Trauma Informed Care

Facilitated by: Cowlitz-Wahkiakum Council of Governments

Speaker: Janis Cleaveland, RN, Director of Nursing; Cascadia, BHCC

Video Recordings of this session been made available by Exclaim Media Video & Marketing at the bottom of this page.

Trauma Informed Care

Trauma sustained at early states of development has been shown to cause actual changes in brain neurobiology of survivors causing an alternative set of responses to triggers for stress and anxiety.

Mental Health Care Treatment

That type of treatment appreciates that trauma in the past effects us now and there are neurobiological changes/effects.

ACEs (Adverse Childhood Experiences)

Learn more at: http://www.fpc.wa.gov/publications/ace_impact.pdf

Of 17,000 people who responded to a survey to establish how ACEs affected them:

1 in 4 were exposed to 2 categories

1 in 6 were exposed to 4 categories

22% were sexually abused as children

66% of women experienced abuse as children

Note: In the study 80% of people poled were white or Hispanic, 10% were black, 10% were Asian

Positive linear correlation between ACEs and Health Problems like smoking, hepatitis, cardiac disease, diabetes, fractures, obesity…

High ACEs predicts alcohol abuse which cause more abuse in homes.
ACEs correlates to higher suicide.
Less than 25% of people who have high ACEs have access to care.
ACEs score of 7 correlate with 51 fold increase in suicide attempts in children and adolescents. 30 fold in adults.
Higher ACEs score = 200% higher risk of smoking.

Depression is the leading cause of disability.

Many providers assume that abuse experiences are additional to trauma.

Effects of trauma:

Actual changes in brain neurobiology
Social, Emotional and Cognitive impairment
Adoption of unhealthy coping strategies
Severe and persistent health/emotional/relationship problems

Human Stress Response:

Hyper-vigilance
Cognitive diminishment
Increased heart rate, blood, adrenaline
Tune our non-important information – may not be able to hear person trying to bring a person back from trauma.

Stress Response to Recurrent Threat (PTSD)

Constant hyper-vigilance is the hallmark
Constant high blood pressure
Constant anxiety – too much cortisol created in body
Enhanced state of sensory sensitivity
Exaggerated intensity of behaviors
Abnormal increased arrousal

The Amygdala – Most primitive area of the brain

Fight, Flight, Freeze
History of trauma will cause an overactive amygdala – Emotional response filter
The memory of events and the feelings regarding the events are stored together so when the person experiences the same event again the same feelings arise.

Traumatic experiences play a really important role in memory and learning.

Causing loss of emotional imagination
Giving up on creating new possibilities
Getting stuck & reliving horror

Cortex & hippocampus are atrophied in a person who has experienced a lot of trauma because of too much cortisol.

Every day stressors begin to elicit exaggerated reactivity
Persistent fear state
Rapid Transition from anxiety

Being in a loud, busy, crowded place will make it difficult to reach a person who has experienced a lot of trauma.

Cognitive engagement is key.
Go for a walk
Engage in a meaningful conversation or hobby
Play cards

Change thinking from “What’s wrong with you” to “What’s happened to you.” People need to tell their story.

Check out www.traumastewardship.com to learn about vicarious trauma.

“Listening = Hope” by Julie Joneston, PhD

Being listened to and understood is a transformational experience.

Providers have our own trauma

We may have to avoid re-experiencing our own emotions
Perceive behaviors as a threat or provocation

Professionalism – taking responsibility for the disciplined management of our attitude, mood, motivation. We can add bad energy with our own stuff.

Pull thought processes to the front part of the brain – thinking and memory.

Celebrate even the smallest of steps – it is hard to learn new ways
Pay attention to your tone of voice
Do you use language that is appropriate, professional and clearly understood?
What does body language say? You don’t want to be perceived as threatening by your body language, tone, verbiage or even eye contact
Do I overreact or underract?

Self Control Plan

Maintain self control in difficult circumstances with professional behavior
No one thinks clearly in a crisis situation
Self control plans are for “the moment”
Quiet yourself – you can only control yourself, don’t add negative energy
Life Balance – Long term
- Find a method, ritual, or routine that helps restore balance, manage stress and prevents burn out
- Self Care Rituals – Gardening, Reading, Crochet, Walks, Exercise, Eating well

Why did you choose this job?

Under resourced, and challenging
Physical and emotional risks

Interpreting behavior through a Trauma Informed Care lens – Behind every behavior is a legitimate felling, request or need.

Basic human needs:

food, clothing, shelter, safety, sleep, belonging, acceptance, control, love, touch

We can’t move forward until basic needs are no longer threatened.

Traumatized people experience a lot of fear, frustration, powerlessness and hopelessness

need for safety
need to be heard/choices, learn control
need to be listened to
need for future hope

People who don’t have needs met live on survival skills

Manipulation = creatively getting your needs met

Avoid these words with traumatized people:

refused
non-compliant
always
never
labeling (manipulative, attention seeking)

These words are an attack on someone who has experienced a lot of trauma.

Negatively talking about the people we serve with others sets a negative tone instead of keeping things hopeful…it is also gossip.

What can you do to be prepared?

Know clients history
Know what the previous shift has been like for clients and staff alike
Be sensitive to the feel and tone of the client as you come on duty
Be prepared and ready for anything
Assume there is trauma history
Validate people’s feelings

Healthy Trauma Informed Staff

Interpret difficult behavior through the lens of trauma exposure
Avoid being over-reacting or under-reacting
Avoid power struggles

Trauma Informed Care Staff

Find the stress or underlying need
Focus on customer service and meeting needs
Open up communication – explain what will happen next…no surprises

Challenges or Crisis Situation

Listen and be patient
Validate feelings
Identify underlying needs
Focus on meeting needs
Offer client something (water, tea, snack)

Triggers

Crowds
Law Enforcement
Dates (anniversary of trauma)
Times of Day
Family
Specific People
Medications

Crisis Cycle Phases:

Triggering event
Escalation
Crisis
De-escalation
Post crisis depression – shame, guilt, hopelessness (let people process)

If a person is a practicing addict on top of mental illness you can only educate and help them survive until they are ready to change.

Keep environment soft – lighting, colors

People don’t often realize the extent of their own traumatic history

Our words/actions can be misinterpreted by skewed perception
Respect

Our respectful, positive behavior and mindset to not cause someone trauma today will bring about faster and better change and growth.

Keep tasks simple, understandable, acheivable
Give people tasks (game, reading) to help people move from amygdala to frontal cortex
Ground yourself (if you are burnt out you will miss important signs.
Be honest if you are showing behavior that can be misunderstood – let client know it is not about them

You’re Invited!

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