From “What’s Wrong?” To “What Happened?” : Moving Towards Trauma-Informed Practices and Holistic Approaches!" Eva Dech Statewide Trainer and Community

From “What’s Wrong?” To “What Happened?” : Moving Towards Trauma-Inf ormed Practices and

Holistic Approaches !"

Eva Dech

Statewide Trainer and Community Organizer

Mental Health Empowerment Project, Inc.

[email protected]

What is Trauma?

“Trauma can result from experiences of violence. Trauma includes physical, sexual and institutional

abuse, neglect, intergenerational trauma, and disasters that induce powerlessness, fear,

recurrent hopelessness, and a constant state of alert.” National Center for Trauma-Informed Care

“Trauma can be any experience or event in which an individual feels overwhelmed by a perceived

threat to life, bodily integrity, or sanity, circumstances commonly include abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss.” NYSCASA-MHANYS Building Connections,

which results in “Extreme stress that overwhelms the person’s capacity to cope.” APA 2000,DSM-IV-TR

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How does trauma affect me?

“Traumatic experiences can be dehumanizing, shocking or terrifying, singular or multiple

compounding events over time, and often include betrayal of a trusted person or institution and a

loss of safety.” National Center for Trauma-Informed Care

A person’s response often involves intense/overwhelming:

Fear, Horror, and Helplessness

It’s both Psychological and Physiological“There may not be bodily injury, but psychological

trauma is coupled with physiological upheaval that plays a leading role in long-range effects.” Jon

Allen, psychologist at Menninger Clinic Topeka, Kansas

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How else I’m I affected by trauma?

“Trauma impacts one's spirituality and relationships with self, others, communities and environment,

often resulting in recurring feelings of shame, guilt, rage, isolation, and disconnection.

There is a consensus in the field that most consumers of mental health services are trauma survivors and that their trauma experiences help shape their responses to outreach and services.”

National Center for Trauma-Informed Care

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Prevalence of TraumaMental Health Population-United States

• 90% of public health clients have been exposed to trauma (Mueser et al., 2004, Mueser et al., 1998)

• Most have multiple experiences of trauma (Mueser et al., 2004, Mueser et al., 1998)

• 97% of homeless women with SMI (psychiatric label) have experienced severe physical & sexual abuse– 87% experience this abuse both in childhood and adulthood. (Goodman et al., 1997)

NASMHPD- Training Curriculum for the Reduction of Seclusion and Restraint ©2008

Prevalence of TraumaSubstance Abuse Population- United States

• Up to 2/3 of men and women in substance abuse(SA) treatment report childhood abuse and neglect (SAMHSA CSAT, 2000)

• Study of male Veterans in SA inpatient unit– 77% exposed to severe childhood trauma– 58% history of lifetime PTSD (Triffleman et al., 1995)

• 50% of women in SA treatment have history of rape or incest (Governor’s Commission on Sexual and Domestic Violence, Commonwealth of MA, 2006)


The Adverse Childhood Experiences (ACE) Study

• The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.

• More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made.

• The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. Progress in preventing and recovering from the nation's worst health and social problems is likely to benefit from understanding that many of these problems arise as a consequence of adverse childhood experiences.

Adverse Childhood ExperiencesAbuse of Child• Psychological abuse• Physical abuse• Sexual abuse

Trauma in Childs Household or Environment• Substance abuse• Parental separation and/or divorce• Mental Illness or suicidal household member• Violence to the mother• Imprisoned household member

Neglect of Child• Abandonment• Child’s basic physical and /or emotional needs unmet

Adverse Childhood Experiences

• Recurrent and severe physical abuse• Recurrent and severe emotional• Growing up in a household with:

– Alcohol or drug user– Member being imprisoned– Mentally ill, chronically depressed, or institutionalized member– Mother being treated violently– Both biological parents absent– Emotional or physical abuse(Felitti et al., 1998)


Other Critical Trauma Correlates: The Relationship of Childhood Trauma to Adult Health

• Adverse Childhood Events (ACEs) have serious health consequences

• Adoption of health risk behaviors as coping mechanisms– Eating disorders, smoking, substance abuse, self-harm,

sexual promiscuity

• Severe medical conditions: – Heart disease, pulmonary disease, liver disease, STDs,

GYN cancer

• Early Death(Felitti et al., 1998)


ACE Study

“Addiction is best viewed as an understandable, unconscious,

compulsive use of psychoactive materials in response to abnormal prior life

experiences, most of which are concealed by shame, secrecy, and social taboo.”

(Felitti et al., 1998)


What does the prevalence data tell us?

• The majority of adults and children in psychiatric treatment settings have trauma histories.

• A sizeable percentage of people with substance use disorders have traumatic stress symptoms that interfere with achieving or maintaining sobriety.

• A sizeable percentage of adults and children in the prison or juvenile justice systems have trauma histories.

(Hodas, 2004, Cusack et al., Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)


What does the prevalence data tell us?

• Growing body of research on the relationship between victimization and later offending

• Many people with trauma histories have overlapping problems with mental health, addictions, physical health, and are victims or perpetrators of crime

• Victims of trauma are found across all systems of care

(Hodas, 2004, Cusack et al., Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)


Mechanism by Which Adverse Childhood Experiences Influence Health and Well-being

Throughout the Lifespan

Adverse Childhood Experiences (ACE) Studywww.cdc.gov/ace/pyramid.htm

Trauma can impact many aspects of everyday life and influences

Conditioned Responses and Tendencies

Six important realms in which people are affected by traumatic stress• Feelings• Judgment• Beliefs• Frame of Reference- World View• Memory and Perception• Body and Brain

Risking Connection 15

Mind and Body

• Emotional Numbing-No connection to feelings and emotions, detachment from others, loss of interest, and lack of motivation.

• Avoidance-Constant avoidance of any activity, place, person, or event associated with the traumatic experience.

• Sensory Reminders-Things person hears, smells, tastes, touches, and sees can remind them of a traumatic event from the feelings of guilt, shame, rage, etc, to recurrent flashbacks of/re-living the event.

• Body and Brain-The body keeps the score. Due to being in a constant state of alert, the body is often under stress engaged in the brain’s flight/fight/freeze automatic response that manifests in actual physiological medical symptoms that include: chronic gastrointestinal distress, headaches/migraines, chronic pain, and gynecological complaints, to name a few.

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Trauma Shapes the Survivor’s Basic Beliefs

Survivors frequently change their beliefs about themselves and the world in order to make sense of their trauma

experience.

Often world views include:

Powerlessness-Expecting a negative outcome; Hopelessness-Seeing the glass half-empty or “waiting

for the penny to drop”;

Helplessness-Untrusting of others’ motives towards self.

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Relating to Yourself

Trauma often affects feelings of self- esteem, sexuality/sexual life, “being in your own skin,”

self-worth, and how you internally/externally cope with life stressors.

Relating to OthersExperiences of trauma can shape how we have

relationships with other people. It affects our ability to trust, and feel comfortable in relating to

and/or being around others. Trauma can also shape the way we perceive and respond to other

people, events, and situations.18

Healing is Possible

“Healing ultimately involves transformation of over generalized negative beliefs about self, world and spirituality that are

harmful and prevent growth and change.”NYSCASA-MHANYS Building Connections

• Healing does not have to be painful, although it can be at times, like life.

• Healing differs by the individual• There are many healing treatments and techniques now

available. • Find out what works

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Trauma Informed Means Asking what Happened, Not What’s Wrong

• What sense did I make of what happened?

• How does that affect how I see myself? How I think others see me?

• What patterns have I developed as a result?

Intentional Peer Support, Shery Mead Consulting Copyright 2010

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What are Trauma-Informed practices?

“When a human service program takes the step to become trauma-informed, every part of its

organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma

affects the life of an individual seeking services. 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 re-

traumatization.”National Center for Trauma-Informed Care

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Not Trauma Informed

• Not informed on trauma prevalence & “universal precautions”

• Cursory or no trauma assessment

• Tradition of “toughness” valued as best approach

• Closed system– advocates discouraged/barred

Trauma Informed

• Recognition of prevalence of trauma

• Assess for History

• Recognize culture and practices that re-traumatize

• Transparent systems open to outside parties

Positive Alternatives to Restraint and Seclusion (PARS) Training- NYSOMH 2008

Not Trauma Informed

• Keys, Security uniforms, staff demeanor, tone of voice (says)= POWER!

• Rule Enforcers-Compliance

• “Patient blaming” is the norm

Trauma Informed

• Power/Control minimized

• Caregivers/supporters- Collaboration

• Staff understand violence, conflict arise due to situational factors


Language

Not Trauma Informed• Calling people by first

name w/out permission or last name w/out title

• Yelling “lunch” or “medications”

• “If I have tell you one more time…”

• “Step away from the desk”

Trauma Informed

Alternatives?


Environment

Not Trauma Informed• Barrier around nursing

station– “Us/Them”

• Checks to simply locate– focus on task, not person

• Coming in and leaving without acknowledgement

Trauma Informed• Modified nursing station

without barrier– welcoming and open

• Routine ‘check-in’ with the person– eye contact

• Saying hello and goodbye at the beginning and end of shift


Trauma Informed Is

All About

Building

Safe & Trusting

Relationships

Recovery Model

• Respect• Hope• Strength-based• Peer support• Empowerment• Responsibility

• Self-direction• Holistic• Non-linear• Individualized and

Person-Centered• Culturally sensitive

27National Consensus on Components of Mental Health

Recovery, SAMHSA

Values and Competencies

• Commitment to recovery, evolution, and inspiring hope

• Accountability (personal and relational)

• The power of language• Direct, honest, respectful,

communication• Consciousness-raising/

critical learning

• Worldview, diversity, trauma informed

• Mutual responsibility,: belief in the power of the relationship

• Shared risk• Moving toward• Creating community and

social change

28Intentional Peer Support, Shery Mead Consulting Copyright 2010

Relating: A Paradigm ShiftWho’s in charge in the relationship?

Power-Over vs. Shared PowerPower-Over: Involves one party believing themselves to be “in-

charge” of another or the “responsible” person within a relationship. This includes issues of client/provider power struggles, bias, “Isms,” discrimination and privilege. The focus is on the needs/wants of the individual in power or control. These dynamics engender recurrent feelings of fear, mistrust, anger, frustration, loss of personal power; can result in abuse of power and control over another and a permanent disconnection.

Shared Power: Involves both parties engaging in a mutual exchange were the connection in the relationship is most important over personal ego as well as establishing trust. The focus is on the relationship and finding common ground; negotiation of power and mutual responsibility to engender hope and possibilities is the outcome. 29

Fear vs. Hope

• Fear based relationships are based on what's wrong, and what we are afraid is going to happen.

• Hope based relationships are based on what is possible, where we are going and how we can co-create something new.


Hope vs. Fear Response

Fear Response Hope Response

• Trying to calm things down: stabilization

• Taking care of , helper/helpee

• Predictability: things going back to the way they were

• Sitting with discomfort

• Staying in connection

• Unpredictability = Possibility


Fear Based language

• Compliance

• “For your own good”

• Decompensate

• Are you safe?


Hope-based Language

• Collaboration

• Positive risk taking

• Recovery


From “What's Wrong with You?” to “What happened to You?”

• How does shifting the question shift what we do in relationships?


Relationships vs. the Individual

When its about the individual

When its about the relationship

• No one else has to change

• We pre-determine outcomes

• We loose sight of our own learning

• We loose sight of the relational dynamic

• Both people contribute to mutual learning

• We learn to communicate with honesty and openness

• Our relationship becomes model of other relationships


Fear-based Response

• Risk assessment

• “For your own good”

• I’m uncomfortable so I need to control the situation

• Take people out of the community


Hope-based Response

• Working out both of our needs

• Shared power

• Willingness to stretch

• Looking together for new meaning

• Proactive planning


Trauma-Informed Practices

The Sanctuary Model-The goal of the Sanctuary Model is to help children who have experienced the damaging effects of interpersonal violence,

abuse, and trauma. The Sanctuary Model’s approach helps organizations to create a truly

collaborative and healing environment that improves efficacy in the treatment of traumatized individuals, reduces restraints and other coercive

practices, builds cross-functional teams, and improves staff morale and retention.

www.sanctuaryweb.com

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http://www.sanctuaryweb.com/

Practices Continued…

Essence of Being Real Model- Is a peer-to-peer structure intended to address the effects of

trauma. The developer feels that this model is particularly helpful for survivor groups (including abuse, disaster, crime, shelter populations, and others), first responders, and frontline service

providers and agency staff. This model is appropriate for all populations and it is geared to promoting relationships rather than focusing on

the “bad stuff that happened.

www.sidran.org

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http://www.sidran.org/

More Practices…

Risking Connection Model- Is intended to be a trauma-informed model aimed at mental health,

public health, and substance abuse staff at various levels of education and training. This

model emphasizes concepts of empowerment, connection, and collaboration. The model

addresses issues like understanding how trauma hurts, using the relationship and connection as a

treatment tool, keeping a trauma framework when responding to crises such as self-injury and suicidal depression, working with dissociation and

self-awareness, and transforming vicarious traumatization.

www.riskingconnection.org40

http://www.riskingconnection.org/

Holistic Alternatives

• Natural diet and herbal remedies

• Nutritional Supplements• Homeopathy • Meditation• Yoga• Acupuncture• Massage Therapy• Reflexology• Music

• Psycho-spiritual counseling

• Reiki and other forms of

Energy Healing• Therapeutic Drumming• Breathing exercises• Relaxation• Dance• Exercise• Art

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Meditation

Any activity that requires your complete focus can be a meditation:• Writing• Snowboarding• Knitting• Martial Arts• Photography• Reading• Gardening• Animals

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Additional Resources

• In The Realm of Hungry Ghosts: Close Encounters With Addiction - Dr. Gabor Mate www.drgabormate.com/

• Growing Beyond Survival – Elizabeth Vermilyea• The Essence of Being Real – Jennifer Wilkerson• Risking Connection- Sidran Press & NYSOMH• Healing the Child Within – John Bradshaw• 8 Keys to Safe Trauma Recovery – Babette Rothschild• Healing Trauma – Peter Levine• You Can Heal Your Life – Louise L. Hay

www.louisehay.com• Healing Neen http://www.healingneen.com/

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http://drgabormate.com/writings/books/in-the-realm-of-hungry-ghosts/



http://www.drgabormate.com/

http://www.louisehay.com/

http://www.healingneen.com/

http://www.healingneen.com/


• Breath~Body~Mind© Seminars – Richard Brown, MD and Patricia L. Gerbarg, www.haveahealthymind.org

• The National Center for Trauma-Informed Care www.samhsa.gov/nctic

• National Association of State Mental Health Program Directors www.nasmhpd.org

• Emotional Freedom Technique (EFT/Tapping) – www.emofree.com • Eye Movement Desensitization Reprocessing www.emdr.com• Biofeedback America http://www.biofeedbackamerica.com/• National Trauma Child Stress Network http://www.nctsn.org/• Sherry Mead http://www.mentalhealthpeers.com/• Adverse Childhood Study http://acestudy.org/• Center for the Study of Empathic Therapy, Education & Living• http://www.empathictherapy.org/

http://www.haveahealthymind.org/

http://www.samhsa.gov/nctic

http://www.nasmhpd.org/

http://www.nasmhpd.org/

http://www.emofree.com/

http://www.emdr.com/

http://www.biofeedbackamerica.com/



http://www.nctsn.org/

http://www.nctsn.org/

http://www.mentalhealthpeers.com/

http://www.mentalhealthpeers.com/

http://acestudy.org/

http://acestudy.org/

http://www.empathictherapy.org/


• International Study for Traumatic Stress Studies http://www.istss.org/Home.htm

• Child Trauma Academy- www.childtrauma.org• Theraplay Instititue - www.theraplay.org• Trayna Art Narrative Therapy- www.learntant.com• Center for the Study of Empathic Therapy, Education & Living• http://www.empathictherapy.org/• ISEPP The International Society for Ethical Psychology & Psychiatry

-http://icspponline.org/• Psychrights http://psychrights.org/index.htm• The Anna Institute http://www.annafoundation.org/• The Freedom Center http://www.freedom-center.org/

http://www.istss.org/Home.htm

http://www.istss.org/Home.htm

http://www.childtrauma.org/

http://www.theraplay.org/

http://www.learntant.com/



http://psychintegrity.org/page/

http://icspponline.org/

http://icspponline.org/

http://psychrights.org/index.htm

http://psychrights.org/index.htm

http://www.annafoundation.org/

http://www.freedom-center.org/

Thank you for your time!For more information contact:

Eva DechStatewide Trainer and Community Organizer

The Mental Health Empowerment Project, Inc.Tel. 518-434-1393 x17

E-mail. [email protected]

mailto:[email protected]

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From “What’s Wrong?” To “What Happened?” : Moving Towards Trauma-Informed Practices and Holistic Approaches!" Eva Dech Statewide Trainer and Community