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Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
Trauma Informed Care & Graduation Rates (Joseph Lavoritano)
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Trauma Informed Care & Graduation Rates (Joseph Lavoritano)

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Developmental trauma is real, and disproportionately affects children from poor neighborhoods. …

Developmental trauma is real, and disproportionately affects children from poor neighborhoods.

Prolonged exposure to stress and trauma has a deleterious effect on the developing brain.

Moving from a "sickness model" to an "injury model" of trauma-informed care has had a positive impact on outcomes for the youth in the St. Gabriel's system.

Published in: Education, Health & Medicine
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  • 1. Presentation at Eastern University January 18, 2012  Joseph Lavoritano, MA, M.Ed., NCSP Executive Director, Saint Gabriel’s System  James J. Black, Ph.D. Director of Mental Health Programs, Saint Gabriel’s System  Martha Tavantzis, M.S.W., L.C.S.W. Director of Treatment, Saint Gabriel’s Hall
  • 2.  DESCRIPTION OF SAINT GABRIEL’S SYSTEM  DEVELOPMENTAL TRAUMA  MAPPING DATA OF PHILADELPHIA VIOLENCE AND POVERTY  EFFECTS OF PROLONGED EXPOSURE STRESS AND TRAUMA ON THE DEVELOPING BRAIN
  • 3.  ACES STUDY  SANCTUARY MODEL OF TRAUMAINFORMED CARE  TRAUMA-FOCUSED CBT AND TRAUMA ART NARRATIVE THERAPY  COMMUNITY MEETING
  • 4.  DATA: POSTIVE OUTCOMES  TAKE-AWAYS
  • 5.  500-600 youth in care on any given day  Serves both delinquent and dependent youth  180 youth in residential care in Audubon, PA (Saint Gabriel’s Hall--SGH)  230 youth in three day-treatment programs in Philadelphia and Bensalem, PA (De La Salle In Towne, De La Salle Vocational, Brother Rousseau Academy)
  • 6.  95 youth in group homes (dependent and delinquent RTF’s) at St. Francis/St. Joseph  60 female youth in the St. Vincent group homes (dependent) The youth we will be discussing today are the Saint Gabriel’s Hall youth
  • 7. 184 YOUTH (MALE) EIGHT “REGULAR RESIDENTIAL” UNITS (16 BEDS EACH) TWO 24 BED DRUG AND ALCOHOL UNITS FARM-BASED PROGRAM (MITCHELL HALL) (16 BEDS EACH)
  • 8. WHAT IS IT? WHY IS IT IMPORTANT ?
  • 9. MANY CHILDREN GO THROUGH CHILDHOOD WITH FEW MAJOR UPSETS…
  • 10.  Dannlowski et al. (2012). Limbic Scars: Long-Term Consequences of Childhood Maltreatment Revealed by Functional and Structural Magnetic Resonance Imaging. Biological Psychiatry, 71(4), 286-293.  McCrory, E., De Brito, S. A., & Viding, E.(2011). The impact of childhood maltreatment: A review of neurobiological and genetic factors. Frontiers in Psychiatry. 2:48. Epub 2011 Jul 28.  Evans, G. and Schamberg, M. (2009) Childhood poverty, chronic stress, and adult working memory. By Gary W. Evans and Michelle A. Schamberg. Proceedings of the National Academy of Sciences, Vol. 106 No. 13.
  • 11. Developmental Trauma Disorder will not make it into the DSM-5, but there was serious consideration to have it included to capture life for these children who have histories of exposure to multiple chronic traumas usually of an interpersonal nature.
  • 12. “Developmental Trauma Disorder” (van der Kolk, 2005) which is characterized by the presence of: psychic conflicts central nervous system alterations distorted images of social life chronic stress a vulnerability to stress-related illnesses warped moral values rage a profound loss of trust, and loss of a sense of security. (NASP Communique, 2010)        
  • 13. IT DOES NOT APPLY WELL TO CHILDREN AND YOUTH WHO HAVE EXPERIENCED PERVASIVE AND CHRONIC EXPOSURE TO LOSS, VIOLENCE, NEGLECT AND ABUSE
  • 14. 8483 9000 8000 7000 6000 Homicide 5000 2011 – 324 homicides 4000 3000 1608 2000 1000 0 306 2012-- 331 homicides Philadelphia Shootings Assaults
  • 15. • WHAT TRIGGERS IT – senses pick up a threat – loud noise, a scary sight, a creepy feeling – the information travels two different routes through the brain A . THE SHORT CUT- When startled the fear center, amygdala, sends all points bulletin and triggers the classic fear response: • STRESS-HARMONE BOOST • Cortisol • RACING HEART • FIGHT, FLIGHT ON FRIGHT • DIGESTIVE SHUTDOWN B. THE HIGH ROAD – Conscious mind kicks in and some sensory information bypasses the amygdala and is routed to the thalamus, processing hub of sensory cues and then the cortex for analysis of the raw data. This signals a continued fear alert or may signal the amygdala to have the body stop alert.
  • 16. • Due to the violence and trauma that was evident in the neighborhoods we were seeing new behaviors • Youth were hypervigilant and showed an inability to distinguish real threats from benign actions. • Brain research was saying continued exposure to violence, poverty and trauma resulted in poor pre-frontal cortex development. We were witnessing youth who had a limited or no ability to control their emotions who moved rapidly to a fight or flight response to any perceived threat
  • 17.   Trauma is an overwhelming event that causes intense feelings of fear, helplessness or horror. There are many different kinds of trauma, and not everyone responds the same way. Chronic Stress is an overwhelming external element that impacts a person’s sense of daily safety.
  • 18. Largest study of its kind ever, almost 18,000 subjects Examined the health and social effects of adverse childhood experiences over the lifespan Majority of participants were 50 or older (62%), were white (77%) and had attended college (72%).
  • 19. 10 categories of experience up to 18 years old CHILD ABUSE • emotional, physical, or sexual CHILDHOOD NEGLECT • emotional or physical GROWING UP WITH: • • • • • domestic violence substance abuse (alcohol or drugs) mental illness parental discord Crime (imprisonment) Add up the # of categories = ACEs score = trauma dose
  • 20. ACE Study Strong, graded relation to childhood adversity Smoking COPD Heart Disease Attempted suicide Revictimization Teen pregnancy Diabetes Obesity Hepatitis Fractures Promiscuity Sexually transmitted disease Poor job performance Poor self-rated health Violent relationships Alcoholism Other substance abuse Depression
  • 21. When a person experiences a traumatic event, some sort of Loss is experienced. When a loss is experienced, a person may feel overwhelming emotions. These overwhelming emotions lead often lead to unsafe behavior. This unsafe behavior has consequences on a person’s future.
  • 22. Understanding trauma is not just about acquiring knowledge. It’s about changing the way you view the world.
  • 23. It’s Just Common Sense That..  People avoid things that scare them  People avoid pain  If somebody hurts you, you get away from them  We can tell who can be trusted and who can’t  People learn from their experience  Parents love their children  You don’t hurt people you love  People remember anything that is really terrible
  • 24. But traumatized children frequently..  Put themselves in situations of danger  Hurt themselves  Get into and stay in relationships with hurtful people  Are frequently unable to discern who is to be trusted  Don’t seem to learn from experience  Have been hurt by people who were supposed to love them  Frequently hurt the people they love the most  Don’t remember the worse experiences of their lives
  • 25. The Heart of Trauma Theory Sickness vs. Injury Model Changing the fundamental question from: “What's wrong with you?" to "What's happened to you?“ Foderaro, 1991
  • 26. Injury Model What’s happened to you?  Includes physical, psychological, social, and moral forms of injury  Includes deprivation, neglect, and developmental insult  Implies rehabilitation process that is mutual, longterm: Requires active collaborative relationship between helper and injured party  Removes stigma and shame  Provides understandable shared framework  Increase in compassion, increase in expectations
  • 27. S.E.L.F. •Safety: Physical, Psychological, Social, Moral •Emotions: Handling feelings without becoming self/other destructive •Loss: Feeling grief and dealing with personal losses, preparing for change •Future: Re-establishing the S capacity for choice F E L
  • 28. I walk down the street There is a deep hole in the sidewalk I fall in I am lost . . . I am helpless It isn't my fault. It takes forever to find a way out.
  • 29. I walk down the same street, There is a deep hole in the sidewalk, I pretend I don't see it. I fall in again. I can't believe I am in the same place. But it isn't my fault. It still takes a long time to get out.
  • 30. I walk down the same street. There is a deep hole in the sidewalk. I see it is there. I still fall in . . . it's a habit. My eyes are open. I know where I am. It is my fault. I get out immediately. 44
  • 31. I walk down the same street. There is a deep hole in the sidewalk. I walk around it.
  • 32. I walk down a different street.
  • 33. Saint Gabriel’s Hall was awarded a 3-year grant that began in Fiscal Year 2008/2009 to implement the Sanctuary Model of Trauma-Informed Care
  • 34. If children do not make substantial and positive changes then treatment is not working! If treatment isn’t working maybe it’s US and our systems of care that are the problems, not the children.
  • 35. A master program that controls a computer's basic functions and allows other programs to run on a computer IF they are compatible with that operating system.
  • 36.  Evidence-Based  Specifically Targets Trauma  State Grant—7 Therapists  Free 10 Credit Course at www.musc.edu/tfcbt
  • 37.  Developed by Dr. Lyndra Bills  Research Underway with LIU to Establish Evidence-Based Status  All SGH Therapists Trained (Arts Skills Not Necessary!)  Process Speaks to Non-Verbal Part of Brain, Specific Event-A Scene
  • 38.  Developed by Dr. John Briere in 1989  54 Self-report Items, 2 validity scales and 6 clinical scales, and 4 subscales  Normed by age and gender on over 3000 children and youth  Strong validity and reliability, easy to administer and score
  • 39.  HOW ARE YOU FEELING TODAY?— CONNECTS YOU TO YOUR FEELINGS  WHAT IS YOUR GOAL FOR TODAY?— CONNECTS YOU TO THE FUTURE  WHO CAN HELP YOU WITH THAT? – CONNECTS YOU TO COMMUNITY
  • 40.  Does it work? Symptoms Graduation Rates Vocational Certifications Positive Outcomes in Program Psychiatric Hospitalizations
  • 41. GRADUATION RATES
  • 42. SAINT GABRIEL’S HALL GRADUATES Fiscal Year # of Graduates Percentage FY 08/09 28 of 70 40% FY 09/10 39 of 89 44% FY 10/11 52 of 104 50% FY 11/12 68 OF 113 60%
  • 43. 90 80 82 70 73 60 50 56 40 44 30 35 20 10 0 24 06/07 07/08 08/09 09/10 10/11 11/12
  • 44.  Decreased Depression scores (p = .000)  Decreased Post-Traumatic Stress scores (p = .002)  Dissociation (p = .039)
  • 45. 300 250 267 239 200 150 100 50 0 132 14 2008-2009 2009-2010 2010-2011 2011-2012
  • 46. PSYCHIATRIC HOSPITALIZATIONS BY FISCAL YEAR 8 7 6 5 4 3 6 7 4 2 Psychiatric Hospitalizations 4 1 1 1 0 FY07 FY08 FY09 FY10 FY11 FY12
  • 47.  Does it work? Rearrests Counseling Attendance School Attendance Positive Outcomes Post Discharge
  • 48. 70 60 50 40 30 20 60% (297) 25% 10 15% (127) (72) 0 >75% 50%-75% <50%
  • 49. REARREST BY YEAR DURING THE PERIOD OF REINTEGRATION (3-6 MONTHS) (N=775) 120 100 71% 86% 88% 88% 81% (49) 80 (128) (148) (172) (157) Not Rearrested 60 Rearrested 40 20 29% (20) 14% (21) 0 07/08 08/09 12% (20) 12% (24) 09/10 10/11 19% (36) 11/12
  • 50. RATE OF SCHOOL ATTENDANCE (N=427) 70 60 50 40 62% 30 20 (263) 19% 19% (80) 10 (84) 50%-75% < 50% 0 > 75%
  • 51. Saint Gabriel’s Hall Finishes #1 Among CBH-Funded RTF Providers! Several Outcomes Led to this First-Place Finish according to CBH’s most recent Provider Profile Report Most Notably: Less than 1% of youth FTA’d to another RTF 0% of youth FTA’d to psychiatric inpatient services 60% of youth attend a follow-up outpatient appointment within 30 days of discharge Saint Gabriel’s Hall is Sanctuary Certified and Utilizes Master’s Level Therapists Trained in Trauma-Focused Cognitive Behavioral Therapy—Both Sanctuary and TF-CBT are Evidence-Based! POSITIVE OUTCOMES AND EVIDENCE-BASED PROGRAMMING: A WINNING COMBINATION!
  • 52.  DEVELOPMENTAL TRAUMA IS REAL AND DISPROPORTIONATELY AFFECTS KIDS FROM POOR NEIGHBORHOODS  PROLONGED EXPOSURE TO STRESS AND TRAUMA HAS A DELETERIOUS EFFECT ON THE DEVELOPING BRAIN  MOVING FROM A “SICKNESS MODEL” TO AN “INJURY MODEL” OF TRAUMA-INFORMED CARE HAS HAD A POSITIVE IMPACT ON OUTCOMES FOR THE YOUTH IN SAINT GABRIEL’S SYSTEM

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