Screening for Trauma, Without Causing Trauma: A Trauma-Informed Care Discussion
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Screening for Trauma, Without Causing Trauma: A Trauma-Informed Care Discussion

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By Annette Selmer, MS, LPC; Facilitated by Jackei Fabrick, MA, LPC at May 2011 Oregon Problem Gambling Services Spring Training....

By Annette Selmer, MS, LPC; Facilitated by Jackei Fabrick, MA, LPC at May 2011 Oregon Problem Gambling Services Spring Training.

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  • 1. TRAUMA- INFORMED CARE AS PART OF SCREENING AND ASSESSMENT FOR GAMBLING ANNETTE U SELMER, MS, LPC JACKIE FABRICK, MA, LPC 503-525-1150 503-945-7815 [email_address] [email_address]
  • 2. WHY SCREEN FOR TRAUMA?
    • ISSR requires all clients must be screened “for the presence of symptoms related to psychological and physical trauma” 309-032-1525(3)( C)
  • 3. PROBLEM GAMBLERS AND TRAUMA
    • Problem Gamblers experience trauma and abuse at high rates
    • Gambling is thought to be a way to cope with trauma and abuse
    • Escape gambling = way to cope
  • 4. PG and PTSD Research
    • Rates of PTSD among problem gamblers estimated at 12.5% to 29% (Ledgerwood & Petry, 2006).
    • PG experienced higher rates of childhood maltreatment than community control participants (Petry, Steinberg, and The Women’s Problem Gambling Research Group)
  • 5. WHAT IS TRAUMA
    • Trauma is viewed as “a defining and organizing experience that forms the core of an individuals identity” Harris and Fallot, (Eds, 2001)
  • 6. WHAT IS TRAUMA
    • Trauma includes “emotional shock that creates substantial, lasting damage to an individuals psychological development….Also refers to overwhelming, uncontrollable experiences that psychologically (and neurologically) impact victims by creating in them feelings of helplessness, vulnerability, loss of safety and loss of control” B. James
  • 7. WHAT IS TRAUMA
    • Trauma is “interpersonal violence over the life span, including sexual abuse, physical abuse, severe neglect, loss and/or the witnessing of violence” National Assoc. of State Mental Health Program Directors
  • 8. WHAT IS TRAUMA
    • “ When trauma occurs early in life, children do not develop the capacity to regulate their experience. To calm themselves down when they are upset, to soothe themselves, to interact in appropriate ways with other people, to learn from their behavior” Margeret Blaustein
  • 9. TRAUMA CAN BE:
    • HANDS ON OR HANDS OFF
    • PERSONAL OR IMPERSONAL
    • IS EXPERIENCED IN THE CONTEXT OF ONES LIFE EVENTS
  • 10. IMPACT AND EFFECTS OF TRAUMAS
    • BASIC ASSUMPTIONS ABOUT THE WORLD ARE SHATTERED
    • ISSUES OF BEREAVEMENT AND LOSS ARE PROMINENT
    • VICTIMIZATION HIGHLIGHTS CONCERNS ABOUT JUSTICE AND FAIRNESS
    • ONES AUTONOMIC AROUSAL SYSTEM IS OUT OF BALANCE
    • FEELINGS AND IMAGES OF DEATH AND DOOM
  • 11. “ No one can truly begin to heal if they do not feel safe and protected”
  • 12. TRAUMA INFORMED CARE
    • Services that are directed by:
    • A thorough understanding of the profound neurological, biological, psychological, cognitive (i.e. hyper-arousal, high reactivity, impaired affect modulation, impulse control, difficulty calming down) and social effects of trauma and violence on the individual
    • (Trauma is gauged by the meaning that an individual attributes to the event(s))
    • An appreciation for the high prevalence of traumatic experiences in persons who receive mental health and addiction services
  • 13. TRAUMA INFORMED CARE
    • There is a high regard for consumers who each need to be respected, informed, connected and hopeful regarding their own recovery
    • A consistent focus on the interrelationship between trauma and symptoms of trauma (ie gambling, eating disorders, substance abuse, depression)
    • Working in collaborative ways with survivors, families, and friends, and other human services agencies in a manner that will empower all consumers
  • 14. WHAT ARE TRAUMA INFORMED HUMAN SERVICES?
    • Trauma informed services:
    • Refers to the recognition of the pervasiveness of trauma as well as the commitment to identify and address it early, whenever possible
    • Incorporating knowledge about trauma in all aspects of delivered services
    • Engaging with all clients, having a collaborative relationship with the client. The individual is valued in ALL aspects of care
    • No re-traumatizing or re-victimization
    • Facilitating recovery and empowerment in all we do
  • 15. WHAT ARE TRAUMA INFORMED HUMAN SERVICES?
    • Know that both the consumer and the provider both have valid and valuable knowledge bases
    • Be responsive to patients concerns, including fear, anxiety, or other behavior (which may indicate a stressor in the environment
    • Avoid judgmental and critical language while using inclusive and supportive language. Use neutral, objective and supportive language
  • 16. WHAT ARE TRAUMA INFORMED HUMAN SERVICES?
    • Avoid unnecessary power struggles (most are unnecessary and re-traumatizing)
    • The consumer is an active planner and participant in all services
    • Safety is guaranteed and trust is developed over time
    • Treatment plans are individualized and flexible
    • Know your own biases
  • 17. CORE PRINCIPALS
    • Safety: ensuring physical and emotional safety
    • Trustworthiness: make tasks clear and maintain appropriate boundaries
    • Genuiness: be genuine and honest in all interactions
    • Choice: Prioritize consumer choice and control, staying focused on helping the individual take back control of their life
    • Collaboration: collaborating and sharing of power
    • Empowerment: Prioritizing empowerment with skill building
  • 18. IN TRAUMA INFORMED SERVICES:
    • All staff is informed and trained on re-traumatizing practices. This includes but not limited to:
      • Openness
      • Transparency, without coercive or manipulative practices
      • Open ended requests and questions so no one feels trapped or backed into a corner
  • 19. IN TRAUMA INFORMED SERVICES:
    • All treatment facilities are open to outside parties such as advocacy and clinical consultations
    • Training and supervision in assessment and treatment of people with trauma histories is provided.
    • Focus is on what happened to a person rather than what is wrong with the person
    • Questions are asked about current abuse as well as past traumas and abuses in caring and respectful ways. This includes risk assessments and safety planning
    • Roll with resistance
  • 20. TRAUMA INFORMED INTERVENTIONS
    • All services should be designed to address violence, trauma and their related symptoms and reactions
    • Treatment activities are intended to develop skills and strategies that allow people to manage their symptoms and reactions with minimal disruption to their daily obligations.
    • Treatment activities should not detract from the quality of life of the consumers
    • Treatment activities should eventually reduce or eliminate debilitating symptoms to prevent further traumatization and violence
  • 21. SCREENING AND ASSESSMENT ISSUES
    • Symptoms of trauma often mimic symptoms of anxiety and depression
    • Many individuals with trauma symptoms have singular or multiple addictions
    • If trauma screenings are not conducted, these individual are usually treated as people with depression, anxiety or AOD only
  • 22. SCREENING AND ASSESSMENT ISSUES
    • High risk behaviors are signs of an over activated Amygdala. Hyper-arousal leads to poor impulse control and contributes to poor decision making, ineffective use of ones “breaks” and poor problem solving. This happens often when people start talking about traumatic events in their lives. For this reason “safety” skills need to first be in place.
  • 23. TRAUMA INFORMED, EVIDENCE BASED TREATMENT
    • Incorporate some or all of the following:
    • Build a strong, safe relationship
    • Embrace a philosophy where dignity, privacy and respect are maintained for client and staff
    • Normalize responses to trauma
    • Ask all clients to commit to safety in their words and behavior
  • 24. TRAUMA INFORMED, EVIDENCE BASED TREATMENT
    • Continued from previous slide:
    • Utilize family and community support
    • Emotional expression and regulation skills
    • Anxiety management and relaxation skills
    • Cognitive processing or reframing
  • 25. WHAT TO ASK?
    • Ask clients what things have they experienced in their lives that frightened or concerned them in a way that it profoundly impacted their lives
    • Ask them what have been their experiences of being exploited, coerced, controlled or abused?
    • Ask what helped and what makes it worse?
  • 26. WHAT TO ASK?
    • Understand that if we join in on power struggles or perceived controlling stances, we then participate in re- traumatization
    • Asking questions in a way that seeks open ended answers helps prevent a feeling of being psychologically trapped
  • 27. SCREENING AND ASSESSMENT CONSIDERATIONS
    • Strategies that allow exposure to traumatic memories and feelings in tolerable doses so that they can practice their skills to master and integrate those memories into their experiences
    • Addressing skills to manage hyper-arousal first, such as grounding, mindfulness, and yoga breathing.
    • Clients are given the opportunity to develop a construction of a narrative of ones trauma. Remember the accuracy is less important than their perception of their traumas.
  • 28. SCREENING AND ASSESSMENT CONSIDERATIONS
    • Safety training and empowerment activity. This means believing the consumer can change, supporting their wellness while addressing limitations.
    • Upholding standards of care and management while respectfully engaging the patient
  • 29. TRAUMA INFORMED TEAMS:
    • Integrates mental health, addictions and trauma work in an interdisciplinary team approach
    • Support each other at all times, helping eachother address language, attitudes and biases in supportive ways
    • Has a collaborative environment that supports team members expertise and supports direct communication
    • Teams support keeping the focus on patient care, respect and skill building at all times
    • Works with families and social support systems
    • Coordinates efforts with multiple systems involved with and affecting the consumer