Trauma Informed Care & Effective Screening Christine Heyen, MA Crime

Trauma Informed Care & Effective Screening Christine Heyen, MA Crime Victims’ Services Division Oregon Department of Justice Association of Public Health Nursing Supervisors Annual Conference May 9, 2012

Imagine a place that Asks “What happened to you?” instead of “What is wrong with you? Understands past trauma can be triggered by experiences in the present Is committed to supporting people as they heal Leaves a person feeling edified

What is trauma? “Trauma is an event that is extremely upsetting and at least temporarily overwhelms internal resources.” Briere, J. (2006). Dissociative symptoms and trauma exposure: Specificity, affect dysregulation, and posttraumatic stress. Journal of Nervous and Mental Disease, 194, 78-82.

What is Trauma? It can be a single event More often than not it is multiple events over time (complex, prolonged trauma) An interpersonal violence or violation, especially at the hands of an authority/trust figure is especially damaging

What does trauma do to us? Chronic trauma interferes with neurobiological development and the capacity to integrate sensory, emotional and cognitive information into a cohesive whole. Developmental trauma sets the stage for unfocused responses to subsequent stress. Bessel A. van der Kolk , MD http://www.traumacenter.org/products/pdf files/Preprint D ev Trauma Disorder.pdf

ACE Study http://www.cdc.gov/ace/index.htm Adverse Childhood Experiences (ACE) Study

Traditional Approach vs. Trauma Theory Traditional approach You are sick You are bad You are sick and bad Trauma theory You are not sick or bad You are injured

Trauma Informed Care (TIC) “Trauma-Informed Care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors to rebuild a sense of control and empowerment.” (Hopper et al, 2010) “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 retraumatization.” (SAMHAS)

What does TIC offer? Improves our desired outcomes Supports trauma recovery by Reducing re-traumatization Providing “corrective emotional experience” Decreases our own vicarious trauma or compassion fatigue

Core Principles of TIC Awareness: Everyone knows the role of trauma Safety: Ensuring physical and emotional safety Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries Choice: Respect and prioritize consumer choice and control Collaboration: Maximizing collaboration and sharing of power with consumers Empowerment: Prioritizing consumer empowerment and skill-building

TIC Communication Style Transactional Focus on information exchange Transactional with Social Talk Mostly information exchange with some social talk (e.g. joking, comment on weather) Interactional Focus on rapport-building and interpersonal relationship integrated with the information exchange https:// nchdv.confex.com/nchdv/2012/webprogram/Session2199. html

Tips for Practicing TIC Use language the person recognizes “Has your partner messed with your birth control?” Meet the survivor “where they are” If a person is not ready to talk, do not force the conversation. Rather keep the door open for a later time. Consider the person’s cultural context Avoid making assumptions – just ask!

Tips for Practicing TIC Recognize adaptive behaviors serve a purpose Why is a person chronically miss morning appointments? Is the morning the only time she can sleep? Does she have a traumatic brain injury that prevents her from remembering things? Make adjustments to help that person succeed. Set appointment times for the afternoon. Include everyone in your agency From receptionist to treatment staff Provide trauma training to every employee

How do we provide TIC? Listen What is the survivor saying to you? What is the survivor not saying? How is the survivor saying it? Inform What information do you have that may help her? What will happen next in the process? Why is the information important for her to have? How can your services can help her?

How do we provide TIC? To the best of your ability and within your given time constraints: Lose the labels Let her tell her story Give her time and space to tell her story Let the survivor lead Respect her voice and choice Recognize the survivor’s comfort level Consider the survivor’s perspective from her cultural context

Quick & Easy Offer support and validation Communicate care and concern Avoid passing judgement Ask questions of the survivor Find out if she is experiencing some kind of violence or coercion in her life Listen to what she has to say Resist interrupting her Make sure your body language is receptive Offer information and assistance Give her a resource card, a phone number, or a website Refer her to an advocate (warm hand-off) Tell her you are available to her in the future

Resources Trauma and Trauma Informed Care http://www.trainingforums.org/lms/ Trauma Informed Care – PowerPoint presentation by Mandy A. Davis, LCSW, Portland State University http://www.doj.state.or.us/victims/pdf/trauma i nformed care presentation outline.pdf Futures Without Violence http://www.futureswithoutviolence.org/

Resources Supporting health needs of women in shelter: Exploring traumatic brain injury and reproductive coercion https:// nchdv.confex.com/nchdv/2012/webprogram/Session2192.html Violence and reproductive coercion: Assessment strategies for pregnant women, and client feedback to inform what works https:// nchdv.confex.com/nchdv/2012/webprogram/Session2199.html The 6th Biennial National Conference on Health and Domestic Violence (March 29-31, 2012) https:// nchdv.confex.com/nchdv/2012/webprogram/meeting.html

Resources Community Connections – Creating Cultures of Trauma Informed Care http://communityconnectionsdc.org/web/page/673/interi or.html Trauma-Informed Organizational Toolkit http://www.familyhomelessness.org/media/90.pdf Trauma-Informed Care; Best Practices and Protocols for Ohio’s Domestic Violence Programs http://www.odvn.org/images/stories/FinalTICManual.pdf Creating Cultures of Trauma-Informed Care; A Self- Assessment and Planning Protocol http://www.annafoundation.org/CCTICSELFASSPP.pdf

Resources Trauma-Informed Care - PowerPoint http:// www.mhcc.org.au/ticp/research-papers/Risser-2008.pdf Shelter from the Storm: Trauma Informed Care in Homelessness Services Settings - Article http://homeless.samhsa.gov/ResourceFiles/cenfdthy.pdf Adverse Childhood Experience Study http://www.acestudy.org/ Community Re-Traumatization - Article http:// www.annafoundation.org/COMMUNITY%20RETRAUMA TIZATION.pdf

Contact Information Christine Heyen, MA Oregon Department of Justice Crime Victims’ Services Division 1162 Court Street NE Salem, OR 97301 (503) 378-5303 [email protected]