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Trauma Informed

Trauma Informed. Debbie Spaeth, LMFT, LPC, LADC. Section I: Neurological Effects of Trauma Section II: Adverse Childhood Experiences Section III: Trauma Informed Care. Section I: Neurological Effects of Trauma. Prefrontal Cortex.

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Trauma Informed

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  1. Trauma Informed • Debbie Spaeth, LMFT, LPC, LADC

  2. Section I: Neurological Effects of Trauma • Section II: Adverse Childhood Experiences • Section III: Trauma Informed Care

  3. Section I: Neurological Effects of Trauma

  4. Prefrontal Cortex • Top down guidance of attention and thoughts: Your conscious goals for the situation-and your values-determine what you focus on and what you think, including problem solving • Inhibition of inappropriate actions: Stopping yourself before acting on an unhelpful impulse, going too far down a wrong path • Regulating emotions: Decreasing the intensity of your feelings; reducing their grip on how you perceive things, think, and act • Reality testing: Checking out whether perceptions are true or faulty.

  5. PC: Non-Trauma Events Chosen and deliberate, mostly in conscious awareness

  6. Trauma = Impaired PFC • Stress chemicals basically turns it off • Primitive brain takes control • We cannot: control our attention, remember values, think logically • Emotional/Sensory Memories • Evolution origins:stop to think = death

  7. Trauma = Amygdala in Charge Automatic, mostly happening outside of conscious awareness

  8. Freeze, Flight or Fight • Freeze: Assess situation to avoid trauma • Flight: Avoid Trauma by leaving • Fight: When Flight is impossible • If fighting is useles, then: • Dissociation • Tonic Immobility

  9. Peritraumatic Dissociation • Brain’s defense against overwhelming sensations and emotions – automatic, without trying • Parts of experience normally linked are ‘dis-associated’ • ‘Blanked out’ or ‘spaced out,’ or in some way felt that I was not part of what was going on. • Found that I was on ‘automatic pilot’ – I ended up doing things that I later realized I hadn’t actively decided to do. • What was happening seemed unreal to me, like I was in a dream or watching a movie or a play. Felt disconnected from my body.

  10. Tonic Immobility • Tonic immobility is characterized by pronounced verbal immobility, trembling, muscular rigidity, sensations of cold, and numbness or insensitivity to intense or painful stimulation (Marks, 1991) • Tonic Immobility is induced by conditions of fear and physical restriction, although it can also occur in the absence of the latter, so the important aspect may be the perceived inability to escape (Heidt, Marx, & Forsythe, 2005)

  11. Section II: Adverse Childhood Experiences

  12. Adverse ChildhoodExperiences • CDC and Kaiser Permanente Collaboration • Over a decade long and 17,000 people • Looked at ACE effects over lifespan • Largest study ever done on Trauma

  13. Higher ACE = Higher Rates of • Severe/Persistent emotional problems • Health Risk Behaviors • Serious Social Problems • Adult Disease/Disability • High Health, BH, Corr, Soc Serv, Costs • Poor Life Expectancy

  14. Tragic Consequences of Unaddressed Childhood Trauma • Anna at 1.5 yoa • Anna yrs later in a mental institution

  15. ACE Consequences • 67% of all suicide attempts • 64% of adult suicide attemps • 80% of child/adolescent suicide attemps

  16. Substance Abuse Childhood Experiences and Alcoholism ACE score and Intravenous Drug Use

  17. Effect of ACEs on Mortality 0 ACE 60% live to 65 4 ACE <3% live to 65

  18. Cost to Society • Annual Direct Cost: hospitalization, MH and Health care, CW, Law Enforcement = $33,101,302,133 • Annual Indirect Cost: special educ, juvenile delinquency, MH and Health care, DOC/Jail, Lost Productivity = $70,652,715,359 • Total Annual Cost = over $184 million per day • Economic Impact Study (Sept 2007) Prevent Child Abuse America

  19. Section III: Trauma Informed Care

  20. Trauma Informed Care • Is both a philosophy and methodology • Evidenced Based (20 yrs) • Based on the ACEs Study • Early Intervention = Decreased Negative Consequences in Neurological Functions

  21. Trauma Informed Care • A change of practice to consumer- driven care; based on hope, self-determination, and empowerment. • Importance of listening to and hearing the lived experiences of trauma survivors, consumer-driven guided by people with a lived experience. They know better than anyone else what helps and what hurts in recovery.

  22. Creating the TI Culture • Avoid Re-Traumatization of clients and staff • Culture of physical and emotional safety for clients and staff • Belief that all have capacity for progressive change, but overwhelming stressors/traumatic experiences can derail this by developing maladaptive coping skills that make sense in the context of what happened, but does not make sense (and is not healthy) in their lives today. • Surfacing and Resolving Conflicts while emphasizing choices & control • Promoting and Valuing Honest Communication • Respecting everyone’s feelings and perspectives even when different

  23. Creating TI Culture-Cont’d • Maintaining/Supporting emotional regulation for self/others • Extending Kindness/Compassion while maintaining healthy boundaries. • Using a Strength Based approach that honors the belief that everyone is doing the best they know how. • Cultivating a fun attitude/atmosphere and sense of joy amongst staff/clients about the work that has to be done. • Using group process, prob solving, and creative idea sharing whenever feasible, for resolution of shared problems.

  24. Environment • A place to be calm • A place to be quiet • A place to remove stimuli • A place for therapy • A place to pray • A place to regulate emotions

  25. Agency Administration • Be a model for change. • Use data to monitor change and inform practice. • Develop attitudes, behaviors and core competencies. • Assess risk for violence. • Be present on the units to model and witness change. • Use tools to teach self-management of illness and emotions. • Rigorously debriefing analysis of events that do occur. • Complete inclusion of consumers in their own care. • Recognize peer support as a vital component of the spirit of recovery.

  26. Agency Culture • Acknowledge that trauma and compassion fatigue experienced by staff impacts their willingness to change. • Acknowledge that patient and staff safety have to be key point for staff. • Acknowledge that the “management vs. front line staff” attitudes and perceptions have to change.

  27. Consumer Care • Develop key trust points w/patients • Be on time • Take time to talk & listen • Work together on Tx Plan • Pros and Consequences of Change • Inform Px of changes in care before it happens.

  28. Staff Core Principles • Safety: Ensure physical and emotional safety of staff throughout our system of care. • Trustworthiness: Administration must consistently relay procedures and expectations. • Choice: Enhance staff choice in the control of the day to day work. • Collaboration: Maximize collaboration and sharing of power. • Empowerment: Provide skill building, find ways to empower staff and provide needed resources.

  29. Staff Functions • Be open to change. • Assess for risk for violence or self harm. • Use tools to teach self-management of illness and emotions. • Rigorous debriefing & analysis of events that do occur. • Complete inclusion of consumers in their own care. • Peer support is a vital component of the spirit of recovery.

  30. Patient Core Principles • Safety: Ensure physical and emotional safety of patients throughout our system of care. • Trustworthiness: Make tasks and expectations clear and maintain appropriate boundaries. • Choice: Enhance patient choice and control. • Collaboration: Maximize collaboration and sharing of power with patients. • Empowerment: Provide skill building, find ways to empower patients, and provide needed resources.

  31. Phase I: Safety & Stabilization • Attention to basic needs: connection to resources, self-care, ID of support sys • Educate: Trauma and Recovery process • Develop regulation of emotion and self-soothing skills

  32. Phase II: Processing &Grieving of Trauma Memories • Goal: “Have the Px acknowledge, experience, and normalize the emotions/cognitions associated w/the trauma at a pace that is safe and manageable.”- (Luxenberg, Spinazzola, Hildago, Hunt & VanDerKolk, 2001)

  33. Phase III: Reconnection • Develop a firm/new sense of self • Develop healthy and supportive relationships, spirituality, intimacy

  34. Circle of Care in TIC

  35. Resources • Creating Trauma Informed Syst’: www.nctsn.org • CDC ACE Study - www.cdc.gov/nccdphp/ACE/outcomes.htm • Damaging conseq of trauma: www.theannainstitute.org • National Center for TI Care: www.samhsa.gov/nctic/trauma • Treatment & TIC: www.childwelfare.gov • TIC: www.thenationalcouncil.org

  36. THE END • Debbie Spaeth, LMFT, LPC, LADC • dspaeth@questmhsa.com • 405-401-8234

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