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Psychological      TraumaThe Case For the Development ofTrauma-Informed Service Systems    Laurie Robinson, MSW
Agenda1. Setting the Stage – the kidsLINK Project2. Define Trauma3. The Research and Rationale for TI system4. Trauma Info...
Setting the Stage• 2002 - Children with serious and  complex needs• 2006 - Began exploring complimentary  & alternative me...
What is Trauma?“Trauma is an emotional wound resultingfrom a shocking event or multiple andrepeated life threatening and/o...
Variability in Responses toStressors and Traumatic EventsThe impact of a potentially traumatic event is determinedby both:...
The impact of a potentially traumatic event depends on several factors1. Age and developmental        5. Past experience w...
Epidemiologyand Prevalence ofTrauma  What  we  have  learned
General PopulationStudiesAdverse ChildhoodExperiences (ACE) study (1998)Examined the cumulative effects ofmultiple adverse...
What is the Adverse ChildhoodExperiences (ACE) Study?  • 10 year study  • 17,000 people involved  • Looked at effects of a...
Adverse Childhood Experiencesare CommonOf the 17,000 who participated:•   1 in 4 exposed to 2 categories of ACEs•   1 in 1...
The Psychobiologyof Trauma“Our brain helps ussurvive and thrive whilewe develop”          Bruce Perry, M.D., Ph.D.        ...
It Begins With Fear• Faced with a threat, the body  embarks on a cascade of  physiological reactions.• Adrenalin surges, s...
Trauma Altersthe BrainIncreasing evidence suggests that inabused or neglected children, thissystem goes awry, causing a ha...
Vulnerable Population Studies
Vulnerable PopulationsThere is a great deal of research on the prevalence oftrauma in vulnerable populations of children a...
Mental Health• 51 – 98% of public mental health clients with  severe mental illness, including schizophrenia  and bipolar ...
Child Welfare• More than 95% suspected.• 75% experienced moderate to  major event. (Griffin et.al, 2011)
Youth Justice• 75% - 93 % of youth  entering the system  have experienced  trauma (Justice Policy  Institute, July 2010)  ...
Substance Use • 67% of people in   substance use   treatment report   histories of childhood   abuse and neglect   (Nation...
What does the prevalence data invulnerable populations tell us? • Trauma is Epidemic • Victims of trauma are   found acros...
Trauma isoften … • Misdiagnosed • Misinterpreted “Trauma is often unrecognized, ignored or denied” (Jennings, 2008)
“As awareness of the prevalence and impacts oftrauma increases [those individuals affected] areincreasingly viewed not as ...
In SummaryChildhood abuse and trauma:  • Causes serious and chronic health, behavioral    health and social problems  • Im...
Trauma-Informed is MUCH more that        trauma treatment!  There is an important difference  between “Trauma Informed”  c...
Trauma SpecificTreatmentA trauma specific service isdesigned to treat the “actualsequelae” of traumaHarris, M., Fallot, R....
The Science ofTrauma Informed    Services                  27
Roots in the United States• 2001 – 12 States formed and informal  network – State Public System Coalition on  Trauma (SPSC...
Roots in the United States• 2004 – Dare to Act Conference  (National)• 2005 – National Centre for Trauma  Informed Care fo...
“Trauma Informed” - Definition…means that individuals in organizationsare educated on the causes and effects oftrauma and ...
Trauma Informed                                       Organizations1. Every part of a TI organization, its management, and...
Trauma Informed Philosophy “Trauma-informed strategies ultimately seek to do no further harm; create and sustain zones of ...
Universal Precautions as aCore Trauma Informed Concept   Presume that every person in a   treatment setting has been expos...
Re-examination   “What          “What is  happened       wrong with   to you?”         you”
12 Criteria
“Blueprint for Action” Jennings, 2007 • State Accomplishments, Activities   and Resources Toward Meeting   Criteria for Bu...
12 Criteria1. A designated trauma function and focus in the state   mental health department.2. State trauma policy or pos...
12 Criteria5. Consumer/Trauma Survivor/Recovering person   involvement and trauma informed rights.6. Financing criteria an...
12 Criteria con’t9.  Needs assessment, evaluation, and research to explore    prevalence and impacts of trauma; assess tra...
Toolkits• Trauma Services Implementation Toolkit  for State Mental Health (2004)• Child Welfare Trauma Training Toolkit  (...
Substance Abuse and Mental                Health Services Administration                         (SAMSHA)Strategic Initiat...
Canada
kidsLINK -    Ontario• 2009 - Visit Thrive (Maine),  Andrus/Sanctuary (New York)• 2009/10 Explore/implement trauma  specif...
Klinic – ManitobaRecently announced fundingfor a Trauma Resource CentreAdvocating with MentalHealth Commissionof Canada fo...
British                                    Columbia                                     Centre of                         ...
“I have come to believe that traumais the problem and substance usethe solution…until the solutionbecomes the problem”Addi...
Where to Go From Here?Service Providers              Policy Makers & Funders Develop a “trauma team”       Create region...
Thank You!Contact InformationFor further information on trauma informed service systems work,please contact:   Barb Ward, ...
Trauma Informed Care: Theory & Pactice with Laurie Robinson
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Trauma Informed Care: Theory & Pactice with Laurie Robinson

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Trauma Informed Care: Theory & Pactice with Laurie Robinson

  1. 1. Psychological TraumaThe Case For the Development ofTrauma-Informed Service Systems Laurie Robinson, MSW
  2. 2. Agenda1. Setting the Stage – the kidsLINK Project2. Define Trauma3. The Research and Rationale for TI system4. Trauma Informed vs. Trauma Specific5. What’s Happening in North America6. The 12 Criteria for a Trauma Informed System
  3. 3. Setting the Stage• 2002 - Children with serious and complex needs• 2006 - Began exploring complimentary & alternative methods – led to TI literature• 2007 – Began strategic planning process with the Board• 2008 – Linking Research, Training & Practice• 2009 -2012 Implement Trauma Informed Services
  4. 4. What is Trauma?“Trauma is an emotional wound resultingfrom a shocking event or multiple andrepeated life threatening and/or extremelyfrightening experiences that may cause lastingnegative effects on a person, disrupting thepath of healthy physical, emotional, spiritualand intellectual development.”Children and Trauma in America: A Report of the National Child TraumaticStress Network (2004)
  5. 5. Variability in Responses toStressors and Traumatic EventsThe impact of a potentially traumatic event is determinedby both: • The objective nature of the event • The person’s subjective response to itSomething that is traumatic for one person may not betraumatic for another.
  6. 6. The impact of a potentially traumatic event depends on several factors1. Age and developmental 5. Past experience with stage trauma2. Perception of the danger 6. Adversities faced faced following the trauma3. Victim or witness 7. Presence/availability of adults who can offer help4. Relationship to the victim and protection or perpetrator
  7. 7. Epidemiologyand Prevalence ofTrauma What we have learned
  8. 8. General PopulationStudiesAdverse ChildhoodExperiences (ACE) study (1998)Examined the cumulative effects ofmultiple adverse childhoodexperiences on physical and mentalhealth.Felitti and Anda (1998)
  9. 9. What is the Adverse ChildhoodExperiences (ACE) Study? • 10 year study • 17,000 people involved • Looked at effects of adverse childhood experiences over the lifespan • Largest study ever done on this subject
  10. 10. Adverse Childhood Experiencesare CommonOf the 17,000 who participated:• 1 in 4 exposed to 2 categories of ACEs• 1 in 16 was exposed to 4 categories• 22% were sexually abused as children• 66% of the women experienced abuse, violence or family strife in childhood
  11. 11. The Psychobiologyof Trauma“Our brain helps ussurvive and thrive whilewe develop” Bruce Perry, M.D., Ph.D. Child Trauma Academy
  12. 12. It Begins With Fear• Faced with a threat, the body embarks on a cascade of physiological reactions.• Adrenalin surges, setting the heart pounding and blood pressure soaring and readying the muscles for action, a response called "fight or flight."
  13. 13. Trauma Altersthe BrainIncreasing evidence suggests that inabused or neglected children, thissystem goes awry, causing a harmfulimbalance of cortisol in the brain.
  14. 14. Vulnerable Population Studies
  15. 15. Vulnerable PopulationsThere is a great deal of research on the prevalence oftrauma in vulnerable populations of children and youthChildren and youth whoare… • Intellectual • Mental Health• Abused and Disabilities • Child Welfare Neglected • Aboriginal • Homeless Youth• Sexually Abused Decent • Youth Justice• Self Injurious / • Refugees Suicidal • Lesbian and Gay• Substance Using Youth (LGBTQ)
  16. 16. Mental Health• 51 – 98% of public mental health clients with severe mental illness, including schizophrenia and bipolar disorder, have been exposed to childhood physical and/or sexual abuse.• Most have multiple experiences of trauma (Goodman et al., 1999, Mueser et al., 1998; Cusack et al., 2003). 17
  17. 17. Child Welfare• More than 95% suspected.• 75% experienced moderate to major event. (Griffin et.al, 2011)
  18. 18. Youth Justice• 75% - 93 % of youth entering the system have experienced trauma (Justice Policy Institute, July 2010) 19
  19. 19. Substance Use • 67% of people in substance use treatment report histories of childhood abuse and neglect (National Association of State Mental Health Program Directors, 2005).
  20. 20. What does the prevalence data invulnerable populations tell us? • Trauma is Epidemic • Victims of trauma are found across all sectors of care 21
  21. 21. Trauma isoften … • Misdiagnosed • Misinterpreted “Trauma is often unrecognized, ignored or denied” (Jennings, 2008)
  22. 22. “As awareness of the prevalence and impacts oftrauma increases [those individuals affected] areincreasingly viewed not as a subgroup oranomalous population of clients, but asencompassing nearly all children, adolescentsand adults served by public mental health andsubstance abuse service systems” (p. 3)Models for Developing Trauma-Informed Behavioral Health Systemsand Trauma Specific Services (2008)
  23. 23. In SummaryChildhood abuse and trauma: • Causes serious and chronic health, behavioral health and social problems • Impacts brain and nervous system, perception of self and others • Epidemic proportions – a major public health issue • Often unrecognized, ignored or denied (Jennings, 2004)
  24. 24. Trauma-Informed is MUCH more that trauma treatment! There is an important difference between “Trauma Informed” care and delivering “Trauma Specific” treatment. 25
  25. 25. Trauma SpecificTreatmentA trauma specific service isdesigned to treat the “actualsequelae” of traumaHarris, M., Fallot, R., 2001E.g. Trauma Focused Cognitive BehaviourTherapy
  26. 26. The Science ofTrauma Informed Services 27
  27. 27. Roots in the United States• 2001 – 12 States formed and informal network – State Public System Coalition on Trauma (SPSCOT) – Formed a listserv for ongoing communication• 2004 - Produced “Trauma Services Implementation Toolkit for State Mental Health”. (Jennings, 2004) 28
  28. 28. Roots in the United States• 2004 – Dare to Act Conference (National)• 2005 – National Centre for Trauma Informed Care formed.• 2007 – Update to the toolkit (SAMHSA)• 2008 - Dare to Transform Conference,
  29. 29. “Trauma Informed” - Definition…means that individuals in organizationsare educated on the causes and effects oftrauma and understand the potential toretraumatize individuals by providingservices and/or interacting in a mannerthat is not sensitive to their experiencesand needs.(Thrive, Trauma Informed System of Care, Portland, Maine)
  30. 30. Trauma Informed Organizations1. Every part of a TI organization, its management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services.2. The whole organization understand the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re- traumatization. Substance Abuse And Mental Health Services Administration (SAMHSA)
  31. 31. Trauma Informed Philosophy “Trauma-informed strategies ultimately seek to do no further harm; create and sustain zones of safety for children, youth and families who may have experienced trauma; and promote understanding, coping, resilience, strengths-based programming, growth and healing.” (Cooper, Masi, Dababnah, Aratani and Knitzer, 2007; Strengthening Policies to Support Children, Youth and Families Who Experience Trauma, National Centre for Children in Poverty, Columbia University, pg. 17)
  32. 32. Universal Precautions as aCore Trauma Informed Concept Presume that every person in a treatment setting has been exposed to abuse, violence, neglect or other traumatic experiences
  33. 33. Re-examination “What “What is happened wrong with to you?” you”
  34. 34. 12 Criteria
  35. 35. “Blueprint for Action” Jennings, 2007 • State Accomplishments, Activities and Resources Toward Meeting Criteria for Building Trauma Informed Mental Health Service Systems • Reviewed action across the U.S. • 12 Criteria
  36. 36. 12 Criteria1. A designated trauma function and focus in the state mental health department.2. State trauma policy or position paper.3. Workforce recruitment, hiring and retention.4. Workforce orientation, training, support, competencies and job standards related to trauma.Ann Jennings, 2008 Update, Models for Developing Trauma-InformedBehavioural Health Systems and Trauma Specific Services, NationalCentre for Trauma Informed Care, funded by SAMHSA
  37. 37. 12 Criteria5. Consumer/Trauma Survivor/Recovering person involvement and trauma informed rights.6. Financing criteria and mechanisms to support development of trauma-informed service systems and implementation of evidence based and promising practice trauma treatment models and services.7. Clinical practice guidelines for working with children and adults with trauma histories.8. Policies, procedures, rules, regulations and standards to support access to trauma treatment, to develop a trauma- informed system, and to avoid re traumatization.
  38. 38. 12 Criteria con’t9. Needs assessment, evaluation, and research to explore prevalence and impacts of trauma; assess trauma survivor satisfaction, service utilization and needs; and to monitor and make adjustments in trauma-informed and trauma-specific service approaches.10. Universal trauma screening and assessment.11. Collaborations amongst trauma-informed services and service systems.12. Trauma-specific services, including evidence based and promising practice treatment models.
  39. 39. Toolkits• Trauma Services Implementation Toolkit for State Mental Health (2004)• Child Welfare Trauma Training Toolkit (2008)• Child Trauma Toolkit for Educators (2008) National Child Traumatic Stress Network• Toolkit for Refugees (2010) Centre for Refugee Trauma and Resilience• Trauma-Informed Organizational Toolkit for Homeless Services (2010) The National Centre on Family Homelessness Search “trauma informed toolkit” www.kidslinkcares.com
  40. 40. Substance Abuse and Mental Health Services Administration (SAMSHA)Strategic Initiative #2 Trauma and Justice• Overview: Reducing the pervasive, harmful, and costly health impact of violence and trauma by integrating trauma- informed approaches throughout health, behavioural health, and related systems and addressing the behavioural health needs of people involved in, or at risk of involvement in the criminal and juvenile justice system.
  41. 41. Canada
  42. 42. kidsLINK - Ontario• 2009 - Visit Thrive (Maine), Andrus/Sanctuary (New York)• 2009/10 Explore/implement trauma specific service - TFCBT• 2010 – Implement universal trauma screen at Front Door (Joint Initiatives)• 2010 – 2013 Implementation of the Sanctuary Model
  43. 43. Klinic – ManitobaRecently announced fundingfor a Trauma Resource CentreAdvocating with MentalHealth Commissionof Canada for NationalResources
  44. 44. British Columbia Centre of Excellence for Women’sCoalescing on Women and SubstanceUse: Trauma-informed Online Tool Health
  45. 45. “I have come to believe that traumais the problem and substance usethe solution…until the solutionbecomes the problem”Addictions Counselor
  46. 46. Where to Go From Here?Service Providers Policy Makers & Funders Develop a “trauma team”  Create regional/province Seek and share up to date wide standing Trauma Task research and knowledge Force Collaborate with others on  Develop a written policy on training and building Trauma Informed Service awareness (seek training!) System Implement a universal trauma screen (or refer)  Establish a clearly identified Conduct thorough trauma Trauma Office in assessments on admission government (or partner)  Coordinate Trauma Offer trauma specific Informed Treatment treatments (refer and Services across Ministries partner)
  47. 47. Thank You!Contact InformationFor further information on trauma informed service systems work,please contact: Barb Ward, MSW, RSW – Director of Services, kidsLINK bward@kidslinkcares.com Laurie Robinson, MSW, Consultant, kidsLINK lrobinson@kidslinkcares.com; laurie_robinson@rogers.com

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