Christine Heyen, MA
Crime Victims’ Services Division
Oregon Department of Justice
Association of Public Health Nursing
Supervisors
Annual Conference
May 9, 2012
Imagine a place that…
 Asks “What happened to you?” instead of “What is
wrong with you?
 Understands past trauma can be triggered by
experiences in the present
 Is committed to supporting people as they heal
 Leaves a person feeling edified
What is trauma?
“Trauma is an event that is extremely upsetting
and at least temporarily overwhelms internal
resources.”
Briere, J. (2006). Dissociative symptoms and trauma exposure: Specificity,
affect dysregulation, and posttraumatic stress. Journal of Nervous and
Mental Disease, 194, 78-82.
What is Trauma?
 It can be a single event
 More often than not it is multiple events over time
(complex, prolonged trauma)
 An interpersonal violence or violation, especially at the
hands of an authority/trust figure is especially
damaging
What does trauma do to us?
Chronic trauma interferes with neurobiological
development and the capacity to integrate sensory,
emotional and cognitive information into a cohesive whole.
Developmental trauma sets the stage for unfocused
responses to subsequent stress.
Bessel A. van der Kolk , MD
http://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trau
ma_Disorder.pdf
ACE Study
http://www.cdc.gov/ace/index.htm
Adverse Childhood Experiences (ACE) Study
Traditional Approach vs.
Trauma Theory
 Traditional approach
 You are sick
 You are bad
 You are sick and bad
 Trauma theory
 You are not sick or bad
 You are injured
Trauma Informed Care (TIC)
“Trauma-Informed Care is a strengths-based framework that is
grounded in an understanding of and responsiveness to the
impact of trauma, that emphasizes physical, psychological, and
emotional safety for both providers and survivors to rebuild a
sense of control and empowerment.” (Hopper et al, 2010)
“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.” (SAMHAS)
What does TIC offer?
 Improves our desired outcomes
 Supports trauma recovery by
 Reducing re-traumatization
 Providing “corrective emotional experience”
 Decreases our own vicarious trauma or compassion
fatigue
Core Principles of TIC
 Awareness: Everyone knows the role of trauma
 Safety: Ensuring physical and emotional safety
 Trustworthiness: Maximizing trustworthiness, making
tasks clear, and maintaining appropriate boundaries
 Choice: Respect and prioritize consumer choice and
control
 Collaboration: Maximizing collaboration and sharing
of power with consumers
 Empowerment: Prioritizing consumer empowerment
and skill-building
TIC Communication Style
 Transactional
 Focus on information exchange
 Transactional with Social Talk
 Mostly information exchange with some social talk (e.g.
joking, comment on weather)
 Interactional
 Focus on rapport-building and interpersonal
relationship integrated with the information exchange
https://nchdv.confex.com/nchdv/2012/webprogram/Sessio
n2199.html
Tips for Practicing TIC
 Use language the person recognizes
 “Has your partner messed with your birth
control?”
 Meet the survivor “where they are”
 If a person is not ready to talk, do not force the
conversation. Rather keep the door open for a
later time.
 Consider the person’s cultural context
 Avoid making assumptions – just ask!
Tips for Practicing TIC
 Recognize adaptive behaviors serve a purpose
 Why is a person chronically miss morning
appointments? Is the morning the only time she
can sleep? Does she have a traumatic brain injury
that prevents her from remembering things?
 Make adjustments to help that person succeed.
Set appointment times for the afternoon.
 Include everyone in your agency
 From receptionist to treatment staff
 Provide trauma training to every employee
How do we provide TIC?
 Listen
 What is the survivor saying to you?
 What is the survivor not saying?
 How is the survivor saying it?
 Inform
 What information do you have that may help her?
 What will happen next in the process?
 Why is the information important for her to have?
 How can your services can help her?
How do we provide TIC?
To the best of your ability and within your given time
constraints:
 Lose the labels
 Let her tell her story
 Give her time and space to tell her story
 Let the survivor lead
 Respect her voice and choice
 Recognize the survivor’s comfort level
 Consider the survivor’s perspective from her cultural
context
Quick & Easy
 Offer support and validation
 Communicate care and concern
 Avoid passing judgement
 Ask questions of the survivor
 Find out if she is experiencing some kind of violence or
coercion in her life
 Listen to what she has to say
 Resist interrupting her
 Make sure your body language is receptive
 Offer information and assistance
 Give her a resource card, a phone number, or a website
 Refer her to an advocate (warm hand-off)
 Tell her you are available to her in the future
Resources
 Trauma and Trauma Informed Care
 http://www.trainingforums.org/lms/
 Trauma Informed Care – PowerPoint presentation by
Mandy A. Davis, LCSW, Portland State University
 http://www.doj.state.or.us/victims/pdf/trauma_inform
ed_care_presentation_outline.pdf
 Futures Without Violence
 http://www.futureswithoutviolence.org/
Resources
 Supporting health needs of women in shelter: Exploring
traumatic brain injury and reproductive coercion
 https://nchdv.confex.com/nchdv/2012/webprogram/Session2
192.html
 Violence and reproductive coercion: Assessment strategies
for pregnant women, and client feedback to inform what
works
 https://nchdv.confex.com/nchdv/2012/webprogram/Session2
199.html
 The 6th Biennial National Conference on Health and
Domestic Violence (March 29-31, 2012)
 https://nchdv.confex.com/nchdv/2012/webprogram/meeting.
html
Resources
 Community Connections – Creating Cultures of Trauma
Informed Care
 http://communityconnectionsdc.org/web/page/673/interior.
html
 Trauma-Informed Organizational Toolkit
 http://www.familyhomelessness.org/media/90.pdf
 Trauma-Informed Care; Best Practices and Protocols for
Ohio’s Domestic Violence Programs
 http://www.odvn.org/images/stories/FinalTICManual.pdf
 Creating Cultures of Trauma-Informed Care; A Self-
Assessment and Planning Protocol
 http://www.annafoundation.org/CCTICSELFASSPP.pdf
Resources
 Trauma-Informed Care - PowerPoint
 http://www.mhcc.org.au/ticp/research-papers/Risser2008.pdf
 Shelter from the Storm: Trauma Informed Care in
Homelessness Services Settings - Article
 http://homeless.samhsa.gov/ResourceFiles/cenfdthy.p
df
 Adverse Childhood Experience Study
 http://www.acestudy.org/
 Community Re-Traumatization - Article
 http://www.annafoundation.org/COMMUNITY%20R
ETRAUMATIZATION.pdf
Contact Information
Christine Heyen, MA
Oregon Department of Justice
Crime Victims’ Services Division
1162 Court Street NE
Salem, OR 97301
(503) 378-5303
Christine.p.heyen@doj.state.or.us