initiatives)
• 2010 – 2013 Implementation of the
Sanctuary Model
Klinic – Manitoba
Recently announced funding
for a Trauma Resource Centre
Advocating with Mental
Health Commission
of Canada for National
Resources
British Columbia
Centre of
Excellence
for
Women’s Health
Coalescing on Women and Substance Use: Trauma-informed Online Tool
“I have come to believe that trauma
is the problem and substance use
the solution…until the solution
becomes the problem”
Addictions Counselor
Where to Go From Here? Service Providers
Develop a “trauma team” Seek and share up to date
research and knowledge Collaborate with others on
training and building awareness (seek training!)
Implement a universal trauma screen (or refer)
Conduct thorough trauma assessments on admission (or partner)
Offer trauma specific treatments (refer and partner)
Policy Makers & Funders
Create regional/province wide standing Trauma Task Force
Develop a written policy on Trauma-Informed Service System
Establish a clearly identified Trauma Office in government
Coordinate Trauma- Informed Treatment Services across Ministries
Contact Information
For further information on trauma-informed service systems work,
please contact:
Barb Ward, MSW, RSW – Director of Services, kidsLINK
Laurie Robinson, MSW, Consultant, kidsLINK
[email protected]; [email protected]
Thank You!