Health Care for the Homeless Honolulu Hawai’i June 28, 2013

TRAUMA INFORMED EXCELLENCE:TRAUMA INFORMED CARE

Health Care for the Homeless

Honolulu Hawai’iJune 28, 2013

DIVERSE MANAGEMENT SOLUTIONS, LLC

Stay positive

Informal

Interactive

diverse management solutions

www.DiverseManagementSolutions.com(303) 258-3523

Matt Bennett, MBA, MAbennett@diversemanagementsolutions.com

TIE LEARNING GOALS Have a basic understanding of the trauma informed

paradigm as it relates to: Self-care Leadership/Culture Trauma Informed Care Trauma Treatment

Conceptualize the impact of trauma on client functioning

Conceptualize how you can utilize this research change the way you and your programs interact with clients

TRAUMA INFORMED CORE COMPETENCIESExcellence in care

TRAUMA INFORMED EXCELLENCE: THE PATH

Trauma Specific

Treatment

Thrive: Self Care

Trauma Informed

Care

Leadership & Culture

The Goal: World Class Services

TRAUMA INFORMED CARE

Science & Proven Methodologies

DEFINING TRAUMA

Physical

SocialMind

Robustness Having or exhibiting strength or vigorous health

Capable of performing with success under a wide range of conditions

Resiliency The power or ability to return to the original form, position, etc.

Ability to recover readily from illness, depression, adversity, or the like.

ACE FINDINGS

Acestudy.org, 2013

TRAUMA VICTIM TO TRAUMA SURVIVORVictim

When you hear the term trauma victim what does it mean to you?

What role does trauma play in the life of the victim?

Survivor

When you hear the term trauma survivor what does it mean to you?

What role does trauma play in the life of the victim?

Stress

& Trauma

Negativity & Survival

Epigenetics!!!!

Caring Environment: • Genes are expressed that alter the

regulation of the nervous system • Qualities associated with emotional

resiliency are reinforced

Genes Proteins Cells Traits

EnvironmentAbusive Environment: • Stress inhibits proteins that lead to

the development & operation of brain areas associated with survival

• Decreases ability to manage stress in the future

Shenk, 2010

Stress

& Trauma

Negativity & Survival

Inse

cure

/Dis

orga

nize

d Att

achm

ent

Power of Attachment

• Attachment provides the template for how we see all relationships

• Think how Windows allows us to operate software like Word, ITunes and internet browsers

• Our emotional, cognitive and social functions operate from our attachment experience

• Trauma = Virus in the system

Bloom & Farragher, 2011

Stress

& Trauma

Negativity & Survival

Inse

cure

/Dis

orga

nize

d Att

achm

ent

Automatic Response

Brain Structure & Processing

•Brainstem – Basic processes• Limbic – Emotions & Survival•Cortex – Guides us in the

physical world•Prefrontal Cortex – Thinking &

Conceptualization Bottom-up information

(sensations) meet top-down information (memories) to create or experience of the world

Siegel, 2010

Hypo-arousal

Habitual

Hyper-arousal

Fight/Flight

Freeze

Negativity & Survival

LifestyleStre

ss & Trauma

Inse

cure

/Dis

orga

nize

d Att

achm

ent

Automatic Response

Retraumatization

•Mind’s attempt at integrating the experience into the personality

•As long as the trauma can not be put into words it will be relived through emotions and behaviors

•The emotions that are experienced are the emotions that need to be overcome in order to gain mastery over the trauma that they could not stop

Bloom & Farragher, 2011 & Herman, 1997

Hypo-arousal

Habitual

Hyper-arousal

Fight/Flight

Freeze

LifestyleStre

ss & Trauma

Negativity & Survival

Inse

cure

/Dis

orga

nize

d Att

achm

ent

Automatic Response

Safety & Trust

Relationship with Helper: Foundation for Focused Attention

“Recovery can take place only within the context of relationships; it cannot occur in isolation. In her renewed connections with other people, the survivor re-creates the psychological faculties that were damaged or deformed by the traumatic experience.”

– Judith Herman

Your Impact

Client CharacteristicsRelationship HopeTechniques

Achor, 2010; Murphy, 2008

RelationshipHopeTechniques

Determinants of Successful Client Outcomes

Steps to Prevent Re-traumatization•See the environment through the client’s eyes.

• Is the environment safe, calm and predictable or overly chaotic or rigid• Do your procedures and program rules treat clients as you would want to be

treated

•Help set client expectations of what their experience will be like in your program• New situation elicit fear that can be associated with the fear of the traumatic

experience• Boundaries that define the helping relationship• Program rules and expectations of the client• Introduction to staff

Bloom & Farragher, 2011; Rock, 2009 & Herman, 1997

Steps to Prevent Re-traumatization•Build Safety

• Do what you say you will do• Do it to the best of your ability• Adhere to and model healthy boundaries• Provide honest reflection• Trust and respect client

•Go slow and go slower• Re-traumatization occurs most often when the helper or program pushes the

client beyond their sense of safety• Check in often

Bloom & Farragher, 2011; Rock, 2009 & Herman, 1997

Hypo-arousal

Habitual

Hyper-arousal

Fight/Flight

Freeze

Lifestyle

Focused Attention

Emotional Regulation

F.A.C.E.S

BehaviorChange

Health & Wellness

Negativity & Survival

Inse

cure

/Dis

orga

nize

d Att

achm

ent

Safety & Trust

Focus Strategies• Life Management

• Regain control of small aspects of life• Build self efficacy• Lowering stress not associated with trauma

• Reclaiming the Positive• Counterbalance negative worldview with small infusions of positive thought• Shift brain to the creation of new neuropathways• Improves outcomes of the helping relationship

• Techniques• Motivational Interviewing• Solution Focused Therapy• Mindfulness• Etc….

TRAUMA TREATMENT

Strategies toward Post Traumatic Growth

Hypo-arousal

Fight/Flight

Freeze

Focused Attention

Emotional Regulation

F.A.C.E.S

BehaviorChange

Health & Wellness

Post-Traumatic

GrowthHope

Negativity & Survival

Inse

cure

/Dis

orga

nize

d Att

achm

ent

Safety & Trust

Positivity & Logic

Hea

lthy

Rela

tions

hips

Client’s Journey of Post Traumatic Growth

• Establishing Safety• Awareness & Management of Arousal States

Internal Regulation

Courtois & Ford, 2009

QUESTIONS & COMMENTS

Thank You!

REFERENCES & RESOURCES 1 Acestudy.org

Achor, S. (2010). The Happiness Advantage. New York, NY: Crown Business.

Bloom, S. L. & Farragher, B. (2011). Destroying Sanctuary: The crisis in human service delivery systems. New York: Oxford.

Ford, J. D.; Courtois, Christine A. (2009). Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide (p. 90). Guilford Press. Kindle Edition.

http://www.samhsa.gov/nctic/

J. Douglas Bremner. (2005). Does Stress Damage the Brain? W.W. Norton & Company: New York

Lewis, G. (2006). Organizational Crisis Management: The Human Factor. Boca Raton, FL: Auerbach Publications.

Miller, W. & Rollnick, S. (2002). Motivational Interviewing: Preparing People For Change.

REFERENCES & RESOURCES 2

Ogden, P., Minton, K., Pain, C. (2006). Trauma and the Body. New York: W. W. Norton and Company.

Rock, D. (2009). Your Brain at Work: Strategies for overcoming distraction, regaining focus, and working smarter all day long. New York, NY: HarperCollins.

Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2007). Collaborative Treatment of Traumatized Children and Teens. New York: The Guiford Press.

Schwartz, T. (2010). The Way We Are Working Isn’t Working. New York: Free Press.

Shenk, D.. (2010). The Genius in All of Us. New York: Doubleday.

Siebert, A. (2005). The Resiliency Advantage. San Francisco, CA: Berrett-Koehler Publishers Inc.

Siegel, D. (2010). Mindsight: The new science of personal transformation. New York, NY: Random House.