File - 2014 Trauma Informed Care Conference

Trauma-Informed Care
National Perspective
Teresa Descilo, MSW, MCT
Founder and Executive Director of the Trauma Resolution Center, Miami
▪ Define the six key principles of a trauma-informed approach and
what this will mean for service providers
▪ The focus on and importance of early detection and adequate
▪ Moving ahead in a mindful way
SAMHSA’s Definition of Trauma
Individual trauma results
from an event, series of
events, or set of
circumstances that is
experienced by an individual
as physically or emotionally
harmful or life threatening
and that has lasting adverse
effects on the individual’s
functioning and mental,
physical, social, emotional, or
spiritual well-being.
SAMHA’s Concept of Trauma and Guidance
for a Trauma-Informed Approach
▪ Unresolved trauma is a public health issue
▪ It has no boundaries of race, age, gender, socioeconomic status, ethnicity, geography
or sexual orientation
▪ It is a universal experience for those with substance abuse, mental health issues and
chronic diseases
▪ Addressing trauma requires a multi-pronged, multi-agency public health
▪ It will require public education and awareness, prevention and early identification
and effective trauma-specific assessment and treatment
The Current Paradigm
▪ Officer Krupke
Multiple Service Sectors
▪ Not just mental health and substance abuse
Criminal justice
Social welfare
Primary care
The Impact of the Existing Paradigms
▪ Many are trauma-inducing
▪ Seclusion and restraints
▪ Punishing traumatized kids who act out
▪ Victimizing the victims
▪ No compassion for those who have traveled the path of unresolved trauma to
the harsh outcomes that are inevitable for many. Most offenders started off as
victims. When trauma triggers, the choice is to experience the trauma as a
victim or perpetrator. Sometimes we slip into ‘offender’ as it is less painful to
experience than ‘victim’.
The Shift
A program, organization, or system that is traumainformed realizes the widespread impact of trauma and
understands potential paths for recovery; recognizes the
signs and symptoms of trauma in clients, families, staff,
and others involved with the system; and responds by
fully integrating knowledge about trauma into policies,
procedures, and practices, and seeks to actively resist retraumatization
The Four “R’s”: Key Assumptions in a
Trauma-Informed Approach
▪ Realization of the widespread impact of trauma
▪ Individuals, families, groups, organizations and communities. Behaviors understood
from the context of trauma, as coping
▪ Recognize signs of trauma – across age, gender, culture
▪ Respond
▪ All staff understands TIC and responds appropriately
▪ Evidenced-based Trauma-specific services available
▪ Policies, handbooks, manuals promote resilience, recovery and healing
from trauma
▪ Re-Traumatization
▪ Doesn’t retraumatize staff as well as clients
Six Key Principles of a Trauma-Informed Approach
▪ Safety
▪ Trustworthiness and Transparency
▪ Peer Support
▪ Collaboration and Mutuality
▪ Empowerment, Voice and Choice
▪ Cultural, Historical and Gender Issues
Harris, M. & Fallot, R. (2001) & Bloom, S. (2012)
Safety, Trustworthiness and Transparency,
Peer Support
▪ throughout the organization, staff and the people they serve feel physically and
psychologically safe; the physical setting is safe and interpersonal interactions
promote a sense of safety.
▪ organizational operations and decisions are conducted with transparency and
the goal of building and maintaining trust among staff, clients, and family
members of people being served by the organization.
▪ are integral to the organizational and service delivery approach and are
understood as a key vehicle for building trust, establishing safety, and
Collaboration and Mutuality
Empowerment, Voice and Choice
Cultural, Historical and Gender Issues
▪ there is true partnering and leveling of power differences between staff
and clients and among organizational staff from direct care staff to
administrators; there is recognition that healing happens in relationships
and in the meaningful sharing of power and decision-making.
▪ the organization aims to strengthen the staff's, clients', and family
members' experience of choice and recognize that every person's
experience is unique and requires an individualized approach.
▪ the organization addresses cultural, historical, and gender issues; the
organization actively moves past cultural stereotypes and biases (e.g.
based on race, ethnicity, sexual orientation, age, geography, etc.), offers
gender responsive services, leverages the healing value of traditional
cultural connections, and recognizes and addresses historical trauma.
What will this mean for you as a service
▪ How will this impact your immediate work
▪ How will this impact services that are delivered?
▪ Will the method of delivery change? If so, how?
▪ How will you address eliminating power differentials?
▪ What are some of Mississippi’s special needs?
Healing Starts With Us
Avoidance and Denial
▪ Are kinda normal for us – part of the human condition- coping
▪ Won’t work in the context of resolving trauma
▪ If we aren’t feeling safe, resolved, strong, our clients will know
▪ Our work environments are a product of each individual
The Importance of Self-Care
Not a luxury- An imperative ethical responsibility
Effectively deal with your own stuff
Rest, exercise, eat well
Keep a balance in your life with spirit, mind, body
Establish a life view that works for you
Advocate for changes in the areas that most impact you
Make sure that your clients can receive effective help – closure
Employer’s Responsibility
Vary caseload
Vary activities
Provide stress-reduction activities
Create a pleasant work environment
▪ My job description includes that I take care of my staff.
▪ SAMHSA consultants have interviewed me twice about our staff
care policies and practices to inform national policy.
The Focus on and Importance of Early
Detection and Adequate Intervention
▪ The Adverse Childhood Experiences Study
▪ Trauma Spectrum Disorders
▪ Stress Diseases
▪ SAMHSA’s General Adult Trauma Screening and Brief Intervention (GATSBI)
Borrowing from Lisa Najavits, Ph.D
▪ Phases of Recovery
▪ Stage 1: Safety (present)
▪ Stage 2: Mourning (past)
▪ Stage 3: Reconnection (future)
(adapted from Herman, Trauma and Recovery, 1992)
▪ Seeking Safety Focus only on First phase treatment Safety
Adequate Intervention
▪ Decide what your goals are as far as providing healing experiences
for your clients. Cope and manage, feeling better or a new, higher
functioning normal?
▪ Functional/complementary/holistic medicine.
Some of the Initiatives From Across the Country
▪ Vermont -Bill includes trauma screening in health evaluation of adults
▪ Maine’s “Thrive Initiative” incorporates a trauma-informed care focus for
▪ New York – introducing a trauma-informed initiative in the JJS
▪ Florida – JJS adopting trauma-informed care. TIC knowledge is a
requirement for agencies receiving state mental health and substance abuse
▪ Connecticut – Multiple state agencies are collaborating to build a traumainformed system of care
▪ Tarpon Springs, FL – the first US trauma-informed city
Explosion of Information
▪ Google – Trauma Informed Care – 17,000,000 results one
month ago. 38,600,000 results on September 3!
▪ Certificate in Trauma Informed Care – 471,000 results!
Moving Ahead in a Mindful Way
▪ Trauma Informed Care is now a ‘sexy cause’
▪ Accept that the paradigm is changing – business as usual hasn’t worked
▪ Need to define what constitutes TIC
▪ Need to define what is sufficient for Trauma Specific Care
▪ Funders need to educate themselves about trauma and effective services and be
willing to let go of what hasn’t worked.
The secret of change is to focus all your energy, not on fighting the old, but on
building the new.
A World Where No One
is Acting Out of Their
Past Wounds

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