Trauma Informed Care

Rick Edwards, LPC

FUNDAMENTALS OF TRAUMA

1. What are the types of Trauma? 2. What is a Traumatic Response? 3. What causes a Traumatic Response?

Post-Traumatic Stress Disorder

• The Diagnostic and Statistical (DSM) lists the key aspects of Post Traumatic Stress Disorder (PTSD): – Re-experiencing – Avoidance – Emotional Dysregulation

• Loss of perspective • Unable to interpret signals • Loss of skills, functions and flexibility

Types of Trauma • Type I – PTSD: acute trauma

Types of Trauma • Type I – PTSD: acute trauma • Type II – Developmental trauma

– Abuse, neglect, violence – Brain development

Types of Trauma • Type I – PTSD: acute trauma • Type II – Developmental trauma

– Abuse, neglect, violence – Brain development

• Type III – Both PTSD & Developmental

Types of Trauma • Type I – PTSD: acute trauma • Type II – Developmental trauma

– Abuse, neglect, violence – Brain development

• Type III – Both PTSD & Developmental • Type IV – PTSD plus Developmental Trauma plus ENVIRONMENTAL STRESS!

The Two Roads • The Low road • Prepares the body for

emergency response • Pathway is

unconscious and does not contain contextual information.

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• The High Road • Provides context • Insures accurate

perception of the stimulus

• Helps prepare a response.

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Survival Circuits • How one perceives stimuli makes the

determination if a threat or not. • Low road sensory processing is very fast

and unconscious. • Low road is only concerned with survival. • Emotion hijacks reason

A moment in time • Traumatized kids will not be able to see

their futures if they are fighting for their lives in the present and if they have trouble making sense of the their past and seeing any likelihood of rewards or pleasure in future events.

ELEMENTS IN ACE STUDY Abuse • Emotional Abuse • Physical Abuse • Sexual Abuse Neglect • Emotional Neglect • Physical Neglect Household Dysfunction • Mother Treated Violently • Household Substance Abuse. • Household Mental Illness • Parental Separation or Divorce • Incarcerated Household Member

ACE PYRAMID

ANATOMY

OF TRAUMA

Traumatic Stress Response • Trauma activates a biological response in

the brain. – Norepinephrine (neurotransmitter) “locks in”

the memory of the stress event. – The brain processes the event in context to:

• Age • Culture • Development • And other factors

Traumatic Stress Response • The people we work with have been

severely, negatively affected by trauma. – Our approach can help restore hope…

– Or

– Neglecting what we know about trauma can

cause us to harm these patients further.

Traumatic Stress Response

• A MAJORITY of people served in public mental health and substance abuse systems have experienced REPEATED TRAUMA since childhood.

Traumatic Stress Response

• Exposure to traumatic experiences may result in a person staying “stuck” in: – Fight – Flight – Freeze

What Activates A Traumatic Stress Response?

TRIGGER – words, sounds, posture

PERCEPTION

REACTION

What Activates A Traumatic Stress Response?

• Compliance Trigger – Message: You are wrong; do this now;whether

you like it or not. – Guilt-based

• Performance Trigger – Message: You failed; you will fail; you don’t

measure up; you don’t know how to do this. – Shame-based

What Activates A Traumatic Stress Response?

Guilt Message versus Shame Message

• Guilt – Your behavior is/was bad because of how it affected someone else.

“I can’t believe you did that!”

• Shame – You are bad. “You are bad/messed up/________!”

What Activates A Traumatic Stress Response?

• Compliance Trigger – Message: You are wrong; do this now;whether

you like it or not. – Guilt-based

• Performance Trigger – Message: You failed; you will fail; you don’t

measure up; you don’t know how to do this. – Shame-based

What Activates A Traumatic Stress Response?

• Reminder Trigger – Sensory experiences (sights, sounds, tastes,

smells, tactile) that feel like “this happened before and it was bad!”

– Evokes “re-experiencing” of a previous event

Traumatic Stress Response • Loss of 15-30 points of IQ

• This is not a good time to:

– Ask questions – Teach life lessons – Remind of past infractions – Process.

Traumatic Stress Response • Loss of 15-30 points of IQ

• This IS a good time to:

– Step back and give some space – Use non-verbal interventions – Low doses of sympathy & reassurance – Provide concrete help to meet a need

Sources of Triggers

• Local Sources of Triggers for Trauma Response – Program: Schedules, rules, “requirements” – Staff: Tone of voice, posture, facial

expressions – Self: Internal stimulation (delusions, paranoid

symptoms, substance abuse)

Sources of Triggers

• External sources of Trauma Triggers

– Demands for compliance or performance – Trauma reminders (sensory) – Failure to deliver on promises, expectations

Considerations… • Trauma Informed Care (TIC) means

treating every person with the care and sensitivity we would use for those with trauma.

• TIC is treating people who have special needs due to trauma history in a sensitive and respectful way.

Considerations… • We acknowledge that we could be a

trigger to someone else and work to be very sensitive toward their needs.

• Allow as much self determination and self control as possible.

Clarity’s Journey to Trauma Informed Care

• Sanctuary • Open Arms • Clarity Care

– Transactional approach: Fit is everything; goal of treatment is to maximize fit between the demands of the environment and the person’s current abilities while promoting development of skills that are lacking.

– Values, Attitudes, Beliefs determine your interpretation – Your interpretation guides your actions; believing is

seeing

Clarity’s Journey to Trauma Informed Care

Transactional Approach (fit is everything) What happens if: The environment expects a child to

behave/perform like an adult? A 10 year old acts with the stress and frustration

tolerance of a 3 year old? Compatibility (degree of fit) is the best predictor

of good behavioral outcomes.

Core Values • Core Values (Values, Attitudes, Beliefs)

– Clarity Child Guidance Center

• Dignity for Children

• Respect for Children

• Understanding for Children

Tool box

FOR TRAUMA INFORMED CARE

TOOLS FOR THE TOOL BOX

The Transactional Assumption:

Compatibility between expectations of the environment and the person’s abilities(Fit)

is the best predictor of behavioral outcomes.

Therapeutic goal: Match environmental

expectations (as much as possible) to the individual’s skills while promoting

development.

TOOLS FOR THE TOOL BOX

• A core Clarity belief: Kids do well when they can.

– What does this mean?

When they are NOT doing well… – There is a perceived or real demand they

cannot accommodate

TOOLS FOR THE TOOL BOX

• When your clients are NOT doing well: – What behaviors do you see… – Examples:

TOOLS FOR THE TOOL BOX

• Recognize a trauma response. – Fight – Behavior Escalation – Flight – Avoiding – Freeze – Shutting Down

See the behavior for what it is…

TOOLS FOR THE TOOL BOX

• How to respond to a trauma response? – Empathy – Reassurance – Take a step back (check your IQ) – Ask, “How can I help?” – Ask for a person centered goal – Leave the field if necessary – And…

TOOLS FOR THE TOOL BOX

• Do everything you can to avoid adding more triggers!

• So, avoid… – Compliance demands – Performance demands – Giving Reminders – Teaching Life Lessons

TOOLS FOR THE TOOL BOX

• Clarity Staff Development Model – Self Awareness

• Focus Model brings into awareness the role of our Values, Attitudes and Beliefs.

– Cognitive Flexibility • Believing is Seeing?

– Emotional Attunement