rhonda craig, mpa anne tapia, msw building resilience
TRANSCRIPT
RHONDA CRAIG, MPAANNE TAPIA, MSW
Building Resilience
Why Build Resilience?
Trauma impacts a majority of people in Developmental Disability & Mental Health systems
Statistics are startling ranging from 20-70%, but all agree it is likely under-reported
Impacts all areas: Behavior Functioning levels Cognitive processing Mental Health Physical Health
“It is not our responsibility to identify necessarily the limits in our patients, but
rather for us to identify the limits in the care that we give them. It is then, and only then,
when we can go beyond them.”
Albert Einstein
Trauma Impacts People in Predictable Ways:
Impact on the brain (Schupp, 2004)Over time with repeated release of fight or flight
chemicals: The cortexes ability to plan, organize, and execute
action while regulating emotions is damaged. The amygdala is damaged & no longer accurately
recognizes danger. The hippocampus no longer effectively tracks
memory, controls consciousness, or circadian rhythms.
The brainstem misfires causing enuresis, encopresis, digestive issues, impulsive aggression from an over active startle response.
Trauma Impacts People in Predictable Ways:
Impact on development 50% of brain development occurs after birth (Putnam,
2004)Impact on social, psychological, and
emotional regulation Emotional development begins chemically in the brain
at six months gestation (Schupp, 2004) The ability to trust, and the brain chemistry connected
with it, begin at one month of age.
What happens when we ignore trauma?
Disregard of trauma and its impact causes additional trauma
Constantly putting out firesReactive rather than proactiveDisregard of trauma causes our services to
be ineffective
Trauma Responsive Services
Shift from:What’s wrong with you?
To: What happened to you and how can we help?
What Staff Are Saying
“His file was 3 inches thick, and honestly, there’s some things about him that were scary to me. I had no idea
what to do.
Until we held the Biographical Timeline session, I had no idea what he had been through. Now I have a lot of
respect for him as a survivor.
Now I see also how his past is showing up today – and I know what to say and do to help him move forward
instead of repeating the past”.
RESILIENCE PROJECTTarget: Young adults served by Hamilton County DD Services: Average ACE Score of SEVEN -- increases the likelihood of
childhood and adolescent suicide attempts 51-fold and adult suicide attempts 30-fold, chronic pulmonary lung disease increases more than 390 percent; hepatitis more than 240 percent; depression more than 460 percent
Involved with multiple systems: DD, mental health, courts, JFS, APSI, etc.
“HOT SPOTS” of high cost -- and poor outcomes
Intended Outcomes: Build Five Resilience Factors: 1.)Positive experiences with people
outside of abusive relationships, 2.) cohesive support group, 3.) external support system, 4.) self esteem, and 5.) autonomy
Decrease MUIsIncrease staff knowledge of trauma
RESILIENCE PROJECT COMPONENTS
BUILD CROSS SYSTEM TEAM: County Board staff, Lighthouse resiliency-builder aide, DD provider staff, mental health system staff, Guardian, etc.
OFFER TRAUMA TRAINING: Focus on PRACTICAL TOOLS that staff can use across settings: Five Resilience Factors, Safety Scripts, Affirmations, 3Ps, etc.
CONDUCT TRAUMA-INFORMED BIOGRAPHICAL TIMELINE: What’s the trauma history? What does the person need? What will we DO across systems to build resilience?
BUILD RESILIENCY FACTORS through intensive support from Lighthouse staff AND help all team members IMPLEMENT TRAUMA APPROACHES ACROSS SETTINGS
REVIEW DATA AND OUTCOMES and make changes as needed during Monthly Team Meetings and Trauma-informed Supervision
RESILIENCE PROJECT: PRODUCTS
PROJECT WORKBOOK Streamlines and standardizes a complex process Allows for dissemination and ease of
implementation
PROJECT OUTCOME DATA TO DATE Change in Resilience Factors/First Year Data:
Average increase = seven Resilience FactorsMUI Data/First Year Data: Average decrease = 37%Change in Staff Knowledge of Trauma as measured
by Retrospective Evaluations: 90% increase in understanding the 3 stages of trauma resolution and how to address them
Top 5 Resilience Factors
5. Autonomy (Agency) What decisions can I make for my life? How do I define power? Is it power over or power with to have the power to
achieve goals?
4. Self Esteem
Sense of Self – Personal Preferences (likes & dislikes) Sense of Self Worth – When do you feel loved and valued? Sense of Self-efficacy –
How do you affect change? How do I make things happen? How do I use & how do I want to use my powers of influence?
Top 5 Resilience Factors
3. External Supports Can be a person, pet, fantasy Or a spiritual or other belief system What is my system of meaning? How do I make sense of my world?
2. Affiliation (With a cohesive supportive group working toward
a positive goal and/or recognition of your own acts that contribute to the greater good) To what groups do I belong? What are my circles of connection?
1. YOU! (Positive Experiences with safe adults, especially people in positions of authority.) Who are the “adults” in my life? Who lets me “let go,” nurtures me? Who gives me a sense of play? Who tells me “well done!” and supports me?
The Five good things from mutually enhancing relationships
1. Zest 2. Clarity
3. Increased sense of worth
4. Creativity/Productivity
5. Desire for more connection
3 P’s
Predict
Practice
Plan B
Safety Script
“This is a safe place and I won’t let anyone_________ you, so I can’t let you _________
because this is a safe place.”
MUIs That are Often OUT of the Individual’s Control
MUIs That are Often WITHIN the Individual’s Control
Accidental/Suspicious Death, Alleged Abuse – PHYSICAL Alleged Abuse – SEXUAL Alleged Abuse – VERBAL Alleged Neglect Exploitation (By Someone else) Failure To Report (provider failed
to report incident) Misappropriation (provider
misappropriated funds of the individual)
Non Accidental / Suspicious Death Rights Code Violation Unapproved Behavior Support
Attempted Suicide Law Enforcement Medical Emergency Missing Individual Peer-to-Peer Acts (something
they did to someone else) Prohibited Sexual Relations Significant Injury Unscheduled Hospitalization
MUI Categories
MUIs That are Often OUT of the Individual’s Control
MUIs That are Often WITHIN the Individual’s
Control
HCDDS-MST, LYS-WAS and LPS-DBTMUI Change
LYS-MST LPS-DBT Total0%
20%
40%
60%
80%
100%
Graph #1: Average Per-cent Decrease in Num-ber of MUIs That are
Often OUT of the Indi-vidual's Control
LYS-MST LPS-DBT Total0%
10%20%30%40%50%60%70%80%90%
100%
Graph #2: Average Per-cent Decrease in Num-ber of MUIs That are
Often WITHIN the Indi-vidual's Control
Total Number of MUI Occurrences from Year Prior to Year One
Total Occurrences (10/1/12-9/30/13)
Total Occurrences (10/1/13-6/30/14)
0
5
10
15
20
25
30
Total LYS-MST
# o
f O
ccu
rren
ces
Trauma-Informed Biographical Timelines
An approach for building empathy and creating shared understanding of: The person’s trauma history Impact of that trauma on how the person experiences
the world Who the person IS today What they NEED WHAT WE WILL DO to help the person get what they
need
Sample Biographical Timeline
Examples of Creative Approaches
• Goals for Marsha:1. Seek opportunities to validate Marsha’s funny,
caring, loving, and respectful nature, as well as opportunities to be around similar people who can offer positive healthy loving unpaid relationships.
2. Facilitate and further enhance Marsha’s life purpose through connection to healthy opportunities, and provide a reason to give good, healthy, positive attention and love to others.
3. Provide Marsha with direction, structure, and predictability.
Examples of Creative Approaches
Goals for Tony:Seek opportunities for healthy, safe interactions with family
RESILIENCE PROJECT: MICHAEL’S STORY
WHAT WE LEARNED IN THE TRAUMA-INFORMED BIOGRAPHICAL TIMELINE
HOW STAFF HELPED BUILD RESILIENCE FACTORS
CHANGE IN RESLIENCE FACTORS
IMPACT ON QUALITY OF LIFE
What we have learned:
Defining roles Communication from all team members
Administrative Monthly team meetings with client supports Trauma-Informed Supervision
Transparency An overall objective to enhance the quality of
the person’s lifePeople are individuals & the team may not
consider all aspects that the client finds important
Thank you!
Any questions?
Contact Us:
Rhonda Craig, MPA Hamilton County Developmental Disability Services
Multi-System Team Supervisor [email protected] 513-746-9785
Anne Tapia, BA Lighthouse Youth Services
School Based Services Program Director [email protected] 513-487-7157
References
Putnam, F.W. (2004). Experience Dependent Maturation 0f Neuronal Systems.
Schupp L. J. (2004). Assessing and Treating Trauma and PTSD, Eau Claire, Wisconsin: PESI, LLC.