Supporting Trauma Recovery:

1. Supporting Trauma Recovery: A Short-term Psycho-educational Role for the Job Corps Center Mental Health Consultant Linda Sharpe-Taylor, Ph.D. Psychological Network 58 Portwest Court St. Charles, Missouri 63303 Phone (636) 916-5800

2. Learning Objectives Participants will be able to: • 1- Recognize and identify at least 3 trauma symptoms exhibited by students and staff. • 2-Articulate the connection between trauma and employability • 3- List the components necessary for a psychoeducational support group for young women who have been the victim of abuse/assault.

3. Youth, Trauma, and Employability • Employment plays a vital role in the general well-being of all people, but especially for those with stress related health conditions.

4. Youth, Trauma, and Employability • The structure of a work schedule, connection to community, and self-efficacy from gainful employment all contribute to recovery, improvement in self-esteem, and life satisfaction.

5. Youth, Trauma, and Employability • The research literature well establishes the relationship between gainful employment, stress, depression, anxiety disorders, and well-being for those in the workplace.

6. Youth, Trauma, and Employability • WinefieldandTiggemann (1990) found gainful employment produces an improvement in psychological well-being in school leavers

7. Youth, Trauma, and Employability • O’Brian and Feather (2011) suggest school-leavers who obtained good quality employment had lower depressive affect, higher life-satisfaction, higher internal control and higher personal competence.

8. Youth, Trauma, and Employability • Matsuba, et. al (2008) showed significant psychological improvement among vocational program participants on measures of well-being. • The results suggest the need for employment training programs to be more holistic by working with youth to improve their psychological health, and thus helping them to overcome a barrier to employment.

9. Job CORPS MISSION to Serve • The Disadvantaged • Those Impacted by Violence • Those Impacted by Poverty • Those Impacted by Abuse and Neglect

10. Job CORPS MISSION to Serve Research supports the conclusion that many of the youth served by Job Corps are susceptible to stress related health conditions such as Post Traumatic Stress Disorder and Depression and Anxiety. These conditions can be barriers to employability (see Fowler, Tompsett, Braciszewski,Jacques-Tiura, and Baltes , 2009, for review).

11. Symptoms of Trauma: Barriers to Employability • Within the local region of St. Louis, it has been estimated that more than two-thirds of public school students may be suffering from symptoms of trauma (see Tindall, 2009, for discussion) • Many of these youth will attend Job Corps

12. Job CORPS MISSION to Serve • Psychological Distress is helped by gainful employment • Psychological Distress and symptoms are also barriers to employment

13. Symptoms of Trauma: Barriers to Employability Common experiences of trauma • Abuse, including sexual, physical, emotional, • Exposure to domestic violence • Severe natural disaster, such as a flood, fire, earthquake or tornado • Abandonment

14. Symptoms of Trauma: Barriers to Employability • Witness to violence in the neighborhood or school setting, including fights, drive-by shootings, and law enforcement actions • Personal attack by another person or an animal • Kidnapping • Severe bullying • Medical procedure, surgery, accident or serious illness.

15. Symptoms of Trauma: Barriers to Employability Before we continue, take one minute and write three examples of recent referrals for CMHC services you have received.

16. Symptoms of Trauma: Barriers to Employability Van derKolk, et al., (1996), described the following long term effects of trauma: • Generalized hyper-arousal and difficulty in modulating arousal • Aggression against self and others • Inability to modulate sexual impulses

17. Symptoms of Trauma: Barriers to Employability • Problems with social attachments – excessive dependence or isolation • Alterations in neurobiological processes involved in stimulus discrimination • Problems with attention and concentration • Dissociation

18. Symptoms of Trauma: Barriers to Employability • Somatization • Conditioned fear responses to trauma related stimuli • Loss of trust, hope, and a sense of personal agency

19. Symptoms of Trauma: Barriers to Employability • Social avoidance • Loss of meaningful attachments • Lack of participation in preparing for the future

20. Symptoms of Trauma: Barriers to Employability • Of the referrals you wrote earlier, how many could be conceptualized under a trauma related concern?

21. Symptoms of Trauma: Barriers to Employability ...by looking through a trauma lens and conceptualizing problems as possibly related to current or past trauma,

22. Symptoms of Trauma: Barriers to Employability it becomes possible to better understand that trauma victims, young and old, organize much of their lives around repetitive patterns of reliving and warding off traumatic memories, reminders, and affects.

23. Explaining the continued impact of the past • Real Time • Psychological Time

24. Jumping Out of Plane

25. Jumping Out of Plane

26. Jumping Out of Plane

27. Jumping Out of Plane • Real Time of a Jump is an average of 8 to 10 Minutes • Psychological Time is potentially for a life time

28. Role of Memory • Psychological Time is a function of memory • Human survival is benefitted by holding images of danger in memory (the role of the amygdala, Wehrenberg, 2007) • Recovery from traumatic experiences involve the processing of memories and making sense of what has happened so that the memory can be put away

29. AROUSAL • Traumatic events flood the body system with stress hormones • The flood of norepinephrine and cortisone makes the system more responsive to everyday stress

30. Arousal • Examples of Arousal • Numbing • Flashbacks • Hypersexual Behavior • Blanking Out • Anger • Tension • Defensiveness • Depression • Poor Concentration • Panic

31. Arousal • Flipping off the switch of arousal is related to processing the memory to end the psychological time of the traumatic event

32. R.I.S.E.Reaching Inside for Strength and Empowerment • RISE is all about education on trauma, and how to begin turning off arousal symptoms • The group is an eight week educational format

33. R.I.S.E.Reaching Inside for Strength and Empowerment • The basic components of RISE are: • Limiting inappropriate self-blame (sessions 1 through 8) • Understanding of Abuse and Identifying the Impact in their lives (sessions 1 through 4) • Recognizing the healing from breaking the silence that you are not alone (sessions 5 through 6) • Recovery and Healing is possible (sessions 7 through 8)

34. Self-Blame

35. The Impact of Abuse

36. Breaking the Silence

37. Healing and Recovery

38. The impact of RISE • Comparing the completion rate of those student employees who participate with nonparticipants with similar experiences • Impact of report of active symptoms. The PTSD Symptom Checklist is used pre and post. The expectation is not to treat PTSD but to discern if participation can have an impact. Those students who are positive for PTSD are referred for treatment but are allowed to participate in R.I.S.E. • Participant satisfaction

39. Results--Completion • Comparisons regarding completion were made between those who regularly attended and those who opted out or dropped out before attending three sessions (n=49) • Consistent attendees in R.I.S.E. had less AWOL (17% versus 58%); less negative incident reports (average of 9.42 v. 15.6); and 83% of consistent attendees were in Good Standing compared to 42% of inconsistent attendees

40. Results--Symptoms • 16% agreed, 34% were not sure, and 50% disagreed that they have fewer worries about the past • 16% agreed, 34% were not sure, and 50% disagreed/strongly disagreed that they only think about the trauma when they decide to • 34% were not sure and 66% strongly disagree that they blamed themselves for what happened

41. Results--Satisfaction • 100% of those responding either strongly agreed or agreed that they were satisfied with the group • 100% of those responding either strongly agreed or agreed the group is important because it helps me stay motivated to complete Job Corps • 67% of respondents indicated that they know how to get additional help if needed • All but one student indicated that confidentiality was respected

42. Preparing Your Center for a RISE GROUP • Educate the Wellness Manager • Educate the Center Director • Educate the Counselors • Market to the Center Director, Wellness Manager, Counselors

43. Issues to Address • CONFIDENTIALITY • Time and Commitment • Coordination with SART on-campus and off

44. R.I.S.E. Manual • A manual for the R.I.S.E. group is available via http://www.psynetinc.com/downloads • The access is Password Protected. • Username: psynetinc • Password: RISE • It is an Adobe PDF file, so you will need to have Adobe reader or compatible software

45. References • Gee, G. & Walsemann, K. (2009). Does health predict the reporting of racial discrimination or do reports of discrimination predict health? Findings from the National Longitudinal Study of Youth. Social Science and Medicine, 68 (9), 1676–1684. Retrieved from Science Direct. Retrieved from http://www.sciencedirect.com/science/ journal/02779536/68/9

46. References • Matsuba,M.K., Gavin J. Elder, G.J., Franca Petrucci, F., & Tammy Marleau, T. (2008). Employment Training for At-risk Youth: A Program Evaluation Focusing on Changes in Psychological Well-being. Child & Youth Care Forum, 37 (1), 15-26. Retrieved from Springer US. Retrieved from http://link.springer.com/journal/10566 • O’Brian, G.E. & Feather, N.T. (2011). The relative effects of unemployment and quality of employment on the affect, work values and personal control of adolescents. Journal of Occupational Psychology, 63 (2), 151–165. doi: 10.1111/j.2044- 8325.1990.tb00517.x

47. References • Tindall, J.A. (2009). Workbook: Applying Peer Helper Skills. (3rd ed.). New York, NY: Routledge. • Van derKolk, Pelcovitz, Roth, Mandel, McFarlane & Herman (1996). Dissociation, Affect Dysregulation & Somatization: the complex nature of adaptation to trauma. American Journal of Psychiatry, 153(7),83-93.

48. References • Wehrenberg, M. & Prinz, S. M. (2007). The Anxious Brain. New York, NY: W.W. Norton & Company. • Winefield, A.H.& Tiggemann, M. (1990). Employment status and psychological well-being: A longitudinal study. Journal of Applied Psychology, 75(4), 455-459. doi: 10.1037/0021-9010.75.4.455

49. Special Thanks • Any successful effort requires contribution and support from a variety of sources. Special thanks to Tara Triplett, TEAP Specialist for her support and leadership in implementation of R.I.S.E. • Special thanks to the St. Louis Job Corps staff led by the Center Director, Reginald Young. Also thanks to the Wellness staff lead by Marsha Smith, Manager. Everyday the St. Louis team pushes for the best for their student/employees • Special thanks to Judith Tindall, Ph.D. for her support and feedback regarding R.I.S.E.