NOPH Orientation forTrauma Informed Care

(SAMHSA, 2012)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 threatening and that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being.

What is trauma?

• Safety

• Trustworthiness and Transparency

• Peer Support

• Collaboration and Mutuality

• Empowerment, Voice, and Choice

• Cultural, Historical, and Gender Issues

SAMHSA’s Six Key Principles of Trauma Informed Care

High percentage of public health clients have trauma history; prevalence

Will help you to better understand our patients and how to treat them more effectively

Why is it important to be informed about trauma at NOPH?

Adverse Childhood Experiences Provided research linking trauma experiences

to later high risk behaviors and emotional and physical health problems i.e.- Anxiety, depression, diabetes, drug use,

heart disease, pulmonary disease, liver disease, STDs, gynecologic cancer

This research provided awareness of funding for training and interventions

ACE Questionnaire- 10 questions

ACE Study

Resilience- an individual's ability to adapt to stress and adversity

Research has shown Top 5 resilience factors are: Having power over one’s own life Having a sense of self and self worth Having external supports Being affiliated with a group Having positive experiences with safe adults,

esp adults in positions of authority. (Show resilience questionnaire)

We’ve all been through bad experiences, how come we have coped

better than some of the patients?

Effects of Trauma

Thinking

Feeling

Acting

Thinking Feeling ActingDistrust of others, self, worldGuilt, shameLow self-worth; lack of identityDissociationLoss of hope

Feeling UnsafeDepression, AnxietyDys-regulated EmotionsReactive, ImpulsiveHallucinations/Intrusive Memories

Cutting, self injuryAggressivenessInterpersonal difficultiesImpulsiveHyper-vigilance, alertKeyed up, excitable

What are the effects of trauma?

Neurobiologic Effects of TraumaToxic Stress Derails Healthy Development

1:52 YouTube videoTrauma during developmental period produces an

overactive stress response system (fight/flight/freeze)

Brain is always on high alert, impulsive and reactive, in protective mode due to perceived dangers

Less able to develop positive coping responses, problem solving skills and communication skills

What are the effects of trauma?

Even treatment can be triggering/traumatic: Loss of freedom Loss of privacy Loss of coping techniques (smoking, using,

support system) Intrusion from other patients Restraint/Seclusion

Hospitalization can address precipitating crisis and re-stabilize; outpatient treatment best for long-term trauma treatment

Hospitalization and Trauma

Powerlessness/Lack of Control Feeling Unsafe loud noise, fighting, threats, getting too

close, people coming up behind them, patients’ scary symptoms

Lack of Predictability Specific reminders

Triggers

Know the patient’s triggers Know your triggers Know team member triggers

INTERVENE

Know Triggers

During hospitalization- we can help contain emotional reactions and work to improve coping skills

Seeking Safety is a great resource for teaching skills and for core groups.

Recovery from Trauma

Behind Closed Doors

Video Time!

He’s being manipulative. She just wants attention. There’s no reason for him to get upset. She doesn’t want to change. He is resisting. She’s too needy. He’s just playing games. I’ve tried what works for everyone else, it should

work for them. It isn’t fair to the other patients, they shouldn’t get

special treatment.

Blaming the VictimActual Staff Statements

Reminder

“We take away everything they would use to handle the world and ask them to behave like angels.”

Think… “What happened to you?” Not “What is wrong with you?”

Understand maladaptive behavior from a faulty coping style (sick) perspective rather than from a volitional (bad) perspective.

You do NOT “understand” “I’m trying to better understand you.” “Thank you for sharing that with me.” “How can I support you?”

Recognize their difficulties, AND THEIR STRENGTHS! Acknowledge their truth in what they are saying/experiencing

How do we understand maladaptive behaviors we see in

patients from a Trauma Perspective?

Help patient to develop and use their Comfort Plan and comfort items available on the unit

Meet the patient’s needs/Be present and attentive Good staff/team communication to minimize

splitting Set limits in a firm but kind manner; be consistent Work with team/unit staff to develop a unified

Safety Plan for high risk situations Allow the opportunity for the patient to re-gain

control without coercive measures

How do we respond in a trauma-sensitive manner?

Do NOT assume we “know what’s best.” Give choices and alternatives Ask their opinions Emphasize what IS allowed Reevaluate practices if they are always

challenged

Share Power

Model healthy/adaptive interactions, emotional stability, good coping skills, problem solving skills

Unit milieu is very important – a functional team models teamwork, good unit dynamics

Debriefings are important – debrief staff and the patient after a code

Do not take verbalizations/actions personally- keep a professional empathic boundary

How do we respond in a sensitive manner?

Comfort Plan- Review with patient, clarify what may help, encourage use of safe coping strategies

Comfort Box materials- explore comfort box/weighted blanket

Safety Plans – being aware and preventative, anticipatory Headphones Distraction items such as Sudoku, Crosswords, Word

Search Talking/Venting Sensory items, lotions Respectful Communication with each other and the patient Good utilization of Bad News Protocol, pre-planning and

foresight 

Tools to use for early escalation, pre-crisis

intervention

Pay attention to personal emotional well-being and coping

Understand what secondary trauma is, burnout, and compassion fatigue

Learn to process with supervisor/colleagues – debrief

Take advantage of coaching options

Staff Self-Care and Wellness

Trauma causes long-lasting problems Do not blame the victim. Not everyone charged of a crime

is a criminal. Everything you do either helps or hurts Ask “What happened to you?” not “What’s wrong with

you?” Validate and accept them while supporting change They are trying to cope. We want to teach them healthier

coping. Remember to give choices and control whenever you can. Know yourself: check in regularly with your self, colleagues,

friends and family. Patients First. Patience First.

Take-Aways

Thank you!