Presented by: Circuit 20 Trauma Informed Care Work Group

1. TRAUMA INFORMED CARE: Recognizing and understanding the effects of traumatic experiences Presented by:Circuit 20 Trauma Informed Care Work Group

2. TRAUMA CAN OCCUR AT ANY AGE Trauma can affect any: RACE GENDER ETHNICITY SOCIO-ECONOMIC GROUP COMMUNITY WORKFORCE

3. WHAT IS TRAUMA? Definition (NASMHPD,2006) • The experience of violence and victimization including sexual abuse, physical abuse, severe neglect, loss, domestic violence and/or the witnessing of violence, terrorism or disasters DSM IV-TR (APA, 2000) • Person’s response involves intense fear, horror and helplessness • Extreme stress that overwhelms the person’s capacity to cope

4. EXPOSURE TO TRAUMA IT IS AN INDIVIDUAL’S EXPERIENCE OF THE EVENT…… not necessarily the event itself that is traumatizing.

5. Exposure to Trauma Trauma can be: Trauma can occur from: • A single event • A connected series of events • Chronic lasting stress • Being in a car accident or other serious incident • Having a significant health concern or hospitalization • Sudden job loss • Losing a loved one • Being in a fire, hurricane, flood, earthquake or other natural disaster • Witnessing violence • Experience emotional, physical or sexual abuse

6. TRAUMA IS UNDER-REPORTED AND UNDER-DIAGNOSED(NTAC,2004)

7. Definition of Trauma Informed Care (TIC) • Mental health Treatment that incorporates: • An appreciation for the high prevalence of traumatic experiences in person who receive mental health services • A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual (Jennings, 2004)

8. Trauma: The “Common Denominator” • The APA’s DSM IV defines a “traumatic event” as one in which a person experiences, witnesses, or is confronted with actual or threatened death or serious injury, or threat to physical integrity of oneself or others. A person’s response to trauma often includes intense fear, helplessness or horror. • Trauma can result from experiences that are “private”: • Sexual assault • Domestic violence • Child abuse/neglect • Witnessing interpersonal violence Trauma can also result from “public” experiences: • War • Terrorism • Natural disaster

9. Trauma is becoming increasingly recognized as a significant factor in a wide range of health, behavioral health & social problems Trauma is a central mental health concern and the one “common denominator” of all violence & disaster victims

10. National Comorbidity Survey indicates…. • Slightly more than ½ of all women in the U.S. will be exposed to at least one traumatic event in their lifetime (Kessler et al, 1995) • The lifetime prevalence of trauma exposure revealed that 51% of women & 61% of men had experienced at least one traumatic event in their lifetime (Kessler et al, 1995) • Women report exposure to a range of traumatic events. Although estimates vary, finding suggest that between 17% & 34% of women will experience a rape at some point in their lifetime (Brener et al, 1999;Tjaden et al, 2000) • Women are also at higher risk for sexual molestation, childhood parental neglect, childhood physical abuse, domestic violence and the sudden death of a loved one (Kessler et al, 1995;Norris et al, 2002)

11. Trauma Informed Careprovides a new model under which the basic premise for organizing services is transformed: “WHAT IS WRONG WITH YOU?” “WHAT HAS HAPPENED TO YOU?” FROM TO

12. Trauma is when people live with more fear than HOPE

13. What does the data tell us? • The majority of adults & children in psychiatric treatment settings have trauma histories • A sizable % of people with substance use disorders have traumatic stress symptoms that interfere with achieving or maintaining sobriety • A sizable % of adults & children in the prison or juvenile justice system have trauma histories ( Hodas, 2004, Cusack et al., Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)

14. How common are traumatic events? • National survey of 5,877 people aged 15-54 concluded that trauma is very common • 60.7% of men and 51.2% of women reported experiencing a traumatic event at some point in their lives • 10% of men and 6% of women reported experiencing four or more types of trauma (kessler, et al,1995)

15. Gender Differences in Traumatic Events Tolin & Foa conducted an analysis in 2006 of existing research on prevalence of traumatic events and severity of PTSD, looking specifically at sex differences. They found the following: • Females were significantly more likely to report experiencing adult sexual assault and child sexual abuse • Males were significantly more likely to report accidents & non-sexual assault, regardless of age. Male adults, war-related events, disaster or fire, witnessing death or injury and illness were more common • For childhood experiences, no differences were found for: child abuse/neglect, war-related events, disaster or fire, witnessing death or injury, or illness

16. Trauma Informed Systemsuse: *UNIVERSAL PRECAUTIONS* Presume that EVERY person in a treatment setting has been exposed to abuse, violence, neglect, or other traumatic events

17. For this reason… We need to presume the clients we serve have a history of traumatic stress and exercise “Universal Precautions” by creating systems of care that are trauma-informed (HODAS, 2005)

18. Trauma Informed Non Trauma Informed • Recognition of high prevalence of trauma • Recognition of primary and co-occurring trauma diagnoses • Assess for history and symptoms of trauma • Recognition of culture and practices that are re-traumatizing • Lack of education on trauma prevalence & “universal precautions” • Over diagnosis of Schizophrenia, Bipolar, Conduct Disorder & Addictions • Cursory or no trauma assessment • “Tradition of Toughness” valued as best care approach

19. Trauma Informed Non Trauma Informed • Power/control minimized-constant attention to culture • Caregivers/supporters-COLLABORATION • Address training needs of staff to improve knowledge, sensitivity and understanding • Keys, security uniforms, staff demeanor, & tone of voice • Rule enforcers-COMPLIANCE • “Patient blaming” as fallback position without training

20. Trauma Recovery is when people live with MORE hope than fear

21. Recovery Model Recovery is… “ a process, an outcome and a vision. We all experience recovery at some point in our lives from injury, from illness, from loss or from trauma. Recovery involves creating a new personal vision for one’s self ( Spaniol, Gagne, & Koehler, 1997)

22. Recovery is… …a common human experience and a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills or roles toward our understanding of mental illness (Anthony, 1993)

23. Understanding Values of Consumer Self Help & Recovery include: • EMPOWERMENT • INDEPENDENCE • RESPONSIBILITY • CHOICE • RESPECT & DIGNITY • HOPE

24. Recovery oriented treatment approaches • Peer delivered services • Self-help techniques • Emphasis on recovery • Understanding the relationship between trauma and mental illness • Cognitive Behavioral Therapy (individual therapy) • Medication Management-new medications • EMDR: Eye Movement Desensitization & Reprocessing

25. What is the Staff Involvement in the Recovery Process? Staff members provide: • Encouragement • Support • Education • Acceptance • Choices • Information • Understanding • Respect • HOPE

26. What Consumers want to hear from Staff • You have come a long way • You are a strong person • I admire your courage in dealing with this pain • I encourage you • Don’t give up • I can’t promise, but I will do my best to help • I don’t understand. Please tell me what you mean • You are doing well • How can I help you • I am here for you • We can work together through this • It is OK to feel like that • I accept you the way you are • What do you need at this time

27. Customer service What is a customer? • The most important person in any business • Is not dependent on us…..We are dependent on them • Is not the interruption of work, but the purpose of it • Customers do us a favor when they come…..We aren’t doing them a favor by waiting on them

28. Resolving Conflict • Stay calm • Show empathy • Show respect • LISTEN • Reflect what they have said • DON’T ARGUE • Think • Know your procedure (get Supervisor if needed) • Explain policy and procedure • Be willing to “go the extra mile” • Keep customers’ best interest in mind

29. Remember….. • It’s not what you say but how you say it • Voice tone counts for 38% of the message sent….this increases to 90% when using the telephone • You may be the first contact with the agency so make it a GOOD experience • Smile • Be Courteous, Attentive and Pleasant