Trauma Informed Excellence: Trauma Informed Care

1. Trauma Informed Excellence:Trauma Informed Care Health Care for the Homeless Honolulu Hawai’i June 28, 2013

2. Diverse Management Solutions, LLC www.DiverseManagementSolutions.com (303) 258-3523 Matt Bennett, MBA, MA bennett@diversemanagementsolutions.com • Stay positive • Informal • Interactive diverse management solutions

3. TIE Learning Goals • Have a basic understanding of the trauma informed paradigm as it relates to: • Self-care • Leadership/Culture • Trauma Informed Care • Trauma Treatment • Conceptualize the impact of trauma on client functioning • Conceptualize how you can utilize this research change the way you and your programs interact with clients

4. Trauma Informed Core Competencies Excellence in care

5. The Goal: World Class Services Trauma Informed Excellence: The Path

6. Trauma Informed Care Science & Proven Methodologies

7. Defining Trauma • Robustness • Having or exhibiting strength or vigorous health • Capable of performing with success under a wide range of conditions • Resiliency • The power or ability to return to the original form, position, etc. • Ability to recover readily from illness, depression, adversity, or the like.

8. ACE Findings Acestudy.org, 2013

9. Trauma Victim to Trauma Survivor Victim Survivor When you hear the term trauma survivor what does it mean to you? What role does trauma play in the life of the victim? • When you hear the term trauma victim what does it mean to you? • What role does trauma play in the life of the victim?

10. Negativity & Survival Stress & Trauma

11. Epigenetics!!!! • Environment Caring Environment: • Genes are expressed that alter the regulation of the nervous system • Qualities associated with emotional resiliency are reinforced Abusive Environment: • Stress inhibits proteins that lead to the development & operation of brain areas associated with survival • Decreases ability to manage stress in the future Shenk, 2010

12. Insecure/Disorganized Attachment Negativity & Survival Stress & Trauma

13. Power of Attachment • Attachment provides the template for how we see all relationships • Think how Windows allows us to operate software like Word, ITunes and internet browsers • Our emotional, cognitive and social functions operate from our attachment experience • Trauma = Virus in the system • Bloom & Farragher, 2011

14. Insecure/Disorganized Attachment Automatic Response Negativity & Survival Stress & Trauma

15. Brain Structure & Processing • Brainstem – Basic processes • Limbic – Emotions & Survival • Cortex – Guides us in the physical world • Prefrontal Cortex – Thinking & Conceptualization Bottom-up information (sensations) meet top-down information (memories) to create or experience of the world Siegel, 2010

16. Hyper-arousal Insecure/Disorganized Attachment Automatic Response Negativity & Survival Fight/Flight Hypo-arousal Freeze Stress & Trauma Lifestyle Habitual

17. Retraumatization • Mind’s attempt at integrating the experience into the personality • As long as the trauma can not be put into words it will be relived through emotions and behaviors • The emotions that are experienced are the emotions that need to be overcome in order to gain mastery over the trauma that they could not stop Bloom & Farragher, 2011 & Herman, 1997

18. Hyper-arousal Insecure/Disorganized Attachment Automatic Response Negativity & Survival Fight/Flight Hypo-arousal Freeze Stress & Trauma Safety & Trust Lifestyle Habitual

19. Relationship with Helper: Foundation for Focused Attention “Recovery can take place only within the context of relationships; it cannot occur in isolation. In her renewed connections with other people, the survivor re-creates the psychological faculties that were damaged or deformed by the traumatic experience.” – Judith Herman

20. Your Impact Determinants of Successful Client Outcomes Achor, 2010; Murphy, 2008

21. Steps to Prevent Re-traumatization • See the environment through the client’s eyes. • Is the environment safe, calm and predictable or overly chaotic or rigid • Do your procedures and program rules treat clients as you would want to be treated • Help set client expectations of what their experience will be like in your program • New situation elicit fear that can be associated with the fear of the traumatic experience • Boundaries that define the helping relationship • Program rules and expectations of the client • Introduction to staff Bloom & Farragher, 2011; Rock, 2009 & Herman, 1997

22. Steps to Prevent Re-traumatization • Build Safety • Do what you say you will do • Do it to the best of your ability • Adhere to and model healthy boundaries • Provide honest reflection • Trust and respect client • Go slow and go slower • Re-traumatization occurs most often when the helper or program pushes the client beyond their sense of safety • Check in often Bloom & Farragher, 2011; Rock, 2009 & Herman, 1997

23. Hyper-arousal Emotional Regulation Focused Attention Insecure/Disorganized Attachment Negativity & Survival Fight/Flight F.A.C.E.S Hypo-arousal Freeze Safety & Trust Lifestyle Health & Wellness Behavior Change Habitual

24. Focus Strategies • Life Management • Regain control of small aspects of life • Build self efficacy • Lowering stress not associated with trauma • Reclaiming the Positive • Counterbalance negative worldview with small infusions of positive thought • Shift brain to the creation of new neuropathways • Improves outcomes of the helping relationship • Techniques • Motivational Interviewing • Solution Focused Therapy • Mindfulness • Etc….

25. Trauma Treatment Strategies toward Post Traumatic Growth

26. Emotional Regulation Focused Attention Insecure/Disorganized Attachment Healthy Relationships Negativity & Survival Fight/Flight F.A.C.E.S Positivity & Logic Hypo-arousal Post- Traumatic Growth Freeze Hope Safety & Trust Health & Wellness Behavior Change

27. Client’s Journey of Post Traumatic Growth Courtois & Ford, 2009

28. Questions & Comments Thank You!

29. References & Resources 1 • Acestudy.org • Achor, S. (2010). The Happiness Advantage. New York, NY: Crown Business. • Bloom, S. L. & Farragher, B. (2011). Destroying Sanctuary: The crisis in human service delivery systems. New York: Oxford. • Ford, J. D.; Courtois, Christine A. (2009). Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide (p. 90). Guilford Press. Kindle Edition. • http://www.samhsa.gov/nctic/ • J. Douglas Bremner. (2005). Does Stress Damage the Brain? W.W. Norton & Company: New York • Lewis, G. (2006). Organizational Crisis Management: The Human Factor. Boca Raton, FL: Auerbach Publications. • Miller, W. & Rollnick, S. (2002). Motivational Interviewing: Preparing People For Change.

30. References & Resources 2 • Ogden, P., Minton, K., Pain, C. (2006). Trauma and the Body. New York: W. W. Norton and Company. • Rock, D. (2009). Your Brain at Work: Strategies for overcoming distraction, regaining focus, and working smarter all day long. New York, NY: HarperCollins. • Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2007). Collaborative Treatment of Traumatized Children and Teens. New York: The Guiford Press. • Schwartz, T. (2010). The Way We Are Working Isn’t Working. New York: Free Press. • Shenk, D.. (2010). The Genius in All of Us. New York: Doubleday. • Siebert, A. (2005). The Resiliency Advantage. San Francisco, CA: Berrett-Koehler Publishers Inc. • Siegel, D. (2010). Mindsight: The new science of personal transformation. New York, NY: Random House.