The Impact of Trauma on - PowerPoint Presentation

Slide1

The Impact of Trauma on Women and Girls Across the Lifespan

Healthy Women, Healthy Hoosiers: Healthcare Practice Across the

Lifecourse

October 7, 2011Slide2

Michelle Hoersch, MSOffice on Women’s Health - Region VU.S. Department of Health and Human ServicesIllinois, Indiana, Michigan, Minnesota, Ohio and WisconsinSlide3

Office on Women’s HealthWho We AreEstablished in 1991 to improve women’s health Charge expanded to include girls Focal point for women’s health activities in HHSSlide4

OWH Vision & MissionVISION All women and girls are healthier and have a better sense of well-being.MISSION Provide leadership to promote health equity for women and girls through sex/gender-specific approaches Slide5
Slide6

Violence Against Women Violence against women is so pervasive that the United Nations has addressed and defined violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life.” (United Nations General Assembly, 1993).Slide7

Definition of TraumaTrauma occurs when an external threat overwhelms a person’s internal and external positive coping resources. Bloom & Fallot, 2009 Slide8

TraumaA traumatic event is defined as one in which a person experiences, witnesses, or is confronted with actual or threatened death or serious injury, or threat to the physical integrity of oneself or others. These events can include violence between people, abuse of any kind, neglect, institutionalization, disasters, or war.Sources: The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV) and SAMHSA-National Center for Trauma Informed CareSlide9

TraumaWomen who suffer from trauma carry it with them everywhere they go. Despite the impact trauma has on the health of women and girls, it is rarely considered when delivering services Slide10

Trauma Defined Traumatic experiences come in many forms, and can leave survivors with overwhelming feelings of loss, danger, and helplessness. They include:• Unexpected loss of a loved one

• Accidents

• School violence

• Community violence

• Domestic violence

• Neglect

• Physical abuse

• Sexual abuse

• Man-made and natural disasters

• Terrorism

Slide11

The Adverse Childhood Experience (ACE) StudyWhat is the ACE Study?It is a scientific research study analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.An on-going collaboration between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente Health System.Slide12

What is an ACE?Growing up experiencing any of the following conditions in the household prior to age 18Recurrent physical abuseRecurrent emotional abuseContact sexual abuseAn alcohol/and or drug abuser in the householdAn incarcerated household memberSomeone who is chronically depressed, mentally ill, institutionalized or suicidalMother is treated violentlyOne or no parentsEmotional or physical neglectSlide13

The NumbersBetween 51% and 98% of public mental health clients diagnosed with severe mental illness have trauma histories. An individual with an ACE Score of 4 or more was 460% more likely to be suffering from depression than an individual with an ACE Score of 0. 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. There was a 250% increase in the odds of having a sexually transmitted disease between individuals with an ACE Score of 4 compared to individuals with an ACE Score of 0 Between two-thirds and 80% of all attempted suicides could be attributed to adverse childhood experiences Slide14

http://www.cdc.gov/ace/pyramid.htmSlide15

FindingsThe impact of ACEs on adult health status is strong and cumulative. (2)Of 17,337 study participants, 16% of the men and 25% of the women reported being sexually abused as children. (1)25% of respondents had at 1 ACE (3)6.25% had 4 ACEs (3)A person with a midrange ACE score of 4 is 390% more likely to have COPD than is a person with an ACE Score of 0. (3)a person with ACE score >4 was 460% more likely to be depressed than a person with ACE score of 0

(3)two thirds of suicide attempts could be attributed to adverse childhood experiences.

(3)

1. Kaiser Permanente Press Release, Kaiser Permanente Research: Gender And Sexual Abuse Female Perpetrators More Common than Known Previously; Boys Abused Almost as Often as Girls. July 6, 2005.

2. Fellitte, Vincent J. MD, FACP, Robert F. Anda MD, MS, Dale Nordenberg, MD, David F. Williamson, MS, PhD, Alison M. Spitz, MS, MPH, Valerie Edwards, BA, Mary P. Koss, PhD, James S. Marks, MD, MPH, “Relationship of Childhood Abuse and Household Dysfunction to Mnay of the Leading Causes of Death in Adults” Am J Prev Med 1998;14(4).

3. Felitti, MD., Vincent J., The Permanente Journal Winter 2002/Vol. 6, No.1 Slide16

From SAMHSA’s website: http://www.samhsa.gov/children/social_media_apr2011.aspSlide17

From SAMHSA’s website: http://www.samhsa.gov/children/social_media_apr2011.aspSlide18

From SAMHSA’s website: http://www.samhsa.gov/children/social_media_apr2011.aspSlide19

Graph shows relation between Adverse Childhood Experiences (ACE) Score and smoking status. Felitti, MD., Vincent J., The Permanente Journal Winter 2002/Vol. 6, No.1 Slide20

Graph shows relation between ACE Score and illicit use of injected drugs. a male child with an ACE score of 6 has a 4600% increase in the likelihood of later using intravenous drugs Felitti, MD., Vincent J., The Permanente Journal Winter 2002/Vol. 6, No.1 http://xnet.kp.org/permanentejournal/winter02/goldtolead.htmlSlide21

Region VFocus on TraumaVision: To equip every health and social service provider and institution with the knowledge, resources, and support to provide services that are gender responsive and trauma informed so as to provide the best possible care for trauma-affected individuals. Slide22

History Grew out of work focusing on incarcerated womenIncarcerated women have a disproportionately high rate of trauma exposure.If we can understand and ideally prevent trauma or at least provide trauma-informed interventions, programs and services, the well-being of these women and their families could be improved.Slide23

Early WorkGender- responsive trauma-informed trainings for leadership and staff of women's prisons and jailsTrauma-informed care trainings for health and social service providers Stephanie Covington, Center for Gender and Justice Curricula: “Helping Women Heal”, “Beyond Trauma”Slide24

Region V Trauma Initiatives Goal: To equip every health and social service provider and institution with the knowledge, resources, and support to provide services that are gender-responsive and trauma-informed.Slide25

The impact of violence, abuse, neglect, disaster, war, and other harmful experiences continues long after the traumatic event has ended. The Office on Women’s Health has partnered with SAMSHA to host this a monthly webinar series that addresses the Impact of Trauma on Women and Girls Across the Lifespan. The series was launched on November 2, 2010 We invite renowned speakers from all over the nation to speak for 45 minutes and then answer questions for the remaining 15 minutes. Our trauma webinars are 1 hour in length and typically max out attendance at 2,400 individuals. After the live broadcast, the webinars are available via archive for one year. Slide26

Special Topics/Populations: Clinical Services for women’s reproductive health Incarcerated Women and Re-EntryDental Health ProvidersWomen VetsRefugees & ImmigrantsTrauma-Informed Practices for the

Community SettingTrauma-Informed Systems & Organizational Change

The

ACE study - Life course effects of childhood trauma

Understanding the Importance of Sex and Gender in providing Trauma-Informed Services

Trauma-Informed Best Practices: What EVERYONE needs to

knowSlide27

Trauma-informed Services These are services that are provided for problems other than trauma but require knowledge about violence against women and the impact of trauma thereby increasing their effectiveness.Slide28

Universal Precaution Approach“Presume that every person in atreatment setting has been exposed toabuse, violence, neglect or othertraumatic experiences.”http://www.health.vic.gov.au/chiefpsychiatrist/creatingsafety/ntac/module6.pdfSlide29

Current Work with Sheela RajaThe Office on Women’s Health in Region V has partnered with Sheela Raja, PhD and Assistant Professor of Dentistry and Medicine at the University of Illinois at Chicago, to develop a new symposium. The symposium will bring together academics, teachers, community providers, clinical service providers, state and local legislators, researchers, survivors, and students to discuss ways to collaborate and integrate trauma-informed care across disciplines. Slide30

Trauma StewardshipThe Office on Women’s Health Region –V has co-hosted two Trauma Stewardship trainings with Laura Van Dernoot LipskyThe workshops explore the ways we reconcile the trauma we experience through our work. Laura’s book is called Trauma Stewardship: An Everyday Guide to Caring for Self while Caring for OthersMore information can be found at TraumaStewardship.comSlide31

Incarcerated Women Re-Entry ActivitiesJSI work-Advisory Council -Literature Review -Framework of RecommendationsNational Summit- Spring 2012Slide32

The Federal Partners Mental Health Transformation Committee on Women, Girls and Trauma Purpose: Raise awareness and expand the common knowledge base among Federal Partners and collaborators regarding the prevalence and behavioral impacts of trauma on the lives of women and girlsSlide33

The Federal Partners Mental Health Transformation Committee on Women, Girls and TraumaRoundtable I Woman and Trauma MonographRoundtable II- December 6-7, 2011Slide34

Intervention ModelsAddiction and Trauma Recovery Integration Model (ATRIUM) Essence of Being Real Risking Connection Sanctuary Model Seeking Safety Trauma, Addictions, Mental Health, and Recovery (TAMAR) Model Trauma Affect Regulation: Guide for Education and Therapy (TARGET) Trauma Recovery and Empowerment Model (TREM and M-TREM) http://www.samhsa.gov/nctic/trauma.aspSlide35

Resources The National Child Traumatic Stress Network http://www.nctsnet.org/The Centers for Disease Control and Prevention on their website lists many of the publications that use the ACE study for their findings. (http://www.cdc.gov/ace/year.htm)The Substance Abuse and Mental Health Services Administration www.samhsa.govSlide36

Michelle D. Hoersch, MSOffice on Women’s Health- Region V233 N Michigan Ave, Suite 1300Chicago, IL 60601312-353-8122Michelle.Hoersch@hhs.gov