Trauma Informed Careand

Motivational Interviewing

Background and Theory

STRESS! - Fight, Flight, Freeze In order to protect itself, the body uses increased energy to respond to danger in 1 of 3 ways:

Flight

Freeze

Fight

Stress & the Brain•Frontal executive functioning areas are disengaged•Subcortical fight or flight areas are engaged

Trauma:Allostatic loadThe wear and tear that the body experiences due to repeated cycles of stressful events as well as the inefficient turning-on or shutting off of these responses

Toxic Stress and Trauma

Adverse Childhood Experiences (ACE) Study• 14 + year collaboration between the CDC and

Kaiser Permanente in San Diego.

• Over 17,000 HMO Members – were interviewed and answered a series of questions about their childhood experiences.

– Middle Class; 80% White; 74% with Some College

Adverse Childhood Experiences10 ACE Categories (score 1 for presence of each)

Abuse of Child Emotional abuse Physical abuse Contact Sexual abuse

Trauma in Child’s Household Chronically depressed, emotionally disturbed or suicidal household member Alcohol or Drug User

Trauma in Child’s Household Mother treated violently Imprisoned household member Not raised by both biological parents (Loss of parent - Worst if by abandonment)

Neglect of Child Physical neglect Emotional neglect

Adverse Childhood Experiences ScoreNumber of categories of childhood experiences are

summedACE Score Prevalence (after

Wave 2)

0 33%1 25%2 15%3 10%4 6%

5 or more 11%

• Approximately two-thirds have at least one ACE• More than one-third have experienced 2 – 4 ACE categories

Childhood Experiences and Adult Alcoholism

0

2

4

6

8

10

12

14

16

18

% A

lco

ho

lic

ACE Score

0

1

23

4+

Childhood Experiences and Chronic Depression

0

10

20

30

40

50

60

70

80

% W

ith

a L

ifet

ime

His

tory

of

Dep

ress

ion

0 1 2 3 >=4

ACE Score

WomenMen

Childhood Experiences and Suicide

0

5

10

15

20

25

% A

tte

mp

tin

g S

uic

ide

ACE Score

1

2

0

3

4+

0

2

4

6

8

10

12

0 1 2 3 4 5 6 >=7

No

Yes

ACE Score

Ever

Hallu

cin

ate

d*

(%)

AbusedAlcohol

or Drugs?

*Adjusted for age, sex, race, and education.

ACE Score and Hallucinations

ACE Score and Intravenous Drug Use

0

0.5

1

1.5

2

2.5

3

3.5

% H

ave

Inje

cted

Dru

gs

0 1 2 3 4 or more

ACE Score

N = 8,022 p<0.001

Trauma Histories

• As many as 90% of people in psychiatric hospitals and 92 - 97% of homeless women have histories of physical or sexual abuse.

• Between 75% and 93% of youth entering the juvenile justice system have experienced some degree of trauma

• Among males who experienced maltreatment prior to 12 years of age, 50-79% became involved in serious juvenile delinquency.– “Implementing the New “Germ” Theory for the Public’s Health: A Call to

Action” Andrea K. Blanch, Ph.D and David L. Shern, Ph.D., 2011

Social Work 101

Meet individuals where they’re at.

Stages of Change

•Pre-contemplation – (No intention to change, not even thinking about it, in denial)

•Contemplation– (Starting to think about changing, looking at the pros and cons)

•Preparation – (Ready to make a change, beginning to take the first steps)

•Action – (Taking specific actions in reducing the problem behavior or acquiring new behaviors)

•Maintenance– (Able to sustain the change for some time and working to prevent relapse)

•Termination – (Completed the change and certain not to return to the old problematic habit)

(Prochaska, Norcross, and DiClemente, 1994)Assessing Motivation

Pre-contempleation

Contemplation

PreparationAction

Maintenance

Termination

Change is a process that is not always linear or direct. There are six stages that most people go through in changing problematic habits.

Action, Maintenance, Termination

• Homelessness is the absence of stable housing in a context of disaffiliation from social supports and resources that are normally available through the mainstream culture.

– L.L. Bachrach (1993)

• Homelessness and risk of homelessness can be minimized or prevented by:– Providing emotional and practical support during the

critical time of transition– Strengthening the individual’s long-term ties to services,

family, and friends

Projects for Assistance in Transition from Homelessness (PATH)