truly trauma informed: creating safe environments...trauma-informed recovery • samhsa (12/2011):...
TRANSCRIPT
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Truly trauma informed: creating safe
environments
Gabriella Grant, Director California Center of Excellence for
Trauma Informed Care, Santa Cruz CA www.trauma-informed-california.org
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Trauma-Informed Recovery
• SAMHSA (12/2011): – “Recovery is a process of change through which
individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”
– “Recovery is supported by addressing trauma : Services and supports should be trauma-informed to foster safety (physical and emotional) and trust as well as promote choice, empowerment, and collaboration.”
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Trauma Informed: Core values
• Safety • Trustworthiness • Choice • Collaboration/connection • Empowerment
(Harris and Fallot, 2001)
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SAMHSA: Trauma & Justice Strategic Initiative
• To reduce the pervasive, harmful and costly health impact of violence and trauma – By integrating trauma-informed approaches
throughout the health and behavioral health care systems and
– By diverting people with substance use and mental disorders from criminal and juvenile justice systems into trauma-informed treatment and recovery
SAMHSA Lead Larke Huang October 19, 2010
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Federal Focus
• Administration for Children and Families (HHS) – Child welfare professionals must understand the
impact of trauma on child development and learn how to effectively minimize its effects without causing additional trauma.
• https://www.childwelfare.gov/responding/trauma.cfm
• Federal Partners Committee on Women and Trauma – Report from the Federal Intergovernmental
Partnership on Mental Health Transformation, 2011 • http://www.vawnet.org/Assoc_Files_VAWnet/WomenAndTr
auma.pdf
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Trauma-informed safety
• Trauma-informed: create a milieu that acknowledges the impact of trauma and attempts to create a sense of safety
• Trauma-specific: services whose primary task is to address the impact of trauma and to facilitate trauma recovery
• All social service programs benefit from becoming trauma
informed and can choose to become also trauma-specific.
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Trauma lack of safety
Safety = Empowerment and connection
Trauma = disempowerment
and disconnection
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What is trauma? • An event or circumstance that overwhelmed a
person’s ability to cope with the situation, leading to a sustained loss of safety.
• Cumulative impact over time, the more events, the less an ability to cope, the more safety is lost.
Overwhelming event
Inability to cope Loss of safety
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Complex trauma
Unsafe home base (presence of harm, absence of safety)
Survival strategies in unsafe home base feel unproductive
and confusing outside of home base
Punitive and shaming interventions exacerbate
unsafe behaviors and alienate children from helpers and help
Unsafe outside the home relationships that feel safe and
more accepting than home, self, or help
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Complex domestic violence
Unsafe homebase, abuse, chaotic home, instability unmet needs for safety,
connection,
Behaviors that temporarily resolve the problem but look
problematic outside home
Punitive and shaming interventions that blame
victim, use controlling mechanisms to force change,
rules that confuse safety
Unsafe dynamics “feel” safer: Return to DV relationship, new
DV relationship, suicide, chronic substance abuse, self-
harm
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Central trauma roles
Bystander Perpetrator
Rescuer Victim
Integrated Self
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Complex trauma = Trauma roles
Unsafe home base: Perpetrator
Unproductive behaviors: Victim
Unsafe interventions:
Bystander
Unsafe out-of-home relationships and
situations: Rescuer
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Trauma uninformed interventions • Do not know what trauma is or how to recognize signs – trauma
blindness • Serve trauma survivors without being aware that any ever
trauma happened (never ask) – trauma muteness • Do not involve consumers/end-users in decision-making,
reinforcing past negative dynamics of powerlessness – trauma deafness
• Treat survivors for presenting issues (often related to trauma) without connecting them to trauma -- disconnection
• Do not know the impact of trauma over the lifespan – denial/minimization
• Do not recognize that trauma is central to the development of most social problems and diseases -- isolation
• Responding disproportionately to trauma triggers, escalation while blaming the consumer as instigator – hyper-reactivity
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The key is safety
• Domestic violence, crisis intervention, physical health are all safety issues.
• Parenting is a safety issue. • Unsafe behaviors and thoughts are a safety
issue • Providing publicly funded services are a
safety issue.
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Trauma Informed Intervention
Safe base, safe housing, safe relationships
Understanding behaviors as attempts to solve a
problem that becomes the basis of empowerment
Collaboration that is safety focused and choice driven
to strengthen clients’ abilities and relationships
Reconnection to social, work and family activities that promote safety and
trustworthiness
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Who can be trauma-informed • Mental health and substance abuse services • Hospitals and medical treatment centers • Nursing homes and adult protective services • Child protective services and children-focused
agencies • Criminal justice and prisons, jails, detention • Residential programs, housing, DV and other
shelters and social service programs • Schools and dissemination of information • Libraries, public transportation, environmental
health – just about any place
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Trauma-informed services are ‘safety increase’ oriented
An approach to services that looks at safety as the key to helping people who are
struggling
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Created by youth in a homelessness program ~ San Diego Youth Services
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Thank you!
• Gabriella Grant, Director • [email protected] • CA Center of Excellence for Trauma Informed
Care • www.trauma-informed-california.org • 916-267-4367