Post on 19-Mar-2018
transcript
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.