2012 HEALTH CARE FOR THE HOMELESS REGIONAL TRAINING

O R L A N D O F L O R I D A

N O V E M B E R 1 - 2

Trauma Informed Excellence Trauma Informed Care

�  Stay positive

�  Informal

�  Interactive

Diverse Management Solutions, LLC

diverse management solutions

www.DiverseManagementSolutions.com (303) 258-3523

Matt Bennett, MBA, MA bennett@diversemanagementsolutions.com

TIE Learning Objectives

�  Understand the trauma informed paradigm as it relates to: ¡  Self-care ¡  Leadership/Culture ¡  Trauma Informed Care ¡  Trauma Treatment

�  Conceptualize the impact of trauma on client functioning

�  Utilize knowledge about the impact of stress/trauma in work with clients.

E S T A B L I S H I N G T H E N E E D F O R A N E W P A R A D I G M

Defining Trauma and Stress

Robustness

Types of Trauma

�  Active Trauma – Intense stress that overwhelms our robustness resulting in a life dominated by the traumatic event.

�  Passive Trauma – Being overwhelmed by the trauma with no support to regain control.

�  Attachment Trauma – Threats to the availability of the attachment figure through illness (physical/emotional), substance abuse, imprisonment or other loss of meaningful contact.

�  Betrayal Trauma – Attachment figure is the perpetrator of the trauma.

�  Complex Trauma – Repeated systematic trauma that occurs over time.

Bloom & Farragher, 2012 & Lewis, 2006

E X C E L L E N C E I N C A R E

Trauma Informed Core Competencies

Trauma Informed Excellence: The Path

• Excellence

•  Trauma Treatment

•  Trauma Informed Care

•  Thrive: Self Care

•  Leadership & Culture

INDIVIDUAL & GROUP EXCELLENCE

TIE Leadership & Culture

A STRATEGIC APPROACH TO HEALTH AND EXCELLENCE IN LIFE AND WORK

Thrive: Self Care

Dangers in Helping Others

�  Clients’ Trauma + Duration> Robustness = Compassion Fatigue

�  Compassion Fatigue + Countertransference = Secondary Trauma

�  Direct Witness to Another’s Trauma > Robustness = Vicarious Trauma

�  Stress + Duration> Robustness = Burnout

Helping Trauma Burnout

�  Loss of positive worldview �  Feeling of incompetence and

self doubt �  Negative attitude &

hopelessness �  Inability to engage in

relationships �  Blurred boundaries �  Constant anxiety �  Decreased productivity �  Compromised physical health �  PTSD & Mental Health Issues

�  Heart disease �  Cancer �  Increase in turnover (40%) �  Absenteeism �  Poor productivity �  Mental illness �  Job dissatisfaction �  Cognitive impairment �  Increase in aggressive and

violent behavior �  Difficulty adjusting to

change

We MUST Care for Ourselves First!!!

BUILDING PRACTICE OFF SCIENCE & PROVEN METHODOLOGIES

Trauma Informed Care

ACE Findings

Acestudy.org, 2012

Warning: Science Content

�  Survival Road – Amygdala ¡  Increased activation in traumatized people ¡  Survival Flight/Freeze/Fight reflex

�  Thinking Road – Sensory Cortex/ Hippocampus ¡  Smaller in traumatized people ¡  Controls negative emotional response of Amygdala ¡  Manages abstract and higher level thinking

�  The Relay – Thalamus ¡  Decides whether survival or thinking road addresses stimulus ¡  Environment and past impact how stimulus is processed

Window of Tolerance

Window of Tolerance: Flexible; adaptive; coherent; energized; stable

Hyperarousal Zone (Flight/Fight): Increased sensation; emotional reactivity; hypervigilance; disorganized cognitive processing

Hypoarousal Zone (Freeze): Relative absence of sensation; numbing of emotions; disabled cognitive processing; reduction of physical energy

Siegel, 2010 & Ogden, Minton, & Pain, 2006

Brain Structure & Processing

�  Brainstem – Basic processes �  Limbic – Emotions & Survival �  Cortex – Guides us in the

physical world �  Prefrontal Cortex – Thinking &

Conceptualization Bottom-up information

(sensations) meet top-down information (memories) to create or experience of the world

Siegel, 2010

Processing

�  Traumatized clients have less ability to limit survival reaction through top down processing

�  Neuropathway development ¡  Experience lays down traces that permanently alter brain

structure ¡  Intensity or repetition consolidates and strengths structure ¡  Cascading constraints emerge making it more difficult for new

structures to develop and ‘degrees of freedom’ limits potential of a consistent integrated self

Ogden, Minton, & Pain, 2006

Dissociation

�  Fragmentations of our personality and mind resulting from traumatic experience that we cannot integrate into our sense of self

�  These fragmentations, memories or personalities remain separate from an integrated sense of self

�  Brain processes no longer operates as an integrated whole

Courtois & Ford, 2009

Trauma & Memory

�  Explicit Memory (Conscious Memory) ¡  During trauma massive amounts of cortisol are released ¡  Cortisol slows or shuts down the hippocampus ¡  Explicit memories are blocked leading to blackouts and

dissociation

�  Implicit Memory (Unconscious Memory) ¡  During trauma the amygdala massive amounts of adrenaline is

released ¡  Adrenaline heightens the formation of implicit memories ¡  The implicit memories of fear, terror, perceptual details and

bodily feeling are remembered all throughout the body

Bremner, 2005

Retraumatization

�  Mind’s attempt at integrating the experience into the personality

�  As long as the trauma can not be put into words it will be relived through emotions and behaviors

�  The emotions that are experienced are the emotions that need to be overcome in order to gain mastery over the trauma that they could not stop

Bloom & Farraagher, 2011 & Herman, 1997

Rattlers Everywhere

Client Rattlers

�  What Rattlers (stress and trauma) depletes your client’s Robustness

�  What behaviors do you see when they are trigger

STRATEGIES TOWARD POST TRAUMATIC GROWTH

Trauma Treatment

Phases of Trauma Treatment

�  Internal Regulation ¡  Establish safety ¡  Awareness and management of arousal states

�  Integration ¡  Finding meaning in the experience ¡  Integration of trauma into view of self and world ¡  Maintain safety in face of strong emotions

�  Post Traumatic Growth ¡  Prevent future trauma ¡  Returning stronger and wiser ¡  Finding new meaning in life

T H A N K Y O U !

Questions & Comments

References & Resources 1

�  Acestudy.org �  Achor, S. (2010). The Happiness Advantage. New York, NY: Crown

Business. �  Bloom, S. L. & Farragher, B. (2011). Destroying Sanctuary: The crisis in

human service delivery systems. New York: Oxford. �  Ford, J. D.; Courtois, Christine A. (2009). Treating Complex Traumatic

Stress Disorders: An Evidence-Based Guide (p. 90). Guilford Press. Kindle Edition.

�  http://www.samhsa.gov/nctic/ �  J. Douglas Bremner. (2005). Does Stress Damage the Brain? W.W. Norton

& Company: New York �  Lewis, G. (2006). Organizational Crisis Management: The Human

Factor. Boca Raton, FL: Auerbach Publications. �  Miller, W. & Rollnick, S. (2002). Motivational Interviewing: Preparing

People For Change.

References & Resources 2

�  Ogden, P., Minton, K., Pain, C. (2006). Trauma and the Body. New York: W. W. Norton and Company.

�  Rock, D. (2009). Your Brain at Work: Strategies for overcoming distraction, regaining focus, and working smarter all day long. New York, NY: HarperCollins.

�  Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2007). Collaborative Treatment of Traumatized Children and Teens. New York: The Guiford Press.

�  Schwartz, T. (2010). The Way We Are Working Isn’t Working. New York: Free Press.

�  Shenk, D.. (2010). The Genius in All of Us. New York: Doubleday. �  Siebert, A. (2005). The Resiliency Advantage. San Francisco, CA: Berrett-

Koehler Publishers Inc. �  Siegel, D. (2010). Mindsight: The new science of personal transformation.

New York, NY: Random House.