INTRODUCTIONS

1. INTRODUCTIONS

2. UNDERSTANDING TRAUMA AND ITS IMPACT

3. WHAT MAKES AN EXPERIENCE TRAUMATIC?

4. The experience involves a threat to one’s physical or emotional well-being. It is OVERWHELMING. It results in intense feelings of fear and lack of control. It leaves people feeling vulnerable and helpless. It changes the way people view themselves, the world, and others. WHAT MAKES AN EXPERIENCE TRAUMATIC?

5. Sources of Traumatic Stress Loss of a loved one Accidents Homelessness Community/school violence Domestic violence Neglect Physical abuse Sexual abuse Man-made or natural disasters Terrorism Photo credit: K. Volk

6. Most of us have experienced at least one traumatic event on the list we just discussed. TRAUMATIC EXPERIENCES ARE COMMON

7. Even if the people who walk through your doors have no history of trauma, homelessness is traumatic. Source: Poems, Pictures, and Other Great Stuff. (1996). Salem-Keizer Public Schools. Salem, Oregon.

8. They have often experienced multiple traumas in addition to homelessness. WHAT WE KNOW ABOUT PEOPLE WHO ARE HOMELESS

9. Experiences of Trauma among Youth Family conflict/violence is the primary cause of homelessness. 46% have been physically abused. Foster care involvement: One in five youth who arrived at shelters came directly from foster care. Over 25% had been in foster care in the previous year. Sources: U.S. Department of Health and Human Services (1997). National Evaluation of Runaway and Homeless Youth; Bass, Deborah. Helping Vulnerable Youths: Runaway and Homeless Adolescents in the United States, 1992. The National Association of Social Workers, Washington DC.

10. Experiences of Trauma among GLBTQ Youth Comprises 20% to 40% of homeless youth. Coming out is often associated with being kicked out of home or physically assaulted. Mental health and substance abuse issues are common. Risky sexual behaviors are prevalent (increased risk of HIV). Seven times more likely to be a victim of a violent crime. Source: National Gay and Lesbian Task Force Policy Institute and The National Coalition for the Homeless (2006). Lesbian, Gay, Bisexual and Transgender Youth: An Epidemic of Homelessness.

11. After a traumatic experience, the brain remembers even the smallest details of the experience, so that if faced with a similar situation in the future, you will be able to react even more quickly.

12. triggers Reminders of past trauma sight smell taste feeling sound Alarm system is activated Respond as though there is current danger

13. Triggers Think back to our definition of what makes a stress traumatic – It leaves people feeling helpless, fearful, vulnerable and out of control. Any experience in the present that mimics these feelings can “trigger” or remind someone of a past trauma and cause them to respond as if back in the past.

14. What Happens? . . . when it happens in your family? . . .when the trauma starts young? . . . when you already face other challenges? . . . when it doesn’t stop?

15. Complex Trauma Prolonged, persistent traumatic stress. Often occurs within the caregiving system during critical developmental stages. Leads to immediate and long-term difficulties in many areas of functioning. Source: Slide adapted from NCTSN, 2005

16. Traumatic experiences, particularly experiences that are repeated, prolonged and severe, can have a significant impact on how people think, feel and respondin the present.

17. Impact of Complex Trauma Effects are neurological, biological, psychological and social in nature, including: Changes in brain neurobiology Social, emotional & cognitive impairment Adoption of health risk behaviors as coping mechanisms (eating disorders, smoking, substance abuse, self harm, sexual promiscuity, violence) Severe and persistent behavioral health, health and social problems (Felittiet al, 1998; Herman, 1992)

18. WHERE HAVE YOU SEEN TRAUMA HAVE THE BIGGEST IMPACT IN THE LIVES OF THOSE YOU WORK WITH? (POLL) • Emotional health • 2) Physical health • 3) Coping skills • 4) Relationships • 5) Sense of self

19. Trauma survivors have adopted a set of survival skills that have helped them manage their trauma in the past. These strategies make sense given what people have experienced, even if they are confusing to others or are seen as getting in the way of current goals.

20. Responses that are on based traumatic experiences can be very challenging for service providers to understand in the present.

21. Without an understanding of trauma and its impact, consumer responses may be misunderstoodormis-labled, leading to increased frustration for providers and the potential to do harmto those you are trying to help.

22. How can organizations use their knowledge of trauma and its impact to modify their services in ways that benefit staff and consumers? In response to this question, the homelessness field is moving towards a new way of providing care.

23. BECOMING TRAUMA-INFORMED

24. “Viewing the world through the lens of trauma.”

25. Providing “trauma-informed” care involves using what we know about trauma and its impacttodo our work differentlyand avoid causing additional harm to those we serve.

26. This type of change requires that staff at ALL levels and in ALL roles modify what they do based on an understanding of . . . the impact of trauma, and the specific needs of trauma survivors.

27. Recovery is possible. Integrate care. Share power and governance. Understand trauma and its impact. Healing happens in relationships. Support client control, choice, and autonomy. Ensure cultural competence. Promote safety. Principles of a Trauma-Informed System

28. Putting the Principles Into Practice

29. Youth on Fire: A safe space in Cambridge, MA for Homeless and Street-involved youth ages 14-24

30. YOF GOAL: • To encourage young people to • prioritize their health, • stay HIV-negative, & • seek greater stability through • permanent housing, • employment, & • connection to social support services.

31. who do we see?

32. BASIC DEMOGRAPHICS

33. OTHER RELEVANT INFO 52% have lived in an abusive household 11% forced to have sex in the previous year 58% have been diagnosed with a mental health condition 42% have been hospitalized for psychiatric reasons 23% report suicide attempt 22% report DSS involvement (foster care, group home) 20% report sex in exchange for money, food, or shelter

34. what we offer: Three tiers of service that follow Maslow’s Hierarchy of Needs and the Youth Development Model Opportunities for Leadership, Growth, Development and Change Supports: Case Managers, Doctor on-site, Therapist on-site, Housing Search, Employment Support, HIV testing Services: Showers, Lockers, Laundry, Meals, Hygiene Products, Med supplies, Internet, TV, Couches

35. BECOMING A TRAUMA-INFORMED SPACE: Emerging Staff Awareness of Need – how do we deal with trauma as non-clinicians? Connected with Local Resources / Trauma Experts Implemented Staff Training Assessed Space Developed Trauma-informed Intervention

36. STAFF TRAINING What is trauma? How does it affect people? What are triggers? How do they come out? How are people’s trauma and triggers related to their coping mechanisms? (“Why do people do what they do?” “Because what they do works.”) How can this affect us as providers and people? As non-clinicians, how can we help people deal with their experiences?

37. CHANGES MADE TO PHYSICAL SPACE Re-arranged space to make all Case Managers have a semi-private cubicle with curtains for privacy Re-arranged space so that TV is facing the wall-members who do not want to watch what is on TV do not have to see it More quiet space for members to sleep Improved lighting in space Changed color of walls from yellow to blue Staff training and written protocol on Crisis Prevention and De-escalation. Extended hours for evening access

38. CHANGES RECOMMENDED BUT NOT MADE Will not screen out people with violent histories or criminal records Will not install metal detector to screen for weapons Will not limit members’ ability to write about their experiences of violence (in literary magazine) Not able to provide flip-flops for shower use Are not able to become wheelchair accessible

39. PHOENIX RISING: A TRAUMA-INFORMED INTERVENTION Based on ARC Framework for for intervention with youth exposed to complex trauma. (Kinniburgh, Blaustein, Spinazzola & van der Kolk) ARC = Attachment, Regulation, Competence Integrated with Motivational Interviewing techniques, Harm Reduction practices, and Prevention Case Management model Went through a number of versions of the curriculum, and eventually came to a 5 session, low-threshold version For more information on the ARC Framework: http://www.traumacenter.org/research/ascot.php

40. Phoenix Rising Curriculum (Regulation & attachment): • Values Sort/ Clarification • Trauma & Trigger Education • Arousal & Coping Mechanisms • Regulation Skills • Risk Reduction • HIV Counseling and Testing

41. phoenix rising competence activities : • Speakers Bureau • Youth Advisory Board • Cooking for the Center • Hiring Committees

42. IMPACT OF PHOENIX RISING On Staff On Members On Space

43. TOOLS AND RESOURCES

44. FIRST STEPS TOWARDS BECOMING TRAUMA-INFORMED Basic trauma education for staff (see resource list). Partner with community agency to provide clinical supervision/consultation. Take a look at your physical space with an eye for creating a sense of safety and cultural relevance, while minimizing triggers. Identifying ways to give people as much choice and control as possible within their environment.

45. RESOURCES Homelessness and Traumatic Stress Training Package. This training package includes a trainer’s guide, power-point slides, a trainer’s script, hand-outs, and evaluation materials. What About You? A Workbook for Those Who Work With Others. A Long Journey Home: A Guide for Creating Trauma-Informed Services. Shelter from the Storm:Creating Trauma-Informed Homeless Services.This report outlines current trends and promising models for developing trauma-informed homeless service systems and organizations.

46. NEXT STEPS TOWARDS BECOMING TRAUMA-INFORMED For organizations who would like to make a broader and more significant organizational commitment to becoming trauma-informed, next steps may involve engaging in an organizational self-assessment process.

47. ASSESSMENT TOOLS Organizational needs assessment – “Shorter” tool. Used by Youth on Fire. Trauma-Informed Organizational Toolkit – “Longer” tool. Includes the Trauma-Informed Organizational Self-Assessment and User’s Guide, along with a How-To Manual for Creating Trauma-Informed Organizational Change.

48. YOUTH ON FIRE RESOURCES Sample Intake and Risk Assessments Sample Rights and Responsibilities For additional resources, see resource page for youth drop-in centers.

49. QUESTION AND ANSWER