Brian Burman BA Residential Service Coordinator Project HOME Rowan Homes Introduction 3 Learning Objectives Trauma Theory Case Manager as an Interrupter of Cycles of Poverty and Trauma ID: 710763
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Trauma Informed Care in Case Management: Interrupting the Intergenerational Cycles of Trauma and Poverty
Brian Burman, BA
Residential Service Coordinator
Project HOME- Rowan HomesSlide2
Introduction
3 Learning Objectives
Trauma Theory
Case Manager as an “Interrupter” of Cycles of Poverty and Trauma
Providing Trauma Informed Services Slide3
Sanctuary Model Community Check-In
Your name and where you’re from
Who do I come as?
Your goal for today
Who will help you achieve your goal?
*Feeling Wheel developed by Dr. Gloria WilcoxSlide4
Trauma Informed Care
Services that are grounded in and directed by a thorough understanding of the neurological, biological, psychological, social, and existential effects of trauma, adversity and violence on individuals, families, organizations, communities, and societies (Bloom, 2004)
Trauma: damaging stress and it’s effects on the brain and the body
Relentless stress (poverty, racism), toxic stress (children who experience adversity), traumatic stress (traumatic events) (Bloom, 2016)Slide5
Effects of Trauma on the Brain and Body
The Big 3 Symptoms of Trauma and PTSD
Flashbacks, Rumination, Hypervigilance
Past, Present, Future
Fight, Flight, and
Freeze
Frontal Lobe is activated and this effects judgment, memory, self-control
Mindfulness Interventions
Van der
Kolk
, Bessel. (May 22
nd
,2015). The body keeps the score: brain, mind, and body in the healing of trauma. Center for Healthy Communities.
Obtained from:
https://
www.youtube.com/watch?v=53RX2ESIqsM
. Slide6
ACES Study
Physical Abuse
Sexual Abuse
Emotional Abuse
Physical Neglect
Emotional Neglect
Mother Treated
Violently
Household
Substance Abuse
Household Mental Illness
Parental Separation or Divorce
Incarcerated Household Member
https://www.cdc.gov/violenceprevention/acestudy/index.html
ACES study connects experiences of childhood abuse, neglect, and family dysfunction with poor health outcomes and negative effects throughout the life course (Wade,
2015)
A person with any number of ACES (4 or more is clinically significant) has an increased risk of negative health outcomes: adopting risk-taking behaviors, chronic illness, disability early death (Wade,
2015)
Information was gathered from 17,000 Kaiser Health Plan members between 1995 and 1997. Participants were mostly Caucasian and of a high SES (Wade,
2015)Slide7
Urban ACES
Study was designed to gain understanding and insight around the complex relationship between poverty, childhood adversity, and the effects of trauma and poverty throughout the life course, particularly on health
outcomes (Wade, 2015).
The study expands on the conventional ACES and adds several expanded ACES
Expanded ACES: experiencing racism, witnessing violence, bullying, experiencing foster care, living in unsafe
neighborhoods (Wade, 2015). Slide8
Scope of Intergenerational Poverty and Trauma in Philadelphia
Philadelphia has the highest rate of deep poverty than any other big city in the United States
Deep poverty: people with incomes below half of the poverty line (200,000 people in Philadelphia)= 12.9 % of the population
Poverty line for a family of four: $22,113
Every school in Philadelphia meets the definition of a low-income school (30% of students low income)- Many schools have 100 % students low-income and living below the poverty line
Since 1988 9,000 people have been killed on the streets of Philadelphia
As of March, 2016 3,517 troops were killed in Iraq. At the same time 3,113 people were killed on the streets of Philadelphia
Bloom, Sandra. (2016). Toward a trauma informed city live webcast. Drexel University
Dornslife
School of Public Health.
Obtained from: https://www.youtube.com/watch?v=nXv65ITR89ISlide9
Intergenerational Trauma: Relational and Attachment Theories
Dissociation and Relationship Patterns
Trauma transmitted through dissociation
Negative parent response to child distress results in “intolerable anxiety” in children
Results in disorganized attachment
Dissociation and Transmission of Trauma
Impairs dialogue between conscious and unconscious self-states (Bromberg)
Limits self-awareness
Dissociated memories and affects negatively impact the self and others in relationships
Turning up the Volume
“Relational Attunement vs. Relational Malattunement”- effects of emotional dysregulation across generations
Bradfield, Bruce (October, 2011).
The dissociation of lived experience: a relational psychoanalytic analysis of the intergenerational transmission of trauma.
International Journal of Psychoanalytic Self Psychology
, 6:531–550. Slide10
Example
Single mother living with 5 children ages 3 YO to 16 YO
Family became homeless fleeing DV situation and due to financial stressors.
Mom denies MH issues and refuses treatment. Speaks often about trauma history. Ambivalent about support for her children.
Family has history of DV, impacted all family members, 11 YO son has significant behavioral issues.
Family has strong natural support system, reside in permanent supportive housing, and recently authorized for intensive in home support.
Mom recently returned to work, varying academic performance and interest among children. Slide11
Sanctuary Model
Trauma Informed Versus Trauma Organized Cultures
What happened to you versus what’s wrong with you
SELF (Safety, Emotions, Loss, Future)
Creating Sanctuary
Dawn and the
beginning
of Sanctuary
Challenging power and the status quo
Destroying Sanctuary
Organizational Culture
Organization as a living being
Practical Applications in Case Management Slide12
Commitments of the Sanctuary Model
Nonviolence
Emotional Intelligence
Social Learning
Open Communication
Democracy
Social Responsibility
Growth and Change Slide13
Triangulation and Trauma Reenactments
“We cannot help it. We are bound to tell the story of our unresolved past through our behavior in current relationships (Bloom, 2013).”
“We reenact our past everywhere… we cue each other to play roles in our own personal dramas, secretly hoping that someone will give us a different script, a different outcome to the drama, depending on how damaging our experiences have been (Bloom, 1999
).”
Van der Kolk’s Story: Reenacting the HolocaustSlide14
Karpman’s Trauma Triangle
What role does each family member play?
Stay out of the triangle!
Fulkerson, Michael. (2003). Integrating the karpman drama triangle with choice theory and reality therapy.
International Journal of Reality Therapy
, vol. 23, no. 1. Slide15
References
American Fact Finder. Retrieved from:
https://factfinder.census.gov/faces/nav/jsf/pages/error.xhtml
.
Bloom, Sandra. (2013). Creating sanctuary. Routledge Taylor and Francis Group: London and New York.
Bloom, Sandra. (1999). Trauma theory abbreviated.
CommunityWorks
. Obtained from:
http://iheartenglish.pbworks.com/f/Trauma+Theory+Explained+14+pages.pdf
.
Bloom, Sandra. (2016). Toward a trauma informed city live webcast. Drexel University
Dornslife
School of Public Health. Obtained from: https://www.youtube.com/watch?v=nXv65ITR89I
Bradfield
, Bruce (October, 2011).
The dissociation of lived experience: a relational psychoanalytic analysis of the intergenerational transmission of trauma.
International Journal of Psychoanalytic Self Psychology
, 6:531–550.
Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward,
A., Kiser, L., Strieder, F. Thompson, E. (2010). Understanding the impact of trauma and urban poverty
on family systems: Risks, resilience, and interventions. Baltimore, MD: Family Informed Trauma
Treatment Center. http://nctsn.org/nccts/nav.do?pid=ctr_rsch_prod_ar or
http://fittcenter.umaryland.edu/WhitePaper.aspx
Corbin, Theodore, Sandra Bloom, Ann Wilson, Linda Rich, John Rich. (2010). Approaching the health and well-being of boys and men of color through trauma-informed practice.
Changing Places: How Communities Will Improve the Health of Boys of Color.
University of California Press. Slide16
References
Fulkerson, Michael. (2003). Integrating the karpman drama triangle with choice theory and reality therapy.
International Journal of Reality Therapy
, vol. 23, no. 1.
Lubrano, Alfred. (2017). Of big cities, philadelphia worst for people in deep poverty.
Philadelphia Inquirer
. Retrieved from:
https://www.philabundance.org/of-big-cities-phila-worst-for-people-in-deep-poverty/
.
Sweet, Victoria. (May 21, 2015). Victim series 8- system induced trauma.
National Council of Juvenile and Family Court Judges.
(2014). Trauma informed care in behavioral health.
Treatment Improvement Protocol
, 57. SAMHSA: Rockville, MD.
Volk, Steve. (September, 2016). Generational poverty: trying to solve philly’s most enduring problem.
Philadelphia Magazine
. Retrieved from:
http://www.phillymag.com/news/2016/09/17/generational-poverty/
.
Van der Kolk, Bessel A. (2014). The body keeps score. Penguin Group (USA).
Van der
Kolk
, Bessel. (May 22nd,2015). The body keeps the score: brain, mind, and body in the healing of trauma. Center for Healthy Communities. Obtained from: https://www.youtube.com/watch?v=53RX2ESIqsM.
Wade, Roy.
(
2015).
Household and community-level Adverse Childhood Experiences and adult health outcomes in a diverse urban
population. Elsevier volume 52, 135-142.
obtained from: http://www.sciencedirect.com.proxy-wcupa.klnpa.org/science/article/pii/S0145213415004524?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb&ccp=ySlide17
Thank You!
Contact Information:
Brian Burman-
brianburman@projecthome.org
215-232-7272 ext. 5355