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  • Estimated Module Time: 20 minutes Training Outline Learning objectives Brainstorming session on strategies to enhance home visitors’ safety Secondary traumatic stress Handout on common reactions to working with trauma Strategies for home visitors and program managers Organizational self-assessment tool  Overview Working with clients who experience trauma can affect the caregiver/service provider, creating secondary traumatic stress. This module reviews personal safety and self-care strategies for caregivers and policies that managers can implement to support their staff. The subsequent slides can be used as a large group brainstorming session to ask participants what they do to enhance their safety during home visits, especially when they suspect or know that domestic violence is occurring in a household. Review the explanation of secondary traumatic stress and acknowledge that personal experiences with violence can impact how home visitors respond to clients experiencing violence and vulnerability to secondary traumatic stress. Then provide the handout on common reactions to caring for survivors of trauma and give participants a few minutes to review the handout. Home visitors face unique challenges and risks when working with families who are experiencing domestic violence. Home visitors may see things while visiting clients in their homes that other service providers working with the same family are not aware of such as escalating tension, threatening behaviors, and signs of violence (broken furniture, hole in the wall etc.). Because a home visitor may be in the home when physical violence erupts, it is essential that home visitation programs have a safety protocol for staff to follow when they are working with families experiencing domestic violence.
  • Notes to Trainer: It is very helpful to have a domestic violence advocate present or on call when you are doing a training on domestic violence. This type of training can trigger painful memories while also creating the opportunity for survivors to process their feelings and experiences. Encourage participants to do what they need to feel safe and comfortable throughout the training such as leaving the room and taking unscheduled breaks. They may also approach one of the trainers at breaks or lunch to talk about issues. Trainers anticipate that survivors will come forward and want to talk to them, or an advocate for support. Remain aware of anyone who may be reacting to or be affected by the content of the training. A good example of this is the DVD, First Impressions, which is used in the module on “The Effects of Violence on Children,” which sometimes brings up strong emotions. Consider giving extra breaks after particularly sensitive material, or when you observe that someone is having a difficult time. Connect with that person during the break to check-in and ask if he or she would like to talk with someone and determine how follow-up can occur.
  • Secondary traumatic stress, also referred to as vicarious trauma, burnout, and compassion fatigue, describes how caring for trauma survivors can have a negative impact on service providers.
  • Ask participants to follow the directions below. Advise them that they do not have to share what they draw/write. Take out a sheet of paper and draw a line with the words “not at all comfortable” on the far left side of their line and the words “very comfortable” on the far right side of their line. Ask participants to take a minute to think about their comfort level right now with talking to clients about domestic violence—and if he or she feels comfortable asking questions and getting a “yes” as the answer. Discuss how the goal at the end of today’s session is that each person has personally moved that needle towards the ‘totally comfortable’ end of the scale. Advise participants that this exercise will be repeated at the end of today’s session and that you will ask them to consider whether the needle moved as a result of the training, where it moved, and their thinking about this in the context of what they have learned. The exercise is followed by small group discussion (see next slide) to help participants identify and share why it is important for home visitors to know about domestic and sexual violence. The “Where Am I?” exercise is followed by small group discussion (see next slide) to help participants identify and share why it is important for home visitors to know about domestic and sexual violence.
  • Estimated Module Time: 45 minutes Training Outline Learning objectives Information on the effects of violence on parenting Past exposure to violence and resiliency Universal education with safety card Video clip and role play with safety card Overview The following slides introduce the issue of adults’ childhood experiences with violence. This topic will be addressed in the home visitor video clip and role play. We discuss the role of the home visitor in talking with parents about their childhood experiences, using the Loving Parents, Loving Kids safety card featured in the slides. Acknowledge that parenting is personal, subjective and can be difficult—especially if there is a history of violence or current violence. Explain how talking with parents about their experiences as children can be a platform for discussing safe homes, safe strategies for caring for children, and what it means to be in a healthy relationship. Remind home visitors that parents who seem uncaring or neglectful—may not know another way based on their life experiences. If we believe change can happen—they are more likely to believe it too.
  • Go to www.fosteringresilience.com for description of resiliency on slide Kenneth Ginsburg, M.D., M.S. Ed Dr. Ginsburg is a pediatrician specializing in Adolescent Medicine at The Children's Hospital of Philadelphia and a Professor of Pediatrics at the University of Pennsylvania School of Medicine. He also serves Philadelphia's homeless youth as Director of Health Services at Covenant House Pennsylvania. The theme that ties together his clinical practice, teaching, research and advocacy efforts is that of building on the strength of teenagers by fostering their internal resilience. His goal is to translate the best of what is known from research and practice into practical approaches parents, professionals and communities can use to prepare children and teens to thrive
  • Wrenn GL, Wingo AL, Moore R, Pelletier T, Gutman AR, Bradley B, Ressler KJ. The effect of resilience on posttraumatic stress disorder in trauma-exposed inner-city primary are patients. Journal of the National Medical Association. 2011;103(7):560-566.
  • Estimated Module Time: 45 minutes Training Outline Learning objectives Information on the effects of violence on parenting Past exposure to violence and resiliency Universal education with safety card Video clip and role play with safety card Overview The following slides introduce the issue of adults’ childhood experiences with violence. This topic will be addressed in the home visitor video clip and role play. We discuss the role of the home visitor in talking with parents about their childhood experiences, using the Loving Parents, Loving Kids safety card featured in the slides. Acknowledge that parenting is personal, subjective and can be difficult—especially if there is a history of violence or current violence. Explain how talking with parents about their experiences as children can be a platform for discussing safe homes, safe strategies for caring for children, and what it means to be in a healthy relationship. Remind home visitors that parents who seem uncaring or neglectful—may not know another way based on their life experiences. If we believe change can happen—they are more likely to believe it too.
  • Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14(4):245-258.
  • Anda RF, Dong M, Brown DW, Felitti VJ, Giles WH, Perry GS, Edwards VJ, Dube SR. The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health. 2009;9:106. Anda RF, Brown DW, Dube SR, Bremner JD, Felitti VJ, Giles WH. Adverse childhood experiences and chronic obstructive pulmonary diseases in adults. Am J Prev Med. 2008;34(5):396-403. Dong M, Anda RF, Dube SR, Felitti VJ, Giles WH. Adverse Childhood Experiences and Self-reported liver disease: new insights into a causal pathway. Archives of Internal Medicine. 2003;163:1949-1956. Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, Anda RF. Insights into causal pathways for ischemic heart disease: Adverse Childhood Experiences Study. Circulation. 2004;110:1761-1766. Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB. Cumulative childhood stress and autoimmune disease. Psychom Med 2009;71:243-250. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14:245-258.
  • Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14:245-258.
  • 7 Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14(4):245-258.
  • Graham-Bermann SA, Gruber G, Howell KH, Girz L. Factors discriminating among profiles of resilience and psychopathology in children exposed to intimate partner violence (IPV). Child Abuse and Neglect. 2009;33:648-660. Davies PT, Sturge-Apple ML Cummings EM. Interdependencies among interparental discord and parenting practices: The role of adult vulnerability and relationship perturbances. Development and Psychopathology 2004;16:773-797. Margolin G & Gordis EB. The effects of family and community violence on children. Annual Review of Psychology. 2004;16:753-771. -”Resilient” children had fewer fears and worries and mothers with better mental health and parenting skills

Transcript

  • 1. Trauma Informed Programing: Supporting Staff Exposed to Violence and Trauma
  • 2. Identify the Image
  • 3. Workshop Guidelines Because family violence is so prevalent, assume that there are survivors among us. •Be aware of your reactions and take care of yourself first •Respect confidentiality 3
  • 4. What is: Secondary Trauma? 4
  • 5. Secondary Trauma: vicarious trauma, burnout, and compassion fatigue, describes how caring for trauma survivors can have a negative impact on service providers.
  • 6. SECONDARY TRAUMA Common Reactions to Caring for Survivors of Trauma • Helplessness • Depressive symptoms • Feeling ineffective with clients • Reacting negatively to clients • Thinking of quitting [contact with clients] work • Fear • Recurrent thoughts of threatening situations • Chronic suspicion of others • Sleep disruptions
  • 7. • Chronic lateness • Boundary Violation and Transference • Taking excessive responsibility for the client • Use of Alcohol and Drugs/Fries • Physical symptoms • Inability to relax or enjoy pleasurable activities • Anger • Reacting angrily to clients/staff, colleagues • Feelings of guilt • Detachment • Avoiding patients
  • 8. Exposure to Violence and Secondary Traumatic Stress • Lifetime exposure to violence is common • Working with clients who are experiencing domestic/sexual violence can trigger painful memories and trauma for staff • A personal history of exposure to violence increases the risk of experiencing secondary traumatic stress 9
  • 9. Self Care? On a scale 0 (not at all) to 4 (Routinely) How many of you actively take extra care of yourselves when it comes to this work?
  • 10. On a scale 0 (not at all) to 4 (Routinely) How many of you currently have the opportunity to formally debrief complicated DV cases?
  • 11. Compliment Exercise Pen and Paper needed If you can’t think of an answer that’s ok, it is part of the exercise. Think of the last time you gave a colleague (not friend or loved one) a compliment (could be personal or professional) and write it down.
  • 12. Last time you received a compliment from a colleague what it was and write it down.
  • 13. Last time you gave a compliment to a client and what it was?
  • 14. Compliment Continued: Think about the colleague who has driven you the most crazy in your work life, makes you think of nails on a chalk board and makes you ask yourself why they work here and how you can stand to work with them (Remember, it’s best not to write down names on your paper ) and write down a compliment for them.
  • 15. Compliment Continued Lastly, I want you to think about the compliment you bring to the world. What is your special gift? What write it down.
  • 16. Why did we do this exercise?
  • 17. Which was the easiest question to answer?
  • 18. Why did we have you think about the person who drove you crazy?
  • 19. What if you did the compliment exercise as an ongoing part of staff development?
  • 20. We are reminded that the work has inevitable benefits and challenges, that we are stewards not just of those who allow us into their lives but of our own capacity to be helpful, and that a mindful and connected journey, both internally and externally, allows us to sustain the work. — Jon R. Conte, Ph.D. Seattle, Washington •http://traumastewardship.com
  • 21. Thank You Gifts: Polished Rocks and Sea Glass •
  • 22. By Linda Chamberlain, PhD MPH and Rebecca Levenson, MA Addressing the Bigger Picture: AdverseAddressing the Bigger Picture: Adverse Childhood Experiences Impact on ParentingChildhood Experiences Impact on Parenting
  • 23. http://vimeo.com/71
  • 24. VideoVideo DebriefDebrief Connected Parents Video: • Meets parents where they are • De-stigmatizes ACEs • Normalizes using resources (e.g. hotlines, apps, etc) • Primary prevention of child abuse in a way that feels supportive of parents not punitive or judgmental
  • 25. Resiliency is a Developmental Process ResilienceResilience is the capacity to rise above difficult circumstances, allowing our children to exist in this less-than- perfect world, while moving forward with optimism and confidence.Kenneth Ginsburg, M.D., M.S. Ed www.fosteringresilience.com
  • 26. CardCard ReviewReview
  • 27. Resiliency is for Parents Too! • Building resiliency is a lifelong process • Resiliency factors including self- esteem, ability to cope with stress, and sense of control reduce the likelihood of PSTD among adults who have experienced trauma (Wrenn et al, 2011) • Social support is a resiliency factor for adults too • 10 ways to Build Resilience” resource can be downloaded at: www.apa.org/helpcenter/road-resilience.aspx
  • 28. UniversalUniversal EducationEducation ApproachApproach Universal education plant a seeds for clients to understand that adverse childhood experiences can influence their parenting skills and how they react to stressful situations as adults.
  • 29. Question:Question: How might this video and safety card connect to conversations about DV?
  • 30. By Linda Chamberlain, PhD MPH and Rebecca Levenson, MA Preventing ACEs by Enhancing Family SupportPreventing ACEs by Enhancing Family Support
  • 31. Abuse, by CategoryAbuse, by Category Psychological (by parents) 11% Physical (by parents) 28% Sexual (anyone)Sexual (anyone) 22%22% Neglect, by CategoryNeglect, by Category Emotional 15% PhysicalPhysical 10%10% Household Dysfunction, by CategoryHousehold Dysfunction, by Category Alcoholism or drug use in home 27% Loss of biological parent < age 18 23% Depression or mental illness in home 17% Mother treated violentlyMother treated violently 13%13% Imprisoned household member 5% Prevalence of Adverse Childhood Experiences PrevalencePrevalence (%)(%) (Felitti et al, 1998)
  • 32. ACEs have a dose-response relationshipACEs have a dose-response relationship with the following adult health outcomes:with the following adult health outcomes: • Obesity • Ischemic heart disease • Cancer • Chronic lung disease • Autoimmune disease • Skeletal fractures • Liver diseases • Premature death (Anda et al, 2009; Dong et al, 2004; Dong et al, 2003; Dube et al, 2009; Felitti et al, 1998)
  • 33. 4-12 times greater4-12 times greater riskrisk of alcoholism, drug abuse, depression, and suicide attempts Adults with 4 or more ACEs: (Felitti et al, 1998)
  • 34. If any one ACE is present, there is an 87% chance87% chance at least one other category of ACE is present in that household (Felitti et al, 1998) ACEs Cluster
  • 35. Effective Parenting Skills Can MitigateEffective Parenting Skills Can Mitigate Effects of Trauma on ChildrenEffects of Trauma on Children • Effective parenting skills and parental warmth promote resiliency among children exposed to domestic violence (Graham-Bermann et al, 2009) • Parents’ ability to parent under stressful circumstances is a protective factor that buffers the effect of family violence on child adjustment (Davies et al, 2004; Margolin et al, 2004)
  • 36. Thank You 37 By providingBy providing universaluniversal education abouteducation about ACEs andACEs and providing supportproviding support to parents youto parents you can change lives.can change lives.