4. tia epl week 4

1. Integrating a Trauma-Informed
Approach in Behavioral Health
Settings

2. Brain & Body Connection for
Staff Members
Week 4

3. Self Care is Important

4. Week 3 Learning Activity- Discussion
• Read the article, “On Being Sane in Insane Places” (1973).
• Watch the video, “Behind Closed Doors” (2007).
• DISCUSSION: Contrast how organizations and systems may have
changed through the decades and how a trauma-informed
approach could have made a difference in these scenarios.

5. Week 4 Topics
• Key Principals of TIC - Review
• Organizational Stress
• Secondary forms of stress reactions
• Treatment strategies
• Self care

6. Key Principles to Trauma-Informed Care
• Safety
• Trustworthiness & transparency
• Peer support
• Collaboration & mutuality
• Empowerment & choice
• Cultural, historical & gender issues

7. Creating Cultures of Trauma-Informed
Care
CCTIC
Procedures
and
Settings
Formal
Services
Policies
Identifying
& Serving
Survivors
Support
from the
Top
Staff
Training
and
Education
Human
Resources
Practices
(Fallot and Harris, 2009)

8. Three Key Elements of TIC
1. Realizing the prevalence of
trauma;
2. Recognizing how trauma
affects all individuals
involved with the program,
organization, or system,
including its own
workforce; and
3. Responding by putting this
knowledge into practice”
(SAMHSA, 2012, p 4).

9. Who Is a Trauma Champion?
A CHAMPION:
• Understands the impact of violence and victimization on
the lives of people seeking mental health services
• Is a front-line worker who thinks ‘trauma first’ when trying
to understand behavior
• Asks ‘is this related to abuse and violence?
• Think about whether his or her own behavior is hurtful or
insensitive to the needs of a trauma survivor.
• The champion is there to do an identified job as a case
manager/counselor/residential specialist - in addition to
the job, is there to shine the spotlight on trauma issues.”
Harris & Fallot, 2001a, p. 8.

10. Peer Support
Strengths Peer Providers Add Unique Strengths and Qualities to the Integrated Workplace:
• Personal experience with whole health recovery that includes addressing wellness of both mind
and body
• Insight into the experience of internalized stigma and how to combat it
• Compassion and commitment to helping others, rooted in a sense of gratitude
Remove the “you do not know what it’s like” defense
• Experience of moving from hopelessness to hope
• In a unique position to develop a relationship of trust, which is especially helpful in working with
people in trauma recovery
• A developed skill in monitoring their illness and self-managing their lives holistically

11. Peer Support
A peer provider (e.g., certified peer specialist,
peer support specialist, recovery coach) is a
person who uses his or her lived experience of
recovery from mental illness and/or addiction,
plus skills learned in formal training, to deliver
services in behavioral health settings to promote
mind-body recovery and resiliency.
• Primary Care and Integrated Care settings
• Job descriptions are tailored to the settings
• Peer providers create personal self-
management tools like a Wellness Recovery
Action Plan (WRAP) to promote ongoing
recovery and whole health
• Formally trained
Lived Experience

12. Organizational Stress as a Barrier to
Trauma‐Informed Service Delivery
Anonymous activity calculating
ACE scores with staff members
• Residential programs for children
• Juvenile justice programs
• Community-based workers
• Public health professionals
• Other clinicians working in the
mental healthcare industry
Bloom, S.L.(2010)

13. Out of the 78 Staff Members:
33 – experienced psychological abuse via parents
24 – physically abused by parents
22 – sexually abused by someone as children
33 – emotionally neglected
8 – physically neglected
32 – had lived as a child with a substance abuser in the household
29 – experienced parental separation
20 – witnessed domestic violence directed at their mothers
14 – had lived with a household member who was imprisoned

14. QUESTION…..
•On a scale of 1 (low) – 5 (high) what level
of importance would you assign to knowing
your own ACE’s score?

15. Shelter from the Storm: Trauma-Informed Care in
Homelessness Services Settings
TIC is a strengths-based service delivery
approach:
 Grounded in an understanding of
and responsiveness to the impact of
trauma, that emphasizes physical,
psychological, and emotional safety
for both providers and survivors
Creates opportunities for survivors
to rebuild a sense of control and
empowerment.
TIC involves vigilance in anticipating
and avoiding institutional processes
and individual practices that are likely
to re-traumatize individuals with
histories of trauma,
Upholds the importance of consumer
participation in the development,
delivery, and evaluation of services.

16. Mirror Neurons
• Action performed by one, activated the same area in
the monkey’s brain – down to a single neuron
• Mirror Neurons - fMRI - motor cortex, but Keysers is
looking at touch, emotions, and pain
• Somatic empathy - empathizing with our body
Winerman, L. The mind's mirror. Monitor on Psychology, 36, 48. Retrieved June 18, 2014, from
http://www.apa.org/monitor/oct05/mirror.aspx

17. Wisdom of Pooh
“Now then, Pooh," said Christopher Robin, "where's
your boat?“
"I ought to say," explained Pooh as they walked
down to the shore of the island, "that it isn't just an
ordinary sort of boat. Sometimes it's a Boat, and
sometimes it's more of an Accident. It all depends.“
"Depends on what?“
"On whether I'm on the top of it or underneath it.”
Milne, A. (2009). In Which Piglet is Entirely Surrounded by Water. Winnie the Pooh (). New York: Penguin. (Original
work published 1926)
This Photo by Unknown Author is licensed under CC BY-NC-ND

19. IMPORTANT

20. Vicarious
Traumatization –
Sandra Bloom
Term that describes the cumulative
transformative effect on the helper of
working with survivors of traumatic
life events.
This Photo by Unknown Author is licensed under CC BY-SA

21. Vicarious Trauma
 Coined by Pearlman and
Saakvitne
 Worldview shifts
 Fundamental beliefs are
altered
 sense of purpose
 sense of meaning
 sense of hope

22. Secondary Traumatic Stress
(STS)
This Photo by Unknown Author is licensed under CC BY-NC-ND

23. DISCUSSION
• What are some of the signs that we need to pick up on when staff
are experiencing secondary traumatic stess?

24. Secondary Traumatic Stress
Fear
Sleep problems
Hypervigilance
Intrusive images
Feeling helpless regarding clients
Piglet - "I'll get some help. Oh
dear, I am the help."

25. Possible Signs of STS
 Missing work
 Increased use of alcohol/drugs
 Avoiding clients
 Avoiding or missing work
 Difficulty making decisions
 Relationship problems
 Pigeonholing, labeling, and/or losing
compassion for clients
 Silencing response in an effort to not
hear more traumatic experiences
This Photo by Unknown Author is licensed under CC BY-NC-ND

26. Compassion Fatigue
• Unfolds over time
• Because you care
• You feel committed or responsible
 More common with high workload
or in non-supportive environments
 Physically and emotionally
exhausted
 Gradual erosion of hope,
empathy, compassion
Moral Distress
 Policies or routines conflict with
personal beliefs or values
 May be a contributing factor to
compassion fatigue

27. Burnout
 Workload/Workplace
 Exhausted, Frustrated, Depression, hopelessness, difficulty working
effectively
 Doesn't really matter
 Situation feels hopeless
 Pessimist/Cynical
 Feel detached
 No sense of accomplishment
 Eeyore - "End of the road. Nothing to do, and no hope of things getting
better."

28. Burnout Quote from an M.D.
"The expectation that we can be
immersed in suffering and loss
daily and not be touched by it is
as unrealistic as expecting to be
able to walk through water
without getting wet.
We burn out because we’ve
allowed our hearts to become so
filled with loss that we have no
room left to care.”
Remen, R. (1996). Kitchen Table Wisdom:
Stories that Heal. New York: Penguin Putnum.
This Photo by Unknown Author is licensed under CC BY

29. PROFESSIONAL
QUALITY OF
LIFE SCALE
(PROQOL)
• http://www.proqol.org/uploads/ProQOL_5_E
nglish_Self-Score_3-2012.pdf

32. Self Care IS Important

33. Diaphragmatic Breathing
This Photo by Unknown Author is licensed under CC BY-SA

34. A quote from Komp (1993), a pediatric oncologist:
“For an agonizing hour he poured out
his young-ancient soul. Then he rose
from the chair with tears pouring
down his face. "You’re the best doctor
I’ve ever met," he exclaimed. "No one
has ever helped me as much as you
have. How can I thank you?“
I had never gotten to say a word to
Jay. I had only listened."
This Photo by Unknown Author is licensed under CC BY-ND

35. Motivational Interviewing
• Many parallels/complements
• Collaboration
• Respect for autonomy
• Empowerment
• Skills to maintain engagement
• Open-ended questions
• Reflective listening
• Affirmations
• Summaries (OARS)

36. Treatment - overall plan that addresses both sources of
difficulty and their interrelationships - ISTSS
• Experienced/skilled practitioners with expertise in mental health,
and the treatment of traumatic stress
• Coordinate and integrate treatment if practitioner is not skilled in
both
• Identify patterns of past/current mental health symptoms
• Treatment planning – discuss possible effects of mental health
symptoms on trauma-related matters, including sleep, anger,
anxiety, depression, and work/relationship difficulties
• Education, therapy and support groups that are acceptable to
the client

37. Week 4 Learning Activity
• Choose one self-assessment to complete as it relates to your position
within the organization
• “Creating Cultures of Trauma-Informed Care (CCTIC): A Self-Assessment and
Planning Protocol”
• “Trauma-Informed Organizational Toolkit for homeless services”
• Note: You may not have the answers to all of these areas depending on
your position. If possible and comfortable, ask others in your
organization to discuss other areas (e.g. Human Resources may be able
to provide information on interviewing/hiring) to get additional information.
• Be ready to discuss one area that you would like to improve with in your
current position

38. Toolbox
• Quick-guide Suggestions Prevention/Intervention with the Negative
Effects of Caregiving
• Links for additional Organizational Assessments
• Links for additional HR and staff considerations
How will you use this?
 Complete one self-assessment in the toolbox based on your role
in your organization

39. Acknowledgments
Kate Speck, Ph.D., MAC, LADC
Pam Oltman, MS, LIMHP, LADC
Mountain Plains Addiction Technology Transfer Center (MPATTC)