TRAUMA-INFORMED CARE A NATIONAL HEALTHCARE MOVEMENT

Treating the Hidden Epidemic of Abuse, Violence & Chronic Illness  

The Hidden Epidemic – ACEs

The Hidden Epidemic – ACEs

The Hidden Epidemic – ACEs

It is not all in your head…

Picard, M. et al. (2014) Mitochondrial allostatic load puts the ‘gluc’ back in glucocorticoids Nat. Rev. Endocrinol. doi:10.1038/nrendo.2014.22

Clinical Review – The Human Impact

¨  Trauma exposer increases the incident of paradoxical and complex reactions to medications.

¨  DM-II: Hypothalmic-pituitary-adrenal activity is enhanced in patients DM-II related complications and the degree of cortisol relates to presence and number of diabetes complications. Journal Diabetes Care - Cortisol Secretion in Patients With Type 2 Diabetes - doi: 10.2337/dc06-1267

¨  Clinical Case – Discussion

Pathways of Care - 3 Core Impacts +1

¨  PTSD Treatment Addressing Impact of PTSD and Acute Stress Reactions

¨  Trauma Informed Care Addressing sub-syndromal impacts of high stress and adverse events

¨  Trauma Informed Disease Management Impact of Stress and Dysregulation on Health Conditions

¨  +1 - Providers are People First Impact of Patient Trauma on Treatment Providers

Human Interaction - The Heart of the Mater From Disconnection to Connection

¨  Neuroception: Sub-conscious threat detection system. Simple behaviors can indicate safety. ¤  Stanford’s Compassion Care Conference

Link: https://www.youtube.com/watch?v=MYXa_BX2cE8

¨  Serve and Return: The Basic Human Pattern of Relationship ¤  Harvard’s Center for Developing Child

Link: https://www.youtube.com/watch?v=bF3j5UVCSCA

¨  Still Face Experiments: ¤  Threat and Disconnection ¤  What Happens When Serve and Return Brakes Down. ¤  Ed Tronic’s work on Human Connection – PCPs

https://www.youtube.com/watch?v=apzXGEbZht0

Notice How You Feel When You See…

Notice How You Feel When You See…

7 Core Domains: Trauma Informed Care

Early Screening and Assessment

Consumer-Driven Care and Services

Trauma Responsive Work Force

Evidenced Based & Emerging Best Practices

Community Out-Reach - Building Community Partners

Trauma Safe Work Environments

Ongoing Training, Performance Improvement & Eval

Link on TIC http://www.samhsa.gov/nctic

Trauma Informed Care National and International Movements

¨  Harvard’s Project 1 Billion Link to Site: http://hprt-cambridge.org/project-1-billion-2/

¨  2013 Iowa Adverse Childhood Experiences Summit Link to Speakers: http://www.iowaaces360.org/iowa-aces-summit.html

¨  California’s first ACEs summit: Children Can Thrive (2015) A three-day summit on Adverse Childhood Experiences, or ACEs, strengthens California’s efforts to orient policy and practice around preventing and responding to child trauma. Link to Article: http://acestoohigh.com/2014/11/20/children-can-thrive/

¨  National Summit on Adverse Childhood Experiences (2013/14) Purpose: Bring together national and local leaders committed to understanding the research, policy and practice implications about adverse childhood experiences (ACEs) in order to create a paradigm shift within healthcare, mental health, and child-serving systems. Link to Page: http://instituteforsafefamilies.org/events/national-summit-adverse-childhood-experiences

¨  ACEs Connection Network: ACEs Connection is a social network that accelerates the global movement toward recognizing the impact of adverse childhood experiences in shaping adult behavior and health, and reforming all communities and institutions -- from schools to prisons to hospitals and churches -- to help heal and develop resilience rather than to continue to traumatize already traumatized people. Link to Site: http://www.acesconnection.com/ Link to Sonoma ACEs Connection: http://www.acesconnection.com/g/sonoma-county-aces-connection Link to Contra Costa County Aces Connection: http://www.acesconnection.com/blog/contra-costa-county-to-end-isolation-of-special-ed-students-in-juvenile-hall-edsource-org

Stress and the Front Brain

Stress Shuts Down Frontal Lobe

Function

When the frontal lobe is shut down you are speaking

to pure emotion or

at times even reptilian systems

Homeostasis and Dysregulation

Clinical Tools – Treatment Relationships

¨  Bruce Perry’s “4 Steps” ¤  Regulate Self – When we are stressed we have

non-verbal cues that indicate to those we are around we are stressed. Individuals exposed to trauma have a heightened sensitivity to these cues (Facial Expression of Emotion Studies).

¤  Regulate Other – Actively help your patient regulate. Use a stress reduction tool, distraction technique or simply become more interesting then their stress.

¤  Attune – Engage the ‘Serve and Return’ style. When people feel seen, heard and understood they shift from stress to rest.

¤  Reason – Once some one is regulated they are more available to reason. Signs of regulation are good eye contact, taking a deep breath, borboygmi, expression of curiosity (indicates frontal lobe is working again). Clinical Story – Proximity and Stress

PACE Attitude – Quality of Contact

¨  Playfulness – A willingness to laugh, joke and play even in difficult situations. Pulls an individual out of fight flight into frontal lobe and limbic connection.

¨  Acceptance – Acceptance builds a context of safety and connection. Accepting is not agreeing or supporting but just recognizing reality when it is present.

¨  Curiosity – Curiosity is the hallmark of social engagement. This pulls an individual out of fear or anger states and into the state where new possibilities can arise. It begins to support decreased stress reaction and increase parasympathetic tone.

¨  Empathy – The experience of being understood develops the ability to care for one’s self. Creates a context of safety and understanding. This allows for an individuals guard to go down and the shift into more curiosity and possibility.

Trauma Informed

Approach Impact in Treatment

CASE REVIEW AND DISCUSSION

Role Play: Trauma Informed Care

Using tools discussed practice a clinical interaction.

PACE Attitude

4 Steps

Instructions for Dyads