impact of traumatic events on children voice of a survivor and helper in the healing process

Impact of Traumatic Events on Children

Voice of a Survivor and Helper in the Healing Process

2

Brain Gym

0-10 0-10

Before Brain Gym After Brain Gym

3

Brain Gym Practice

• Figure 8 with whole right arm/left arm• Figure 8 with both arms

4

Trauma Present … What We Know Now

• Over the last 10 -20 years there has been an explosion of information provided to us about the relevance and impact of trauma on the brain, on relationships, and on our development

• This explosion has resulted from new abilities to see the brain in ways that we are better connecting life experiences and over all well being (Physical and Mental Health)

Information and slide part of Dr. Allison Sampson's Trauma Presentation

5

6

Defining Trauma:

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. - SAMHSA definition 2014

7

Key Component of Trauma

Is the experience of loss!Loss of:• boundaries• safety• trust• power and control• innocence• protection• attachment• possessions• consistency/predictability• sense of self/body image

http://www.lisaferentz.com

8

Adverse Childhood Experiences

A research screening tool

9

10

“Henry” and Some Data http://www.ovc.gov/pubs/ThroughOurEyes/index.html

Child Welfare SystemJuvenile Justice System

School System Mental Health System

Court System ProfessionalsFaith Based Community

Residential Facilities Resource Parents

First Responders (Police & Fire Fighters)Medical Community and Primary Care

Child Advocacy Agencies

11

Exposure to Violence in Childhood

46 million of 76 million children are exposed to violence, crime and abuse each

year

Finkelhor, D., et al. (2010). Trends in childhood violence and abuse exposure: evidence from 2 national surveys. Archives of Pediatric and Adolescent Medicine, 164(3), 238–242.

Information and slide part of Dr. Allison Sampson's Trauma Presentation

12

U.S. Prevalence, cont'd.• One in four children/adolescents experience at least one

potentially traumatic event before the age of 16.1

• In a 1995 study, 41% of middle school students in urban school systems reported witnessing a stabbing or shooting in the previous year.2

• Four out of 10 U.S. children report witnessing violence;8% report a lifetime prevalence of sexual assault, and 17% report having been physically assaulted.3

1. Costello et al. (2002). J Trauma Stress;5(2):99-112.2. Schwab-Stone et al. (1995). J of Accad Child Adolescent

Psychiatry;34(10):1343-1352.3. Kilpatrick et al. (2003). US Dept. Of Justice.

http://www.ncjrs.gov/pdffiles1/nij/194972.pdf.

13

Prevalence of Traumain the Child Welfare Population

• A national study of adult “foster care alumni” found higher rates of PTSD (21%) compared with the general population (4.5%). This was higher than rates of PTSD in American war veterans.1

• Nearly 80% of abused children face at least one mental health challenge by age 21.2

Pecora, et al. (December 10, 2003). Early Results from the Casey National Alumni Study. Available at:

http://www.casey.org/NR/rdonlyres/CEFBB1B6-7ED1-440D-925A-E5BAF602294D/302/casey_alumni_studies_report.pdf

.

2. ASTHO. (April 2005). Child Maltreatment, Abuse, and Neglect. Available at: http://www.astho.org/pubs/Childmaltreatmentfactsheet4-05.pdf.

14

Trauma Impacts Learning and Academic Outcomes

Decreased IQ and reading ability (Delaney-Black et al., 2003)

Lower grade-point average (Hurt et al., 2001)

More days of school absence (Hurt et al., 2001)

Decreased rates of high school graduation (Grogger, 1997)

Increased expulsions and suspensions (LAUSD Survey)

15

Suspension and Expulsion

• Attachment to school and peers is correlated with school success and reduces likelihood of disciplinary involvement

• Suspended students are twice as likely to drop out of school and three times as likely to have contact with the juvenile justice system

16

Impact of Being in Child Welfare System for Foster Care Children

•25% will be incarcerated within first 2 years of aging out of the system •More than 20% will become homeless •Only 58% will have a High School Diploma•Less than 3% will have a college education by age of 25•Many will re-enter the system as parents •For children under age of 5, increase likelihood of developmental delays 13-62% compared to 4-10%

1)Conradi, L. (2012) Chadwick Trauma Informed System Project p. 54

2) Leslie et. al. (2005). Developmental and Behavioral Pediatrics 26(3), 177-185

17

Child trauma is endemic in the juvenile justice system. At least 75% of youth involved in the juvenile delinquency system have experienced traumatic victimization and 11–50% have developed posttraumatic stress disorder (PTSD)

1.Abram, K. M., Teplin, L. A., Charles, D. R., Longworth, S. L., McClelland, G. M., & Dulcan, M. K. (2004). Posttraumatic stress disorder and trauma in youth in juvenile detention. Arch Gen Psychiatry, 61(4), 403-410.2. Cauffman, E., Feldman, S. S., Waterman, J., & Steiner, H. (1998). Posttraumatic stress disorder among female juvenile offenders. J Am Acad Child Adolesc Psychiatry, 37(11), 1209-1216.3. Arroyo, W. (2001). PTSD in children and adolescents in the juvenile justice system. In S. Eth (Ed.), PTSD in Children and Adolescents (Vol. 20, pp. 59-86). Arlington, VA: American Psychiatric Publishing.4. Garland, A. F., Hough, R. L., McCabe, K. M., Yeh, M., Wood, P. A., & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. J Am Acad Child Adolesc Psychiatry, 40(4), 409-418.5. Teplin, L. A., Abram, K. M., McClelland, G. M., Dulcan, M. K., & Mericle, A. A. (2002). Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry, 59(12), 1133-1143.6. Wasserman, G. A., McReynolds, L. S., Lucas, C. P., Fisher, P., & Santos, L. (2002). The voice DISC-IV with incarcerated male youths: prevalence of disorder. J Am Acad Child Adolesc Psychiatry, 41(3), 314-321.

18

• 65 percent of girls and 70 percent of boys in detention diagnosed with multiple mental health disorders

• Nearly 1/4th of youth in residential placements have attempted suicide

• Confinement often reactivates memories of the trauma and exacerbate PTSD symptoms

Teplin L., et al. (2006, April). Psychiatric disorders of youth in detention. (Juvenile Justice Bulletin, Office of Juvenile Justice and Delinquency Prevention.) p. 9.

19

The needs of the adults and caregivers of the youth …

are no different

They are often trauma survivors too

20

Cross-Generational Trauma Hendricks (2012) Chapter 12 of Creating Trauma Informed Child Welfare Systems

Using Trauma Informed Services to Increase Parental Protective Factors

• Women who have experienced trauma are more likely to self- medicate with a substance (55-99%) (1)

• Intergenerational transmission of trauma (Depression, PTSD) (2) • Unresolved childhood trauma can lead to reenactments with partners in adult

relationships and/or with their children (3)• Unresolved childhood trauma can lead to difficulty forming secure attachments

with their children (4) • Childhood trauma can result in parenting styles that include threats & violence

(2)• Childhood sexual abuse survivors can miss “red flags” of sexual abuse with

their own children due to avoidance of trauma memories themselves (2)Najavits, Weiss, & Shaw (1997) The American Journal on Addiction, 6 (4), 273-283Hendricks, A. (2012). Using Trauma-Informed Services to Increase Parental Factors (pp. 89-91)Walker (2007) Journal of Social Work Practice, 21 (1), 77-87. Main & Hess (1990) In M. Greenberg, D. Cicchetti, & E. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 121-160)

21

BIG PICTURE with Caregivers

• Often the caregivers … are the kids we as a system “missed”

• They come to us with their own trauma histories• Successful outcomes with our clients means successful

work with the family • Screening all caregivers and finding them services is

critical to the prevention/treatment/reduction of recidivism for children entering the juvenile justice system

22

Cross-Generational Trauma Hendricks (2012) Chapter 12 of Creating Trauma Informed Child Welfare Systems

Using Trauma Informed Services to Increase Parental Protective Factors

Caregiver functioning following a child’s exposure to trauma is a major predictor of child’s functioning (1 & 2)

If we want to improve a child’s outcome, we must address parent’s trauma history … failure to do so can result in (2) …

- Failure to engage in treatment services - An increase in symptoms - An increase in management problems - Retraumatization - An increase in relapse - Withdrawal from service relationship - Poor treatment outcomes

Linares et al (2001) Child Development, 72, 639-652Liberman, Van Horn, & Ozer (2005) Development and

Psychopathology, 17, 385-396 Hendricks, A. (2012) pp. 91

23

1 year of violence=

124 billion dollars in

recovery costs

The breakdown per child is:• $32,648 in childhood health care costs• $10,530 in adult medical costs• $144,360 in productivity losses• $7,728 in child welfare costs• $6,747 in criminal justice costs• $7,999 in special education costs

24

223,400,000

317,572,282

25

ACE SCREEN

A way to explain this information to clients

Partnering with Parents Brochure

26

•Alcoholism and alcohol abuse•Chronic obstructive pulmonary disease (COPD)•Depression•Fetal death•Health-related quality of life•Illicit drug use•Ischemic heart disease (IHD)•Liver disease•Risk for intimate partner violence•Multiple sexual partners•Sexually transmitted diseases (STDs)•Smoking•Suicide attempts•Unintended pregnancies•Early initiation of smoking•Early initiation of sexual activity•Adolescent pregnancy

27

28

Unlocking the BrainAt least for today…3 brain levels-they each speak a different language

Brainstem-housekeeping of the Body, sleeping, eating, breathingLimbic-smoke alarm, implicit memoriesCortex-planning, logic, reason, judgment

29

A Person’s Response to Perceived Danger

Trauma Event

Danger Response

Fight Flight FreezeAggression Run Away Dissociate

Verbal attack Substance Abuse Non-emotionality

Slide from Ellen Williams, LCSWCenter for Child & Family Services

30

Looking Through The Eyes of a Traumatized Child- How it looks to Us….

31

How it looks to The Traumatized Child

32

The Hand Model of the Brain

33

The Handy Model

34

35

Chasing Behaviors

Agitation

Traumatic Event

Intrusive Memories

Nightmares

Hopelessness

Numbing

Insomnia

Shame & Self-Hatred

Panic Attacks

Substance Abuse

Somatic Symptoms

Eating Disorder

s

Self-Destructiv

e Behavior

Dissociation

Poor Impulse Control

Defiance

Withdrawal

Slide by Trish Mullen, Chesterfield CSB

36

Behavior Wheel

• Can anyone in the audience give me an example of a at-risk health behavior they have experienced with a client they work with ??

• As a group, lets all think about what NEEDS that behavior meets??

• Are they different than our needs ??

• So what is the problem with the behavior if it meets a need??

• THEIR AT RISK HEALTH BEHAVIORS POSE A RISK TO THEMSELVES AND/OR OTHERS

37

Behavior Wheel

• Tell me … as a result of reacting to the behavior, what are some of the first things we do to a child/youth who is “acting out” in our symptoms by being aggressive for example ???

• Take away exercise opportunities • Take away social opportunities • Take away Self-Regulation opportunities • Utilize “upstairs brain” techniques with them (redirection vs

connection)

38

We must ……

Respond to the need ….

Not react to the behavior

39

Resilience Trumps ACEs

From Trish Mullen, Chesterfield Community services Board

40

Trauma And The Brain

41

Invisible Wounds: Realizing the Impact

42

Trauma Present … The Brain

PERRY’s PET SCAN

http://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm

43

http://www.healthnative.com/wpcontent/uploads/2009/04/nerve_diagram.jpg

44

Upper and Lower Brain

http://www.tipsontalking.com/wp-content/uploads/2009/11/brain_triune.gifhttp://3.bp.blogspot.com/_c6OGZNS3CPQ/S-M06sx_-dI/AAAAAAAAAJ0/pF3GixTXOQw/s400/TriuneBrain.gif

45

Impact to Right and Left Hemisphere Talk

46

Right and Left Hemisphere

Information and slide part of Dr. Allison Sampson's Trauma Presentation

47

48

http://msaprilshowers.com/wpcontent/uploads/2013/02/total_brain_function.jpg

49

Brain and Stress

• When stress is predictable and moderate, stress can facilitate resiliency and enhance memory

• When stress is unpredictable and severe, stress can create vulnerability and memory impairment

• Severe and chronic stress in childhood via multiple traumas from caregivers can impact affect regulation, interpersonal relationship skills, and states become traits (fight/flight/freeze… disassociation or hyper arousal)

50

Types of Stress

Unaddressed RepeatedProlongedIntense

Effective Intervention

Early Detection

Parental Resilience

Social –emotional buffering

Positive Stress Tolerable Stress Toxic Stress

Normal and essential part of healthy development

Body’s alert systems activated to a greater degree

Occurs with strong, frequent or prolonged adversity

Brief increases in heart rate and blood pressure

Activation is time limited and buffered by caring adult

Disrupts brain architecture and other organ systems

Mild elevations in hormonal levels Brain and organs recover Increased risk of stress-related disease and cognitive impairment

Example: Tough test at school or a playoff game

Example: Death of a loved one, divorce, natural disaster

Example: abuse, neglect, caregiver substance dependence or mental illness

Information and slide part of Harris (2013) Buzz on Brain and Babies Presentation

51

Trauma Impacts Learning and Academic Outcomes

Decreased IQ and reading ability (Delaney-Black et al., 2003)

Lower grade-point average (Hurt et al., 2001)

More days of school absence (Hurt et al., 2001)

Decreased rates of high school graduation (Grogger, 1997)

Increased expulsions and suspensions (LAUSD Survey)

52

Most Frequent Discipline Violations Reported to Virginia Department of

Education (2006-2012)• Disorderly/Disruptive Behavior • Severe Disorderly Conduct/Disruptive Demonstrations • Classroom or Campus Disruption • Insubordination • Disrespect of Authority • Using Obscene Language/Gestures • Minor Insubordination

Safe School Information Resource: https://p1pe.doe.virginia.gov/pti

53

Traumatic Transfer

54

Suspension and Expulsion

• Attachment to school and peers is correlated with school success and reduces likelihood of disciplinary involvement

• Suspended students are twice as likely to drop out of school and three times as likely to have contact with the juvenile justice system

55

TRAUMA PRESENT … Attachment

Many argue that these early relationships (experiences) shape neuronal circuits which regulate emotional and social functioning

Look at how we are taught soothing and self-regulation through our connections in early relationships

56

Trauma and Memory

57

We Learn by Experience

58

Trauma 101

59

We Learn by Experience

60

61

Three factors have been shown to raise the chances that children will get PTSD.

These factors are:• How severe the trauma is • How the parents react to the trauma • How close or far away the child is from

the trauma

62

Mirror Neurons

A mirror neuron is a neuron that fires both when an animal acts and when the animal observes the same action performed by another.

Thus, the neuron "mirrors" the behavior of the other, as though the observer were itself acting

63

Mirror Neurons

64

Attachment’s PurposeSiegel, 1999

Evolutionary Level – biological Infant Survival (Bowlby)

Mind Level – biological and social Caregiver’s brain helps child’s brain to organize regulationCaregiver’s brain teaches child self-soothing Child experience of safety allows for exploration

65

Experiential Activity

What does this mean for children who have experienced trauma?

NOTE: We will listen to music for 90 second segments and view pictures. Some participants experience stress and intense emotions during this activity. Please practice your own good self care strategies and know that this exercise will be very brief to give you a window into many of our clients worlds and maybe some of ours too.

66

A Person’s Response to Perceived Danger

Trauma Event

Danger Response

Fight Flight FreezeAggression Run Away Dissociate

Verbal attack Substance Abuse Non-emotionality

Slide from Ellen Williams, LCSWCenter for Child & Family Services

67

Most Frequent Discipline Violations Reported to Virginia Department of

Education (2006-2012)• Disorderly/Disruptive Behavior • Severe Disorderly Conduct/Disruptive Demonstrations • Classroom or Campus Disruption • Insubordination • Disrespect of Authority • Using Obscene Language/Gestures • Minor Insubordination

Safe School Information Resource: https://p1pe.doe.virginia.gov/pti

68

Chasing Behaviors

Agitation

Traumatic Event

Intrusive Memories

Nightmares

Hopelessness

Numbing

Insomnia

Shame & Self-Hatred

Panic Attacks

Substance Abuse

Somatic Symptoms

Eating Disorder

s

Self-Destructiv

e Behavior

Dissociation

Poor Impulse Control

Defiance

Withdrawal

Slide by Trish Mullens, Chesterfield CSB

69

We MUST Respond to the need

Not react to the behavior

70

Trauma Informed Care is a Culture Change

andAsks that all systems apply TIC principles to their work

71

RESOURCES

• http://www.nctsn.org/

• National Technical Center for Children’s Mental Health Trauma Resource

• DEMO

72

Key Elements of TIC Culture

Five Core Values (Fallot, 2009)

1) Safety

2) Trustworthiness

3) Choice

4) Collaboration

5) Empowerment

73

Trauma Informed Schools

74

Climate: Creating Positive Conditions For Learning

• Safety and Well-Being

• Teaching and Learning/Academic Environment

• Interpersonal Relationship/Engagement Environment

Student Assistance Programming: Creating Positive Conditions for Learning Resource, VDOE Web site, Student Support Services

75

“If our aim is to nurture healthy children within safe communities, we need to change our approach and the values that drive our responses to violence. The reliance on highly punitive approaches [is] not working — they make people more alienated and angry, they feed cycles of revenge, and, as if that is not enough, they are costly.”

— Dr. Lauren Abramson, Executive Director, Community Conferencing Center, Baltimore

76

Trauma Informed Juvenile Justice

77

“We need to redefine the terms that can lead a young person into a correctional facility and protect the public by detaining the most violent felons, not the young people who, with the proper supports, could be promising members of the next generation.”— Dr. Patrick McCarthy, President and CEO, Annie E. Casey Foundation

78

Rethinking the Juvenile Justice System -Defending Childhood and Attorney General Eric Holder , Jr.

• 6.1 Make trauma informed screening, assessments, care the standard in juvenile justice services

• 6.2 Abandon juvenile justice correction practices that traumatize children and further reduce their opportunities to become productive members of society

• 6.3 Provide juvenile justice services appropriate to children's ethnocultural background that are based on assessment of each violence exposed child’s individual needs

• 6.4 Provide care and services that address the special circumstances and needs of girls in the juvenile justice system

79

Rethinking the Juvenile Justice System

6.5 Provide care and services that address the special circumstances and needs of LGBTQ youth in the juvenile justice system6.6 Develop and implement policies in every school system across the country that aim to keep children in school rather than relying on policies that lead to suspension and expulsion and ultimately drive children into the juvenile justice system 6.7 Guarantee that all violence exposed children accused of a crime have legal representation 6.8 Help, do not punish, victims of child sex trafficking6.9 Whenever possible, prosecute young offenders in the juvenile justice system instead of transferring their cases to adult court

80

Trauma Informed Child Welfare

81

NCTSN Guidance • Understand that parents’ anger, fear, or avoidance may be a

reaction to their own past traumatic experiences, not to the caseworker him/herself.

• Assess a parent’s history with an eye towards trauma and how it impacts parenting

• Remember that traumatized parents are not “bad” and that approaching them in a punitive way, blaming them, or judging them likely will worsen the situation rather than motivate a parent.

• Build on parents’ desires to be effective in keeping their children safe and reducing their children’s challenging behaviors.

• Pay attention to ways trauma can play out during case conferences, home visits, visits to children in foster care, court hearings, and so forth. Help parents anticipate their possible reactions and develop different ways to respond to stressors and trauma triggers

82

NCTSN GUIDANCE

• Refer parents to trauma-informed services whenever possible, generic treatment solutions may not be effective

• Become knowledgeable about the trauma informed services in your area

• Be an advocate for building more trauma informed services in your community

• Be aware of your own secondary trauma from the work you do … and at all levels of child welfare address secondary trauma

83

Trauma Informed Mental Health Providers

84

Core Components of Evidence-Based Trauma Treatment (cont’d)

• Opportunity for trauma integration• Strategies that allow exposure to traumatic memories

and feelings in tolerable doses so that they can be mastered and integrated into the child’s experience

• Personal safety training and other important empowerment activities

• Resilience and closure

85

What are the Core Components of Evidence-Based Trauma Treatment?

•Building a strong therapeutic relationship•Psycho-education about normal responses to trauma•Parent support, conjoint therapy, or parent training•Emotional expression and regulation skills•Anxiety management and relaxation skills•Cognitive processing or reframing

86

All of which requires us to look at:

OurselvesOur Organizations

Our systems of Care

87

Trauma and Professionals Bride (2007) did a study of master’s level social workers licensed in a southern state. The study found that…

• 70.2% of workers experienced at least one symptom of STS in the previous week

• 55 % met the criteria for at least one of the core symptom clusters

• 15 .2% met the core criteria for a diagnosis of PTSD.

• The intrusion criterion was endorsed by nearly half of the respondents.

• The most often reported symptoms were intrusive thoughts, avoidance of reminders of clients, and numbing responses.

88

Trauma and Human Service Systems Within and between human service organizations we witness fight flight and freeze …

When we think about where this comes from … it is very similar to the experience of our clients

• We bring in our own ACE scores• Our environments are stressful, demanding and sometimes abusive

• Budget Cuts• Higher Caseloads• Increase paperwork demands• Higher expectations for outcomes and evidence informed practices • Constantly changing regulations

• Vicarious Trauma with and through our clients

89

So We Develop Coping Behaviors to Survive Within and Between the Systems

• Remember … the “problems” we see in our clients are often their solutions to coping with stress and trauma

• Our challenges in and between our systems are often the way we cope within and between our agencies

• Fight/Flight/ Freeze can be our coping behaviors too

90

Cross-System Challenges

• Adversarial Relationships • Blaming other people or departments for …. • Lack of Communication • Avoiding Communication with certain People or

Agencies • Staying close only to those in “our circle” • Doing nothing (waiting for the storm to pass)

91

Cross System Challenges can also be because of …

• Lack of Knowledge • Lack of Awareness • Lack of True Collaboration • Lack of Resources

92

Trauma Present …

Trauma Informed Knowledge and Literature applies to human service professionals at all levels …

-Youth -Families-Caregivers -Professionals-Supervisors and Administrators -Agencies we work in -Systems with which we engage every day

93

Trauma FUTURE … Where do we go

Henry’s Story EMOTIONAL CHAIN OF CUSTODY

94

What does it mean to be a Trauma Informed SYSTEM… NCTSN

A trauma-informed youth- and family-service system is one in which all parties involved recognize and respond to the impact of traumatic stress on those within the system including youth, caregivers, and service providers. Programs and agencies within such a system infuse and sustain trauma awareness, knowledge, and skills into their organizational cultures, practices, and policies. They collaborate with all those involved, using the best available science, to facilitate and support the recovery and resiliency of the youth and family.

95

Trauma Informed System A service system with a trauma-informed perspective is one in which programs, agencies, and service providers do the following:

1. Routinely screen for trauma exposure and related symptoms2. Use culturally appropriate evidence-based assessment and treatment for traumatic stress and associated mental health symptoms3. Make resources available to youth, families, and providers on trauma exposure, its impact, and treatment4. Engage in efforts to strengthen the resilience and protective factors of youth and families affected by and vulnerable to trauma5. Address parent and caregiver trauma and its impact on the family system 6. Emphasize continuity of care and collaboration across youth-serving systems 7. Maintain an environment of care for staff that addresses, reduces, and treats secondary traumatic stress and increases staff resilience

96

Trauma Informed Organizational Assessment

• Examining where as an organization you score on the NCTSN Youth and Family Service System Domains

• Creating Cultures of Trauma-Informed Care (CCTIC): A Self-Assessment and Planning Protocol Roger D. Fallot, Ph.D. and Maxine Harris, Ph.D. July, 2009

• NCTSN’s Trauma System Readiness Tool (TSRT)

• National Council Organizational Assessment Survey (OSA) and TIC Learning Collaborative

97

Case Example in Providence

and FPS of Virginia

One Story of Becoming a Trauma Informed Organization

98

Trauma Informed Organization

Domain 1. Early Screening and Comprehensive Assessment of Trauma

Domain 2. Consumer Driven Care and Services

Domain 3. Trauma-Informed, Educated and Responsive Workforce

Domain 4. Provision of Trauma-Informed, Evidence Based and Emerging Best Practices

Domain 5. Create a Safe and Secure Environment

Domain 6. Engage in Community Outreach and Partnership Building

Domain 7. Ongoing Performance Improvement and Evaluation

99

Family Preservation Services of VA

1) Working on incorporating TIC language in all service lines.

2) Identifying ways to ensure our environments are safe and secure. Home safety plans, staff training on workplace sensitivity knowledge, consumer buy-in to safe homes.

3) Rolling out AIM Forward as our clinical modality for our front-line staff and also incorporating Trauma-101 training for all levels of staff to ensure consistency across the state. 4) Advanced trauma training for Masters level clinicians including; AIM Forward, TF-CBT, DBT, EMDR, and advanced training on various trauma assessment tools.

5) Parent training on trauma with children with ASD and other forms of ID, DD, and communication disorders. 6) Employee self-care packages that include resources on self-care strategies and best practices for reducing compassion fatigue. 7) Consumer welcome kit that includes contact numbers, local resources, and information about FPS and a survey to ensure we address all their needs.

8) Outcome driven care model that is tied into our EHR. Some regions are piloting this as we speak. This will help focus our care on measurable goals and ensure our clinicians are operating at maximized effectiveness.

9) Employee appreciation structure that focuses on self-care and rewards positive modeling of TIC practices.

10) Developing consumer-driven services that incorporates peer-to-peer advocates and family-to-family advocates. Consumers will be involved at all levels of organization from the interview process through reviewing our policies.

100

DOMAIN 3 and 6 work resulted in the very training you are sitting in today

We wanted to collaboratively engage with our partners in becoming a more

trauma informed workforce

101

Domain 6 – TICN DevelopmentRecognizing that the children and families we serve may be part of a larger service system, community collaboration is a key element of being a trauma informed organization. Important linkages may include: • housing • corrections • courts • primary health • emergency care • social services • education • mental health treatment services • use programs

The TIC Community Partnership Network invites trauma informed system stakeholders to meet and shape the continuum of trauma informed care services within a community.

102

Greater Richmond Trauma Informed Community Network

(TICN)Question becomes where do I turn in my community for resources? Education? Consultation?

The Greater Richmond Trauma Informed Community Network (TICN) is a diverse group of professionals in your community dedicated to supporting all child welfare stakeholders in utilizing strengths based trauma informed practices in their work with children and families. In short, we are here to support and honor the important role you have in facilitating a positive environment for change in children and caregivers' lives using trauma informed practices to guide your way.

103

Committee Development

• Service gap surveys• Provider service books with TIC services listed• Higher Education Development/Certification• Outcomes Groups • Provider Certification Committees• Communication Groups • Screening and Assessment Best Practice• Development of Case Planning Integration processes for

Child Welfare Workers and Juvenile Justice Workers• Education and Training Resources (including people)

104

Community Education and Collaboration

• Department of Criminal Justice

• Department of Education

• Juvenile Domestic Relation Courts

• Child Advocacy Agencies

• Local Schools• School

Administration • Judge’s

Conferences

• Court Service Units• Truancy Officers• Department of

Social Services (child and family)

• Law Schools and Clinics

• Department of Mental Health

• Learning Collaborative

• Adoption Advocacy Agencies

• Parent/caregiver groups

• Consumer Conferences

105

How can we get more Trauma Informed Community Networks (TICN) Going??

106

Our own examination of our TIC practices and areas of strength and

growth have helped us to engage with community partners on what does good

TIC treatment look like?

107

Core Areas of Focus in Complex TraumaCourtois, C. & Ford, J. (2009),

Introduction (p.2)• Self-Regulation

• Affect Regulation• Disassociation (difficulty in being “present”)• Somatic Dysregulation

• Self-Identity • Impaired Self-Concept• Impaired Self-Development

• Co-regulation • Secure working model of caring relationship • Disorganized Attachment Patterns

108

Phase Oriented Care“Goal Standard”

109

Understand What Good Trauma Treatment Looks Like …

Phase Oriented Treatment “ Gold Standard”• Phase I: Safety and Stabilization • Phase 2: Trauma Reprocessing• Phase 3: Reintegration

• Handout on questions to ask Mental Health Providers • Resource

http://www.nctsnet.org/nccts/nav.do?pid=ctr_top_trmnt_prom

• Mental Health Trauma Assessment Guidelines (NCTSN)

110

Phase Oriented Treatment for Trauma (Herman 1992, Janet 1889) from Courtois, C. “Treating Complex Traumatic Stress Disorders”)

PHASE ONE: Safety and Stabilization • Personal and Interpersonal Safety Established:

Education/Support/Safety Planning • Enhance Client’s ability to manage extreme arousal (hyper/hypo)• Active engagement in positive/negative experiences (deal with

automatic avoidance behaviors, self awareness of avoidance, increase coping skills and use of coping skills)

• Education (psychotherapy, trauma, skills to be learned) • Assess and develop relationship capacity (decrease avoidance of

relationships or negative thoughts about relationships, build support network, define client’s attachment network)

111

Phase Oriented Treatment Phase Oriented Treatment for Trauma

(Herman 1992, Janet 1889) from Courtois, C. “Treating Complex Traumatic Stress Disorders”

PHASE TWO: Trauma Reprocessing • Disclosure of traumatic memories, development of an autobiographical

narrative (identify emotions connected to trauma memories, grieve and mourn losses, resolution of relationships when appropriate, increased awareness, increase interpersonal and self-regulation skills)

• Supporting client in maintaining functioning and not getting lost in memories or seeing themselves as “disabled”, need to affirm strengths, promote positive self-esteem, and internal and external resources now available to them

PHASE THREE: Re-Integration • Growth and period and reengagement in life• Can be time of client realizing losses, discover of unresolved developmental

deficits, fine tuning of self-regulation skills

112

What we will look at later today is how we can use Phase One approaches in all of our organizations to enhance youth and families healthy coping behaviors

113

10 percent is what you learn today …

90 percent is what you do with what you have learned today to create a

more trauma informed community …

114

Resilience Trumps ACEs

From Trish Mullen, Chesterfield Community services Board

115

Post Traumatic Growth

Typically 30-70 percent of survivors say that they have experienced positive changes of one form or another

• Construct meaning from what happened

• Survivor and thriver stories

• What to do with the “broken vase” ?

116

Post Traumatic Growth

http://ptgi.uncc.edu/

Posttraumatic growth tends to occur in five general areas.

• Sense that new opportunities have emerged from the struggle, opening up possibilities that were not present before.

• Changes in relationships with others (ex: closer relationships with some specific people, increased sense of connection to others who suffer)

• Increased sense of one’s own strength – “if I lived through that, I can face anything”

• Greater appreciation for life in general• Experience a deepening of their spiritual lives, however, this deepening can

also involve a significant change in one’s belief system

117

Resilience

http://acestoohigh.com/

Resilience Factors (APA website) • Caring/Supportive Relationships (primary) • Capacity to make realistic plans and take steps to carry

them out• A positive view of yourself and confidence in your

strengths and abilities• Skills in communication and problem solving• The capacity to manage strong feelings and impulses

118

Georgetown Project

119

10 percent is what you learn today …

90 percent is what you do with what you have learned today to create a

more trauma informed community …

THANK YOU ……

We are committed to helping all our community partners!

Contact Deb Chandler at 540-381-7500

or visit www.fpscorp.com