PowerPoint - Trauma Informed Care and Effective Screening
Download
Report
Transcript PowerPoint - Trauma Informed Care and Effective Screening
Christine Heyen, MA
Crime Victims’ Services Division
Oregon Department of Justice
Association of Public Health Nursing
Supervisors
Annual Conference
May 9, 2012
Imagine a place that…
Asks “What happened to you?” instead of “What is
wrong with you?
Understands past trauma can be triggered by
experiences in the present
Is committed to supporting people as they heal
Leaves a person feeling edified
What is trauma?
“Trauma is an event that is extremely upsetting
and at least temporarily overwhelms internal
resources.”
Briere, J. (2006). Dissociative symptoms and trauma exposure: Specificity,
affect dysregulation, and posttraumatic stress. Journal of Nervous and
Mental Disease, 194, 78-82.
What is Trauma?
It can be a single event
More often than not it is multiple events over time
(complex, prolonged trauma)
An interpersonal violence or violation, especially at the
hands of an authority/trust figure is especially
damaging
What does trauma do to us?
Chronic trauma interferes with neurobiological
development and the capacity to integrate sensory,
emotional and cognitive information into a cohesive whole.
Developmental trauma sets the stage for unfocused
responses to subsequent stress.
Bessel A. van der Kolk , MD
http://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trau
ma_Disorder.pdf
ACE Study
http://www.cdc.gov/ace/index.htm
Adverse Childhood Experiences (ACE) Study
Traditional Approach vs.
Trauma Theory
Traditional approach
You are sick
You are bad
You are sick and bad
Trauma theory
You are not sick or bad
You are injured
Trauma Informed Care (TIC)
“Trauma-Informed Care is a strengths-based framework that is
grounded in an understanding of and responsiveness to the
impact of trauma, that emphasizes physical, psychological, and
emotional safety for both providers and survivors to rebuild a
sense of control and empowerment.” (Hopper et al, 2010)
“Trauma-informed organizations, programs, and services are
based on an understanding of the vulnerabilities or triggers of
trauma survivors that traditional service delivery approaches
may exacerbate, so that these services and programs can be more
supportive and avoid re-traumatization.” (SAMHAS)
What does TIC offer?
Improves our desired outcomes
Supports trauma recovery by
Reducing re-traumatization
Providing “corrective emotional experience”
Decreases our own vicarious trauma or compassion
fatigue
Core Principles of TIC
Awareness: Everyone knows the role of trauma
Safety: Ensuring physical and emotional safety
Trustworthiness: Maximizing trustworthiness, making
tasks clear, and maintaining appropriate boundaries
Choice: Respect and prioritize consumer choice and
control
Collaboration: Maximizing collaboration and sharing
of power with consumers
Empowerment: Prioritizing consumer empowerment
and skill-building
TIC Communication Style
Transactional
Focus on information exchange
Transactional with Social Talk
Mostly information exchange with some social talk (e.g.
joking, comment on weather)
Interactional
Focus on rapport-building and interpersonal
relationship integrated with the information exchange
https://nchdv.confex.com/nchdv/2012/webprogram/Sessio
n2199.html
Tips for Practicing TIC
Use language the person recognizes
“Has your partner messed with your birth
control?”
Meet the survivor “where they are”
If a person is not ready to talk, do not force the
conversation. Rather keep the door open for a
later time.
Consider the person’s cultural context
Avoid making assumptions – just ask!
Tips for Practicing TIC
Recognize adaptive behaviors serve a purpose
Why is a person chronically miss morning
appointments? Is the morning the only time she
can sleep? Does she have a traumatic brain injury
that prevents her from remembering things?
Make adjustments to help that person succeed.
Set appointment times for the afternoon.
Include everyone in your agency
From receptionist to treatment staff
Provide trauma training to every employee
How do we provide TIC?
Listen
What is the survivor saying to you?
What is the survivor not saying?
How is the survivor saying it?
Inform
What information do you have that may help her?
What will happen next in the process?
Why is the information important for her to have?
How can your services can help her?
How do we provide TIC?
To the best of your ability and within your given time
constraints:
Lose the labels
Let her tell her story
Give her time and space to tell her story
Let the survivor lead
Respect her voice and choice
Recognize the survivor’s comfort level
Consider the survivor’s perspective from her cultural
context
Quick & Easy
Offer support and validation
Communicate care and concern
Avoid passing judgement
Ask questions of the survivor
Find out if she is experiencing some kind of violence or
coercion in her life
Listen to what she has to say
Resist interrupting her
Make sure your body language is receptive
Offer information and assistance
Give her a resource card, a phone number, or a website
Refer her to an advocate (warm hand-off)
Tell her you are available to her in the future
Resources
Trauma and Trauma Informed Care
http://www.trainingforums.org/lms/
Trauma Informed Care – PowerPoint presentation by
Mandy A. Davis, LCSW, Portland State University
http://www.doj.state.or.us/victims/pdf/trauma_inform
ed_care_presentation_outline.pdf
Futures Without Violence
http://www.futureswithoutviolence.org/
Resources
Supporting health needs of women in shelter: Exploring
traumatic brain injury and reproductive coercion
https://nchdv.confex.com/nchdv/2012/webprogram/Session2
192.html
Violence and reproductive coercion: Assessment strategies
for pregnant women, and client feedback to inform what
works
https://nchdv.confex.com/nchdv/2012/webprogram/Session2
199.html
The 6th Biennial National Conference on Health and
Domestic Violence (March 29-31, 2012)
https://nchdv.confex.com/nchdv/2012/webprogram/meeting.
html
Resources
Community Connections – Creating Cultures of Trauma
Informed Care
http://communityconnectionsdc.org/web/page/673/interior.
html
Trauma-Informed Organizational Toolkit
http://www.familyhomelessness.org/media/90.pdf
Trauma-Informed Care; Best Practices and Protocols for
Ohio’s Domestic Violence Programs
http://www.odvn.org/images/stories/FinalTICManual.pdf
Creating Cultures of Trauma-Informed Care; A Self-
Assessment and Planning Protocol
http://www.annafoundation.org/CCTICSELFASSPP.pdf
Resources
Trauma-Informed Care - PowerPoint
http://www.mhcc.org.au/ticp/research-papers/Risser2008.pdf
Shelter from the Storm: Trauma Informed Care in
Homelessness Services Settings - Article
http://homeless.samhsa.gov/ResourceFiles/cenfdthy.p
df
Adverse Childhood Experience Study
http://www.acestudy.org/
Community Re-Traumatization - Article
http://www.annafoundation.org/COMMUNITY%20R
ETRAUMATIZATION.pdf
Contact Information
Christine Heyen, MA
Oregon Department of Justice
Crime Victims’ Services Division
1162 Court Street NE
Salem, OR 97301
(503) 378-5303
[email protected]