Honoring Our Strengths Conference
June 25, 2014
Bill Mussell & Dr. Brenda Restoule
Native Mental Health Association of
Can...
 Define necessary skills and knowledge
needed to provide culturally competent care
in addressing trauma
 To build knowle...
 Culture refers to integrated patterns of human
behavior that include the language, thoughts,
communications, actions, cu...
 Cultural competence is the integration and
transformation of knowledge about individuals
and groups of people into speci...
 Cultural competence mandates that
organizations, programs and individuals must
have the ability to:
1. Value diversity a...
 Trauma: Any life event(s) that threatens a
person’s physical or emotional/psychological
health or safety
 Traumatic eve...
“Intergenerational or multi-generational
trauma happens when the effects of trauma
are not resolved in one generation. Whe...
 Adrenaline is produced during a traumatic event to provide for
greater strength and endurance causing hyperarousal of th...
Neurobiological and physiological changes:
memory impairment that impacts on the ability to
process and integrate informa...
 Regardless of the source of the trauma, the
experience has four common traits:
it was unexpected;
it was psychological...
 Indigenous peoples’ experiences of contact
and cultural domination may reasonably be
viewed as a loss of predictability ...
Chronic and complex
grief
High rates of suicide
and homicide
High rates of violence
Accidental deaths
Lateral violenc...
 Has led to family histories of ongoing trauma
and dependencies
 Created family histories of maladaptive
coping
 Led to...
 The hypersensitivity to recognizing and
responding in maladaptive ways to stress are
transmitted to their children
 Ind...
“under the relentless influence of forced
assimilation, economic dependence and
isolation, Aboriginal cultures have underg...
 Requires an understanding of trauma in all
aspects of service delivery
 Places the survivor’s safety, choice and contro...
1. Trauma awareness
2. Emphasis on safety and trustworthiness
3. Opportunity for choice, collaboration and
connection
4. S...
 Having a comprehension of cultural effects to
trauma
 Having a comprehension that cultural loss,
degeneration and cultu...
 The World Health Organization defines traditional
medicine and healing as “the sum total of knowledge,
skills, and pract...
 When Aboriginal people discuss the elements of traditional
healing, “they include a wide range of activities, from physi...
1. Teaching cultural and community history
2. Teaching how historical trauma creates
risk for health, social and relations...
 Cultural ceremonies
Sweats
Smudges
Use of medicines
Cedar baths
Soul retrieval
 Traditional teachings
Roles
medi...
 Physical: relaxation, exercise, hunting or
being on the land, therapeutic dance,
healthy diet (including drinking water)...
1. Confront our trauma & embrace our history
 educate our people about our history & what
happened to us. Knowledge is po...
 Takini Network has conducted research on
their model that addresses trauma
testimony, trauma response issues and
moving ...
Attend to:
1. The mind by remembering, speaking & coming to
terms with the horrifying, overwhelming
experience(s) that led...
1. The Journey Begins
 gathering of core group of people to address their own healing
needs
2.Gathering Momentum
 increa...
Views Aboriginal peoples’ reaction to
Residential School as a Post-Traumatic
Stress Response to avoid terminology
of blame...
 PTSR may arise from a multitude of individual &
community traumas, within and across
generations.
 Compound trauma refe...
 PTSR model reframes PTSD symptoms as human
responses to extreme circumstance seen as more
compassionate for individuals ...
 Need to promote holistic perspective of health that
is consistent with cultural concepts of Medicine
Wheel
 PTSR model ...
 People do recover from post-traumatic
stress through effective psycho-
educational & therapeutic approaches.
 The Lakot...
 Therapeutic approaches to PTSD are
consistent with Indigenous values of
respect, care & collective models of
healing. Th...
Healing, in Aboriginal terms, refers to
personal and societal recovery from the
lasting effects of oppression and systemic...
MIIGWECH! THANK YOU
Brenda restoule   cultural competency in trauma informed care
Brenda restoule   cultural competency in trauma informed care
Brenda restoule   cultural competency in trauma informed care
Brenda restoule   cultural competency in trauma informed care
Brenda restoule   cultural competency in trauma informed care
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  • 1. Trauma awareness: All services taking a trauma-informed approach begin with building awareness among staff and clients of: how common trauma is; how its impact can be central to one’s development; the wide range of adaptations people make to cope and survive; and the relationship of trauma with substance use, physical health and mental health concerns. This knowledge is the foundation of an organizational culture of trauma-informed care [15].
    2. Emphasis on safety and trustworthiness: Physical and emotional safety for clients is key to trauma-informed practice because trauma survivors often feel unsafe, are likely to have experienced boundary violations and abuse of power, and may be in unsafe relationships. Safety and trustworthiness are established through activities such as: welcoming intake procedures; exploring and adapting the physical space; providing clear information about the programming; ensuring informed consent; creating crisis plans; demonstrating predictable expectations; and scheduling appointments consistently [16]. The needs of service providers are also considered within a trauma-informed service approach. Education and support related to vicarious trauma experienced by service providers themselves is a key component.
    3. Opportunity for choice, collaboration and connection: Trauma-informed services create safe environments that foster a client’s sense of efficacy, self-determination, dignity and personal control. Service providers try to communicate openly, equalize power imbalances in relationships, allow the expression of feelings without fear of judgment, provide choices as to treatment preferences, and work collaboratively. In addition, having the opportunity to establish safe connections—with treatment providers, peers and the wider community—is reparative for those with early/ongoing experiences of trauma. This experience of choice, collaboration and connection is often extended to client involvement in evaluating the treatment services, and forming consumer representation councils that provide advice on service design, consumer rights and grievances.
    4. Strengths-based and skill building: Clients in trauma-informed services are assisted to identify their strengths and to further develop their resiliency and coping skills. Emphasis is placed on teaching and modelling skills for recognizing triggers, calming, centering and staying present. In her Sanctuary Model of trauma-informed organizational change, Sandra Bloom described this as having an organizational culture characterized by ‘emotional intelligence’ and ‘social learning.’ Again, parallel attention to staff competencies and learning these skills and values characterizes trauma-informed services.


  • Brenda restoule cultural competency in trauma informed care

    1. 1. Honoring Our Strengths Conference June 25, 2014 Bill Mussell & Dr. Brenda Restoule Native Mental Health Association of Canada
    2. 2.  Define necessary skills and knowledge needed to provide culturally competent care in addressing trauma  To build knowledge on utilizing a trauma informed approach with a focus on cultural interventions for healing of intergenerational trauma
    3. 3.  Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups.  Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities  Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system agency or among professionals that enables effective work in cross-cultural settings  Adapted from Cross (1989)
    4. 4.  Cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes to increase the quality of services; thereby producing better outcomes Davis (1997)  Cultural competence requires cultural humility which is a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues and with themselves that requires one to bring into check the power imbalances that exist in the dynamics of caregiver-client communication by using client-centered care
    5. 5.  Cultural competence mandates that organizations, programs and individuals must have the ability to: 1. Value diversity and similarities among all peoples; 2. Understand and effectively respond to cultural differences; 3. Engage in cultural self-assessment at the individual and organizational levels; 4. Make adaptations to the delivery of services and enabling supports; 5. Recognize and acknowledge cultural knowledge
    6. 6.  Trauma: Any life event(s) that threatens a person’s physical or emotional/psychological health or safety  Traumatic events cause people to lose a sense of control, connection and meaning (Herman, 1997)  Complex Trauma: repetitive, prolonged and cumulative usually resulting from interpersonal betrayal  Intergenerational Trauma: A collective emotional or psychological injury over the lifespan and across generations. Often resulting from a history of genocide with the effects being mental, emotional, physical and spiritual
    7. 7. “Intergenerational or multi-generational trauma happens when the effects of trauma are not resolved in one generation. When trauma is ignored and there is no support for dealing with it, the trauma will be passed from one generation to the next. What we learn to see as “normal” when we are children, we pass on to our own children….The unhealthy ways of behaving that people use to protect themselves can be passed on to children, without them even knowing they are doing so. This is the legacy of physical and sexual abuse in residential schools.” (Aboriginal Healing Foundation, 1999:A5)
    8. 8.  Adrenaline is produced during a traumatic event to provide for greater strength and endurance causing hyperarousal of the nervous system  If the trauma is re-experienced repeatedly, the brain loses its ability to regulate its own chemistry; flooding the brain with adrenaline until temporarily depleted. The brain will compensate by alternating patterns of over-stimulation and depletion  The body will enter a state of hyperarousal, anxiety and fear causing the trauma victims to react to seemingly harmless situations. If adrenaline is depleted the trauma victim may shut down with no interest or energy to react or reach out  Neuroscience has found that individuals who experience chronic and perpetuating stress develop a hypersensitivity to it and are more likely to respond to it in maladaptive ways
    9. 9. Neurobiological and physiological changes: memory impairment that impacts on the ability to process and integrate information (i.e., difficulty remembering aspects of the trauma, difficulty making decisions, poor concentration) increased bodily response to fear triggers Increased sensitivity to startle reflex Sleep abnormalities increased reactivity to both explicit and implicit trauma reminders Hyper-vigilance Increased autonomic reactions (i.e., shaky, sweaty, heart palpitations, trouble breathing)
    10. 10.  Regardless of the source of the trauma, the experience has four common traits: it was unexpected; it was psychologically overwhelming; the person was unprepared or unable to cope with it; there was nothing the person felt they could do to prevent or mitigate it. It is thus, not the event per se that determines whether an experience is traumatic, but the subjective experience of that person.
    11. 11.  Indigenous peoples’ experiences of contact and cultural domination may reasonably be viewed as a loss of predictability and control and increases in vulnerability  A report on mental health needs of 127 survivors of residential school found that 64.2% of these individuals met with criteria for PTSD
    12. 12. Chronic and complex grief High rates of suicide and homicide High rates of violence Accidental deaths Lateral violence incarceration Poor health conditions that impact on functioning Residential schools Loss of language, identity & culture (through various acts of assimilation) High rates of family violence High rates of abuses, particularly physical & sexual abuse, especially toward women & children Poor social conditions (i.e., extreme poverty, housing, water, sewage) Culture of dependency
    13. 13.  Has led to family histories of ongoing trauma and dependencies  Created family histories of maladaptive coping  Led to loss of cultural understanding and cultural behaviours to effectively deal with trauma  Neuroscience has found that individuals who experience chronic and perpetuating stress develop a hypersensitivity to it and are more likely to respond to it in maladaptive ways
    14. 14.  The hypersensitivity to recognizing and responding in maladaptive ways to stress are transmitted to their children  Individuals who suffer from historical trauma often identify events or situations as stressful or traumatic more frequently than those who do not have historical trauma  Historical trauma have co-occurring health and social problems  Individuals who suffer from historical trauma often have more complex needs requiring more long term and comprehensive care
    15. 15. “under the relentless influence of forced assimilation, economic dependence and isolation, Aboriginal cultures have undergone a process of deculturation. Evidence for this process of cultural degeneration is found in such phenomena as alcoholism, substance abuse, child neglect, suicide, family violence, sexual abuse, vandalism and theft, all of which are epidemic in many Aboriginal communities. It is paramount to notice that none of these indicators of cultural and identity degeneration characterized pre- colonized Aboriginal culture.” (RCAP - Peavey, 1993)
    16. 16.  Requires an understanding of trauma in all aspects of service delivery  Places the survivor’s safety, choice and control as a priority  Creates a treatment culture of nonviolence, learning and collaboration  Treatment requires building confidence and trust to facilitate healing and recovery  Facilitate engagement and meaningful participation by consumers & families in planning of services and programs  Create collaborative relationships with other systems from the social determinants of health
    17. 17. 1. Trauma awareness 2. Emphasis on safety and trustworthiness 3. Opportunity for choice, collaboration and connection 4. Strengths-based and skill building  Also common to the principles of cultural competency
    18. 18.  Having a comprehension of cultural effects to trauma  Having a comprehension that cultural loss, degeneration and culture stress are significant forms of trauma  Requires understanding cultural responses to addressing trauma
    19. 19.  The World Health Organization defines traditional medicine and healing as “the sum total of knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement of treatment of physical and mental illness” (Martin Hill, 2003 p.3).  Traditional healing has also been defined as “practices designed to promote mental, physical, and spiritual well-being that are based on beliefs which go back to the time before the spread of western ‘scientific’ bio- medicine” (Martin Hill, 2003 p.7).
    20. 20.  When Aboriginal people discuss the elements of traditional healing, “they include a wide range of activities, from physical cures using herbal medicines and other remedies, to the promotion of psychological and spiritual well-being using ceremony, counseling and the accumulated wisdom of elders” (Martin Hill, 2003, p.7).  On comparison with western medicine that typically has the goal ‘to cure’, the goal of traditional medicine is ‘to improve the quality of life with an emphasis on the healing journey’ (NAHO, 2002, p.9). As NAHO (2002) states, a basic principle of the scientific method is “to separate parts from the whole and to concentrate on the parts that need the most attention. In the traditional model, the approach is to consider the whole of the person’s being. Quality of life is the focus, with an emphasis on achieving balance in all aspects” (lbid, p.9).
    21. 21. 1. Teaching cultural and community history 2. Teaching how historical trauma creates risk for health, social and relationship problems 3. Supporting opportunities for developing self-awareness, self-worth and cultural identity 4. Teaching life skills 5. Teaching strategies to cope with stress and regulate emotions
    22. 22.  Cultural ceremonies Sweats Smudges Use of medicines Cedar baths Soul retrieval  Traditional teachings Roles medicines  Traditional counselling  Integrative or collaborative traditional & western techniques
    23. 23.  Physical: relaxation, exercise, hunting or being on the land, therapeutic dance, healthy diet (including drinking water)  Mental: teachings, identifying triggers and symptoms, safety plans to reduce risk, trauma narrative or map, visualization  Emotional: anger management/release, art therapy, strengthening support system, personal affirmation, restoring pride in self/identity/culture/history  Spiritual: meditation, prayer, storytelling, singing, drumming or dancing, involvement in traditional activities (beading, carving), hunting or spending time on the land
    24. 24. 1. Confront our trauma & embrace our history  educate our people about our history & what happened to us. Knowledge is power! 2. Understand the trauma  educate about trauma response features & cultural context to mourning & grief 3. Release the pain 4. Transcend the trauma  heal & move beyond the trauma so that we no longer define ourselves in terms of the trauma *as presented by Dr. Maria Yellow Horse Brave Heart (April 2005)
    25. 25.  Takini Network has conducted research on their model that addresses trauma testimony, trauma response issues and moving beyond trauma  All participants found intervention helped them with grief resolution, feeling better about themselves, experienced improvements in their parenting and a better understanding of why they felt so bad & had so many health & social problems
    26. 26. Attend to: 1. The mind by remembering, speaking & coming to terms with the horrifying, overwhelming experience(s) that led to trauma response 2. The body by learning to acknowledge and master the physical stress response like anxiety & sleeplessness 3. The emotions by re-establishing relationships and secure social connections 4. The spirit by recognizing that the spiritual & cultural have often been critical aspects of the original wound or trauma for Aboriginal people
    27. 27. 1. The Journey Begins  gathering of core group of people to address their own healing needs 2.Gathering Momentum  increase in healing activity with recognition of root causes of addiction & abuse through community-wide awareness workshops 3. Hitting the Wall  building healing capacity by providing training & employment with a focus on community development 4. From Healing to Transformation  shifting from fixing the problem to transforming the system
    28. 28. Views Aboriginal peoples’ reaction to Residential School as a Post-Traumatic Stress Response to avoid terminology of blame & weakness Five (5) components to addressing PTSR and health inequalities 1. Acknowledgement of socio-historical context 2. Reframing of stress responses 3. Focus on holistic health & cultural renewal 4. Proven psycho-educational & therapeutic approach 5. Communal and cultural model of grieving and healing
    29. 29.  PTSR may arise from a multitude of individual & community traumas, within and across generations.  Compound trauma referred to as historical trauma or IT rooted in cultural loss  Need to partner and share information about social/historical impacts on the health of indigenous people & conduct research across similar populations. This will help identify relationship between IT, health inequalities and strategies to improve health within & across indigenous peoples/communities.
    30. 30.  PTSR model reframes PTSD symptoms as human responses to extreme circumstance seen as more compassionate for individuals & communities who have endured external trauma that is so profound that it affects their ability to cope  Need for a process to name historical & systemic sources of personal & social ills that is a critical political lens in developing a compassionate view of current health inequalities. May assist in better service delivery for Aboriginal people  Rename, manage & transform historical stressors & stress responses to health promoting behaviors & positive health outcomes
    31. 31.  Need to promote holistic perspective of health that is consistent with cultural concepts of Medicine Wheel  PTSR model includes life experiences and environmental stressors as preconditions for health & illness. Acknowledges historical stressors, culture, Elders, traditional healing & community processes  Need to incorporate a lifespan approach to healing, focus on capacity building & address all aspects of the person’s response to stress.
    32. 32.  People do recover from post-traumatic stress through effective psycho- educational & therapeutic approaches.  The Lakota First Nation has adapted western based approaches that are more suitable for Indigenous settings & approaches to historical trauma. They recommend 4 main components to healing from intergenerational trauma
    33. 33.  Therapeutic approaches to PTSD are consistent with Indigenous values of respect, care & collective models of healing. They bring people together who share a history of trauma to identify with one another & further accept stress responses and support a path to wellness  Many Indigenous ceremonies that promotes group healing and reduces isolation; alleviates guilt, shame & anger; and enhances feelings of self-worth
    34. 34. Healing, in Aboriginal terms, refers to personal and societal recovery from the lasting effects of oppression and systemic racism experienced over generations. Many Aboriginal people are suffering not simply from specific diseases and social problems, but also from a depression of spirit resulting from more than 500 years of damage to their cultures, languages, identities and self-respect. The idea of healing suggests that to reach ‘whole health’, Aboriginal people must confront the crippling injuries of the past (RCAP, 1996:109).
    35. 35. MIIGWECH! THANK YOU

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