TRAUMA-INFORMED CARE PERSPECTIVE
STRAIGHT TALK ABOUT THE PARADIGM SHIFT
Going Mainstream Series: Level I
Cathy S Harris, M...
CATHY S. HARRIS, MSW, LCSW
619.807.9159
if you become overwhelmed
Breathe
Exercise self-care
Note your questions
Remain curious
Cathy S Harris, MSW, LCSW copyrigh...
TRAUMA-INFORMED PERSPECTIVE
The real nitty-gritty
Cathy S Harris, MSW, LCSW copyright 2011
warning: scenes of graphic violence
http://www.youtube.com/watch?v=ipmNpisZadw
BILLY JOEL: WE DIDN’T START THE FIRE
• we all want peace and safety
•
• Where/when did you first hear the term:
• “Trauma-Informed”?
• What does “Trauma-Informed” mean to you?
• What has bee...
TRAUMA-INFORMED CARE PERSPECTIVE
OVERVIEW (PART 1)
• What is the Trauma-Informed Care Perspective?
How does our background...
?
WHAT IS IT
Cathy S Harris, MSW, LCSW copyright 2011
. . . a deeper view
Cathy S Harris, MSW, LCSW copyright 2011
Trauma-Informed perspective is first and foremost about
“What happened to you?”
Trauma-Informed approach is based in compa...
WATCH ON YOUTUBE (copy & paste)
http://www.youtube.com/watch?v=Zc6oSsXUeyw
WHY ARE WE TALKING ABOUT THIS?
what’s it all about?
Cathy S Harris, MSW, LCSW copyright 2011
Trauma Informed Care Perspective is
based on the “recognition of
psychological trauma as a pivotal force
that shapes the m...
FREE DOWNLOAD AT (copy & paste)
http://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdff
what’s wrong with
you?
what happened
to you?
Cathy S Harris, MSW, LCSW copyright 2011
THE PIONEERS
Names to know
Bessel van der Kolk Babbette Rothschild Bruce Perry Christine Courtois
Cathy S Harris, MSW, LCS...
Colin Ross
Lenore Terr
James Chu
Alice Miller
Peter Levine
Judith Herman
Cathy S Harris, MSW, LCSW copyright 2011
Background Trauma
Paradigm Shift The challenge
Cathy S Harris, MSW, LCSW copyright 2011
background
what are your influences?
• Freedom through education
• Training
• A dream fulfilled
residential: children & te...
?
HOW ABOUT YOU
Cathy S Harris, MSW, LCSW copyright 2011
Trauma
don’t be afraid
Cathy S Harris, MSW, LCSW copyright 2011
• What is trauma?
• What are the effects
of trauma?
• Who ...
Trauma is not just the result of major disasters. It
does not happen to only some people. An
undercurrent of trauma runs t...
WATCH CLIP
• Has Elizabeth experienced trauma?
• How would you ask her about trauma?
• What factors do you consider?
• What diagnoses...
Disaster: fire, tornado, hurricane,
auto accident, floods; moving to a
new location, death of loved and
significant person...
breathe
Cathy S Harris, MSW, LCSW copyright 2011
Traumatic experience challenges a person’s
ability to cope; the person may believe
he/she will die or “go crazy”, they may...
Denial of victimization is a
COPING DEFENSE
for victimization
copyright Cathy S Harris, MSW, rLCSW
copyright Cathy S Harris, LISW September 2010
?
WHAT WOULD YOU ADD
Cathy S Harris, MSW, LCSW copyright 2011
pause for a moment. . .
Cathy S Harris, MSW, LCSW copyright 2011
LEVELS OF EXPOSURE
• Acute Trauma refers to a single traumatic event that is limited in time, such as an auto
accident, a ...
• TRAUMA is NOT a particular diagnosis
• TRAUMA is NOT always ‘reportable’
• TRAUMA is NOT a particular treatment
• TRAUMA...
TRAUMA-INFORMED CARE PERSPECTIVE
IS NOT
“just the next big fad in behavioral health”
“just another training we have to att...
“Any event or situation that causes a person
to experience stress so extreme that it
overwhelms his or her natural
ability...
any situation that leaves you feeling
overwhelmed and alone can be
traumatic, even if it doesn’t involve
physical harm
Cat...
Under-education
Under-employment
Life-time physical ills
Mental Health Diagnoses
Dysfunctional relationships
Poor parentin...
The Brain and Trauma: Simon Fallavollita youtube.com
Adverse Childhood Experiences: ACE Study
IT HURTS US TO HURT US
Cathy S Harris, MSW, LCSW copyright 2011
?
WHO IS AFFECTED
Cathy S Harris, MSW, LCSW copyright 2011
It Can Begin in Infancy
Small Child, Big Worries Time Magazine 03/11
Cathy S Harris, MSW, LCSW copyright 2011
WHO IS AFFECTED?
public mental health clients…
51-98% of have been exposed to childhood physical and/or sexual abuse
MODEL...
Who is affected?
homeless women with mental illness
97% experienced severe physical and/or
sexual abuse, 87% experienced a...
Who is affected?
children and adolescents in …inpatient
and …residential treatment
In Massachusetts, 82% of all have
traum...
Cathy S Harris, MSW, LCSW copyright 2011
TIC “…recognizes that when patients come to us in the
hospital, they have often been trapped for many years in a
cycle of ...
• Individually
• Organizationally
• Socially
• Nationally
• Worldwide
The Paradigm Shift
will we do it?
Cathy S Harris, MS...
what’s wrong with
you?
what happened
to you?
Cathy S Harris, MSW, LCSW copyright 2011
Injury model
Whole person
Recovery-oriented: strengths,
assets, resilience
Compassion-based
Universal experience
Validates...
MEDICAL MODEL VS TRAUMA-INFORMED
WHAT’S WRONG WITH YOU? WHAT HAPPENED TO YOU?
AXIS III, IV, V
AXIS II
AXIS I
AXIS II,
III,...
EXAMPLES OF TRAUMA-INFORMED APPROACH
• Training for police officers: dealing with persons who have autism, (others)
• Priv...
?
WHAT HAPPENS WHEN IT IS IGNORED
Cathy S Harris, MSW, LCSW copyright 2011
Ann Jennings, Ph D
MODELS FOR DEVELOPING TRAUMA-INFORMED BEHAVIORAL HEALTH
SYSTEMS AND TRAUMA SPECIFIC SERVICES
Cathy S Ha...
a family tragedy
Cathy S Harris, MSW, LCSW copyright 2011
DO NO HARM
RE-TRAUMATIZATION
System-Induced Trauma for the child include:
• A child's trauma history is not identified;
• A child's t...
Cathy S Harris, MSW, LCSW copyright 2011
additional effects of ignorance
How childhood abuse primes the brain for mental illness
Trauma and
Behavioral Health
In th...
TRAUMA DENIED OR IGNORED
, Oppositional Defiant
Disorder, Conduct
Disorder, Borderline,
Anti-Social, etc.
No One Asks abou...
GRIEF/LOSS/ANGER
Think about your clients. Often we identify the child or children as
being “the problem”, however, if we ...
A CONTINUUM OF EXPERIENCE
Family of Origin Issues
Divorce (unresolved)
Adoption
Death of parent/significant
caretaker
Alco...
ASSOCIATED DIAGNOSES
Family of Origin Issues Shock Event/Abuse/Neglect
Childhood
Oppositional Defiant, Conduct Disorder,
A...
•
• Where/when did you first hear the term: “Trauma-
Informed”?
• What does “Trauma-Informed” mean to you?
• What has been...
NON-TRAUMA-INFORMED APPROACH
• Patients/Clients: labeled/pathologized: manipulative, needy, attention-
seeking
• Mis/over-...
NON-TRAUMA-INFORMED APPROACH (CONT.)
• TIC in name only
• Institutional disempowerment/disrespect/non-value of staff-this ...
?
WHAT ARE THE BENEFITS OF USING
TRAUMA-INFORMED CARE PERSPECTIVE
Cathy S Harris, MSW, LCSW copyright 2011
BENEFITS: SERVICE RECIPIENTS
• Educational & experiential approach
• Addresses real life difficulties now
• Validating & a...
Cathy S Harris, MSW, LCSW copyright 2011
BENEFITS: PROFESSIONALS
• Addresses counter-transference
• Relieves compassion fatigue, effects of vicarious traumatizatio...
WHAT WILL CHANGE?
think about your own setting
Cathy S Harris, MSW, LCSW copyright 2011
WHAT will change?
• Assessment
• Diagnoses
• Treatment
• Medication
Cathy S Harris, MSW, LCSW copyright 2011
“Humans are complex creatures. While having
the capacity to be humane, we also have
the capacity to be cruel. Why? What
de...
http://acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf
(copy & paste)
“In psychiatry mental illness is a metaphor
imposed on people’s behavior. There
aren’t any physical methods of
diagnosing ...
A survivor speaks:
“In the system I was taught to identify with all of the
labels I was given and so I lived them all. Exp...
1992: Three stage model
1. Establishing safety
2. Reconstructing the traumatic story
3. Restoring the connection between t...
“… at Oregon's Salem Hospital, I was part of the miraculous transition
to a trauma-informed environment. Seclusion and res...
PSYCHIATRIC INDUSTRY DRIVEN BY WEALTH AND STEALTH,
NOT MENTAL HEALTH
Drug company corporate websites tell us of their
inte...
Treatment Education Legal Support
Macro Daycare-PhD On the streets Behavioral
Micro In the courts Parenting
Jails & Prison...
JUST GOOGLE IT
what is your interest?
Cathy S Harris, MSW, LCSW copyright 2011
WHAT ABOUT IOWA?
The Iowa Consortium for Mental Health:
University of Iowa
Iowa Foster and Adoptive Parents Association
Mi...
“Training programs, degree programs…etc.
are still woefully deficient in conveying the
research data to the people who nee...
• Our own mirrors
• Self-care
• Spread the word
• Your experience?
The Challenge
how will we meet it?
Cathy S Harris, MSW,...
wisdom to
create serenity
Cathy S Harris, MSW, LCSW copyright 2011
explanation, not an excuse
Cathy S Harris, MSW, LCSW copyright 2011
explanation, not an excuse
Cathy S Harris, MSW, LCSW copyright 2011
people are trying to get their needs met
Cathy S Harris, MSW, LCSW copyright 2011
people are doing the best they can
and...
they need to improve
Cathy S Harris, MSW, LCSW copyright 2011
and the day came
when the desire to
remain the same
was more painful
than the risk to grow…
Cathy S Harris, MSW, LCSW copy...
• to apply compassion in all my relationships
• to be aware of my own trauma-related issues
• to establish an environment ...
• for balance in boundaries, respecting that those I serve
need my support but also need assurance that they are
capable
•...
Trauma-Informed Care Perspective: Straight Talk About the Paradigm Shift (conference session 1)
Trauma-Informed Care Perspective: Straight Talk About the Paradigm Shift (conference session 1)
Trauma-Informed Care Perspective: Straight Talk About the Paradigm Shift (conference session 1)
Upcoming SlideShare
Loading in …5
×

Trauma-Informed Care Perspective: Straight Talk About the Paradigm Shift (conference session 1)

1,958 views

Published on

This is an overview of Trauma-Informed Care Perspective. Why do we need it? Why are we talking about it now? Who are the pioneers? What are the benefits to professionals and their customers? What will change when we engage in the paradigm shift to Trauma-Informed Care Perspective? Gain CEUs and a certification at www.trauma-informedtraining.com OR invite Cathy to present all 5 Power-point shows to your organization: http://www.trauma-informedtraining.com/contact-us.html
A statement of Trauma-Informed Care Ethics is included

Published in: Education
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,958
On SlideShare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
0
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide
  • Template Flower Title Slide
  • Thanks to Susan, Dr. Phillips, Travis and the Sheraton AND THANKS TO ALL OF YOU FOR COMING


  • Use each session’s questionnaire to follow along and take notes; this afternoon I’ll be sharing how you can use your answers to gain the first level of certification in my 4 level cert program. Please jot down your questions; I’ll try to stop periodically to allow time throughout the presentation.
  • Throughout the day I invite you to exercise self-care. We are here to talk about trauma. If you need a break, take one. If you need to check out for a minute, do so. At key moments, we’ll pause to reflect or distract. Use images that are presented, or those mental ones that appeal to you.

  • This song is 25 years old; we could update it (go on youtube to see that many have) but the point is made.

    We live in a world filled with trauma. Big trauma, little trauma, acute trauma, chronic trauma, real trauma, threatened trauma, imagined trauma. TRAUMA TRAUMA TRAUMA

    And WE have chosen to work in fields where we meet this trauma every day, in the faces and lives of our clients and patients.

    Yet, most of our schools of training and places of employment have not openly acknowledged this. THAT has been traumatizing for some of us. THAT has been re-traumatizing for many, many of our clients and patients
  • We could add many, many more examples of Big T trauma and Little t trauma—a lot of them unspeakable, but many of us HEAR about these unspeakable traumas, every day.

  • In the midst of all this trauma, we need to remember beauty, goodness, our own power to evoke change in our worlds and the idea that we are all part of something much larger than ourselves.
  • Please keep this slide handy; we’ll be discussing these questions….
  • Overview Session 1
  • Trauma-Informed Care Perspective goes beyond the surface, beyond symptoms.

    It goes beyond our formal educations, it may trigger our own experiences and it requires our courage with determination to use it in our many settings. It may challenge those around us, those who supervise us; can we take this plunge?
  • ANSWERS: WHAT IS TRAUMA-INFORMED CARE PERSPECTIVE?
  • While working with adolescents in and Intensive Outpatient Program, I needed a way to reach the kids—to help them understand some basics about their situation; many were in shelter, some had been left by their families, some had been removed, some were experiencing trouble at home…
  • What has brought about the need to discuss Trauma-Informed Care Perspective?

  • Let’s look at part of what has brought about SAMHSA’s role
  • Seems simple, but if we make this shift, many things will change in our work, whatever that work may be.
  • Before discussing more, what this paradigm shift is all about, take a look at some of the pioneers in the field. These are some of the professionals—doctors, psychologists, social workers, counselors—who have given weight to the effects of trauma in the patients and clients they’ve treated and in the research they have conducted. You may know of others; these are the ones who have influenced me.

    Bessel van der Kolk: Boston Trauma Center yoga for trauma research, mind/body effects; as early as 1984—Psychological Trauma 1987—classic

    Rothschild: Social Worker: Somatic Work

    Bruce Perry Houston TX Child Trauma Academy: groundbreaking work: how child maltreatment affects the biology of the brain; works with children from around the world--The Boy Who Was Raised As A Dog: What Traumatized Children Can Teach Us About Loss, Love and Healing, and Born for Love: Why Empathy is Essential and Endangered

    Christine Courtois: 1988 Healing the Incest Wound; more recently: Treatment for Complex Traumatic Stress

  • Colin Ross: Pioneer in the treatment of trauma-based disorders, many books including: The Trauma Model; director of 3 inpatient programs for over 25 years

    Lenore Terr: Child psychiatrist known for her research on the adults kidnapped as children (school bus buried underground in Chowchilla/Livermore CA), a proponent of repressed memory theory and author of significant books on the after-effects of trauma

    James Chu: Psychiatrist, author of Rebuilding Shattered Lives, expert on treatment of dissociative disorders

    Alice Miller: Swiss psychologist, prolific author of The Drama of the Gifted Child, Thou Shalt Not Be Aware, For Your Own Good (12 in all); compared psychoanalysis to poisonous pedagogies; In April 1987 Miller announced in an interview with the German magazine 'Psychologie Heute' (Psychology Today) her rejection of psychoanalysis.[15] The following year she cancelled her membership of both the Swiss Psychoanalytic Society and the International Psychoanalytic Association, because she felt that psychoanalytic theory and practice made it impossible for former victims of child abuse to recognize the violations inflicted on them and to resolve the consequences of the abuse,[10] as they "remained in the old tradition of blaming the child and protecting the parents.“

    Peter Levine; Psychologist, author: Waking the Tiger: Somatic Experiencing therapy—work is based on animal response to trauma “immobility response” and the need to discharge the energetic memory by trembling

    Judith Herman: Psychiatrist, author: 1981: Father-Daughter Incest; Trauma and Recovery 1997

  • These are the four general areas we’ll examine in this first session
  • Every one of us is in this field due to our backgrounds: our experiences, interests and life events led to our chosen education, to our work and to our presence here today. Each of us has a story and our story informs who we are today.

    Here’s a bit of my story;

    what about you?

    (PAUSE FOR SMALL OR ENTIRE GROUP DISCUSSION)
  • 911, school shootings, corporate shootings, loss of life savings during economical disasters

    When I present this information, there are often listeners in the audience who disagree with my presentation about “what is trauma”? In our jobs, we have often learned to speak of “trauma” as only the most severe and obvious events. But we are learning, through a great deal of research, in recent years, that there are many kinds and levels of trauma.

    Consider this next video clip:
  • ANSWERS: WHAT IS TRAUMA? What CATEGORIES do we need to know?

    IN WHICH OF THESE CATEGORIES DO MOST OF YOUR CUSTOMERS FALL?

    TREATING COMPLEX TRAUMATIC STRESS IN CHILDREN & ADOLESCENTS (QUOTE)
  • Many survivors don’t recognize that their after-effects have anything to do with trauma; we need to keep in mind the primary defense for surviving trauma (denial)

    Part of making the paradigm shift to Trauma-Informed Care Perspective is to withhold judgment; what might be traumatic to one may not seem so to us…
  • To access our clients’ historical information we’ll need clinical expertise, sensitivity and willingness to explore
  • As difficult as these images are to look at, remember, these are the things your client brings to your encounter.
    How would you think about and speak to a person who had experienced such things?
    How does your setting respect the social history of your clients?
  • Brief guided visualization here

    I INVITE YOU TO FOCUS ON THE IMAGE, TAKE A DEEP BREATH IN, LETTING IT OUT NATURALLY –JUST DO THIS A FEW TIMES UNTIL YOU ARE CALM AND FEELING COMFORTABLE
  • ANSWERS WHAT IS TRAUMA?

    Treating Complex Traumatic Stress in Children & Adolescents (quote) re “event” vs “complex”
  • http://helpguide.org/mental/emotional_psychological_trauma.htm ANSWERS: WHAT IS TRAUMA?
  • http://helpguide.org/mental/emotional_psychological_trauma.htm
  • PTSD is normal response to abnormal treatment or events and circumstances

    Simon Fallavollita
  • IT HURTS US TO HURT US

    ACE Study
    The ACE Study is ongoing collaborative research between the Centers for Disease Control and Prevention in Atlanta, GA, and Kaiser Permanente in San Diego, CA. The Co-principal Investigators of The Study are Robert F. Anda, MD, MS, with the CDC; and Vincent J. Felitti, MD, with Kaiser Permanente.

    17,000+ surveys using the ACE Adverse Childhood Experiences tool

    The study found that early life experiences have a significant effect on later, adult health: early heart disease, cancer, diabetes, tendency to addictions, including nicotine and early death.
  • All of us come into the world with our own genetic predispositions to psychological ills. Depression, anxiety, the whole panoply of adult woes are woven into our genomes. That may not be surprising to scientists, but new research shows that these conditions can start to express themselves much earlier than we knew — sometimes during the first year of life. Trauma can trigger the onset; so can stress, and so can still unknown variables.

    a growing body of research shows that many others — including posttraumatic stress disorder (PTSD), social-anxiety disorder, major depression, insomnia, even prolonged bereavement — also afflict young children. "Disorders we see in adulthood have antecedents in childhood," says Dr. Robert Emde, an emeritus professor of psychiatry at the University of Colorado School of Medicine. "The psychopathology simply becomes more complex.“

    Chronic stress can have a similar impact on the brain. In a 2010 study, psychologist Nim Tottenham of Weill Cornell Medical College in New York City conducted magnetic-resonance-imaging scans of the brains of 78 children (9 years old on average; babies would never hold still long enough), about half of whom had spent part of their early lives in orphanages. She also conducted behavioral tests on the kids' emotional-regulation skills. In general, she found that the later the children had been adopted — and thus the longer they'd been institutionalized — the larger their amygdalae were. (The amygdala governs emotions such as fear and alarm.) Those kids also performed worse on the emotional test. Another 2010 study of abused children yielded similar findings.
    Even the subtler pressures of the home — combative parents, economic hardship, parental substance abuse — can do long-term damage. "Babyhood has its stresses," says Dr. Jack Shonkoff, professor of child health and development at the Harvard School of Public Health.
  • a report that identifies criteria for building a trauma-informed mental health service system, summarizes the evolution of trauma-informed and trauma-specific services in the U.S. mental health systems, and describes a range of trauma-based service models and approaches implemented by increasing numbers of state systems and localities across the United States.

    By Anne Jennings, PH D (Maine), in 2004, updated in 2008

    Among her many accomplishments: She initiated and for 8 years directed the first state system Office of Trauma Services in the country for Maine’s Department of Behavioral and Developmental Services.
  • Misdiagnoses: As children and adolescents, a multiplicity of trauma-related behaviors
    and coping mechanisms may lead to misdiagnoses such as attention deficit
    hyperactivity disorder, oppositional defiant disorder, conduct disorder, substance
    related disorders, juvenile or pediatric bipolar, bipolar depression, borderline
    personality disorder, and major depression. (Glad and Teicher, 1996; Perrin et al,
    2000, Hodas, 2006).

    In spite of the prevalence of trauma and its severe impacts
    on the mental health of adults and children, a primary or secondary trauma-based
    diagnosis of Post-traumatic Stress Disorder is seldom given. (NYS-OMH, 2001;
    Tucker, 2002) MDTIBHSTSS Update 2007, pg 10


    MDTIBHSTSS: Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services by Ann Jennings, PhD
  • Virtually anyone needing/seeking services has experienced trauma at some level.
  • ALL OF US/HUMANS started out just like this:
    WHY DID TICP DEVELOP? Why are you here? Why are you in this field?

    PAUSE HERE: GROUP DISCUSSION? ASK SMALL GROUPS TO DISCUSS:
    WHERE DO YOU WORK?
    WHAT IS YOUR INTEREST IN TICP?
    WHAT HAS BEEN YOUR EXPERIENCE IN YOUR SETTINGS?
  • ANSWERS? WHY DID TICP DEVELOP?
  • As with any change, this one has been ‘in the works’ for decades, perhaps longer

    Who can “I” change? me. And in the process “I” may influence others…(ME: ‘TRAUMA QUEEN” sometimes disparagingly—BUT—THAT is what is remembered…)
  • We’re not saying “throw out” the medical model; but we are saying “shift the balance” to a more human-centered approach
  • ANOTHER WAY TO SEE IT
  • GO TO LINK: JUDGES

    Bloom: There is chronic short-staffing…in mental health “The System Bites Back”
  • Spent 17 years in mental health system, completing suicide at 32 years old while inpatient

    CLICK DO NO HARM for re-traumatization chart
  • When the child becomes an “adult”, the system continues to fail and to reinforce “you’re crazy, sick, damaged beyond repair”
  • Find serenity in the midst of pain
  • GO TO LINKS
  • Can you recognize the re-traumatization that may be occurring?
  • Let’s look at how the solution and the benefits are entwined
  • Emphasis on “evidence-based”—one positive effect is: research is important and our treatment modalities, service contracts, even our mission statements can hold us accountable—this is a good thing---

    elevates our work
  • At every level, in any organization, we benefit by the use of TICP
  • Really, if we work from a TICP mindset, we will ‘practice what we preach’ to our customers: clients, patients—this will benefit us physically, emotionally, socially, psychologically, spiritually
  • I have seen changes in these areas when TICP is the norm
  • He’s a child psychiatrist AND neurobiologist; he is saying that “how” we are, as humans, is NOT primarily genetic.
  • ACE

    How is this different than merely asking “were you abused”?

    I have experienced asking specifics, like this, with a matter of fact demeanor, can bring out a client or patient;

    WHAT ARE YOUR OBJECTIONS?
  • What is your response? Diagnostics are not objectively driven; they are driven by our training, biases, professional and personal experiences.

    The doctor who says: “I don’t believe in PTSD” will NOT see the effects; he will see “genetics”: bi-polar, OCD, oppositional defiant, schizophrenia, etc
  • WHAT DO YOU SAY THIS PERSON IS A SURVIVOR ‘OF’? (Childhood/Adult trauma AND re-traumatization by the system of care)

    What would be the outcome if this person’s expressions about trauma (past and present) had been validated, affirmed, treated?
  • READ HIGHLIGHTS FROM ARTICLE
  • Hospitals, crisis centers, community mental health, substance abuse treatment, behavioral health inpatient (PHYSICAL AND CHEMICAL RESTRAINTS), outpatient, private practice
    Schools: school violence, bullying, date rape, insensitive/wounded teachers, administrators; effects of trauma on learning
    Police officers: CPS cases, caseworkers, Judges, attorneys, Guardian Ad Litums
    Behavioral support settings, parenting programs (preventative), nursing homes etc etc etc
  • CLICK LINK
  • CLICK LINKS AS TIME ALLOWS

    IA DEPT PUB HEALTH: MATERNAL & CHILD HEALTH SERVICES TITLE 5 BLOCK GRANT: 2011 REPORT: #2 INTEGRATE TRAUMA-INFORMED PROFESSIONAL DEVELOPMENT ACROSS ALL DEPARTMENTS AND SYSTEMS SERVING FAMILIES

  • What are your thoughts? HOW is the shift “challenging, threatening”? What “resistance” and “denial” have you seen and experienced?
  • Trauma-Informed Care Perspective: Straight Talk About the Paradigm Shift (conference session 1)

    1. 1. TRAUMA-INFORMED CARE PERSPECTIVE STRAIGHT TALK ABOUT THE PARADIGM SHIFT Going Mainstream Series: Level I Cathy S Harris, MSW, LCSW www.trauma-informedtraining.com
    2. 2. CATHY S. HARRIS, MSW, LCSW 619.807.9159
    3. 3. if you become overwhelmed Breathe Exercise self-care Note your questions Remain curious Cathy S Harris, MSW, LCSW copyright 2011
    4. 4. TRAUMA-INFORMED PERSPECTIVE The real nitty-gritty Cathy S Harris, MSW, LCSW copyright 2011
    5. 5. warning: scenes of graphic violence http://www.youtube.com/watch?v=ipmNpisZadw BILLY JOEL: WE DIDN’T START THE FIRE
    6. 6. • we all want peace and safety
    7. 7. • • Where/when did you first hear the term: • “Trauma-Informed”? • What does “Trauma-Informed” mean to you? • What has been your experience in settings where trauma is not the focus? • What training did you pursue for your degree? Does it relate to your work and interests? • What is your interest in “Trauma-Informed Care” training? • What are your challenges/mirrors? Cathy S Harris, MSW, LCSW copyright 2011
    8. 8. TRAUMA-INFORMED CARE PERSPECTIVE OVERVIEW (PART 1) • What is the Trauma-Informed Care Perspective? How does our background relate? • What is trauma? What categories and levels do we need to know? What are the after-effects? Who is affected? Why did TICP Develop? • What is the Paradigm Shift? What are the effects of ignorance of TICP? What will change when we use TICP? • Who would benefit from the use of TICP? What are the benefits? • What Challenge do we face? Cathy S Harris, MSW, LCSW copyright 2011
    9. 9. ? WHAT IS IT Cathy S Harris, MSW, LCSW copyright 2011
    10. 10. . . . a deeper view Cathy S Harris, MSW, LCSW copyright 2011
    11. 11. Trauma-Informed perspective is first and foremost about “What happened to you?” Trauma-Informed approach is based in compassion and a recognition that all humans experience trauma in their lives. Trauma-Informed approach recognizes that all humans possess strengths and as survivors, have demonstrated courage with resiliency. Victimization must be acknowledged and validated but individuals’ assets must be utilized in an empowerment process. Essentially it’s about working with an understanding of who the person is, what they are coping with, “where” they are coming “from”. Cathy S Harris, MSW, LCSW copyright 2011
    12. 12. WATCH ON YOUTUBE (copy & paste) http://www.youtube.com/watch?v=Zc6oSsXUeyw
    13. 13. WHY ARE WE TALKING ABOUT THIS? what’s it all about? Cathy S Harris, MSW, LCSW copyright 2011
    14. 14. Trauma Informed Care Perspective is based on the “recognition of psychological trauma as a pivotal force that shapes the mental, emotional, and physical well-being of those seeking healing and recovery with the support of mental health and human services.” US DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse Mental Health Services Administration SAMHSA Cathy S Harris, MSW, LCSW copyright 2011
    15. 15. FREE DOWNLOAD AT (copy & paste) http://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdff
    16. 16. what’s wrong with you? what happened to you? Cathy S Harris, MSW, LCSW copyright 2011
    17. 17. THE PIONEERS Names to know Bessel van der Kolk Babbette Rothschild Bruce Perry Christine Courtois Cathy S Harris, MSW, LCSW copyright 2011
    18. 18. Colin Ross Lenore Terr James Chu Alice Miller Peter Levine Judith Herman Cathy S Harris, MSW, LCSW copyright 2011
    19. 19. Background Trauma Paradigm Shift The challenge Cathy S Harris, MSW, LCSW copyright 2011
    20. 20. background what are your influences? • Freedom through education • Training • A dream fulfilled residential: children & teens Red Cross counselor Magellan care coordinator in-home therapist IOP therapist agency private practice crisis center military substance abuse civilian treatment on the ‘other’ side Cathy S Harris, MSW, LCSW copyright 2011
    21. 21. ? HOW ABOUT YOU Cathy S Harris, MSW, LCSW copyright 2011
    22. 22. Trauma don’t be afraid Cathy S Harris, MSW, LCSW copyright 2011 • What is trauma? • What are the effects of trauma? • Who is affected?
    23. 23. Trauma is not just the result of major disasters. It does not happen to only some people. An undercurrent of trauma runs through ordinary life, shot through as it is with the poignancy of impermanence...Our world is unstable and unpredictable, and operates, to a great degree and despite incredible scientific advancement, outside our ability to control it. Cathy S Harris, MSW, LCSW copyright 2011
    24. 24. WATCH CLIP
    25. 25. • Has Elizabeth experienced trauma? • How would you ask her about trauma? • What factors do you consider? • What diagnoses might you utilize? • What treatment approach(es) would you consider? • What medication(s) would you expect? • What outcomes would you expect? WHAT DO YOU SAY? Cathy S Harris, MSW, LCSW copyright 2011
    26. 26. Disaster: fire, tornado, hurricane, auto accident, floods; moving to a new location, death of loved and significant person, divorce, injury, illness, separation from loved ones, terrorism, violence including rape, physical assault, robbery, personnel’s war injury TRAUMA EXAMPLES Family member’s ongoing physical or mental illness, addiction behavior, ongoing physical, emotional, verbal, mental, sexual abuse, neglect, poverty, ongoing war or community conflict, racism, repeated childhood hospitalization and/or medical procedures, misdiagnosis of conditions, personnel's’ war experience, financial abuse or exploitation SHOCK TRAUMA/EVENT SPECIFIC: CHRONIC/RELATIONAL/COMPLEX: Cathy S Harris, MSW, LCSW copyright 2011
    27. 27. breathe Cathy S Harris, MSW, LCSW copyright 2011
    28. 28. Traumatic experience challenges a person’s ability to cope; the person may believe he/she will die or “go crazy”, they may exclaim “I can’t stand it!” GROWING BEYOND SURVIVAL Page xi “trauma is defined by the experience of the survivor”… AND GROWING BEYOND SURVIVAL Page xi Cathy S Harris, MSW, LCSW copyright 2011
    29. 29. Denial of victimization is a COPING DEFENSE for victimization
    30. 30. copyright Cathy S Harris, MSW, rLCSW copyright Cathy S Harris, LISW September 2010
    31. 31. ? WHAT WOULD YOU ADD Cathy S Harris, MSW, LCSW copyright 2011
    32. 32. pause for a moment. . . Cathy S Harris, MSW, LCSW copyright 2011
    33. 33. LEVELS OF EXPOSURE • Acute Trauma refers to a single traumatic event that is limited in time, such as an auto accident, a gang shooting, a parent's suicide, or a natural disaster. • Chronic Trauma refers to repeated assaults on the child's mind and body, such as chronic sexual or physical abuse or exposure to ongoing domestic violence. • Complex Trauma is a term used by some trauma experts to describe both exposure to chronic trauma, often inflicted by parents or others who are supposed to care for and protect the child, and the long-term impact of such exposure on the child (Cook et al, 2005). Department of Children and Families, Connecticut Cathy S Harris, MSW, LCSW copyright 2011
    34. 34. • TRAUMA is NOT a particular diagnosis • TRAUMA is NOT always ‘reportable’ • TRAUMA is NOT a particular treatment • TRAUMA is NOT always newsworthy • TRAUMA is NOT a rare condition/experience THINK ABOUT YOUR CLIENTS Cathy S Harris, MSW, LCSW copyright 2011
    35. 35. TRAUMA-INFORMED CARE PERSPECTIVE IS NOT “just the next big fad in behavioral health” “just another training we have to attend”
    36. 36. “Any event or situation that causes a person to experience stress so extreme that it overwhelms his or her natural ability to cope” DEFINITION by DICTIONARY.COM “An experience that produces psychological injury or pain.” GROWING BEYOND SURVIVAL by ELIZABETH VERMILYEA Cathy S Harris, MSW, LCSW copyright 2011
    37. 37. any situation that leaves you feeling overwhelmed and alone can be traumatic, even if it doesn’t involve physical harm Cathy S Harris, MSW, LCSW copyright 2011
    38. 38. Under-education Under-employment Life-time physical ills Mental Health Diagnoses Dysfunctional relationships Poor parenting of future generations Increased vulnerability to new trauma Criminal activity & behavior---incarceration Substance overuse & abuse, behavioral addictions Suicide WHAT ARE TRAUMA’S AFTER-EFFECTS? Cathy S Harris, MSW, LCSW copyright 2011
    39. 39. The Brain and Trauma: Simon Fallavollita youtube.com
    40. 40. Adverse Childhood Experiences: ACE Study IT HURTS US TO HURT US Cathy S Harris, MSW, LCSW copyright 2011
    41. 41. ? WHO IS AFFECTED Cathy S Harris, MSW, LCSW copyright 2011
    42. 42. It Can Begin in Infancy Small Child, Big Worries Time Magazine 03/11 Cathy S Harris, MSW, LCSW copyright 2011
    43. 43. WHO IS AFFECTED? public mental health clients… 51-98% of have been exposed to childhood physical and/or sexual abuse MODELS FOR DEVELOPING TRAUMA-INFORMED BEHAVIORAL HEALTH SYSTEMS AND TRAUMA SPECIFIC SERVICES pg. 12 women and men in substance abuse treatment 75% report abuse and trauma histories Cathy S Harris, MSW, LCSW copyright 2011
    44. 44. Who is affected? homeless women with mental illness 97% experienced severe physical and/or sexual abuse, 87% experienced as both children and adults female offenders Nearly 8/10 with a mental illness reports having been physically and/or sexually abused Cathy S Harris, MSW, LCSW copyright 2011
    45. 45. Who is affected? children and adolescents in …inpatient and …residential treatment In Massachusetts, 82% of all have trauma histories teens with alcohol and drug problems 6-12 times more likely to have a history of physical abuse and 18-21 times more likely to have been sexually abused than those without (substance abuse) problems Cathy S Harris, MSW, LCSW copyright 2011
    46. 46. Cathy S Harris, MSW, LCSW copyright 2011
    47. 47. TIC “…recognizes that when patients come to us in the hospital, they have often been trapped for many years in a cycle of traumatic experiences and symptoms of trauma, and their entrance into the hospital offers us a critical moment to treat that trauma.” SUBSTANCE ABUSE MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) What is Trauma-Informed Care? “Most individuals seeking public behavioral health services and many other public services…have histories of physical and sexual abuse and other types of trauma-inducing experiences. These experiences often lead to mental health and co-occurring disorders such as chronic health conditions, substance abuse, eating disorders, and HIV/AIDS, as well as contact with the criminal justice system.” DR. THEODORE CORBIN, CO-DIRECTOR, NNHVIP National Network of Hospital-based Violence Intervention Programs Cathy S Harris, MSW, LCSW copyright 2011
    48. 48. • Individually • Organizationally • Socially • Nationally • Worldwide The Paradigm Shift will we do it? Cathy S Harris, MSW, LCSW copyright 2011
    49. 49. what’s wrong with you? what happened to you? Cathy S Harris, MSW, LCSW copyright 2011
    50. 50. Injury model Whole person Recovery-oriented: strengths, assets, resilience Compassion-based Universal experience Validates Results: connection, move beyond Science Humanitarian Spiritual PARADIGM SHIFT NEEDED Illness model Symptom-oriented Business as usual Medication: prime ‘treatment’ Reductionist “You’re sick, I’m not” Re-traumatizes via lack of validation, acknowledgment, affirmation “Revolving door”, lifetime of illness, medication TRAUMA-INFORMEDMEDICAL MODEL Cathy S Harris, MSW, LCSW copyright 2011
    51. 51. MEDICAL MODEL VS TRAUMA-INFORMED WHAT’S WRONG WITH YOU? WHAT HAPPENED TO YOU? AXIS III, IV, V AXIS II AXIS I AXIS II, III, IV,V AXIS I Cathy S Harris, MSW, LCSW copyright 2011
    52. 52. EXAMPLES OF TRAUMA-INFORMED APPROACH • Training for police officers: dealing with persons who have autism, (others) • Privacy practices in physical environments • Staffing practices in various settings • The Dog Whisperer/The Horse Whisperer • Sexual harassment training/sensitivity training • Integrated medicine • 10 Things Every Juvenile Court Judge Should Know About Trauma Cathy S Harris, MSW, LCSW copyright 2011
    53. 53. ? WHAT HAPPENS WHEN IT IS IGNORED Cathy S Harris, MSW, LCSW copyright 2011
    54. 54. Ann Jennings, Ph D MODELS FOR DEVELOPING TRAUMA-INFORMED BEHAVIORAL HEALTH SYSTEMS AND TRAUMA SPECIFIC SERVICES Cathy S Harris, MSW, LCSW copyright 2011
    55. 55. a family tragedy Cathy S Harris, MSW, LCSW copyright 2011 DO NO HARM
    56. 56. RE-TRAUMATIZATION System-Induced Trauma for the child include: • A child's trauma history is not identified; • A child's trauma history is identified, but there is no referral and follow through regarding trauma-specific assessment and/or trauma-specific treatment; • A child's traumatic stress is compounded by a failure to address ongoing safety needs of the child and adult survivor; and/or • The child's traumatic stress is compounded by ongoing experiences of instability and uncertainty involving abrupt, unexplained removals from one's own home or multiple out-of-home placements in a short period of time. Department of Children and Families, Connecticut Cathy S Harris, MSW, LCSW copyright 2011
    57. 57. Cathy S Harris, MSW, LCSW copyright 2011
    58. 58. additional effects of ignorance How childhood abuse primes the brain for mental illness Trauma and Behavioral Health In the workplace Burden on society Common Denominator Anna Financial costs Buffalo School of Social Work Human rights Comorbidity Colin Ross, MD Cathy S Harris, MSW, LCSW copyright 2011
    59. 59. TRAUMA DENIED OR IGNORED , Oppositional Defiant Disorder, Conduct Disorder, Borderline, Anti-Social, etc. No One Asks about environment thus defense: self-blame “I’m Bad” Medication, counseling focus on child as PROBLEM Adult rejects treatment, passes on pain to offspring Child “acts out” Cathy S Harris, MSW, LCSW copyright 2011
    60. 60. GRIEF/LOSS/ANGER Think about your clients. Often we identify the child or children as being “the problem”, however, if we use a family systems perspective and think in terms of response to environment, we can recognize that both the children and adults of many families are manifesting issues of grief, loss and anger. This phrase may take some of the stigma out of the word trauma as trauma-informed perspective is NOT about blame and shame of anyone. Cathy S Harris, MSW, LCSW copyright 2011
    61. 61. A CONTINUUM OF EXPERIENCE Family of Origin Issues Divorce (unresolved) Adoption Death of parent/significant caretaker Alcoholism/Addictions Mental/Physical Illness Shock Event/ Abuse/Neglect Physical Emotional Spiritual Sexual Witness to Violence Disasters etc. Cathy S Harris, MSW, LCSW copyright 2011
    62. 62. ASSOCIATED DIAGNOSES Family of Origin Issues Shock Event/Abuse/Neglect Childhood Oppositional Defiant, Conduct Disorder, Attention Disorders, Adjustment Disorders (DSM V: Temper Dysregulation Disorder) Adult Schizophrenic, Post-Traumatic Stress Axis II— “Personality” Disorders, Obsessive-Compulsive, Mood Disorders, Panic, Anxiety, Addictions, Eating Disorders, Dissociative Disorders, Agoraphobia, etc. Cathy S Harris, MSW, LCSW copyright 2011
    63. 63. • • Where/when did you first hear the term: “Trauma- Informed”? • What does “Trauma-Informed” mean to you? • What has been your experience in settings where trauma is not the focus? • What training did you pursue for your degree? Does it relate to your work and interests? • What are your challenges/mirrors? Cathy S Harris, MSW, LCSW copyright 2011
    64. 64. NON-TRAUMA-INFORMED APPROACH • Patients/Clients: labeled/pathologized: manipulative, needy, attention- seeking • Mis/over-use of power: keys, security, demeanor • Culture of secrecy: no advocates, insufficient monitoring of staff • Staff believe primary role: rule enforcers (Nurse Ratchet) • Restraints: physical and chemical • Emphasis: compliance rather than collaboration
    65. 65. NON-TRAUMA-INFORMED APPROACH (CONT.) • TIC in name only • Institutional disempowerment/disrespect/non-value of staff-this is passed on to patients/clients (Lissa R) • High rates of staff and recipient assault and injury • High rates of adult, child/family complaints • Higher rates of staff turnover and low morale • Longer lengths of stay/increase in recidivism
    66. 66. ? WHAT ARE THE BENEFITS OF USING TRAUMA-INFORMED CARE PERSPECTIVE Cathy S Harris, MSW, LCSW copyright 2011
    67. 67. BENEFITS: SERVICE RECIPIENTS • Educational & experiential approach • Addresses real life difficulties now • Validating & affirming of client’s experience • Empowering: assists clients to take responsibility for self, creates hopeful outlook, creates productive members of larger society • Can break the cycle of trans-generational family pain that results in under- fulfilled lives • Avoids re-traumatization by organizations and individuals Cathy S Harris, MSW, LCSW copyright 2011
    68. 68. Cathy S Harris, MSW, LCSW copyright 2011
    69. 69. BENEFITS: PROFESSIONALS • Addresses counter-transference • Relieves compassion fatigue, effects of vicarious traumatization, prevents burn-out • Provides tools and prevents re-traumatization • Measurable and cost-effective • Reduces “revolving door” cycle • Can provide structure, appropriate boundaries, protection re liability issues Cathy S Harris, MSW, LCSW copyright 2011
    70. 70. WHAT WILL CHANGE? think about your own setting Cathy S Harris, MSW, LCSW copyright 2011
    71. 71. WHAT will change? • Assessment • Diagnoses • Treatment • Medication Cathy S Harris, MSW, LCSW copyright 2011
    72. 72. “Humans are complex creatures. While having the capacity to be humane, we also have the capacity to be cruel. Why? What determines whether a child grows up to be compassionate, thoughtful, and productive? Or, impulsive, aggressive, hateful, and non-productive? Is it genetic? Likely not.” BRUCE PERRY, MD, PH D (CHILD PSYCHIATRIST AND NEUROBIOLOGIST) Child Trauma Academy PLEASE CLICK LINK assessment
    73. 73. http://acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf (copy & paste)
    74. 74. “In psychiatry mental illness is a metaphor imposed on people’s behavior. There aren’t any physical methods of diagnosing a mental illness: There’s no blood test. There’s no MRI.” GAIL HORNSTEIN, PH D, PROFESSOR OF PSYCHOLOGY: MT HOLYOKE COLLEGE The Sun, July 2011, Issue 427 diagnosis
    75. 75. A survivor speaks: “In the system I was taught to identify with all of the labels I was given and so I lived them all. Expertly. I was rewarded for ‘being’ what my defined role was in these "therapeutic" relationships. I was punished and shamed for resisting by being labeled as difficult etc. I was groomed my entire life to see myself as ‘nuts’ and the grooming continued as my reality was denied and I was told that my life issues were because I was ‘sick’.” QUOTED WITH PERMISSION A Journey treatment Cathy S Harris, MSW, LCSW copyright 2011
    76. 76. 1992: Three stage model 1. Establishing safety 2. Reconstructing the traumatic story 3. Restoring the connection between the survivor and his/her community. JUDITH HERMAN: TRAUMA & RECOVERY Cathy S Harris, MSW, LCSW copyright 2011
    77. 77. “… at Oregon's Salem Hospital, I was part of the miraculous transition to a trauma-informed environment. Seclusion and restraint were eliminated, and there was a substantial decline in the administration of involuntary medications (as well as a 30 percent decline in the use of routine medication).” CHARLES B NEMEROFF, ET AL Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma “The superiority of psychotherapy (with or without nefazodone) for patients reporting early life trauma persisted…” DR. BENNINGTON–DAVIS , CHIEF MEDICAL & OPERATING OFFICER: CASCADIA BHC IN PORTLAND, OREGON. SAMHSA: Recovery to Practice e-newsletter Cathy S Harris, MSW, LCSW copyright 2011 medication
    78. 78. PSYCHIATRIC INDUSTRY DRIVEN BY WEALTH AND STEALTH, NOT MENTAL HEALTH Drug company corporate websites tell us of their integrity and utmost commitment to people's health and well-being. The American Psychiatric Association's website begins with "Healthy Minds. Healthy Lives" and asserts the "highest ethical standards of professional conduct." Yet a mountain of evidence points to an entirely different picture. naturalnews.com Cathy S Harris, MSW, LCSW copyright 2011
    79. 79. Treatment Education Legal Support Macro Daycare-PhD On the streets Behavioral Micro In the courts Parenting Jails & Prisons Geriatric WHERE IS IT NEEDED? Cathy S Harris, MSW, LCSW copyright 2011
    80. 80. JUST GOOGLE IT what is your interest? Cathy S Harris, MSW, LCSW copyright 2011
    81. 81. WHAT ABOUT IOWA? The Iowa Consortium for Mental Health: University of Iowa Iowa Foster and Adoptive Parents Association Midwest Trauma Services Network Trauma-Informed Care Training of Iowa Orchard Place Iowa Department of Education Family Resources: Eastern Iowa/Western Illinois Schulte Consulting IA Dept of Public Health Cathy S Harris, MSW, LCSW copyright 2011 UNI UI DSM UI?? ISU??
    82. 82. “Training programs, degree programs…etc. are still woefully deficient in conveying the research data to the people who need to know it. Trauma training is not about the seemingly simple problem of giving people information…The real problem is that the material is challenging, threatening, and it may elicit resistance to change and denial within individuals and within entire systems.” DR. SANDRA BLOOM The Sanctuary Model Cathy S Harris, MSW, LCSW copyright 2011
    83. 83. • Our own mirrors • Self-care • Spread the word • Your experience? The Challenge how will we meet it? Cathy S Harris, MSW, LCSW copyright 2011
    84. 84. wisdom to create serenity Cathy S Harris, MSW, LCSW copyright 2011
    85. 85. explanation, not an excuse Cathy S Harris, MSW, LCSW copyright 2011
    86. 86. explanation, not an excuse Cathy S Harris, MSW, LCSW copyright 2011
    87. 87. people are trying to get their needs met Cathy S Harris, MSW, LCSW copyright 2011
    88. 88. people are doing the best they can and... they need to improve Cathy S Harris, MSW, LCSW copyright 2011
    89. 89. and the day came when the desire to remain the same was more painful than the risk to grow… Cathy S Harris, MSW, LCSW copyright 2011
    90. 90. • to apply compassion in all my relationships • to be aware of my own trauma-related issues • to establish an environment of safety: physical, mental, emotional and spiritual • to work in balance, including balance in my own self-care • to offer hope, focusing on strengths while offering practical tools for improvement TRAUMA-INFORMED ETHICS I WILL STRIVE… Cathy S Harris, MSW, LCSW copyright 2011 619.807.9159
    91. 91. • for balance in boundaries, respecting that those I serve need my support but also need assurance that they are capable • to treat with respect those I serve and those with whom I serve • to keep up to date with developments in the trauma- informed field, but refrain from holding up any one method or modality as the only or right way to offer education, support, practical tools and resources TIC ETHICS (CONT.)

    ×