Transcript Trauma Informed Care - Florida Department of Juvenile Justice

Charlie Crist,
Governor
Frank Peterman, Jr.
Secretary
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Trauma-Informed Care
Tracy L. Shelby, M.S., Ed.S.
Mental Health and Substance Abuse Coordinator
Orlando Community Forum
Orlando, Florida
January 28, 2010
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Outline
 Trauma Definitions
 Facts
 Impact
 Behavioral Symptoms
 Organizational Commitment
 Accomplishments to Date
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Trauma Definitions
Trauma:
The experience of violence and victimization
including sexual abuse, physical abuse, severe
neglect, loss, domestic violence and/or the
witnessing of violence, terrorism or disasters.
(NASMHPD, 2006)
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Trauma Definitions
Acute Trauma:
Typically involves a one-time experience (e.g.,
natural disaster or car accident. (NASMHPD,
2006)
Complex Trauma:
Involves prolonged or multiple traumatic
events. Complex trauma typically occurs within
a caregiving relationship by neglect, physical,
sexual or verbal abuse.
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Trauma Facts
• Being abused or neglected as a child increases
the likelihood of arrest as a juvenile by 59%
(Widom, CS, 1995).
• 70% - 92% of incarcerated girls reported sexual,
physical, or severe emotional abuse in childhood
(DOC, 1998; Chesney & Shelden, 1992).
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Trauma Facts
• Some researchers describe a pathway in which
exposure to violence and pervasive feelings of
not being safe develop into a state of chronic
threat requiring the youth/adult to use physical
aggression in order to manage (Schwab-Stone et
al, 1995).
Violence
Physical
Aggression
Threat
Unsafe
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Trauma Facts
• Trauma does not automatically cause PTSD
(25% risk), violation/degradation/betrayal
increases risk to 50-75+%
• Trauma is Epidemic in 60% of Adults and 50%
of Children
• Trauma is almost universal for boys (93%) and
girls (87%) in the JJ System
• Trauma increases the risk of further trauma
(most survivors have at least 2 distinct trauma
incidents).
Gender and Trauma
• Females:
▫ Sexual assault/abuse;
▫ Domestic violence;
▫ Childhood neglect;
• Males:
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Physical assault;
Physical abuse;
Military violence;
Accidents.
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Impact Over Lifespan
• Are neurological, biological, psychological and
social in nature. They include:
▫ Changes in brain neurobiology;
▫ Social, emotional & cognitive impairment;
▫ Adoption of health risk behaviors as coping
mechanisms (eating disorders, smoking, substance
abuse, self harm, sexual promiscuity, violence); and
▫ Severe and persistent behavioral health, health and
social problems, early death. (Felitti et al, 1998;
Herman, 1992)
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The ACE Study
The pyramid in the next slide helps
visualize the process by which harsh
experiences such as child abuse and
neglect, growing up with domestic
violence, substance abuse, mental illness
in the home, or the loss of birth
parent(s) during childhood results in
health problems in adulthood.
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Findings
• ACEs are surprisingly common
• ACEs still have profound effect 50 years
later
• Transformed from psychosocial
experience into organic disease, social
malfunction and mental illness
• ACEs are the main determinant of the
health and social well-being of the nation.
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“…early experiences help to determine brain
structure thus shaping the way people learn,
think, and behave for the rest of their lives.”
I Am Your Child
Reiner Foundation
Impact on Child Development
• The ability to form healthy relationships is highly
dependent on learned social skills;
• Children’s social skill learning is directly related to
the characteristics of their environments;
• Disordered environments=dysfunctional skills;
Impact on Child Development
• Violence teaches withdrawal, anxiety, distrust,
over-reaction and/or aggression as coping
behaviors; and
• Extreme behaviors are rooted in dysregulated
emotional states (NF Commission, 2003; SG
Report, 1999; Hodas, 2004; Saxe et al, 2003).
Traumatized Children:
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Appear guarded and anxious;
Are difficult to re-direct, reject support;
Are highly emotionally reactive;
Have difficulty “settling” after outbursts;
Hold onto grievances;
Do not take responsibility for behavior;
Make the same mistakes over and over;
World is threatening and bewildering;
Traumatized Children:
• World is punitive, judgmental, humiliating
and blaming;
• Control is external, not internalized;
• People are unpredictable and untrustworthy;
• Defend themselves above all else; and
• Believe that admitting mistakes is worse
than telling truth.
(Hodas, 2004)
Trauma
• By adolescence, children have sufficient skill and
independence to seek relief through the
following:
▫
▫
▫
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▫
Drinking alcohol
Smoking tobacco
Sexual promiscuity
Using psychoactive materials
Overeating/eating disorders
Delinquent behavior
Trauma-Informed Care (TIC)
Provides the foundation for a basic understanding of the
psychological, neurological, biological, and social impact
that trauma and violence have on many young Floridians.
Incorporates proven practices into current operations to
deliver services that acknowledge the role that violence
and victimization play in the lives of most of the children
entering our system.
“It’s about the right to have a present and a future
that are not completely dominated and dictated by
the past.” Karen Saakvitne
Trauma-Informed Care (TIC) provides a
new paradigm under which the basic
premise for organizing services is
transformed.
From:
To:
What is wrong
with you?
From:
What happened
to you?
To:
Control
Collaboration
Trauma-Informed Systems
Key Principles:
• Are based on current literature
• Are informed by research and evidence of
effective practice
• Recognize that coercive interventions cause
traumatization and re-traumatization
Trauma Informed Systems
When a human service program takes the
steps to become trauma-informed, every
part of the organization, management, and
services delivery system is assessed and
potentially modified to include a basic
understanding of how trauma impacts the
life of an individual receiving services.
Trauma Informed Systems
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.
Trauma Informed Systems
Universal Precautions:
Operate as if every child in our care has been
exposed to abuse, violence, neglect, or other
traumatic event(s).
What happened to you?
Keys to TIC Organizational Commitment
• Adoption of a trauma informed policy to include:
▫ commitment to appropriately assess trauma;
▫ avoidance of re-traumatizing practices;
• Get key administrators on board;
• Allocate resources for modifications &
performance improvement;
• Prioritize education of staff;
• Advance directives (safety plans, de-escalation
preferences) are communicated and used; and
• Power & Control are minimized by attending
constantly to unit culture.
(Fallot & Harris, 2002; Cook et al, 2002)
DJJ - Accomplishments to Date
• Presented Trauma-Informed Care to Executive
Leadership Team
• Headquarters Trauma-Informed Care Steering
Committee
• Interagency Trauma-Informed Care Workgroup
• “Trauma Champions” in all Program Areas
• Training Integrated into Academies (new
probation/direct care staff in state operated
facilities)
• “Soft Room” at Marion RJDC
Accomplishments to Date
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ACE Study at Dove Academy
Assessment of Confinement in Detention
TIC Language Placed in Contracts
“Behind Closed Doors” in Detention
“Girl Matters” Training
“Girls Circle” Training
Master Trauma Trainers Identified
Deputy Secretary Identified as Chairperson for
TIC
• Assistant Secretaries Committed to TIC
Accomplishments to Date
• TIC Training in Tampa
▫ Dr. Joan Gillece (NASMHPD)
▫ Dr. Shiari Turner (DOH)
▫ Ms. Tonier Cain (NASMHPD)
• Incorporated TIC into Strategic Plan
Questions
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Contact Information
Tracy L. Shelby, M.S., Ed.S.
Department of Juvenile Justice
Mental Health and Substance Abuse Coordinator
(850)921-2050
(850)528-1277
[email protected]