Creating a Trauma Informed System Al Killen-Harvey, LCSW The Harvey Institute [e-mail] 619-977-8569

1
Creating a Trauma Informed SystemAl
Killen-Harvey, LCSWThe Harvey
InstituteAl_at_theharveyinstitute.com619-977-8569
2
Goals and Objectives

1. Describe the attributes of the various forms of
   trauma
2. Delineate the essential elements of a trauma
   informed system
3. Identify current potential trauma reminders for
   clients in your organization/agency

3
What Is Trauma?

• Witnessing or experiencing an event that poses a
  real or perceived threat
• The event overwhelms the individuals ability to
  cope

4

• Event vs. Experience

5
Types of Trauma(Event)

• Acute trauma

6
Types of Trauma(Event/Experience)

• Chronic trauma

7
Types of Trauma(Experience)

Complex trauma
8
Historical Trauma
9
Historical Trauma

• Collective and cumulative emotional wounding
  across generations
• Cumulative exposure to traumatic events that not
  only affects an individual, but continues to
  affect subsequent generations
• The trauma is a psychological injury held
  personally and transmitted over generations

10
Situations That Can Be Traumatic(Events)

• Physical or sexual abuse/witnessing domestic
  violence
• Abandonment, betrayal of trust (such as abuse
  by a caregiver), or neglect
• The death or loss of a loved one
• Automobile accidents or other serious accidents
• Bullying
• Life-threatening health situations and/or
  painful medical procedures/Life-threatening
  illness in a caregiver
• Witnessing or experiencing community violence
  (e.g., drive by shooting, fight at school,
  robbery)
• Witnessing police activity or having a close
  relative incarcerated
• Life-threatening natural disasters
• Acts or threats of terrorism

11
What Is Traumatic Stress?(Experience)

• The physical and emotional responses of a person
  to events that threaten their life or physical
  integrity or someone critically important to the
  them (such as a parent, child or sibling)
• Traumatic events overwhelm a persons capacity to
  cope and elicit feelings of terror,
  powerlessness, and out-of-control physiological
  arousal
• Trauma is experienced as a series of traumatic
  moments each penetrating deep in the persons
  psyche

12
People Vary in Their Response to Traumatic Events

• The impact of a potentially traumatic event
  depends on many factors, including
• Genetic makeup
• Age and developmental stage
• Perception of the danger faced
• Whether the individual was the victim or a
  witness
• Relationship to the victim or aggressor
• Past experience with trauma
• Adversities the individual faced following the
  trauma
• The response to the events of the individuals
  close friends/caretakers

13
(No Transcript)
14
Prevalence of Trauma in the United States
15
Cumulative Impact of Trauma

• Traumas build upon one another creating a
  cumulative impact upon an individuals
• Neurobiology
• Physiological Responses
• Response to his/her environment
• Ability to regulate emotions
• Judgment and cognitive processes used in
  learning and decision making
• Self concept and self-esteem
• Social relationships and ability to trust
• Worldview

16
Effects of Trauma Exposure

• Attachment Traumatized individuals feel that
  the world is uncertain and unpredictable. They
  can become socially isolated and can have
  difficulty relating to and empathizing with
  others.
• Biology Traumatized individuals may experience
  problems with movement and sensation, including
  hypersensitivity to physical contact and
  insensitivity to pain. They may exhibit
  unexplained physical symptoms and increased
  medical problems.
• Mood regulation Individuals exposed to trauma
  can have difficulty regulating their emotions as
  well as difficulty knowing and describing their
  feelings and internal states.

17
Effects of Trauma Exposure

• Dissociation Some traumatized individuals
  experience a feeling of detachment or
  depersonalization, as if they are observing
  something happening to them that is unreal.
• Behavioral control Traumatized individuals can
  show poor impulse control, self-destructive
  behavior, and aggression towards others.
• Cognition Traumatized individuals can have
  problems focusing on and completing tasks, or
  planning for and anticipating future events. Some
  exhibit learning difficulties and problems with
  language development.
• Self-concept Traumatized individuals frequently
  suffer from disturbed body image, low
  self-esteem, shame, and guilt.

18
Overwhelming Emotion and Behavior

• Maladaptive coping strategies can lead to
  behaviors including
• Sleeping/eating disorders
• Substance abuse
• High activity levels, irritability, or acting out
• Emotional detachment, unresponsiveness, distance,
  or numbness
• Hyper-vigilance, or feeling that danger is
  present even when it is not
• Increased mental health issues (e.g. depression,
  anxiety)

19
Adverse Childhood Experiences

• Household dysfunction
• Mother treated violently
• Household substance abuse
• Household mental illness
• Parental separation/divorce
• Incarcerated household member

• Emotional abuse
• Physical abuse
• Sexual abuse
• Emotional neglect
• Physical neglect

Source Felitti, V. J., Anda, R. F., Nordenberg,
D., Williamson, D. F., Spitz, A. M., Edwards, V.,
... Marks, J. S. (1998). Relationship of
childhood abuse and household dysfunction to many
of the leading causes of death in adults The
Adverse Childhood Experiences (ACE) study.
American Journal of Preventive Medicine, 14,
245-258.
20
Long-Term Trauma ImpactACE Pyramid CDC
Death
Conception
Mechanisms by Which Adverse Childhood Experiences
Influence Health and Well-being Throughout the
Lifespan
21

• Adverse Childhood Experiences
• Abuse and Neglect (e.g., psychological, physical,
  sexual)
• Household Dysfunction (e.g., domestic violence,
  substance abuse, mental illness)

• Impact on Child Development
• Neurobiological Effects (e.g., brain
  abnormalities, stress hormone dysregulation)
• Psychosocial Effects (e.g., poor attachment, poor
  socialization, poor self-efficacy)
• Health Risk Behaviors (e.g., smoking, obesity,
  substance abuse, promiscuity)

Long-Term Consequences

• Social Problems
• Homelessness
• Prostitution
• Criminal Behavior
• Unemployment
• Parenting problems
• Family violence
• High utilization of health and social services

• Disease and Disability
• Major Depression, Suicide, PTSD
• Drug and Alcohol Abuse
• Heart Disease
• Cancer
• Chronic Lung Disease
• Sexually Transmitted Diseases
• Intergenerational transmission of abuse

Source Putnam, F., Harris, W. (2008).
Opportunities to change the outcomes of
traumatized children Draft narrative. Retrieved
from http//ohiocando4kids.org/Outcomes_of_Traumat
ized_Children
22
What is a Trauma-Informed Child-Serving System?

• A Trauma-Informed System
• understands
• 1) The potential impact of traumatic stress on
  the individuals served by the system
• How the system can either help mitigate the
  impact of trauma or inadvertently add new
  traumatic experiences
• How to promote factors related to resiliency
  after trauma

Rule 1 of a Trauma-Informed System Dont Make
It Worse
23
A Trauma-Informed System Understands

• That exposure to trauma is inevitable when
  working in a social service agency
• The impact of vicarious trauma on a social
  service workforce

24
What can be done to help a traumatized client?

• Provide a safe place for the individual to talk
  about what happened. Set aside a designated time
  and place for sharing to help the individual know
  it is okay to talk about what happened.
• Give simple and realistic answers to the
  individuals questions about traumatic events.
  Clarify distortions and misconceptions.
• Be sensitive to the cues in the environment that
  may cause a reaction in the traumatized
  individual. For example, individuals may
  increase problem behaviors near an anniversary of
  a traumatic event.

25
Maximizing Physical and Psychological Safety for
Children and Families

26
Psychological Safety
27
Psychological Safety

• What is it?
• What does it look like?
• How can you tell if a client feels safe?
• How can you tell if a client feels unsafe?

28
Maximizing Safety Understanding
TraumaticResponses

• They exhibit challenging behaviors and reactions
• When we label these behaviors as bad or good
  we forget that their behavior is a reflection of
  their experience
• Many challenging behaviors are strategies that
  have helped them survive in the past

29
Maximizing Safety Understanding Trauma
Reminders/Triggers

• When faced with people, situations, places, or
  things that remind them of traumatic events,
  individuals may experience intense and disturbing
  feelings tied to the original trauma.
• These trauma reminders can lead to behaviors
  that seem out of place, but were appropriateand
  perhaps even helpfulat the time of the original
  traumatic event.

30
Factors that Enhance Resilience
Sources Masten, A. S. (2001). Ordinary magic
Resilience processes in development. American
Psychologist, 56, 227-238. National Child
Traumatic Stress Network, Juvenile Justice
Treatment Subcommittee. (in preparation). Think
trauma A training for staff in juvenile justice
residential settings. Will be available from
http//www.nctsnet.org/resources/topics/juvenile-j
ustice-system
31
Protective Factors

• Individual characteristics
• Cognitive ability
• Self-efficacy
• Internal locus of control (a sense of having
  control over ones life and destiny)
• Temperament
• Social skills
• Community characteristics2
• Positive school experiences
• Community resources
• Supportive peers and/or
• Mentors

• Family characteristics1
• Family cohesion
• Supportive parent-child interaction
• Social support (e.g., extended family support)
• Cultural protective factors
• Strong sense of cultural identity
• Spirituality
• Connection to cultural community
• Protective beliefs and values
• Cultural talents and skills

• 1 Benzies, K., Mychasiuk, R. (2009). Fostering
  family resiliency A review of the key protective
  factors. Child Family Social Work, 14, 103-114.
• 2 Koball, H., Dion, R., Gothro, A., Bardos, M.,
  Dworsky, A., Lansing, J., Manning, A. E.
  (2011). Synthesis of research and resources to
  support at-risk youth. Retrieved from
  Administration for Children and Families Office
  of Planning, Research, and Evaluation website
  http//www.acf.hhs.gov/programs/opre/fys/youth_dev
  elopment/reports/synthesis_youth.pdf

32
Enhance the Well-Being and Resilience of Those
Working in the System
33
Enhance the Well-Being and Resilience of Those
Working in the System

• While behavioral health/social service support
  workers play an important role in supporting
  individuals, working with people who have
  experienced abuse, neglect, violence, and other
  trauma can cause staff to develop secondary
  traumatic stress reactions.
• Agencies/organizations should collect information
  about trauma and secondary trauma experienced by
  staff, implement strategies and practices that
  build resilience and help staff manage stress,
  and address the impact of secondary traumatic
  stress both on individuals and on the system as a
  whole.

34
System Trauma

• The system itself can be a highly reactive,
  traumatizing system without enough services and
  supports to assist the workforce in responding
  effectively.

35
Impact of Working with Victims of Trauma

• Trauma experienced while working in the role of
  helper has been described as
• Compassion fatigue
• Secondary traumatic stress (STS)
• Vicarious traumatization
• STS is the stress of helping or wanting to help a
  person who has been traumatized.
• Unlike other forms of job burnout, STS is
  precipitated not by work load and institutional
  stress but by exposure to clients trauma (acute
  or cumulative).
• STS can disrupt social service workers lives,
  feelings, personal relationships, and overall
  view of the world.

36
STS Signs and Symptoms

• Avoidance (including of certain clients)
• Preoccupation with clients/client stories
• Intrusive thoughts/nightmares/flashbacks
• Arousal symptoms
• Thoughts of violence/revenge
• Feeling estranged/isolated/having no one to talk
  to
• Feeling trapped, infected by trauma, hopeless,
  inadequate, depressed
• Having difficulty separating work from personal
  life

37
What can a professional do to address STS?

• What can a supervisor or manager do to address
  STS?
• What can the agency do?
• Other resources/activities

38
Self-Care for Responders

• Be aware of the signs. Professionals with
  compassion fatigue may exhibit some of the
  following signs.
• Dont go it alone. Guard against isolation
• Recognize compassion fatigue as an occupational
  hazard. Dont judge yourself as weak or
  incompetent for having strong reactions to a
  trauma (its the cost of caring).

39
Self-Care for Professionals (continued)

• 4. Seek help with your own traumas. Any social
  service worker who also has his or her own
  unresolved traumatic experiences,
• is more at risk for compassion fatigue.
• 5. If you see signs in yourself, talk to a
  professional. If you are
• experiencing signs of compassion fatigue
  for more than two to three
• weeks, seek counseling with a professional
  who is knowledgeable
• about trauma.

40
(No Transcript)
41
Contact Information

• Al Killen-Harvey, LCSWThe Harvey
  InstituteAl_at_theharveyinstitute.com619-977-8569