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Trauma-Informed Community Health Workers_Elaine Zook Barge_4.23.13
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  • *My Story - Central America: Guerra, pobreza, trauma y resiliencia *Where there is no doctor – David Werner - Return to US in 1998 - “Where there is no Psychologist” *Faced daily with stories of trauma/pain (personal and listening to others) *STAR is the resource I was looking for…….want every caregiver, humanitarian aid worker, administrator to have this resource WHO are you: Introductions (name/country of origin) Plan for the morning; The impact of trauma on the body, brain and behavior Some tools and processes for addressing trauma and building resilience
  • Trauma-informed, conflict-sensitive, justice-oriented 12-year old program (More about it later) Acknowledge CWS indivd/orgs who are there. Would like to know ALL of your stories – where they work, what they do etc.
  • Difference between trauma/traumatic event and being traumatized Physical and emotional wound comparison
  • What kinds of traumatic events do CHW encounter in their work ( accident, natural disaster, historical harms, violence or sustained poverty). Make sure list includes: Dignity violations/oppressive structures; divorce, betrayal, life-threatening illness, prolonged conflict, collective historic trauma, etc.
  • When we recognize that something is wrong, we often don’t know what to do about it – ACT – El Salvador - humanitarian aid……we know how to get water, food, shelter but don’t know what to say when sitting with the people in the evening. Jeanette Knicely – Guatemala…….
  • Often because they don’t know what to do if people start to cry.
  • In recent years, humanitarian and development orgs recognizing these needs more and increasingly using psychosocial programs when working with disasters or violence. This support is vital but often 2 drawbacks: *the stigma those receiving services often face The fact that addressing economic hardship is outside the mandate of most psychosocial projects.
  • Children witnessing violence – shorter DNA.
  • Includes 4 things that being trauma-informed means……
  • The natural physical response to threat = fight/flight The freeze response traps the fight/flight energy in the body in the nervous system and muscles. (Peter Levine in Waking the Tiger )
  • If it is not released, it caused stress or trauma reactions in individuals and groupsInstinctual responses of wild animals after “freezing” This discharges the compressed energy, completing a natural physiological process . (Levine, Waking the Tiger) Polar Bear clip
  • Read the Levine advice from Boston
  • When we act out ……we hurt others and create more victims…….cycles of violence go on and on
  • Hurt people hurt people Passed from generation to generation Links Between Unhealed Trauma and Cycles of Violence
  • Jin Shin Jyutsu physio-philosophy – an ancient art of harmonizing the life energy in the body. Promotes the natural healing processes of the body
  • Meaning-making creatures - in addition to shaking, need narrative – space to tell our stories Narratives can either keep us stuck or help us move forward Include this in your health plan Acknowledgement Allows the story of what happened to be told (storytelling) Counteracts the isolation, silence, fear, shame, or “unspeakable horror” Mourning and Grieving “unfreeze” the body
  • STAR Snail Model: Awareness tool for individual/orgs who want to be trauma/resilience-informed to better help others An assessment tool for helping themselves as they help others – (self-care) and for identifying other tools they need for their work (FJ, CT, etc. 2. STAR’s Snail model includes many of the body/mind tools like Capacitar Aknowledgement/listening/storytelling is a major component of the snail model like Cabrera Especially in human-caused trauma, reconnection is very important part of breaking cycles of violence - RJ, CT, reconciliation
  • And here we are
  • Works in a variety of contexts……..gives people a framework to hang their experiences on….. “ invitational” – for victims and offenders

Trauma-Informed Community Health Workers_Elaine Zook Barge_4.23.13 Trauma-Informed Community Health Workers_Elaine Zook Barge_4.23.13 Presentation Transcript

  • © 2012 Eastern Mennonite University • www.emu.edu/starTrauma-Informed CommunityHealth WorkersElaine Zook BargeCORE Group Spring Meeting 2013April 24, 2013
  • © 2012 Eastern Mennonite University • www.emu.edu/starText1980’s and 1990’sEl SalvadorNicaraguaGuatemala
  • © 2012 Eastern Mennonite University • www.emu.edu/star
  • © 2012 Eastern Mennonite University • www.emu.edu/starPresentation Outline Trauma-informed – why?Trauma-informed – why? The impact of trauma on theThe impact of trauma on theBodyBodyBrainBrainBehaviorBehavior Some tools for addressing trauma in the communitySome tools for addressing trauma in the communityPhysiological - Fingerholds (Capacitar)Physiological - Fingerholds (Capacitar)Meaning-making - Acknowledgement (Cabrera)Meaning-making - Acknowledgement (Cabrera)Strategies for Trauma Awareness & ResilienceStrategies for Trauma Awareness & Resilience(STAR)(STAR) DiscussionDiscussion
  • © 2012 Eastern Mennonite University • www.emu.edu/starTraumaTraumaFrom the Greek word “traumat”From the Greek word “traumat”meaningmeaning woundwound(n.)(n.) An experience that is emotionally painful,An experience that is emotionally painful,distressful, or shocking and which may resultdistressful, or shocking and which may resultin lasting effects on the mind, body and spiritin lasting effects on the mind, body and spiritof an individual or group.of an individual or group.
  • © 2012 Eastern Mennonite University • www.emu.edu/starViolence – conflict – harm (trauma) are apart of life for individuals, communitiesand societies.ViolenceConflictTrauma
  • © 2012 Eastern Mennonite University • www.emu.edu/starTrauma is often theTrauma is often the “elephant in the room”“elephant in the room”for individuals, families, communitiesfor individuals, families, communitiesand societies.and societies.
  • © 2012 Eastern Mennonite University • www.emu.edu/starLiving and Surviving in a Multiply-wounded Countryby Nicaraguan psychologist, Martha Cabrerahttp://www.envio.org.ni/articulo/1629 ““inventory of wounds”inventory of wounds” Created space toCreated space totalk about pain because people needed to talktalk about pain because people needed to talkabout losses they have never voiced beforeabout losses they have never voiced before Factors for not processing the painFactors for not processing the painInsufficient timeInsufficient timeCultural factorsCultural factorsLack of community resources to deal w/ suchLack of community resources to deal w/ suchproblemsproblemsGrassroots & social organizations who haveGrassroots & social organizations who haveminimized or totally ignored the painminimized or totally ignored the pain
  • © 2012 Eastern Mennonite University • www.emu.edu/star““Multiple wound phenomenonMultiple wound phenomenon””The response of those working on development orThe response of those working on development orcommunity projects all over Nicaragua was…community projects all over Nicaragua was…““So what do you want us to do, putSo what do you want us to do, puta psychologist in every project?”a psychologist in every project?”Enormous lack of knowledgeEnormous lack of knowledgeabout the manifestations andabout the manifestations andconsequences of loss, violenceconsequences of loss, violenceand accumulated painand accumulated pain
  • © 2012 Eastern Mennonite University • www.emu.edu/starTrauma and pain afflict not only individuals.Trauma and pain afflict not only individuals.When they become widespread andWhen they become widespread andongoing, they affect entire communities andongoing, they affect entire communities andeven the country as a whole.even the country as a whole.The implications are serious for people’sThe implications are serious for people’shealth, the resilience of the country’s socialhealth, the resilience of the country’s socialfabric, the success of developmentfabric, the success of developmentschemes, and the hope ofschemes, and the hope offuture generations.future generations.Nicaraguan psychologist, Martha Cabrera.http://www.envio.org.ni/articulo/1629
  • © 2012 Eastern Mennonite University • www.emu.edu/starTrauma-sensitive development and humanitarian aidTrauma-sensitive development and humanitarian aidby Carolyn Yoder,by Carolyn Yoder, MA, LMFT, LPC, NCC andfounding STAR directorounding STAR director A way to address these limitations is forA way to address these limitations is fororganizations to become “trauma-informed”organizations to become “trauma-informed”so that a trauma-sensitive framework can beso that a trauma-sensitive framework can beintegrated into any project: economic, health,integrated into any project: economic, health,governance, etc.governance, etc. This means more than putting a psychologistThis means more than putting a psychologiston every project. Awareness of theon every project. Awareness of therepercussions of trauma needs to extendrepercussions of trauma needs to extendacross the organization to headquarters andacross the organization to headquarters andfield staff alike.field staff alike.
  • © 2012 Eastern Mennonite University • www.emu.edu/starII. The impact of trauma on theII. The impact of trauma on the BodyBody BrainBrain BehaviorBehavior
  • © 2012 Eastern Mennonite University • www.emu.edu/starFlightFlightTrauma and the BodyFightFreezeFreeze
  • © 2012 Eastern Mennonite University • www.emu.edu/starPeter LevinePeter Levine•Waking the TigerWaking the Tiger•In an Unspoken Voice:In an Unspoken Voice: How theHow theBody Releases Trauma and RestoresBody Releases Trauma and RestoresGoodnessGoodnessWild animals discharge theWild animals discharge thecompressed energy, completing acompressed energy, completing anatural physiological process.natural physiological process.
  • © 2012 Eastern Mennonite University • www.emu.edu/starWhen the body shifts into high gear…. . .the brain shifts into low.
  • © 2012 Eastern Mennonite University • www.emu.edu/starTrauma and the BrainTrauma and the BrainInstinctual BrainBrain StemThinking/ RationalBrain Cerebral CortexEmotional BrainLimbic systemFirst Alert!!PastPresentFuture
  • © 2012 Eastern Mennonite University • www.emu.edu/star
  • © 2012 Eastern Mennonite University • www.emu.edu/starSome ways to release the traumaSome ways to release the traumaenergy and “connect the brain”energy and “connect the brain” Deep breathingDeep breathing Connection to loved onesConnection to loved ones Rituals, worship, prayer,Rituals, worship, prayer,meditationmeditation Music, singing, dancing,Music, singing, dancing,drumming,drumming, Sports ...all kinds of exerciseSports ...all kinds of exercise Massage, touchMassage, touch LaughterLaughter Being in natureBeing in nature Playing, having fun, sexPlaying, having fun, sex Mind/body toolsMind/body tools
  • © 2012 Eastern Mennonite University • www.emu.edu/starActing InAgainst SelfActing OutAgainst OthersTrauma and Behavior
  • © 2012 Eastern Mennonite University • www.emu.edu/starPain that is not transformed is transferredPain that is not transformed is transferredFr. Richard RohrFr. Richard RohrActing OutActing Out•Visible depression (blaming,(aggressiveness, irritability)•Getting in trouble with the law•Inability to be flexible or tolerant•Inability to show empathy to others•High risk behaviors such as substanceabuse or inappropriate sexual activity•Bullying•Repetitive conflicts•MurderActing InActing In•Alcohol & drug abuseAlcohol & drug abuse•Increased focus on workIncreased focus on work•Eating disordersEating disorders•Depression (sadness, withdrawal)Depression (sadness, withdrawal)•Feelings of numbness, anxiety,Feelings of numbness, anxiety,self blame, shameself blame, shame•Physical symptoms (pain,Physical symptoms (pain,headaches, digestive problems)headaches, digestive problems)•Self-injuring behaviorsSelf-injuring behaviors•SuicideSuicide
  • Hurt people hurtpeople
  • © 2012 Eastern Mennonite University • www.emu.edu/starCycles of ViolenceAggressor Cycle (Acting Out) Victim Cycle (Acting In)
  • © 2012 Eastern Mennonite University • www.emu.edu/starIII. Tools and Processes forIII. Tools and Processes forAddressing TraumaAddressing TraumaFingerholds (Capacitar)Fingerholds (Capacitar)Meaning-making/ListeningMeaning-making/Listening(Cabrera)(Cabrera)Strategies for Trauma Awareness &Strategies for Trauma Awareness &Resilience (STAR)Resilience (STAR)
  • © 2012 Eastern Mennonite University • www.emu.edu/starFromFrom Capacitar for Kids,Capacitar for Kids, www.capacitar.orgwww.capacitar.orgFinger HoldsFinger Holds
  • © 2012 Eastern Mennonite University • www.emu.edu/star““When people begin to talk about theirWhen people begin to talk about theirstory, assume it, and reflect on it, [they]story, assume it, and reflect on it, [they]find meaning and significance in what theyfind meaning and significance in what theyhave lived through. . . .have lived through. . . .This is what allows us toThis is what allows us togo forward in life.”go forward in life.”Martha Cabrera, Nicaraguan psychologistMartha Cabrera, Nicaraguan psychologist“Living and Surviving in a Multiply-wounded Society”“Living and Surviving in a Multiply-wounded Society”http://www.envio.org.ni/articulo/1629http://www.envio.org.ni/articulo/1629AcknowledgementStorytelling - Meaning Making
  • © 2012 Eastern Mennonite University • www.emu.edu/starBreaking Cycles of Violence • Building ResilienceBreaking Cycles of Violence • Building Resilience
  • © 2012 Eastern Mennonite University • www.emu.edu/starIncreased resilience““The information on the links betweenThe information on the links betweenresilience and addressing trauma isresilience and addressing trauma isvery helpful to me in understandingvery helpful to me in understandinghow to stay healthy in the midst of ahow to stay healthy in the midst of astressful work environment.”stressful work environment.”Humanitarian aid organization worker in Syria
  • © 2012 Eastern Mennonite University • www.emu.edu/starSouth Sudan, CRSA curriculum adaptable to different contextsMexico, USAIDMyanmar, Hope Int’lHaiti, Wozo
  • © 2012 Eastern Mennonite University • www.emu.edu/star•Village STARVillage STAR(Spanish, Urdu, Haitian Creole, Somali)(Spanish, Urdu, Haitian Creole, Somali)•Youth STARYouth STAR(New Orleans, Hurricane Katrina)(New Orleans, Hurricane Katrina)• Coming to the TableComing to the Table(Healing Historical Harms)(Healing Historical Harms)• Journey Home from WarJourney Home from War• Family STARFamily STAR(Gender-based, Pakistan)(Gender-based, Pakistan)• Custom-designed educational packagesCustom-designed educational packages for organizations wantingfor organizations wantingtrauma-informed staff to do trauma-sensitive programmingtrauma-informed staff to do trauma-sensitive programmingSTAR for specific audiences
  • © 2012 Eastern Mennonite University • www.emu.edu/star What was one new thing you learnedWhat was one new thing you learnedabout trauma?about trauma? What new insights did it provide on:What new insights did it provide on:your work with trauma-affectedyour work with trauma-affectedpopulations?populations?trauma-informed community healthtrauma-informed community healthworkers in your organization?workers in your organization?Questions to Consider