From “What’s Wrong?” To “What Happened?” : Moving Towards Trauma- - PowerPoint Presentation

352 views
Uploaded On 2018-11-09

From “What’s Wrong?” To “What Happened?” : Moving Towards Trauma- - PPT Presentation

Inf ormed Practices and Holistic Approaches Eva Dech Statewide Trainer and Community Organizer Mental Health Empowerment Project Inc evamhepaolcom What is Trauma Trauma can result from experiences of violence Trauma includes physical sexual and institutional abu ID: 724937

www trauma informed health trauma www health informed childhood abuse experiences peer training org mead http restraint 2008 seclusion

Link:

Copy

Embed:

<iframe width="560" height="315" src="https://www.docslides.com/embed/724937" frameborder="0" allowfullscreen></iframe>

Download Presentation from below link

Download Presentation The PPT/PDF document "From “What’s Wrong?” To “What Ha..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.

Presentation Transcript

Slide1

From “What’s Wrong?” To “What Happened?” : Moving Towards Trauma-Informed Practices and Holistic Approaches!"

Eva

Dech

Statewide Trainer and Community Organizer

Mental Health Empowerment Project, Inc.

evamhep@aol.comSlide2

What is Trauma? “Trauma can result from experiences of violence. Trauma includes physical, sexual and institutional abuse, neglect, intergenerational trauma, and disasters that induce powerlessness, fear, recurrent hopelessness, and a constant state of alert.”

National Center for Trauma-Informed Care

“Trauma can be any experience or event in which an individual feels overwhelmed by a perceived threat to life, bodily integrity, or sanity, circumstances commonly include abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss.”

NYSCASA-MHANYS Building Connections, which results in “Extreme stress that overwhelms the person’s capacity to cope.” APA 2000,DSM-IV-TR

2Slide3

How does trauma affect me?“Traumatic experiences can be dehumanizing, shocking or terrifying, singular or multiple compounding events over time, and often include betrayal of a trusted person or institution and a loss of safety.” National Center for Trauma-Informed Care

A person’s response often involves intense/overwhelming:

Fear, Horror, and Helplessness

It’s both Psychological and Physiological“There may not be bodily injury, but psychological trauma is coupled with physiological upheaval that plays a leading role in long-range effects.”

Jon Allen, psychologist at Menninger Clinic Topeka, Kansas

3Slide4

How else I’m I affected by trauma?“Trauma impacts one's spirituality and relationships with self, others, communities and environment, often resulting in recurring feelings of shame, guilt, rage, isolation, and disconnection.

There is a consensus in the field that most consumers of mental health services are trauma survivors and that their trauma experiences help shape their responses to outreach and services.”

National Center for Trauma-Informed Care

4Slide5

Prevalence of TraumaMental Health Population-United States90% of public health clients have been exposed to trauma (Mueser et al., 2004, Mueser et al., 1998)Most have multiple experiences of trauma (Mueser et al., 2004, Mueser et al., 1998)97% of homeless women with SMI (psychiatric label) have experienced severe physical & sexual abuse– 87% experience this abuse both in childhood and adulthood.

(Goodman et al., 1997)

Prevalence of TraumaSubstance Abuse Population- United StatesUp to 2/3 of men and women in substance abuse(SA) treatment report childhood abuse and neglect (SAMHSA CSAT, 2000)Study of male Veterans in SA inpatient unit77% exposed to severe childhood trauma

58% history of lifetime PTSD

(

Triffleman et al., 1995)50% of women in SA treatment have history of rape or incest (Governor’s Commission on Sexual and Domestic Violence, Commonwealth of MA, 2006)NASMHPD- Training Curriculum for the Reduction of Seclusion and Restraint ©2008Slide7

The Adverse Childhood Experiences (ACE) StudyThe Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made.

The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. Progress in preventing and recovering from the nation's worst health and social problems is likely to benefit from understanding that many of these problems arise as a consequence of adverse childhood experiences.Slide8

Adverse Childhood ExperiencesAbuse of ChildPsychological abusePhysical abuseSexual abuseTrauma in Childs Household or Environment

Substance abuse

Parental separation and/or divorce

Mental Illness or suicidal household memberViolence to the motherImprisoned household memberNeglect of ChildAbandonmentChild’s basic physical and /or emotional needs unmetSlide9

Adverse Childhood ExperiencesRecurrent and severe physical abuseRecurrent and severe emotionalGrowing up in a household with:Alcohol or drug userMember being imprisonedMentally ill, chronically depressed, or institutionalized memberMother being treated violently

Both biological parents absent

Emotional or physical abuse

Other Critical Trauma Correlates: The Relationship of Childhood Trauma to Adult HealthAdverse Childhood Events (ACEs) have serious health consequencesAdoption of health risk behaviors as coping mechanismsEating disorders, smoking, substance abuse, self-harm, sexual promiscuitySevere medical conditions:

Heart disease, pulmonary disease, liver disease, STDs, GYN cancer

Early Death

ACE Study“Addiction is best viewed as an understandable, unconscious, compulsive use of psychoactive materials in response to abnormal prior life experiences, most of which are concealed by shame, secrecy, and social taboo.”(Felitti

et al., 1998)

What does the prevalence data tell us?The majority of adults and children in psychiatric treatment settings have trauma histories.A sizeable percentage of people with substance use disorders have traumatic stress symptoms that interfere with achieving or maintaining sobriety.A sizeable percentage of adults and children in the prison or juvenile justice systems have trauma histories.(Hodas, 2004, Cusack et al., Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)

What does the prevalence data tell us?Growing body of research on the relationship between victimization and later offendingMany people with trauma histories have overlapping problems with mental health, addictions, physical health, and are victims or perpetrators of crimeVictims of trauma are found across all systems of care(Hodas, 2004, Cusack et al., Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)

Mechanism by Which Adverse Childhood Experiences Influence Health and Well-being Throughout the LifespanAdverse Childhood Experiences (ACE) Studywww.cdc.gov/ace/pyramid.htmSlide15

Trauma can impact many aspects of everyday life and influences Conditioned Responses and Tendencies Six important realms in which people are affected by traumatic stress

Feelings

Judgment

BeliefsFrame of Reference- World ViewMemory and PerceptionBody and BrainRisking Connection15Slide16

Mind and BodyEmotional Numbing-No connection to feelings and emotions, detachment from others, loss of interest, and lack of motivation.

Avoidance

-Constant avoidance of any activity, place, person, or event associated with the traumatic experience.

Sensory Reminders-Things person hears, smells, tastes, touches, and sees can remind them of a traumatic event from the feelings of guilt, shame, rage, etc, to recurrent flashbacks of/re-living the event.

Body and Brain

-The body keeps the score. Due to being in a constant state of alert, the body is often under stress engaged in the brain’s flight/fight/freeze automatic response that manifests in actual physiological medical symptoms that include: chronic gastrointestinal distress, headaches/migraines, chronic pain, and gynecological complaints, to name a few.

16Slide17

Trauma Shapes the Survivor’s Basic BeliefsSurvivors frequently change their beliefs about themselves and the world in order to make sense of their trauma experience. Often world views include: Powerlessness

-Expecting a negative outcome;

Hopelessness

-Seeing the glass half-empty or “waiting for the penny to drop”; Helplessness-Untrusting of others’ motives towards self.17Slide18

Relating to YourselfTrauma often affects feelings of self- esteem, sexuality/sexual life, “being in your own skin,” self-worth, and how you internally/externally cope with life stressors.

Relating to Others

Experiences of trauma can shape how we have relationships with other people. It affects our ability to trust, and feel comfortable in relating to and/or being around others. Trauma can also shape the way we perceive and respond to other people, events, and situations.

18Slide19

Healing is Possible“Healing ultimately involves transformation of over generalized negative beliefs about self, world and spirituality that are harmful and prevent growth and change.”NYSCASA-MHANYS Building ConnectionsHealing does not have to be painful, although it can be at times, like life.

Healing differs by the individual

There are many healing treatments and techniques now available.

Find out what works19Slide20

Trauma Informed Means Asking what Happened, Not What’s WrongWhat sense did I make of what happened?How does that affect how I see myself? How I think others see me?What patterns have I developed as a result?

Intentional Peer Support,

Shery

What are Trauma-Informed practices?“When a human service program takes the step to become trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services. 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.”

National Center for Trauma-Informed Care

21Slide22

Not Trauma InformedNot informed on trauma prevalence & “universal precautions”Cursory or no trauma assessmentTradition of “toughness” valued as best approach

Closed system– advocates discouraged/barred

Trauma Informed

Recognition of prevalence of traumaAssess for HistoryRecognize culture and practices that re-traumatizeTransparent systems open to outside parties

Positive Alternatives to Restraint and Seclusion (PARS) Training- NYSOMH 2008Slide23

Not Trauma InformedKeys, Security uniforms, staff demeanor, tone of voice (says)= POWER!Rule Enforcers-

Compliance

“Patient blaming”

is the normTrauma InformedPower/Control minimizedCaregivers/supporters- CollaborationStaff understand violence, conflict arise due to situational factors

Positive Alternatives to Restraint and Seclusion (PARS) Training- NYSOMH 2008Slide24

LanguageNot Trauma InformedCalling people by first name w/out permission or last name w/out titleYelling “lunch” or “medications”“If I have tell you one more time…”“Step away from the desk”

Trauma Informed

Alternatives?

Positive Alternatives to Restraint and Seclusion (PARS) Training- NYSOMH 2008Slide25

EnvironmentNot Trauma InformedBarrier around nursing station– “Us/Them”Checks to simply locate– focus on task, not personComing in and leaving without acknowledgement

Trauma Informed

Modified nursing station without barrier– welcoming and open

Routine ‘check-in’ with the person– eye contactSaying hello and goodbye at the beginning and end of shiftPositive Alternatives to Restraint and Seclusion (PARS) Training- NYSOMH 2008Slide26

Trauma Informed IsAll AboutBuildingSafe & TrustingRelationshipsSlide27

Recovery ModelRespectHopeStrength-basedPeer supportEmpowerment

Responsibility

Self-direction

HolisticNon-linearIndividualized and Person-CenteredCulturally sensitive

National Consensus on Components of Mental Health Recovery, SAMHSASlide28

Values and CompetenciesCommitment to recovery, evolution, and inspiring hopeAccountability (personal and relational)The power of languageDirect, honest, respectful, communicationConsciousness-raising/critical learning

Worldview, diversity, trauma informed

Mutual responsibility,: belief in the power of the relationship

Shared riskMoving towardCreating community and social change28

Relating: A Paradigm ShiftWho’s in charge in the relationship?Power-Over vs. Shared PowerPower-Over

: Involves one party believing themselves to be “in-charge” of another or the “responsible” person within a relationship. This includes issues of client/provider power struggles, bias, “Isms,” discrimination and privilege. The focus is on the needs/wants of the individual in power or control. These dynamics engender recurrent feelings of fear, mistrust, anger, frustration, loss of personal power; can result in abuse of power and control over another and a permanent disconnection.

Shared Power

: Involves both parties engaging in a mutual exchange were the connection in the relationship is most important over personal ego as well as establishing trust. The focus is on the relationship and finding common ground; negotiation of power and mutual responsibility to engender hope and possibilities is the outcome.29Slide30

Fear vs. HopeFear based relationships are based on what's wrong, and what we are afraid is going to happen.Hope based relationships are based on what is possible, where we are going and how we can co-create something new.

Hope vs. Fear ResponseFear ResponseHope ResponseTrying to calm things down: stabilization

Taking care of , helper/helpee

Predictability: things going back to the way they were

Sitting with discomfort

Staying in connection

Unpredictability = Possibility

Fear Based languageCompliance“For your own good”Decompensate

Are you safe?

Hope-based LanguageCollaborationPositive risk takingRecovery

From “What's Wrong with You?” to “What happened to You?”How does shifting the question shift what we do in relationships?

Relationships vs. the IndividualWhen its about the individualWhen its about the relationship

No one else has to change

We pre-determine outcomes

We loose sight of our own learningWe loose sight of the relational dynamicBoth people contribute to mutual learning

We learn to communicate with honesty and openness

Our relationship becomes model of other relationships

Intentional Peer Support,

Shery

Fear-based ResponseRisk assessment“For your own good”I’m uncomfortable so I need to control the situation

Take people out of the community

Hope-based ResponseWorking out both of our needsShared powerWillingness to stretchLooking together for new meaning

Proactive planning

Trauma-Informed PracticesThe Sanctuary Model-The goal of the Sanctuary Model is to help children who have experienced the damaging effects of interpersonal violence, abuse, and trauma. The Sanctuary Model’s approach helps organizations to create a truly collaborative and healing environment that improves efficacy in the treatment of traumatized individuals, reduces restraints and other coercive practices, builds cross-functional teams, and improves staff morale and retention.

www.sanctuaryweb.com

38Slide39

Practices Continued…Essence of Being Real Model- Is a peer-to-peer structure intended to address the effects of trauma. The developer feels that this model is particularly helpful for survivor groups (including abuse, disaster, crime, shelter populations, and others), first responders, and frontline service providers and agency staff. This model is appropriate for all populations and it is geared to promoting relationships rather than focusing on the “bad stuff that happened.

www.sidran.org

39Slide40

More Practices…Risking Connection Model- Is intended to be a trauma-informed model aimed at mental health, public health, and substance abuse staff at various levels of education and training. This model emphasizes concepts of empowerment, connection, and collaboration. The model addresses issues like understanding how trauma hurts, using the relationship and connection as a treatment tool, keeping a trauma framework when responding to crises such as self-injury and suicidal depression, working with dissociation and self-awareness, and transforming vicarious traumatization.

www.riskingconnection.org

40Slide41

Holistic AlternativesNatural diet and herbal remediesNutritional SupplementsHomeopathy MeditationYogaAcupuncture

Massage Therapy

Reflexology

Music Psycho-spiritual counselingReiki and other forms of Energy HealingTherapeutic DrummingBreathing exercisesRelaxationDanceExerciseArt

41Slide42

MeditationAny activity that requires your complete focus can be a meditation:WritingSnowboardingKnittingMartial Arts

Photography

Reading

GardeningAnimals42Slide43

Additional Resources In The Realm of Hungry Ghosts: Close Encounters With

Addiction

Dr. Gabor Mate www.drgabormate.com/Growing Beyond Survival – Elizabeth VermilyeaThe Essence of Being Real – Jennifer WilkersonRisking Connection- Sidran Press & NYSOMH

Healing the Child Within –

John Bradshaw

8 Keys to Safe Trauma Recovery –

Babette Rothschild

Healing Trauma –

Peter Levine

You Can Heal Your Life

– Louise L. Hay

www.louisehay.com

Healing

Neen

http://www.healingneen.com

43Slide44

Additional Resources Breath~Body~Mind© Seminars – Richard Brown, MD and Patricia L. Gerbarg, www.haveahealthymind.orgThe National Center for Trauma-Informed Care

www.samhsa.gov/nctic

National Association of State Mental Health Program Directors

www.nasmhpd.orgEmotional Freedom Technique (EFT/Tapping) – www.emofree.com Eye Movement Desensitization Reprocessing www.emdr.com

Biofeedback

America

http

://www.biofeedbackamerica.com

National Trauma Child Stress Network

http://www.nctsn.org

Sherry Mead

http://www.mentalhealthpeers.com

Adverse Childhood Study

http://acestudy.org

Center for the Study of Empathic Therapy, Education & Living

http://www.empathictherapy.org/Slide45

Additional Resources International Study for Traumatic Stress Studies http://www.istss.org/Home.htmChild Trauma Academy- www.childtrauma.org

Theraplay

Instititue - www.theraplay.orgTrayna Art Narrative Therapy- www.learntant.comCenter for the Study of Empathic Therapy, Education & Livinghttp://www.empathictherapy.org/ISEPP The International Society for Ethical Psychology & Psychiatry

http

://icspponline.org/

Psychrights

http://

psychrights.org/index.htm

The Anna Institute

http://www.annafoundation.org/

The Freedom Center

http://www.freedom-center.org/Slide46

Thank you for your time!For more information contact:

Eva

Dech