“Trauma-informed organizations, programs, and services are based on an understanding of 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.” (SAMHSA)

Vs.

Trauma Specific Services – intended to reduce trauma symptoms experienced by survivors. (EMDR, TFCBT, Seeking Safety, TREM, ATRIUM)

Calling a client "noncompliant", "treatment-resistant" etc. rather than taking responsibility for failing to better help him or her, or for not knowing what to do or how to understand.

Accusing clients of "splitting" staff rather than staff taking responsibility for splitting themselves. Most of what passes for "splitting" is simply the person asking different people for what she/he wants, hoping for an alternative answer or an ally.

"Your history follows you no matter what you do in the present. I only got assaultive one time and that was when they tore the head off my stuffed doll that I had had for a lifetime. Now providers tell me I'm dangerous and I terrify people. My history follows me“

I got traumatized because of trusting people, so asking me to make a contract with you demands I trust you - which I can't.

We know what works for us and what we need, but no one will listen or take us seriously.

From “In Their Own Words: Trauma survivors and professionals they trust tell what hurts, what helps, and what is needed for trauma services” (1997) Jennings, A. and Ralph, R.

Can be single event.

More often multiple events, over time (complex, prolonged trauma).

Interpersonal violence or violation, especially at the hands of authority/trust figure, is especially damaging.

NVAW Survey (NIJ, 1995-96) 52% of women report lifetime history of physical

assault; 66% of men. 18% of women reported rape or attempted rape

at some time, many before age 18. 22% of women reported domestic violence; 7%

of men.

Adverse Childhood Experiences study (CDC, 1995) 17,337 Kaiser enrolled adults ACE score cumulative based on 10 experiences

in childhood. Includes but not limited to violent trauma.

Lack of nurturance and support (emotional neglect).

Hunger, physical neglect, lack of protection (homelessness).

Divorce in the home.

Alcoholism or drug use in home.

Mental illness or attempted suicide among household members.

Incarceration of household member.

Two-thirds of sample had a score of 1 or more.More than 10% had score of 4 or more.

ACE study (scores 0-10) Score of 4 or more:▪ Twice as likely to smoke▪ 12 times as likely to have attempted suicide.▪ Twice as likely to be alcoholic.▪ 10 times as likely to have injected street drugs.

Score highly correlated with: Prostitution, mental health disorders,

substance abuse, early criminal behavior. Physical health problems, early death.

Fight, Flight, FreezeTend & Befriend (Taylor, et al)

Chronic Trauma, Complex trauma overtime

Emotional Reactions Feelings – emotions, Regulation Alteration in consciousness Hypervigilence

Psychological and Cognitive Reactions Concentration, slowed thinking, difficulty with

decisions, blame Behavioral or physical

Pain, sleep, illness, substance abuse, Beliefs

Changes your sense of self, others, world Relational disturbance

**pay attention to how this intersects with getting basic needs met

Fight, Flight……….& Freeze

Tend and Befriend (Taylor, et al)

Without helpful affect regulation skills people who are traumatized may have to rely on tension reduction behaviors -external ways to reduce triggered distress (Briere, 2004)

▪ Address TRB and/or reduce distress▪ Has to match…

Chronic trauma interferes with neurobiological development and the capacity to integrate sensory, emotional and cognitive information into a cohesive whole. Developmental trauma sets the stage for unfocused responses to subsequent stress.

(Van der Kolk, http://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trauma_Disorder.pdf )

Sue successfully completed her AOD treatment. Part of the safety plan for her to have her 4 y/o is no contact with her abuser. While out one day she runs into her ex-partner who was abusive. Her DHS worker finds out, confronts her about it and she doesn’t tell the truth saying “it never happened”.

Pat agrees to MH counseling in a team mtg but “no shows” for the intake. During follow-up she states she is very interested but “no shows” again.

Jack calls all of his providers, multiples times. The calls are often about the same thing. He is often asking for tangible goods & can be verbally aggressive. For example last week he called requesting bus tickets. One of his providers said “I think I can get you some” but he kept calling the other providers.

You are meeting with Sophie to complete paperwork to get services for her children as she requested. She keeps rustling through her bag while your talking, looking outside your office, and checking her phone. She can’t seem to settle down and focus.

You are meeting with Yumi after an altercation with another resident in your program. She quickly says it is not her fault, that the program is targeting her and the system is unfair.

Tim is completing an intake for your services. Your program has several rules and protocols that need to be followed to successfully complete. Tim’s referral states that he has difficulty with authority and following rules and doesn’t accept help from others.

Takes the trauma into account.

Avoid triggering trauma reactions and/or traumatizing the individual.

Adjust the behavior of counselors, other staff and the organization to support the individual individual’s coping capacity.

Allow survivors to manage their trauma symptoms successfully so that they are able to access, retain and benefit from the services.

Harris, M., & Fallot, R. (2001).

Trauma awareness

Emphasis on safety

Opportunities to rebuild control

Strengths-based approach

Hopper et al, 2010

Trauma Awareness Trauma education and training for all staff; Hiring, management, and supervision practices; Policies and procedures for referral, intake, termination; Recognition of vicarious trauma and the appropriate care of

staff; Universal precaution and/or universal screening; Knowledge of effective trauma recovery services; Advocacy within the agency and with partner

agencies/systems.

Understanding of the impact of historical trauma and all forms of oppression Ongoing training for all staff Ongoing inclusion of consumer voice Procedures and practices that promote and sustain

accountability

With a foundation of awareness and understanding, organizations can strive to reflect three central principles of TIC, by creating policies, procedures, and practices that:

1. create safe context,2. restore power, and3. value the individual.

Physical Safety What does it look like? Where and when are services? Who is there/allowed to come? Attend to unease. Signage about what to expect, where to go… Home visiting plans. End with “whats next” - predict Vicarious trauma prevention plans

Is there anything I can do to help you feel more safe?

Emotional Safety Clear & consistent boundaries▪ Be able to state and model▪ Allowed to speak up re: vicarious trauma

Transparency▪ Explain the “why”▪ Eligibility written out and explained

Predictability▪ What next

Choice▪ True choice

Empowerment Advocate, model May need to do for first

Choice As much as possible 3 options

Strengths Perspective (trauma) Focus on the future

Skill building Every encounter

Respect Life experienced valued

Collaboration Referrals, teams, meetings

Compassion Not an excuse but an explanation Self Care

Relationship Modeling, boundaries, learning, partnering Supervision

I wonder if….. I notice…. In times of stress it is difficult for our

brains to retain information so to make sure we are on the same page can you repeat back ….

Accessing services can sometimes feel traumatizing

I am getting ready to ….. Is there a way to make this more

comfortable, safe, successful Is that your understanding….

DenyPrioritizeAccountability“Your kid is doing great”“Well there is always a chance….”“Do you want her to be worse off”“It was your choice to…”

Asking: Is trauma at play here? Re-frame to a trauma explanation when

appropriate. Trauma education statements Trauma translators

I think applying TIC principles in practice will: Improve our desired outcomes (dependent

on system) decrease vicarious trauma or compassion

fatigue And support trauma recovery by

Reducing re-traumatization Providing “corrective emotional experience” Educating others

Identify policies, practices, and/or experiences in your work that have potential to re-traumatize those accessing your services.

What is at least one thing you can do differently to be more trauma informed?

Awareness, Understanding, Create safety, restore power, value the individual

http://www.familyhomelessness.org/media/90.pdf

http://www.odvn.org/images/stories/FinalTICManual.pdf

http://www.annafoundation.org/CCTICSELFASSPP.pdf

http://www.socialwork.buffalo.edu/students/self-care/

Prescott, L., Soares, P., Konnath, K., and Bassuk, E. (2008). A Long Journey Home: A Guide for Creating Trauma-Informed Services for Mothers and Children Experiencing Homelessness. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; and the Daniels Fund; National Child Traumatic Stress Network; and the W.K. Kellogg Foundation. Available at www.homeless.samhsa.gov