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6. tia epl week 6
- 1. Integrating a Trauma-Informed Approachin Behavioral Health Settings
- 2. Integrating a TraumaInformed Approach in Behavioral Health Settings Week 6
- 3. Week 6 Topics •KeyAssumptions, Principles, and Approaches •Creating Cultures of Trauma Informed Care •Domains of Trauma Informed Care
- 4. Self Care ISImportant
- 5. Week 5 LearningActivity LET’S DISCUSS YOUR INSIGHTS….. • Butterfly Circus - http://thebutterflycircus.com/short-film/ • Organizational Assesemnt: findings/insights learned by doing the assessment how you can be more trauma-informed within your role • SAMHSA-HRSA Center for Integrated Health Solutions page - resources in the section that most closely aligns with your position. https://www.integration.samhsa.gov/clinical- practice/trauma-informed
- 6. SAMHSA – KeyAssumptions The program, organization or system that is trauma-informed: 1. Realizes the widespread impact & understands potential paths for recovery 2. Recognizes the signs/symptoms (client, families, staff, and others) 3. Responds – Fully integrates knowledge into policies, procedures, and practices 4. Resists re-traumatization https://store.samhsa.gov/system/files/sma14-4884.pdf
- 7. SAMHSA – KeyPrinciples 1. Safety 2. Trustworthiness and Transparency 3. Peer Support/Trauma Survivors 4. Collaboration and Mutuality 5. Empowerment, Voice and Choice 6. Cultural, Historical, and Gender Issues
- 8. Creating Cultures of Trauma- InformedCare CCTIC Procedures and Settings Formal Services Policies Identifying & Serving Survivors Staff Training and Education Human Resources Practices Support from the Top
- 9. Creating Cultures ofTrauma-Informed Care Approach 5 Guiding Principles of Trauma-Informed Practice •Safety •Trustworthiness •Choice •Collaboration •Empowerment CCTIC
- 10. Six Domains 1. ServiceLevel - program procedures and settings consistent with principles 2. Formal Services Policies - formal policies reflect an understanding of trauma survivors’ needs, strengths, and challenges 3. Trauma Screening, Assessment, Service Planning and Trauma-Specific Services - consistent ways to identify trauma survivors and provide services 4. Administrative Support for Program-Wide Trauma-Informed Services - support from the top 5. Staff Trauma Training and Education 6. Human Resources Practices - hiring and review practices (CCTIC) CCTIC
- 11. Domain 1 -Program Procedures and Settings Procedures and Settings Key Question - “To what extent are program activities and settings consistent with five guiding principles of trauma- informed practice: safety, trustworthiness, choice, collaboration, and empowerment?”
- 12. On Being Sanein Insane Places – Rosenhan (p. 253) • “…behaviors that are stimulated by the environment are commonly misattributed to the patient’s disorder” • “The notes kept by pseudopatients are full of patient behaviors that are misinterpreted by well-intentioned staff. Often enough, a patient would go “berserk” because he had, wittingly or unwittingly, been mistreated by, say, and attendant. The nurse coming upon the scene would rarely inquire even cursorily into the environmental stimuli of the patient’s behavior. Rather, she assumed that his upset derived from his pathology, not from his present interactions with other staff members” • “Never were the staff found to assume that one of themselves or the structure of the hospital had anything to do with a patient’s behavior” This Photo by Unknown Author is licensed under CC BY-NC-ND
- 13. Safety—Ensuring Physical andEmotional Safety • Parking lot/lighting • Clear directions • Staff aware of signs of discomfort • Free of conflicts/assaults • Sensitivity to unsafe situations • Personal space • Welcoming/respectful contacts Procedures and Settings
- 14. SafetyHow might youimprove emotional and physical safety in your organization? Why would this be important based on what you have learned in this training This Photo by Unknown Author is licensed under CC BY-SA
- 15. Trustworthiness: Clarity, Consistencyand Boundaries • Is the program understandable? (e.g. who will do what, when, why) • Professional boundaries? When do they veer off? (e.g. sharing personal information, touching, etc.) • Clear roles? • Clear and reasonable expectations/decreased disappointment in services • Are goals/risks/benefits clearly stated? • Can supervisors and administrators be trusted to listen respectfully to supervisees’ concerns—even if they might not agree with some of the possible implications? Procedures and Settings
- 16. Maximizing Choice andControl • Choices regarding time, location or gender of the provider? • Choice about how contacts are made? • Choice to start/stop services • Information about choices/options available? • Who determines the priorities? Information about rights and responsibilities given? • Are consequences consistent? • Who is involved in meetings? Are peers and clients included? • When possible, are staff members given opportunities to have meaningful input into factors affecting their work? Procedures and Settings
- 17. Maximizing Collaboration andSharing Power • Are consumers and trauma survivors involved in planning? • Is respect shown for cultures, histories, experiences, skills and strengths? • Are consumer preferences viewed as important in planning, goal setting and development of priorities • Perspective of doing “with” rather than “to” or “for” • Does the program see the consumer as an expert of his or her experiences? • Are providers & consumers working together on some tasks? • Is there a balance of autonomy and clear guidelines in performing job duties? Procedures and Settings
- 18. Prioritizing Empowerment andSkill-Building • Are voices from multiple levels and roles in planning and evaluation included? • How are strengths & skills recognized? • Is there a sense of optimism? Is it realistic? • Is there an emphasis on growth rather than maintenance/stability? • Are skills strengthened? • Do individuals feel a sense of validation & affirmation? • Are each staff member’s strengths & skills utilized to provide the best quality care to consumers/clients & a high degree of job satisfaction to that staff member? Procedures and Settings
- 19. Domain 2 -Formal Services Policy Formal Services Policies Key Questions: To what extent do the formal policies of the program reflect an understanding of trauma survivors’ needs, strengths, and challenges? Of staff needs? Are these policies monitored and implemented consistently?
- 20. Formal Policies • Policyin place to de-escalate and avoid re-traumatization • Clear policies on access to information and confidentiality • Rights and responsibilities easily understood and accessible • Avoids involuntary or potentially coercive aspects of treatment • Ways to respect consumer preferences in crises developed • Policies in place to address staff safety Formal Services Policies
- 21. Dr. Gordon R.Hodas “At least one staff person with a strong understanding of trauma and trauma dynamics should be part of the review group. There is need to determine if any policies or procedures are damaging and replicate past abusive practices. There is special need for alertness to “traumatic reenactments masquerading as benign practice,” and policies and procedures that may inadvertently permit and rationalize abusive responses and relationships (p. 9).” http://www.dhs.pa.gov/cs/groups/public/documents/manual/s_001585.pdf
- 22. Retraumatization – TIP57 • Being unaware of the history • Failing to screen for trauma history • Challenging/discounting reports of events • Isolation/physical restraints • Disrupting counselor-client relationships (schedules, etc.) • Humiliation • Confrontational approaches • Allowing abusive behaviors • Labeling behaviors or feelings as pathological • Limiting participation in treatment decisions and planning • Obtaining UAs in non-private settings
- 23. DISCUSSION •What kinds ofpolicy changes would strengthen trauma informed services in agencies?
- 24. Trauma Policy TemplateState of Michigan - DHHS https://www.michigan.gov/documents/mdhhs/Trauma_Policy_Framework_Guide_576279_7.pdf This Photo by Unknown
- 25. Community Mental HealthPartnership of Southeast Michigan – Sample Policies https://www.washtenaw.org/DocumentCenter/View/6940/Trauma-Informed-Practice-Final-2017-CMHPOL-REG-07-17 This Photo by Unknown Author is licensed under CC BY-SA
- 26.
- 27. Pacific Northwest MHTTC Lookat each option/choice Consider costs and benefits of each choice Decision-making opportunities Cumulative impacts of many small choices can be as significant as the impacts of the large ones Consider who benefits and who may be harmed
- 28. Domain 3 -Trauma Screening, Assessment, Service Planning & Services Identifying & Serving Survivors Key Question: “To what extent does the program have a consistent way to identify individuals who have been exposed to trauma, to conduct appropriate follow-up assessments, to include trauma-related information in planning services with the consumer, and to provide access to effective and affordable trauma-specific services?”
- 29. SAMHSA’s National GAINSCenter for Behavioral Health and Justice: Essential Components of Trauma Informed Judicial Practice http://www.nasmhpd.org/sites/default/files/JudgesEssential_5%201%202013finaldraft.pdf I was in the mental health system for 14 years before somebody thought to ask me if I’d been hit, kicked, punched, slapped, or knocked out. When they asked those kinds of questions, I said, “Oh, yeah, sure.” But when they asked if I’d been abused, I said, “No.” It was just my life. — A Trauma Survivor
- 30. Trauma Screening, Assessment, ServicePlanning, & Services • Screening -minimal questions, avoid unnecessary detail • More detailed assessment after screening • Clinicians & consumers work together to discuss how trauma history can be taken into account • Offers or makes referrals to accessible/affordable/effective trauma-specific services Identifying & Serving Survivors
- 31. PTSD and LifeEvents Checklist
- 32. Dissociation • Dissociative ExperiencesScale II • http://traumadissociation.com/des • DES Taxon scorer • https://www.isst-d.org › uploads › 2019/06 › DES-Taxon-scorer • Sidran Institute • https://www.sidran.org/
- 33. TIP 57, p.59 • Empathy, not sympathy • Early stages – Stay with brief explanations of the trauma, deeper work should only be implemented if trauma-specific treatment planning and services are available • Educate the client about and normalize trauma-related symptoms • Create a sense of safety within the treatment environment • Address how trauma symptoms may interfere with the client’s life in the present, including during treatment and recovery (e.g. groups) • Identify and explore strengths
- 34. Domain 4 -Administrative Support for Program- Wide Trauma-Informed Services Support from the Top Key Question: “ To what extent do program or agency administrators support the integration of knowledge about violence and abuse into all program practices?”
- 35. Support from Administration Administratorssupport the integration of knowledge about violence and abuse into all program practices • Policy statements • Workgroup, trauma-specialist • Advisory group that includes trauma survivors • Support collaboration and shared decision-making • Provide trauma training and education • Willingness to attend training themselves/keep informed Support from the Top
- 36. Undercover Boss This Photoby Unknown Author is licensed under CC BY-NC
- 37. Network for Improvement in Addiction Treatment NIATx- Walk- Throughs
- 38. Domain 5 -Staff Trauma Training and Education Key Question: “To what extent have all staff members received appropriate training in trauma and its implications for their work?” Staff Training and Education
- 39. Staff Training/Education • Generalinformation about trauma and boundaries for all employees • Additional training for clinical staff members • Training to understand unusual or difficult behaviors • Trauma-specific coping skills training • Adequate support for staff • Training on topics such as vicarious trauma Staff Training and Education
- 40. Vicious Cycle Traumaticevent Emotional pain, intrusive memories, poor sleep, guilt, shame, anxiety, etc. Desire to numb Increased substance use Risky behaviors, decreased awareness, etc. Increased risk for more traumatic experiences e.g. https://www.istss.org/ISTSS_Main/media/Docu ments/ISTSS_TraumaStressandSubstanceAbuseP rob_English_FNL.pdf
- 41. International Society forTraumatic Stress Studies • One-quarter to three-quarters of people who have survived abusive or violent traumatic experiences report problematic alcohol use • As many as 50% of adults with both alcohol use disorders and PTSD also have one or more other serious psychological or physical problems. • Treatment for traumatization and substance abuse problems should be designed as an overall plan that addresses both sources of difficulty and their interrelationships. • Although there may be separate interventions devoted primarily to traumatization or to substance problems, they should be carefully coordinated and integrated
- 42. Treatment - overallplan that addresses both sources of difficulty and their interrelationships • Experienced/skilled practitioner with expertise in both substance abuse treatment and the treatment of traumatic stress • Coordinate and integrate treatment if not skilled in both • Identify patterns of past and current substance use • Treatment planning – discuss possible effects of substance abuse problems on trauma-related problems, including sleep, anger, anxiety, depression, and work or relationship difficulties • Education, therapy and support groups that are acceptable to the client
- 43. Domain 6 -Human Resources Practice Key Question: “To what extent are trauma-related concerns part of the hiring and performance review process?” Human Resources Practices
- 44. Human Resources • Aretrauma-related topics brought up in the hiring process as well as during performance reviews? • Seek to hire trauma “champions” • Do interviews include questions/discussions about trauma? • Is there recognition for trauma-related activities involvement for staff? Human Resources Practices
- 45. Learning Activity This Photo byUnknown Author is licensed under CC BY-SA
- 47. From the InsideOut: Think Bronfenbrenner’s Ecological Systems Theory
- 51. SAMHSA’s National GAINSCenter for Behavioral Health and Justice: Essential Components of Trauma Informed Judicial Practice Many treatment court participants have engaged in behavior that others might consider self-destructive, such as IV drug use, other substance abuse, prostitution, and self-injury. An essential component of being trauma informed is to understand these behaviors not as character flaws or symptoms of mental illness, but as strategies or behavioral adaptations developed to cope with the physical and emotional impact of past trauma. This paradigm shift does not imply lack of responsibility for illegal behavior, but it does provide an opportunity to apply approaches that are most effective in promoting recovery and reducing recidivism.
- 54. We all haveour own life to pursue, our own kind of dream to be weaving. And we all have some power to make wishes come true, as long as we keep believing. - Louisa May Alcott This Photo by Unknown Author is licensed under CC BY
- 55. This Photo byUnknown Author is licensed under CC BY-SA-NC