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Connecting Best Practices: Trauma-Informed Motivational Interviewing
Disclosures
Pam Pietruszewski, MA - GSK: Employment
Presenters
Overview
• Trauma Overview• Motivational Interviewing Overview• Building Protective Factors
Trauma Overview
We begin to ask, “What happened to you?”
rather than“What is wrong with you?”
We have to ask, “What’s strong?”
rather than“What’s wrong?”
Paradigm Shift
What is Trauma?
Individual trauma results from an , series of events, or set of circumstances that is by an individual as overwhelming or life-changing and that has profound on the individual’s psychological development or well-being, often involving a physiological, social, and/or spiritual impact.
Definition (SAMHSA Experts 2012) includes
eventexperienced
effects
three key elements
The Adverse Childhood Experience Study Behavioral Heath at the Foundation of all Health
• Over 17,000 adults studied from 1995-1997
• Almost 2/3 of participants reported at least one ACE
• Over 1/5 reported three or more ACEs, including abuse, neglect, and other types of childhood trauma
• Major links identified between early childhood trauma and long term health outcomes,
• including increased risk of many chronic illnesses and early death "Major Findings," Centers for Disease Control and Prevention (CDC)
Life-Long Physical, Mental & Behavioral Health Outcomes Linked to ACEs
• Alcohol, tobacco & other drug addiction• Auto-immune disease• Chronic obstructive pulmonary disease &
ischemic heart disease• Depression, anxiety & other mental illness• Diabetes• Multiple divorces• Fetal death• High risk sexual activity, STDs & unintended
pregnancy
• Intimate partner violence—perpetration & victimization
• Liver disease• Lung cancer• Obesity • Self-regulation & anger management
problems• Skeletal fractures• Suicide attempts• Work problems—including absenteeism,
productivity & on-the-job injury
Survival Mode Response
Survival Mode Response
Inability to
• Respond
• Learn
• Process
Trauma Shapes our Beliefs
Worldview Spirituality
Identity
Impact of Trauma on Behavior Triggers
External reminders of traumatic event
• Smell• Sound• Sight• Touch• Taste
Internal reminders of traumatic event
• Emotions• Thoughts
Anger
Difficult concentrating
Physical Illness
Hyper arousal
Low self-esteem
Avoidant behavior
Traumatic grief
Mistrust Trauma re-enactment
Depression
Sensory sensitivity
Dissociation
AggressionShame
Need to control
Inattention
Persistent irritability
Defiance
Difficulty forming relationships
Disrupted MoodRegressive behavior Perfectionism
GuiltSleep problems
Fear
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Trauma is a risk factor for Substance Abuse
Substance Abuse is a risk factor for Trauma
Trauma-Informed Care
The 7 Domains of Trauma-Informed Care
• Domain 1: Early Screening & Comprehensive Assessment of Trauma
• Domain 2: Consumer Driven Care & Services• Domain 3: Trauma-Informed, Educated & Responsive Workforce• Domain 4: Trauma-Informed, Evidence-Based and Emerging Best
Practices• Domain 5: Safe and Secure Environment• Domain 6: Community Outreach and Partnership Building• Domain 7: Ongoing Performance Improvement
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w w w .T h e N a t i o n a l C o u n c i l. o r g
Motivational Interviewing Overview
Motivational Interviewing Overview
Motivational Interviewing (MI)
Motivational interviewing is a collaborative conversation style for strengthening a person’s
own motivation and commitment to change.
Miller & Rollnick, 2012Motivational Interviewing: Helping People Change
Common Tendencies When Facilitating Change
“That kid is doomed.”
“I can rescue her.” “He just doesn’t get it.”
Just do it!
MI is a Process of…
Engaging
Focusing
Evoking
Planning
Deficit Competenceq Insight & knowledge is lacking
q Telling
ü Capacity to change is within
ü Asking and listeningWhat is Your View?
Partnership
Evocation
Compassion
Acceptance
The Spirit of Motivational Interviewing
Building Protective Factors
We need to exercise…
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Ability to adapt well to stress, adversity, trauma or tragedy
Risk Factors• ACE’s• Poverty• Racism• Intergenerational trauma• Lack of support• Isolation• Hopelessness• Difficulty regulating
emotions• Poor self-confidence• Poor problem solving skills
Protective Factors• Optimism • Faith • Sense of meaning • Self-efficacy • Flexibility • Emotional regulation • Empathy • Close relationships • Spirituality • Effective problem solving
Honor voice and choicePartner with peopleRequest feedbackEnsure comfort
“Keep the Human in Human Services”-Dr. Pat Deegan
Build Relationships
Positive Psychology
Seligman, M. et al, American Psychologist, 2005.
Promoting people’s positive health assets - strengths that can contribute to a healthier, longer life.
• Positive emotions• Optimism• Social community• Meaning & purpose• Grit, determination• Gratitude
• Engaging in grateful thinking tampers the feelings of anxiety, fight or flight to increase our ability to rest and digest.
• Gratitude increases helping behaviors and motivation. Creates a “pay it forward” effect.
• Shifts the focus on what you are receiving, helps you feel more attached to the world and appreciative of what you have.
The Practice of Gratitude
Language Of Resilience
•• Vocabulary reinforces feelings and beliefsVocabulary reinforces feelings and beliefs•• Helps guide behaviorHelps guide behavior•• Leads to greater options for acting Leads to greater options for acting •• Allows us to be able to recognize resilience in Allows us to be able to recognize resilience in
self/othersself/others
Three Statements of Resilience
I Have…a recognition of what is available
I Am… a recognition of my value
I Can… a recognition of mastery, sense of the future
-Strengthening the Human Spirit by Edith Grotberg, PhD 1995
TIC-CARET
Take the time to introduce yourself, your role and explain what you will be doing. Set realistic expectations and goals for your time with them.
I Intently listen to their story and/or request. Be patient and persistent.
CConsistently and mindfully be aware of the language you use when responding to the client’s story and/or request.
CConnect the patient to others that may be able to meet any needs that are out of your scope of practice.
AAsk the patient for their story and try to anticipate their needs and questions. If applicable, provide ongoing choices and support.
RRespectfully respond and communicate at all times, e.g., use Mr./Mrs., be validating and affirming.
EEnsure all patient needs are met before exiting, make warm handoffs/referrals when possible. Follow through with what you say you will do.
Listening Style that Supports Change
Open-Ended Inquiry Seeking to understand “How… What…”
Affirmations Genuine testaments of character
Reflections What you hear, observe
Strengths-Oriented Open-Ended Questions
1. What does recovery look like for you?
2. What would you say are your strengths?
3. What coping skills have you learned from your (life experiences, cultural history, spiritual practices, athletic pursuits, etc.)?
4. What are some of your accomplishments that give you the most pride?
5. Imagine for a moment that a group of people are standing behind you showing you support in some way. Who would be standing there?
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Attributes of Successful ChangersAcceptingAdaptableAlertAmbitiousAssertiveBraveCarefulCommittedConsiderateCreative
DeterminedEagerFaithfulFlexibleFocusedForgivingHopefulIngeniousMatureOpen
PatientPersistentReasonableReliableSteadyStrongThoroughTrustingTruthfulWilling
"Affirmations are
our mental vitamins,
providing the supplementary
positive thoughts we need
to balance the barrage
of negative events and thoughts
we experience daily.“
—Tia Walker
What Can We Do Next?
What do we need to….üStart DoingüStop DoingüDo More of
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Paired Discussion
Contact Information
Linda Henderson-Smith, PhD, LPCDirector, Children and Trauma-Informed Services
Pam Pietruszewski, MAIntegrated Health [email protected]