Trauma Informed Care & Effective Screening

1. Trauma Informed Care & Effective Screening Christine Heyen, MA Crime Victims’ Services Division Oregon Department of Justice Association of Public Health Nursing Supervisors Annual Conference May 9, 2012

2. Imagine a place that… • Asks “What happened to you?” instead of “What is wrong with you? • Understands past trauma can be triggered by experiences in the present • Is committed to supporting people as they heal • Leaves a person feeling edified

3. What is trauma? Briere, J. (2006).  Dissociative symptoms and trauma exposure:   Specificity, affect dysregulation, and posttraumatic stress.  Journal of Nervous and Mental Disease, 194, 78-82.

4. What is Trauma? • It can be a single event • More often than not it is multiple events over time (complex, prolonged trauma) • An interpersonal violence or violation, especially at the hands of an authority/trust figure is especially damaging

5. What does trauma do to us? Bessel A. van der Kolk , MD http://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trauma_Disorder.pdf

6. ACE Studyhttp://www.cdc.gov/ace/index.htm Adverse Childhood Experiences (ACE) Study

7. Traditional Approach vs. Trauma Theory • Traditional approach • You are sick • You are bad • You are sick and bad • Trauma theory • You are not sick or bad • You are injured

8. Trauma Informed Care (TIC)

9. What does TIC offer? • Improves our desired outcomes • Supports trauma recovery by • Reducing re-traumatization • Providing “corrective emotional experience” • Decreases our own vicarious trauma or compassion fatigue

10. Core Principles of TIC • Awareness: Everyone knows the role of trauma • Safety: Ensuring physical and emotional safety • Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries • Choice: Respect and prioritize consumer choice and control • Collaboration: Maximizing collaboration and sharing of power with consumers • Empowerment: Prioritizing consumer empowerment and skill-building

11. TIC Communication Style • Transactional • Focus on information exchange • Transactional with Social Talk • Mostly information exchange with some social talk (e.g. joking, comment on weather) • Interactional • Focus on rapport-building and interpersonal relationship integrated with the information exchange https://nchdv.confex.com/nchdv/2012/webprogram/Session2199.html

12. Tips for Practicing TIC • Use language the person recognizes • “Has your partner messed with your birth control?” • Meet the survivor “where they are” • If a person is not ready to talk, do not force the conversation. Rather keep the door open for a later time. • Consider the person’s cultural context • Avoid making assumptions – just ask!

13. Tips for Practicing TIC • Recognize adaptive behaviors serve a purpose • Why is a person chronically miss morning appointments? Is the morning the only time she can sleep? Does she have a traumatic brain injury that prevents her from remembering things? • Make adjustments to help that person succeed. Set appointment times for the afternoon. • Include everyone in your agency • From receptionist to treatment staff • Provide trauma training to every employee

14. How do we provide TIC? • Listen • What is the survivor saying to you? • What is the survivor not saying? • How is the survivor saying it? • Inform • What information do you have that may help her? • What will happen next in the process? • Why is the information important for her to have? • How can your services can help her?

15. How do we provide TIC? To the best of your ability and within your given time constraints: • Lose the labels • Let her tell her story • Give her time and space to tell her story • Let the survivor lead • Respect her voice and choice • Recognize the survivor’s comfort level • Consider the survivor’s perspective from her cultural context

16. Quick & Easy • Offer support and validation • Communicate care and concern • Avoid passing judgement • Ask questions of the survivor • Find out if she is experiencing some kind of violence or coercion in her life • Listen to what she has to say • Resist interrupting her • Make sure your body language is receptive • Offer information and assistance • Give her a resource card, a phone number, or a website • Refer her to an advocate (warm hand-off) • Tell her you are available to her in the future

17. Resources • Trauma and Trauma Informed Care • http://www.trainingforums.org/lms/ • Trauma Informed Care – PowerPoint presentation by Mandy A. Davis, LCSW, Portland State University • http://www.doj.state.or.us/victims/pdf/trauma_informed_care_presentation_outline.pdf • Futures Without Violence • http://www.futureswithoutviolence.org/

18. Resources • Supporting health needs of women in shelter: Exploring traumatic brain injury and reproductive coercion • https://nchdv.confex.com/nchdv/2012/webprogram/Session2192.html • Violence and reproductive coercion: Assessment strategies for pregnant women, and client feedback to inform what works • https://nchdv.confex.com/nchdv/2012/webprogram/Session2199.html • The 6th Biennial National Conference on Health and Domestic Violence (March 29-31, 2012) • https://nchdv.confex.com/nchdv/2012/webprogram/meeting.html

19. Resources • Community Connections – Creating Cultures of Trauma Informed Care • http://communityconnectionsdc.org/web/page/673/interior.html • Trauma-Informed Organizational Toolkit • http://www.familyhomelessness.org/media/90.pdf • Trauma-Informed Care; Best Practices and Protocols for Ohio’s Domestic Violence Programs • http://www.odvn.org/images/stories/FinalTICManual.pdf • Creating Cultures of Trauma-Informed Care; A Self-Assessment and Planning Protocol • http://www.annafoundation.org/CCTICSELFASSPP.pdf

20. Resources • Trauma-Informed Care - PowerPoint • http://www.mhcc.org.au/ticp/research-papers/Risser-2008.pdf • Shelter from the Storm: Trauma Informed Care in Homelessness Services Settings - Article • http://homeless.samhsa.gov/ResourceFiles/cenfdthy.pdf • Adverse Childhood Experience Study • http://www.acestudy.org/ • Community Re-Traumatization - Article • http://www.annafoundation.org/COMMUNITY%20RETRAUMATIZATION.pdf

21. Contact Information Christine Heyen, MA Oregon Department of Justice Crime Victims’ Services Division 1162 Court Street NE Salem, OR 97301 (503) 378-5303 Christine.p.heyen@doj.state.or.us