Trauma: - What it is - Why it matters to you

1. Trauma: - What it is- Why it matters to you Prepared by the Trauma-Informed Care Initiative of Western New York Trauma-Informed Care Inititative of WNY

2. Trauma is real… “Healing Neen” Documentary Trailer, 2006 video link Trauma-Informed Care Inititative of WNY

3. What is trauma? Trauma-Informed Care Inititative of WNY

4. Trauma is universalRegardless of … Trauma-Informed Care Inititative of WNY Age Culture Gender Class

5. Determined by… Events Ongoing situations Appropriate Pic here Trauma-Informed Care Inititative of WNY

6. more importantly By a person’s experience of the event or ongoing situation Trauma-Informed Care Inititative of WNY

7. Trauma overwhelms ability to cope To integrate one’s own experiences ideas emotions with events Trauma-Informed Care Inititative of WNY

8. Determinedby… not just events but an individual’s experience of the event

9. Trauma can be caused by both ACUTE and CHRONIC situations Trauma-Informed Care Inititative of WNY

10. ACUTE • School shooting • Gang-related violence • Terrorist attack • Natural disaster (e.g., earthquakes, flood, tornado, hurricanes) • Serious accident (e.g., car or motorcycle crashes) • Sudden or violent loss of a loved one • Physical or sexual assault • Out-of-home placement of children • Divorce • Medical procedure, hospitalization, surgery • Suicide of loved one, friend, or acquaintance • Institutional retraumatization • Workplace harassment • Bullying Trauma-Informed Care Inititative of WNY

11. CHRONIC • Physical abuse • Long-standing sexual abuse • Alcohol or substance abuse within the home • Domestic violence • Multiple medical hospitalizations, procedures, and surgeries • Workplace harassment • Malnutrition • Wars and other forms of political violence • Vicarious traumatization resulting from providing services to trauma survivors • “HOW” many systems of care do their work may inadvertently retraumatize individuals Trauma-Informed Care Inititative of WNY

12. Trauma has a very real and significant impact on: Individuals who experience traumatic events Service Providers working with those individuals Public Health as a whole Why does trauma matter? Trauma-Informed Care Inititative of WNY

13. Impact on Individuals The ACE Study (Adverse Childhood Experiences) Analyzes the relationship between • multiple categories of childhood trauma (prior to age 18) • health and behavior outcomes over someone’s lifespan Trauma-Informed Care Inititative of WNY

14. Dr. Vincent Felitti Co-Principal Investigator, ACE Study About the ACE Study… Video link (0:35– 2:29 suggested) Trauma-Informed Care Inititative of WNY

15. Adverse Childhood Experiences ACE Study ACE Response Trauma-Informed Care Inititative of WNY

16. Adverse Childhood Experience (ACE) any of the following categories prior to age 18: abuse neglect loss • Physical abuse by a parent • Emotional abuse by a parent • Sexual abuse by anyone • Growing up with an alcohol and/or drug abuser in the household • Domestic violence • Experiencing the incarceration of a household member • Living with a family member experiencing mental illness • Loss of a parent • Emotional neglect • Physical neglect Trauma-Informed Care Inititative of WNY

17. The more ACEs survived, the more likely behavioral issues and health issues will occur later in life.

18. Impact ofAdverse Childhood Experiences Death Conception Trauma-Informed Care Inititative of WNY

19. Health and behavior outcomes that can result from childhood trauma

20. Impact of trauma can be felt: Physically Emotionally Behaviorally Cognitively Spiritually

21. Trauma can impact an individual’s view of the world “The world is an unsafe place to live.” “Other people are unsafe and can’t be trusted.” “My own thoughts and feelings are unsafe.” “I expect crisis, danger, and loss.” “I have no self-worth and no abilities.” Trauma-Informed Care Inititative of WNY

22. Impact on Service Providers When working with traumatized individuals… Staff can experience increased stress related to: • Secondary/vicarious trauma • Threats to physical/emotional safety • Being asked to do “more and more” with “less and less” Trauma-Informed Care Inititative of WNY

23. Impact on Public Health as a whole American Academy of Pediatrics technical report, 2012 • unhealthy lifestyle substance abuse poor eating and exercise habits • persistent socioeconomic inequalities school failure financial hardship • poor health diabetes cardiovascular disease Trauma-Informed Care Inititative of WNY

24. Trauma-InformedCareabout trauma? What can be done about trauma? Trauma-Informed Care Inititative of WNY

25. … Instead of asking “What is wrong with this person?”ask“What happened to this person?” Trauma-Informed Care Inititative of WNY

26. Trauma-informed care involves a thorough understanding of the • Physical • Psychological • Social effects of trauma informed by and acknowledging • the role that trauma has played in people’s lives. Trauma-Informed Care Inititative of WNY

27. Trauma-informed care strives to • recognize the centrality of trauma • avoid re-traumatization of those already traumatized • ensure an environment characterized by the “Five Guiding Principles” Trauma-Informed Care Inititative of WNY

28. 5 Guiding Principlesof Trauma Informed Care Safety Trustworthiness Choice Collaboration Empowerment Fallot & Harris, 2006 Trauma-Informed Care Inititative of WNY

29. SAFETY Trauma-Informed Care Inititative of WNY • Ensuring physical and emotional safety includes: • Where and when services are delivered • Awareness of an individual’s discomfort or unease What other things would you consider for safety?

30. TRUSTWORTHINESS Trauma-Informed Care Inititative of WNY • Ensuring trustworthiness through clarity, consistency, interpersonal boundaries includes: • How to handle dilemmas regarding role clarification • How to communicate reasonable expectations What other areas would you consider important regarding trustworthiness?

31. CHOICE Trauma-Informed Care Inititative of WNY • Maximizing choice and control includes: • Participation in decision-making regarding services • Built in small choices that make a difference What kind of choice is relevant to providing services?

32. COLLABORATION Trauma-Informed Care Inititative of WNY • Maximizing collaboration and sharing power includes: • Communicating respect for life experience and history • Communicating respect for individuals being the expert on their own lives • Identifying tasks that can worked on together In what ways can collaboration be beneficial for the people we work with?

33. EMPOWERMENT Trauma-Informed Care Inititative of WNY • Prioritizing empowerment and skill building includes: • Ensuring individuals have a voice in planning • Emphasizing growth What can be done to empower the individual?

34. Traumatization in the System • Consider this: • Some actions occurring within the system may re-traumatize the individual receiving services. • What can be done to prevent this from happening? Trauma-Informed Care Inititative of WNY

35. Think About the Similarities Physical/Sexual Abuse Treatment Setting Seclusion as a response to “inappropriate” behavior. Restraints as a way to manage aggressive behavior. Interventions occurring with staff of the opposite sex while client is in a distressed state of mind. Reports of abuse not believed or responded to. • Forced action taken on the part of the perpetrator. • Psychological manipulation on the part of an adult or respected figure in the child’s life. • The perpetrator being the opposite sex of the child. Trauma-Informed Care Inititative of WNY

36. What Can We Do? • Review agency policy regarding trauma-informed care. • Ensure proper training of staff regarding what constitutes trauma-informed care. • Consider alternative methods to how we interact and intervene with the people we work with, especially when there is a concern for their psychological and physical safety. • What we think of as intervention may be abusive and re-traumatizing. Trauma-Informed Care Inititative of WNY

37. To commit to becoming trauma-informed is to commit to a new way of thinking Trauma-Informed Care Inititative of WNY

38. We hold the answers in our own hands Trauma-Informed Care Inititative of WNY

39. Self-Care Trauma-Informed Care Inititative of WNY It is important for us as practitioners and service providers to take care of ourselves as well. Self-Care This link has information that could be helpful as a starting off point for self-care. http://www.socialwork.buffalo.edu/students/self-care/

40. For more information about trauma, trauma-informed care, and trauma-informed training opportunities, please visit: • The Anna Institute www.theannainstitute.org • The National Child Traumatic Stress Network (NCTSN) www.nctsnet.org • The Adverse Childhood Experiences Study www.acestudy.org • Ace Response - partnership between Prevent Child Abuse America and the University at Albany (SUNY) School of Social Welfare www.aceresponse.org • Substance Abuse and Mental Health Services Administration www.samhsa.gov • The Institute of Trauma & Trauma-Informed Care at the University at Buffalo School of Social Work www.socialwork.buffalo.edu/research/ittic •  The Trauma Institute & Child Trauma Institute www.childtrauma.com • The Sanctuary Modelhttp://www.sanctuaryweb.com/ Trauma-Informed Care Inititative of WNY

41. References Trauma-Informed Care Inititative of WNY “Trauma-Informed Care” – PowerPoint presentation by Elizabeth Hudson, LCSW, Consultant to the Wisconsin Dept. of Health Services, Division of Mental Health and Substance Abuse Services “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science into Lifelong Health.” American Academy of PediatricsJanuary 2012 Policy Statement “Creating Cultures of Trauma-Informed Care: A Self-Assessment and Planning Protocol” by Roger D. Fallot, Ph.D. and Maxine Harris, Ph.D. Community Connections, April 2009 http://www.nasmhpd.org/NCTIC.cfm www.trauma-informed.ca The National Child Traumatic Stress Network (NCTSN): www.nctsnet.org Centers for Disease Control and Prevention: www.cdc.gov/ace/index.htm The Adverse Childhood Experiences Study: www.acestudy.org http://www.samhsa.gov/nctic/ http://healingneen.com

42. Local Resources Trauma-Informed Care Inititative of WNY • Crisis Services (Erie County) Niagara County Crisis Services 2969 Main St Buffalo, NY 1001 11th St Niagara Falls, NY (716) 834-3131 (716) 285-3515 • Horizon Health Services (Administrative Office) 3020 Bailey Ave Buffalo, NY (716) 831-1800 • Spectrum Human Services (Administrative Office) 227 Thorn Ave Orchard Park, NY (716) 662-2040 • Catholic Charities (Erie) 525 Washington St Buffalo, NY (716) 856-4494 • Child & Family Services (Erie) 330 Delaware Ave Buffalo, NY (716) 842-2750