Trauma Informed Care Laneita F. Williamson, R.N. - PowerPoint Presentation

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Trauma Informed Care

Laneita F. Williamson, R.N.

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Objectives

To explain how behaviors are impacted by adverse childhood experiences, and how these behaviors increase the risk for adult health issues

To illustrate how adult health is impacted due to the biological changes from adverse childhood experiences, even without the conventional

risk factorsDescribe definition of TIC

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Trauma Informed Care

“What happened to this person” in place of “what’s wrong with this person”

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Becoming Trauma Informed

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Trauma informed care provides the foundation for a basic understanding of the

psychological, neurological, biological, and social

impact that trauma and violence have on many individuals we serve”

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Adverse Childhood Experiences(ACE)Study

Conducted by:

Robert F. Anda, MD, MS, with the Center of Disease Control (CDC)

Vincent Felitti, MD, with Kaiser Permanente

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Adverse Childhood Experience Study

Retrospective and Prospective

17,000 participant (initial phase 1995 – 1997)

Collaboration between CDC and Prevention and Keiser PermanenteBased at Keiser Permanente in San Diego Health and Appraisal ClinicUsed with over 440,000 patients

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Ace Study Demographics

RACE

White

74.8%

Hispanic/

Latino

11.2%

Asian/Pacific

Islander

7.2%

African American

4.6%

Other

1.9%

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Ace Study Demographics

Demographic Categories

Percent

(N = 17,337)

Gender

Female

54%

Male

46%

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Ace Study Demographics

Education

Not High School Graduate

7.2%

High School Graduate

17.6%

Some College

35.9%

College

Graduate or Higher

39.3%

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Categories of Trauma Identified

Abuse

28% Physical Abuse

21% Sexual Abuse11% Emotional AbuseNeglect15% Emotional Neglect

10% Physical Neglect

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Categories of Trauma Identified

Household Dysfunction

27% Someone in household used drugs or alcohol

23% Lost a parent to separation/divorce18% Member of the household was mentally ill13% Witnessed domestic violence against mother5% Member of household was in jail/prison

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ACE Study

Common

Clusters

ACE ScoreCumulative (neuro)developmental ImpactGraded relationship to health, social, and behavioral problemsCo-morbid, Co-occurring

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Aces Are Common

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ACE Study

63% experience at least one category of childhood trauma

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Areas Affected

Brain

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Areas Affected by ACE’s

The Limbic System

The Hypothalamic – Pituitary- Adrenal or HPA axis

The Corpus CallosumThe Cerebellar Vermis

The Prefrontal Cortex

The Ventricles

The Brainstem

The Temporal lobes

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Dysregulation of Limbic System

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Toxic Stress Derails Healthy Development

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Hippocampus

Controls emotional reactions

Constructing verbal memory

Constructing spatial memoryVulnerable to all forms of maltreatment in first 2-3 years of life

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Corpus Callosum

Integrates hemispheres & facilitates:

Language Development

Proficiency in mathProcessing of social cues – facial expressionVulnerable to neglect in infancy and sexual abuse in the elementary school years

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Cerebellar Vermis

Regulating mental health, and movement through the physical environment

Reacting to peripheral details in the world around us

Vulnerable to high levels of cortisol prior to puberty

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Cortex

Thinking & Judgment; Executive Function; Long Term Memory; Vision

Vulnerable to:

Trauma in the first several years of life affecting pre-frontal cortexWitnessing domestic violence in the elementary school years affecting visual cortex

Sexual abuse at 15-16 affecting executive function

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Right Temporal Gyrus

Center for Spoken Language

Vulnerable to emotional abuse, especially between ages 7 and 9

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Adult Health Issues r/t Traumatic

Stress

Hypertension

G.I./GYN

Issues

Ischemic

Heart Disease

Neurological

risk

Cancer

Autoimmune

Chronic Lung Disease

Relationship Issues

Liver Disease

Substance

Abuse

Morbid

Obesity

>

35 %

BMI

Violence/High

Risk Behaviors

Diabetes

Homelessness

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Adult Health Issues r/t Traumatic

Stress

Fibromyalgia

Rheumatoid Arthritis

Irritable Bowel Syndrome

Crohn’s disease

PTSD/Panic

Disorders

Asthma

Addictions

Eating Disorders

Depression/Suicide

Dissociative

Schizophrenia

Chronic Fatigue

Syndrome

Chronic Pain

Syndromes

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Diabetes

Unwanted sexual touching - 16% higher risk

Isolated sexual abuse -19% increased risk

Forced sexual activity before adulthood carried - 34% increased risk if it occurred once

- 69% greater risk if it occurred more frequently

Moderate or severe physical abuse - 26% to 54%

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Windows of Vulnerability -

Teicher

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COPD Risk

A person with an ACE Score of 4 is 260% more likely to have COPD than is a person with an ACE Score of 0

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Liver Disease

A person with an ACE score of 4 is 240% more likely to have Hepatitis than a person with an ACE score of zero

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Suicide Risk

6 or > ACE’s

46 times more likely to attempt suicide

4,600% increase in attempt of suicide compared to those with 0 ACE’s

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ACE Study

Toxic stress from trauma in early childhood has been shown to cause physiologic disruptions that persist into adulthood leading to frank disease,

even in the absence of later health-threatening behaviors

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Understanding

We cannot always recognize a disability, but should not assume that someone doesn’t have one

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Now What

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Guiding Principles of Trauma-Informed Care

Safety

Trustworthiness and Transparency

Empowerment, Voice, and Choice Collaboration and Mutuality

Empowerment

Cultural, Historical, and Gender issues

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Understanding Triggers

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Assess Individual Patient Actions

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Simple Question

WHAT MAKES YOU FEEL UPSET OR UNCOMFORTABLE

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Provide a Calm Environment

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Trauma Informed Care Champions

Trauma-Informed Care Champions: From Treaters to Healers

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Supportive Tools for Patients

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Strategy - HALT

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The Impact of Diet and Exercise

Trauma deregulates cortisol levels (known as the stress hormone) in the body, but this can be corrected through good eating habits and consistent exercise

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Nutritional Strategies

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Community Resources

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High-Resolution Relational Resonance Based

Electroencephalic

Mirroring (HIRREM)

Non invasiveClosed-loopAcoustic SimulationMonitored brainwaves are translated to audible tonesBrain resonance allows self-adjustment

Dr. Charles Tegeler

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Summarizing Thoughts

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Trauma Informed Care

Recognizes that trauma is NOT just an acute injury

Trauma Informed Care understands that Adverse Childhood Experiences lead to adult internal health issues

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Universal Precaution

Trauma informed care is a cultural shift –

Clinicians presume that every patient has been exposed to abuse, violence, neglect, or other adverse event

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Universal Precaution

ACE Study Video

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Resilience

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Resources

http://acestudy.org/

Robert F. Anda

, MD, MS, with the CDC, and

Vicent J. Felitti

, MD, with Kaiser Permanente

http://acestudy.org/download

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Resources

http://acestoohigh.com/resources/

http://acesconnection.com/video/adverse-childhood-experiences-by-vince-felitti-md-13-minute

http://acesconnection.com/notes/Health_care

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Resources

http://acesconnection.com/

http://acestoohigh.com/got-your-ace-score

http://campus.nsvrc.org/login/index.php

National Sexual Violence Resource Center – PCAR

http://www.samhsa.gov/traumajustice/traumadefinition/approach.aspx

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Resources

http://campus.nsvrc.org/

choose course – NSVRC – Understanding Trauma and Sexual Violence – Brain, Body, Trauma

http://www.albertafamilywellness.org/resources/video/adverse-childhood-experiences-connecting-developmental-lens-health-our-society

http://www.avahealth.org/welcome.html

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Resources

http://www.coleva.net/COLEVA-Main-2-2-2011-v2.html

http://pediatrics.aappublications.org/content/129/1/e232.full

http://www.mincava.umn.edu/

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Resources

http://www.sciencedaily.com/releases/2011/11/111113141258.htm

http://www.sciencedaily.com/releases/2012/09/120906123240.htm

http://www.ncbi.nlm.nih.gov/pubmed/21084073

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Resources

http://www.americannursetoday.com/article.aspx?id=9564&fid=9534

http://www.aifs.gov.au/cfca/pubs/factsheets/a146123/index.html

http://www.ncbi.nlm.nih.gov/pubmed/22787111

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Resources

http://www.kaplanuniversity.edu/public-service/articles/childhood-abuse.aspx

http://www.healthcare.uiowa.edu/icmh/documents/CCTICSelf-AssessmentandPlanningProtocol0709.pdf

 

http://www.youtube.com/watch?v=Me07G3Erbw8&feature=share&list=FLvp9_fPIXzgnsi1pAjQvrEw

Vince Felitti

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Resources

http://www.youtube.com/watch?v=SqtBpd-SJ_I

Janine D’Anniballe

 http://www.youtube.com/watch?v=py0mVt2Z7nc

Dr. David Lisak

SAMHSA – CREATING TRAUMA INFORMED SYSTEMS OF CARE – STRATEGIES FOR SELF REGULATION, JOAN GILLECE, PHd

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Resources

DHS-Oregon State Hospital, Education & Development Department, Pat Davis-Salyer,

M.Ed

http://www.massgeneral.org/about/newsarticle.aspx?id=4572

https://www.eventbrite.com/e/trauma-informed-care-the-impact-of-trauma-on-brain-development-and-what-to-do-about-it-tickets-9927910648

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Resources

http://www.massgeneral.org/about/newsarticle.aspx?id=4572

http://www.connectwithpartners.org/2013/11/08/partners-hosts-trauma-informed-care-conference/

http://www.mghpcs.org/socialservice/programs/haven/Documents/2013_TIC_Grp2_Developing_Secondary_TI_Org_Poster.pdf

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Resources

www.merckmanuals.com/.../autonomic../overview

of the autonomic

https://en.Wikipedia.org/wiki/Autonomic nervous systemhttps://www.darmouth.edu/~rswenson/NeuroSci/chapter 9.html

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Resources

https://behindthehumancurtain.com/tag/trauma-informed-care/

http://www.fpc.wa.gov/

http://www.avahealth.org/resources/resource_index/

Brain Consequences of Early Trauma

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Resources:

http://casat.unr.edu/docs/ace_impact_ppt08.pdf

http://www.instituteforsafefamilies.org/national-summit-presentations?page=2

http://www.cdc.gov/violenceprevention/acestudy/

http://casat.unr.edu/docs/ace_impact_ppt08.pdf

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Thank You

Laneita Freeman Williamson R.N.

lwilliams@wakehealth.edu

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