INTRODUCTIONS

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INTRODUCTIONS
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UNDERSTANDING TRAUMA AND ITS IMPACT
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WHAT MAKES AN EXPERIENCE TRAUMATIC?
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WHAT MAKES AN EXPERIENCE TRAUMATIC?
The experience involves a threat to ones
physical or emotional well-being. It is
OVERWHELMING. It results in intense feelings of
fear and lack of control. It leaves people
feeling vulnerable and helpless. It changes the
way people view themselves, the world, and others.
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Sources of Traumatic Stress

• Loss of a loved one
• Accidents
• Homelessness
• Community/school violence
• Domestic violence
• Neglect
• Physical abuse
• Sexual abuse
• Man-made or natural disasters
• Terrorism

Photo credit K. Volk
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TRAUMATIC EXPERIENCES ARE COMMON

• Most of us have experienced at least one
  traumatic event on the list we just discussed.

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Even if the people who walk through your doors
have no history of trauma, homelessness is
traumatic.
Source Poems, Pictures, and Other Great Stuff.
(1996). Salem-Keizer Public Schools. Salem,
Oregon.
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WHAT WE KNOW ABOUT PEOPLE WHO ARE HOMELESS

• They have often experienced multiple traumas
• in addition to homelessness.

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Experiences of Trauma among Youth

• Family conflict/violence is the primary cause of
  homelessness.
• 46 have been physically abused.
• Foster care involvement
• One in five youth who arrived at shelters came
  directly from foster care.
• Over 25 had been in foster care in the previous
  year.

Sources U.S. Department of Health and Human
Services (1997). National Evaluation of Runaway
and Homeless Youth Bass, Deborah. Helping
Vulnerable Youths Runaway and Homeless
Adolescents in the United States, 1992. The
National Association of Social Workers,
Washington DC.
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Experiences of Trauma among GLBTQ Youth

• Comprises 20 to 40 of homeless youth.
• Coming out is often associated with being kicked
  out of home or physically assaulted.
• Mental health and substance abuse issues are
  common.
• Risky sexual behaviors are prevalent (increased
  risk of HIV).
• Seven times more likely to be a victim of a
  violent crime.

Source National Gay and Lesbian Task Force
Policy Institute and The National Coalition for
the Homeless (2006). Lesbian, Gay, Bisexual and
Transgender Youth An Epidemic of Homelessness.
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After a traumatic experience, the brain remembers
even the smallest details of the experience, so
that if faced with a similar situation in the
future, you will be able to react even more
quickly.
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triggers

• Reminders of past trauma

sight
smell
taste
feeling
sound
Alarm system is activated
Respond as though there is current danger
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Triggers

• Think back to our definition of what makes a
  stress traumatic It leaves people feeling
  helpless, fearful, vulnerable and out of control.
• Any experience in the present that mimics these
  feelings can trigger or remind someone of a
  past trauma and cause them to respond as if back
  in the past.

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What Happens?
. . . when it happens in your family?
. . . when the trauma starts young?
. . . when you already face other challenges?

• . . . when it doesnt stop?

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Complex Trauma

• Prolonged, persistent traumatic stress.
• Often occurs within the caregiving system during
  critical developmental stages.
• Leads to immediate and long-term difficulties in
  many areas of functioning.

Source Slide adapted from NCTSN, 2005
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Traumatic experiences, particularly experiences
that are repeated, prolonged and severe, can
have a significant impact on how people think,
feel and respond in the present.
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Impact of Complex Trauma

• Effects are neurological, biological,
  psychological and social in nature, including
• Changes in brain neurobiology
• Social, emotional cognitive impairment
• Adoption of health risk behaviors as coping
  mechanisms (eating disorders, smoking, substance
  abuse, self harm, sexual promiscuity, violence)
• Severe and persistent behavioral health, health
  and social problems
• (Felitti et al, 1998 Herman, 1992)

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WHERE HAVE YOU SEEN TRAUMA HAVE THE BIGGEST
IMPACT IN THE LIVES OF THOSE YOU WORK WITH? (POLL)

• Emotional health
• 2) Physical health
• 3) Coping skills
• 4) Relationships
• 5) Sense of self

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• Trauma survivors have adopted a set of survival
  skills that have helped them manage their trauma
  in the past.
• These strategies make sense given what people
  have experienced, even if they are confusing to
  others or are seen as getting in the way of
  current goals.

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Responses that are on based traumatic experiences
can be very challenging for service providers to
understand in the present.
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Without an understanding of trauma and its
impact, consumer responses may be misunderstood
or mis-labled, leading to increased frustration
for providers and the potential to do harm to
those you are trying to help.
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How can organizations use their knowledge of
trauma and its impact to modify their services in
ways that benefit staff and consumers?
In response to this question, the homelessness
field is moving towards a new way of providing
care.
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BECOMING TRAUMA-INFORMED
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• Viewing the world through the lens of trauma.

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• Providing trauma-informed care involves using
  what we know about trauma and its impact to do
  our work differently and avoid causing additional
  harm to those we serve.

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• This type of change requires that staff at ALL
  levels and in ALL roles modify what they do based
  on an understanding of . . .
• the impact of trauma, and
• the specific needs of trauma survivors.

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Principles of a Trauma-Informed System
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Putting the Principles Into Practice
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Youth on Fire A safe space in Cambridge, MA for
Homeless and Street-involved youth ages 14-24
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• YOF GOAL
• To encourage young people to
• prioritize their health,
• stay HIV-negative,
• seek greater stability through
• permanent housing,
• employment,
• connection to social support services.

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who do we see?
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BASIC DEMOGRAPHICS
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OTHER RELEVANT INFO

• 52 have lived in an abusive household
• 11 forced to have sex in the previous year
• 58 have been diagnosed with a mental health
  condition
• 42 have been hospitalized for psychiatric
  reasons
• 23 report suicide attempt
• 22 report DSS involvement (foster care, group
  home)
• 20 report sex in exchange for money, food, or
  shelter

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what we offer
Three tiers of service that follow Maslows
Hierarchy of Needs and the Youth Development
Model
Opportunities for Leadership, Growth,
Development and Change
Supports Case Managers, Doctor on-site,
Therapist on-site, Housing Search, Employment
Support, HIV testing
Services Showers, Lockers, Laundry, Meals,
Hygiene Products, Med supplies, Internet, TV,
Couches
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BECOMING A TRAUMA-INFORMED SPACE

• Emerging Staff Awareness of Need how do we deal
  with trauma as non-clinicians?
• Connected with Local Resources / Trauma Experts
• Implemented Staff Training
• Assessed Space
• Developed Trauma-informed Intervention

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STAFF TRAINING

• What is trauma? How does it affect people?
• What are triggers? How do they come out?
• How are peoples trauma and triggers related to
  their coping mechanisms? (Why do people do what
  they do? Because what they do works.)
• How can this affect us as providers and people?
• As non-clinicians, how can we help people deal
  with their experiences?

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CHANGES MADE TO PHYSICAL SPACE

• Re-arranged space to make all Case Managers have
  a semi-private cubicle with curtains for privacy
• Re-arranged space so that TV is facing the
  wall-members who do not want to watch what is on
  TV do not have to see it
• More quiet space for members to sleep
• Improved lighting in space
• Changed color of walls from yellow to blue
• Staff training and written protocol on Crisis
  Prevention and De-escalation.
• Extended hours for evening access

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CHANGES RECOMMENDED BUT NOT MADE

• Will not screen out people with violent histories
  or criminal records
• Will not install metal detector to screen for
  weapons
• Will not limit members ability to write about
  their experiences of violence (in literary
  magazine)
• Not able to provide flip-flops for shower use
• Are not able to become wheelchair accessible

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PHOENIX RISING A TRAUMA-INFORMED INTERVENTION

• Based on ARC Framework for for intervention with
  youth exposed to complex trauma. (Kinniburgh,
  Blaustein, Spinazzola van der Kolk)
• ARC Attachment, Regulation, Competence
• Integrated with Motivational Interviewing
  techniques, Harm Reduction practices, and
  Prevention Case Management model
• Went through a number of versions of the
  curriculum, and eventually came to a 5 session,
  low-threshold version
• For more information on the ARC Framework
• http//www.traumacenter.org/research/ascot.php

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• Phoenix Rising Curriculum (Regulation
  attachment)
• Values Sort/ Clarification
• Trauma Trigger Education
• Arousal Coping Mechanisms
• Regulation Skills
• Risk Reduction
• HIV Counseling and Testing

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• phoenix rising competence activities
• Speakers Bureau
• Youth Advisory Board
• Cooking for the Center
• Hiring Committees

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IMPACT OF PHOENIX RISING

• On Staff
• On Members
• On Space

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TOOLS AND RESOURCES
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FIRST STEPS TOWARDS BECOMING TRAUMA-INFORMED

• Basic trauma education for staff (see resource
  list).
• Partner with community agency to provide clinical
  supervision/consultation.
• Take a look at your physical space with an eye
  for creating a sense of safety and cultural
  relevance, while minimizing triggers.
• Identifying ways to give people as much choice
  and control as possible within their environment.

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RESOURCES

• Homelessness and Traumatic Stress Training
  Package. This training package includes a
  trainers guide, power-point slides, a trainers
  script, hand-outs, and evaluation materials.
• What About You? A Workbook for Those Who Work
  With Others.
• A Long Journey Home A Guide for Creating
  Trauma-Informed Services.
• Shelter from the Storm Creating Trauma-Informed
  Homeless Services. This report outlines current
  trends and promising models for developing
  trauma-informed homeless service systems and
  organizations.

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NEXT STEPS TOWARDS BECOMING TRAUMA-INFORMED

• For organizations who would like to make a
  broader and more significant organizational
  commitment to becoming trauma-informed, next
  steps may involve engaging in an organizational
  self-assessment process.

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ASSESSMENT TOOLS

• Organizational needs assessment Shorter tool.
  Used by Youth on Fire.
• Trauma-Informed Organizational Toolkit Longer
  tool. Includes the Trauma-Informed Organizational
  Self-Assessment and Users Guide, along with a
  How-To Manual for Creating Trauma-Informed
  Organizational Change.

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YOUTH ON FIRE RESOURCES

• Sample Intake and Risk Assessments
• Sample Rights and Responsibilities
• For additional resources, see resource page for
  youth drop-in centers.

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QUESTION AND ANSWER