TRAUMA INFORMED CARE
Trauma Informed Oregon
Stephanie Sundborg, MS
ssund2@pdx.edu
503-931-0536
AGENDA - WELCOMING
Intent – context
• Creating common language/knowledge
• What is trauma? How does it impact
engagement with services?
• How do I start thinking about trauma
informed practices?
What to consider
BE GENTLE:
• Care of self
• Experience – you are the
New territory
ahead
expert in your system
AGENDA
9:00-9:15
Welcome & Overview
9:15-9:30
TIC 101
9:30-10:30
Acute & Complex Trauma Impact
10:30-11:00
Through a Trauma Lens Activity
11:00-11:15
BREAK
11:15-11:45
TIC Application: safety, power, value
11:45-12:00
Rescue or throw your colleague under bus
12:00-12:15
Examples
12:15-12:45
Hotspots
12:45-1:00
Next Steps and Wrap up
YOUR CHALLENGE – LISTEN FOR
How this relates to the people you see
How this relates to your role
How can you use this info when
working with each other?
SO HELP ME UNDERSTAND….
BEING
TRAUMA
INFORMED?
YOUR CHALLENGE…
What does this have to do with the
people I work with (clients and or coworkers)?
What does this have to do with my role?
TRAUMA INFORMED CARE
“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.”
(SAMHSA’s Concept of Trauma and guidance for a Trauma-Informed Approach, 2014
http://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdf)
TO BE TRAUMA INFORMED
realize the widespread impact of trauma and
understand potential paths for recovery;
recognize the signs and symptoms of trauma in
clients, families, staff, and others involved with the
system; and
respond by fully integrating knowledge about
trauma into policies, procedures, and practices,
and seek to actively resist re-traumatization”
(SAMHSA’s Concept of Trauma and guidance for a Trauma-Informed Approach, 2014
http://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdf)
TRAUMA SPECIFIC SERVICES VS. TIC
Trauma Recovery/Trauma Specific Services
• Reduce symptoms
• Promote healing
• Teach skills
• Psycho-empowerment, mind-body, other
modalities.
TRAUMA INFORMED CARE
Trauma Sensitive
• Bring an awareness of trauma into view
• Trauma lens
Trauma Informed Care
• Guide policy, practice, procedure based on
understanding of trauma
• Assumption: every interaction with trauma
survivor activates trauma response or does
not.
• Corrective emotional experiences.
• Parallel process
PRINCIPLES OF PRACTICE
With a foundation of awareness and
understanding, organizations can strive
to reflect three central principles of TIC,
by creating policies, procedures, and
practices that:
• create safe context,
• restore power, and
• value the individual.
OUR WORK IS TO
Prevent re-traumatization – triggers
• How can you know?
Recognize early warning signs
• Know your work/population
Intervene – deescalate
• Multi-level – micro, macro
A REMINDER…
You may already be doing TI practices
• Because of the population you serve
• Because it is good practice
It is more than what happens between a
person accessing service and a provider.
TAKE A STEP BACK…
WHAT DO
YOU MEAN BY
TRAUMA?
WHAT IS TRAUMA?
Can be single event.
Three Es of
Trauma
(SAMHSA, 2014)
More often multiple events, over
• Events
time (complex, prolonged
• Experience
trauma).
• Effects
Interpersonal violence or
violation, especially at the hands
of an authority or trust figure, is
especially damaging.
http://store.samhsa.gov/shin/content/S
MA14-4884/SMA14-4884.pdf
Negative Stress (Distress)
Tolerable
Difficult and challenging
but we react and then recover
Toxic
Chronic or repeated circumstances or events
Overwhelms coping skills
Bio-chemical response
Can change brain chemistry and function
TRAUMATIC EVENTS
• Physical assault
• Sexual abuse
• Emotional or
psychological
abuse
• Neglect/abandonm
ent
• Domestic Violence
• Witnessing
abuse/violence
• War/Genocide
• Accidents
• Natural or man-made
disasters
• Dangerous
environment
• Witness or experience
street violence
• Poverty
• Homelessness
• Historical Trauma and
Current Oppression
SO HELP ME UNDERSTAND….
WHY IS THIS
TOPIC
IMPORTANT?
WE KNOW
Trauma is pervasive.
Trauma’s impact is broad, deep and life-shaping.
Trauma differentially affects the more
vulnerable.
Trauma affects how people approach services.
The service system has often been activating or
re-traumatizing.
"WITH ABUSE, YOU SUFFER LOSS OF SOUL, LOSS OF SELF AND
LOSS OF MEANING."
"IN THE SYSTEM, YOU MUST FIGHT EVERY DAY, EVERY MINUTE, TO
KEEP FROM FEELING WORTHLESS - TO KEEP YOUR SPIRIT ALIVE."
K.W. (SURVIVOR)
I got traumatized
"Your history follows you no matter
because of trusting
what you do in the present. I only got
people, and asking me
assaultive one time and that was
to make a contract
when they tore the head off my
with you demands I
stuffed doll that I had had for a
trust you - which I
lifetime. Now providers tell me I'm
can't.
dangerous and I terrify people. My
history follows me.”
We know what works for us and what we
need, but no one will listen or take us
seriously.
From “In Their Own Words: Trauma survivors and professionals they trust tell what hurts, what helps, and what is needed for
trauma services” (1997) Jennings, A. and Ralph, R.
IMPACT ON CHILDREN & FAMILIES
National sample – 60% of 0-17 experienced or witnessed
maltreatment, bullying, or assault within year.
One in four experience traumatic event prior to age 16
In Head Start sample (n=113), 58% caregivers and 27% of
children had 4+ ACEs.
Sample (n=155) Head Start, 66% community violence
Nurse Family Partnership (n=209), 41% of mothers and
fathers had 2-3 ACEs.
(Costello, 2002; Blodgett, 2012; Briggs-Gowan et al 2010; Finkelhor, 2009; Shahinfar et al, 2000)
IMPACT ON HIGH RISK ADULTS
•
High rates of sexual/physical assault among women with
substance abuse challenges (up to 99%).
• Link between substance abuse and domestic violence (up
to 80% co-occurrence).
• Sex work and trauma history (up to 99%)
• Public mental health clients and histories of trauma (up to
90%, most with complex trauma).
Childhood trauma especially linked with Borderline
Personality Disorder, Dissociative Identity Disorder.
IMPACT ON WORKFORCE
Social Workers, Domestic Violence and Sexual Assault:
65 % had at least one symptom of secondary traumatic stress
(Bride, 2007); 70% experienced vicarious trauma (Lobel, 1997).
Law Enforcement:
33% showed high levels of emotional exhaustion and reduced
personal accomplishment; 56.1 percent scored high on the
depersonalization scale (Hawkins, 2001).
Child Welfare Workers:
50% traumatic stress symptoms in severe range
(Conrad & Kellar-Guenther, 2006).
Preschool Teachers:
30% annual turn over
http://www.olgaphoenix.com/statisti
cs-painful-truth-about-vicarioustrauma/
WHY NOW?
IS IT A FAD?
Enormous advances in neurobiology in the last two
decades, brain imaging.
Developmental neuroscience, interpersonal
neurobiology.
Adverse Childhood Experiences Study
• Link with mental, behavioral, and physical
outcomes
• Compelling evidence for a public health
perspective
WHAT IT DOESN’T MEAN
It doesn’t mean excusing or
permitting/justifying unacceptable behavior
• Supports accountability, responsibility
It doesn’t mean just being nicer
• Compassionate yes, but not a bit mushy
It doesn’t ‘focus on the negative’
• Skill-building, empowerment
• Recognizing strengths
SO HELP ME UNDERSTAND….
WHAT CAN I
LEARN FROM
THE ACE
STUDY?
TRAUMA IS PUBLIC HEALTH ISSUE
Adverse Childhood Experiences Study (Kaiser
& CDC, 1995)
• 17,337 Kaiser enrolled adults
• ACE score cumulative based on 10
experiences in childhood.
• Includes mix of interpersonal violence and
family dysfunction
Demographic Categories
Percent (N = 17,337)
Gender
Female
54%
Male
46%
White
74.8%
Hispanic/Latino
11.2%
Asian/Pacific Islander
7.2%
African-American
4.6%
Other
1.9%
19-29
5.3%
30-39
9.8%
40-49
18.6%
50-59
19.9%
60 and over
46.4%
Not High School Graduate
7.2%
High School Graduate
17.6%
Some College
35.9%
College Graduate or Higher
39.3%
Race
Age (years)
Education
ACE SCORE INCLUDES:
• Lack of nurturance
and support
(emotional neglect).
• Hunger, physical
neglect, lack of
protection
(homelessness).
• Divorce in the home.
• Alcoholism or drug
use in home.
• Mental illness or
attempted suicide
among household
members.
• Incarceration of
household member.
Two-thirds of sample had a score of 1 or more; ~1 out of 6 had score of 4
or more.
In Oregon (n=4,000): 62% at least 1; 16% four or more (BRFSS, 2011)
THE CUMULATIVE IMPACT
ACE study (scores 0-10)
• Score of 4 or more:
• Twice as likely to smoke
• 12 times as likely to have attempted suicide.
• Twice as likely to be alcoholic.
• 10 times as likely to have injected street drugs.
Linear relationship with:
• Prostitution, mental health disorders, substance
abuse, early criminal behavior.
• Physical health problems, early death.
ADVERSE CHILDHOOD EXPERIENCES
(WWW.ACESTUDY.ORG)
http://www.acesconnection.com/blog/adding-layers-to-the-aces-pyramid-what-do-you-think
SO HELP ME UNDERSTAND….
WHY DOES
TRAUMA
HAVE THIS
EFFECT?
STRESS RESPONSE….
Illustration: Hallorie Walker Sands
Sympathetic Nervous System
SAM sys (Sympathetic Adrenal
Medullary)
• Releases Adrenaline
• Fast (milliseconds)
• Electrical
• Designed for occasional use
• Routes through spinal cord
HPA Axis (Hypothalamus – pituitary
– adrenal)
• Slow (minutes)
• Chemical
• Reflects perception
• Releases cortisol
ENVIRONMENT  BRAIN  BEHAVIOR
Input from the environment
• vision, hearing, smell, taste, touch
In between stuff – mental activities
• Perception, attention, memory, learning

WHY

Output in the environment (Behavior)
• Smiling, laughing, yelling, fighting, eating, listening,
speaking, walking
Downstairs Brain
Before conscious
awareness; reflexive
Mezzanine
Cognition/Conscious
awareness
Upstairs Brain
Higher level thinking
•Survival functions
• Perception
• Long-term memory
•Incoming sensory
• Selective
• Learning
attention
• Working
Memory
• Judgment
•Orienting attention
•Reflexive
Perception (e.g.
startle)
• Problem solving
• Decision making
Behavior
Opportunity to help
navigate, control, filter
sensory input
What to expect
“With the construction we know the noise in the
waiting area can be
loud…perhaps you’d like
to bring headphones…”
Opportunity to make sure attention is focused? Perception isn’t
distorted? Info is getting into short term memory?
“With so much going on in this room, I know it can be difficult to stay focused on
me, but if you could give me your attention for just a few minutes…”
“I know I just gave you a lot of information, can you tell me your understanding of
next steps”
Opportunity to shape experience / context, and memory
formation
“Remember last time this happened, you were able to XYZ”
SENSORY AND THE TRAUMA BRAIN
• More sensitive to incoming sensory information
• Sensory information act as triggers
• Top down input may be distorted – not available
Connecting to behavior: Do you notice survivors
are more aware or bothered by sensory input?
ATTENTION AND THE TRAUMA BRAIN
• Divided attention is better –hyper vigilance and
the ability to pay attention to a lot of stimuli at
once
• Selective attention is worse in general but better
for threatening stimuli
• Sustained attention worse
Connecting to behavior: Do you notice survivors
have a harder time focusing attention? Are they
easily distracted?
MEMORY AND THE TRAUMA BRAIN
• Memory for facts, information, and episodes is
impaired – damage to hippocampus
• Working memory is usually not great – frontal lobe
activation is decreased
• HOWEVER - Implicit memory is strong for
threatening stimuli
• Connecting to behavior: Do survivors forget
appointments, treatment plans, what was discussed
last time? But, is their memory for threat situations
or details good?
EXEC FUNC AND THE TRAUMA BRAIN
• Frontal lobe function is impaired – affecting
judgment, decision making, planning, reasoning
• Poorer regulation - attention and impulse
control
• Anxiety related, perseverative loops
Connecting to behavior: Do survivors
perseverate, fixate? Do they show problems
with impulse control? Struggle with making
decisions or planning
PROCESSING – TOP DOWN
Past experiences, motives, contexts, or suggestions
prepare us to perceive in a certain way
(Perceptual Expectancy)
“We don’t see things as they are.
We see them as we are”
Anais Nin
OUR WORK IS TO
Prevent re-traumatization – triggers
Recognize early warning signs
• Know your work/population
Intervene – deescalate
WHEN TRAUMA HAPPENS….
Freeze, Flight, Fight, Fright
Complex trauma - Chronic Trauma
overtime
Traumatic Stress – Toxic stress
How does this “look” in parents,
families, children? In staff?
CLIENTS MAY…
• Feel unsafe
• Engage in harmful behaviors
• Tend toward anger and aggression
• Feel hopeless or helpless
• Continue unhelpful patterns of behavior
• Feel hyper aroused with memory and communication
problems
• Have trouble managing emotions
• Be overwhelmed, confused, depressed
• Not be able to imagine any other future
EARLY WARNING SIGNS
• Bouncing leg
• Fist clenching
• Hand wringing
• Giggling or other emotional responses (inappropriate)
• Pacing
• Loud voice
• Can’t sit still
• Restlessness
• Swearing
WHEN TRAUMA HAPPENS….
Central Nervous System becomes unbalanced
Parasympathetic
Nervous Sys:
Rest and Digest
Sympathetic NS:
Arousal system
Fight or Flight
TRAUMA AND THE BRAIN
Over-developed amygdala (limbic system).
• Fight, flight, or freeze reactions
Under-developed frontal lobe.
• Harder to bring on-line when amygdala is
working so hard
The good news?
• The brain is plastic; rewiring is possible.
• Healing/recovery are possible
SOCIAL, EMOTIONAL, COGNITIVE
Emotional Reactions
• Feelings – emotional regulation
• Alteration in consciousness
• Hypervigilence
Psychological and Cognitive Reactions
• Concentration, slowed thinking, difficulty with
decisions, blame
Behavioral or physical
• Pain, sleep, illness, substance abuse
Beliefs
• Changes your sense of self, others, world
• Relational disturbance
INTERGENERATIONAL
Prenatal stress can affect HPA axis function
• Early and chronic abuse is associated with permanent
sensitization of HPA axis
Trans generational Transmission of Trauma
• Lower cortisol levels in mothers and babies of mothers who
developed PTSD following World Trade Center attacks
• In rats, exposure to high levels cortisol prenatally (3rd
trimester) associated with low birth weight, hypertension,
glucose intolerance as adults
Care and Attachment can Buffer Trauma/ Stress
• Early care (tactile) leads to a reduction of CRH neurons in
hypothalamus (Karsten & Baram, 2013) – must be recurrent
INTERGENERATIONALLY – TRAUMA
….
Changes neurobiology and DNA
Affects caregiving attachment / bonding
Provides a narrative that is learned and carried on
NEUROBIOLOGY TAKE AWAYS
Attention can be a problem:
• Amygdala in survivors is hyper-vigilant – scanning for real
or perceived threat; attentional control from frontal lobe
is decreased
Communication is challenging: dominance of RH
• Decreased verbal (left hemisphere) – hypersensitive to
nonverbal (right hemisphere) – prone to misinterpret.
Memory is impaired – damage to hippocampus due to
excess cortisol:
• Explicit memory (hippocampus) – facts, stories, pictures –
impaired
• Implicit memory (amygdala – acute trauma) often clear
and sharp
MORE TAKE AWAYS
Our brains change and welcome change.
Positive interactions which communicate safety and
connection are foundational to changing unproductive
brain patterns.
Every interaction the survivor has with a provider
system has the potential of
• adding to the trauma experiences,
• reactivation of trauma memories,
• or providing a sense of safety and enhancing emotional
regulation.
ACTIVITY
Through a trauma lens…
education statements
A TRAUMA LENS
What might the NON Trauma informed system say about
this person?
Using a trauma lens – what could be going on?
1.
2.
3.
TRAUMA EDUCATION STATEMENT:
What we know about trauma is __[that trauma survivors often
started using substances]__ because/to [either prevent feeling
greater pain, to feel something, or because it was forced onto
them
You are meeting with Kiesha to complete paperwork
for services she requested. She keeps rustling through
her bag while your talking, looking outside your office,
and checking her phone. She can’t seem to settle down
and focus.
Jack calls all of his providers, multiples times. The calls
are often about the same thing. He is often asking for
tangible goods & can be verbally aggressive. For
example last week he called requesting bus tickets.
One of his providers said “I think I can get you some”
but he kept calling the other providers.
Pat agrees to MH counseling in a team mtg but “no
shows” for the intake. During follow-up she states she
is very interested but “no shows” again.
Tim is completing an intake for your services.
Your program has several rules and protocols that
need to be followed to successfully complete.
Tim’s referral states that he has difficulty with
authority and following rules and doesn’t accept
help from others.
Sue successfully completed her substance abuse
treatment program. Part of the safety plan for her
to have her 4 y/o is no contact with her abuser.
While out one day she runs into her ex-partner
who was abusive. Her DHS worker finds out,
confronts her about it and she doesn’t tell the
truth saying “it never happened”.
BREAK
JUST BREATHE
JULIE BAYER SALZMAN & JOSH SALZMAN
(WAVECREST FILMS)
JUST BREATHE
SO HELP ME UNDERSTAND….
HOW DO I DO
THIS?
THE FOUNDATION
Trauma Awareness
• Trauma education and training for all staff;
• Hiring, management, and supervision
practices;
• Policies and procedures for referral, intake,
termination;
• Universal precaution and/or universal
screening;
• Recognition of vicarious trauma and the
appropriate care of staff;
• Knowledge of effective trauma recovery
services;
THE FOUNDATION
Understanding impact of historical
trauma and all forms of oppression
• Ongoing training for all staff
• Ongoing inclusion of consumer voice
• Procedures and practices that promote
and sustain accountability
PRINCIPLES OF PRACTICE
With a foundation of awareness and
understanding
Organizations can strive to reflect three central
principles of TIC, by creating policies,
procedures, and practices that:
• create safe context,
• restore power, and
• value the individual.
Trauma Informed Care
Trauma Informed Care (TIC) recognizes that traumatic experiences terrify, overwhelm,
and violate the individual. TIC is a commitment not to repeat these experiences and, in
whatever way possible, to restore a sense of safety, power, and worth.
The Foundations of Trauma Informed Care
Commitment to Trauma Awareness
Understanding the Impact of Historical
Trauma
Agencies demonstrate TIC with Policies, Procedures and Practices that…
Create Safe Context
Physical safety
Clear and consistent
boundaries
Transparency
Predictability
Choice
Restore Power
Value the
Individual
Choice
Empowerment
Strengths
perspective
Skill building
Respect
Collaboration
Compassion
Mutuality
Relationship
NON-TRAUMA INFORMED SERVICES
• Consumers are labeled as manipulative, needy,
disabled, attention seeking
• Misuse or overuse of displays of power-keys,
security, demeanor
• Culture of secrecy – no advocates, poor staff
monitoring
• expectations
• Patient compliance vs collaboration
• Staff disempowered then pass on …
• SU has to show interest….motivation
CREATE PHYSICAL SAFETY
What does physical
space look like?
Where and when are
services?
Who is there/allowed
to come?
•
•
•
•
•
•
•
Attend to unease…
Is there anything I can do •
to help you feel more
•
safe?
•
Lighting
Bathrooms
Exits/entrances
Signage about what to
expect, where to go…
Home visiting plans.
End with “what’s next”
Vicarious trauma
prevention plans
Space for self-care
Training
Scripts
CREATE EMOTIONAL SAFETY
Transparency
• Explain the “why”
• Clear and specific
language
Predictability
• What’s next
Clear & consistent boundaries
• Be able to state and model
• Allowed to speak up re:
vicarious trauma
• Vicarious trauma
prevention plans
Choice
• Understanding
your role
• Being able to say
no.
• Access to records
• Access to job
expectations
before hire
• Psy evals and
assessments
CREATE EMOTIONAL SAFETY
• Understanding
your role
• Being able to say
no.
• Access to records
• Access to job
expectations
before hire
• Psy evals and
assessments
RESTORE POWER
Empowerment
• Advocate, model
Choice
• As much as possible
• Keep it real; explain the
why
Strengths Perspective
• Adaptability
• Focus on the future
Skill building
• Every encounter
Things to think about
• Learned Helplessness
• Competence &
confidence
• 3 choices
• Relationships not used
as threat
• Frontal lobe
• Peer Support
VALUE THE INDIVIDUAL
Respect
• Life experience and strengths
Things to think about
Collaboration
•Structure to have
• Referrals, teams, meetings
voices heard
Compassion
•Acknowledgement
• Not an excuse but an
•Giving voice to –
explanation
•Advocating for…
• Self Care
Relationship, Mutuality, Authenticity
• Modeling, boundaries, learning,
partnering
ACTIVITY
Rescue or throw your colleague
under the bus
Your client is in the lobby and is pacing - seems
unable to settle down and keeps asking for water.
Colleague says:
“You should give her a surprise UA”
Correction:
I understand what you are saying but I also
know that our offices often make people feel
unsafe because of why they are here or because
they are triggered by the smells and sounds so I
will check in with her and assess her sense of
safety…..
You’re in a group setting and a member says “I can
only calm down by drinking or smoking pot and
taking the Klonapin my psychiatrist gave me.”
Colleague says:
“Does your psychiatrist know you’re drinking and
smoking pot? That sounds really dangerous,
especially since you’re also taking Klonapin!”
Correction:
It sounds like it is hard to get your body to calm
down and you have found that what works is… I
have some concern about mixing the Klonapin
and wonder if you could talk to your dr….
John is a new member to group and on the first day
he moves a chair out of the circle and puts it near
the door to sit.
Colleague says:
“Sorry dude. This is not an “all about John” group. If
you want to get credit for being here I suggest you
bring your chair back and join the group. ”
Correction: acknowledge common fears,
options and group inclusiveness – respond to
the co-worker without putting John on the spot.
“Sometimes it takes people a little while to feel
safe with a new group…”
“You are asking me about my abuse history, what
about you, have you experienced abuse?”
Colleague says:
“We are not here to talk about me. It’s not
appropriate for me to answer that ”
Correction:
This is a common question people ask, often to find
out if we can relate and whether we’re ok. It is hard
to not be touched by trauma, and we do support
each other, but I am going to leave it there for now
because I don’t want you to feel you can’t share
with us [me] because you worry about triggering
us [me]
TRAUMA INFORMED CARE
ON THE GROUND
IN THE SCHOOLS…
Restorative Justice
Positive behavioral
supports
Reduced
expulsions/suspensions
, eliminating the need
for the alternative
school.
How is this trauma
informed?
• Attending to the whole
person, recognizing
strengths, bringing
compassion first.
IN ADDICTIONS TREATMENT…
Resident Council
formed
Clients invited to
negotiate for changes
in rules and policies
What about TIC?
• Respect,
collaboration,
strengths-based,
empowering
“Many of the policies and procedures currently in place
at the WRC were either amended or created by clients.”
IN HEALTHCARE…
Pediatric clinic
adopted screening for
ACEs to engage
parents in a different
way
Showing compassion,
building relationship,
increasing sense of
safety, collaboration
IN AN ANTIPOVERTY AGENCY…
“All sites were assessed for
safety, welcoming
environment, and
confidentiality.”
After an assessment -themes
of Physical Safety,
Confidentiality,
Transparency, & Choice.
• more private interview
spaces, improved lighting,
gender neutral bathrooms –
key access.
• Measure progress in “ways
that honor client choice”
• Consumer Satisfaction
Survey changed
IN HOUSING…
Staff developed & delivered
TIC presentations
• for the Board
• for departments
Hiring and onboarding
practices
Yoga classes, 5 day in a row
vacation,
transparency/appreciation
meetings
“It’s definitely starting to infuse more into the daily part of our
jobs, but it’s always a work in process (which I think is how it
should be always considered….)”
IN DHS BRANCH OFFICES…
Creating physically
welcoming
environments
• Attend to sense of safety
and care for clients
• A different experience for
staff as well
IN A MENTAL HEALTH CLINIC…
Wrote agencywide policy for TIC
Staff Wellness Plans
Altered physical
environment to
include and
integrate peer
supports
HOW DID THEY DO IT?
Staff Training and Information
• Common language
• Motivation, buy-in
Management support
• Early & Ongoing Commitment
TIC Workgroup
• Assess
• Prioritize
• Communicate
• Recommend
HOW DID THEY DO IT?
Identified
Priorities in Core
Domains of TIC:
• Physical and
Emotional Safety
• Power, Choice
• Human Value and
Relationship
Made Realistic
Changes:
• Low Cost, High
Impact
A CULTURE OF TIC
Involves all aspects of program activities, setting,
relationships, and atmosphere (more than
implementing new services).
Involves all groups: administrators, supervisors,
direct service staff, support staff, and
consumers.
Involves making trauma-informed change into a
new routine, a new way of thinking and acting.
WHAT DIFFERENCE DOES IT MAKE?
• Service Recipients can participate in their own
care.
• Service Recipients gain skills for self-regulation
and self-advocacy.
• Service Recipients can remain engaged even when
there are bumps in the road.
• The work is more rewarding for staff.
• Vicarious trauma/worker stress is reduced.
NATIONAL HAPPENINGS
The National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC)
http://www.samhsa.gov/nctic
National Association of State Mental Health Program Directors
http://www.nasmhpd.org/TA/nctic.aspx
Trauma-Informed Organizational Toolkit – The National Center on Family Homelessness
http://www.familyhomelessness.org/media/90.pdf
National Center for Domestic Violence, Trauma & Mental Health
http://www.nationalcenterdvtraumamh.org
National Child Traumatic Stress Network
http://www.nctsn.org/
National Council for Community Behavioral Healthcare- Trauma Informed BHC
http://www.thenationalcouncil.org/wp-content/uploads/2012/11/NC-Mag-Trauma-Web-Email.pdf
The National Institute for Trauma and Loss in Children
https://www.starr.org/training/tlc
The National Association of States Directors of Developmental Disabilities Services
http://www.nasddds.org/resource-library/behavioral-challenges/mental-health-treatment/trauma-informedcare/national-center-for-trauma-informed-care/
National Center for Social Work Trauma Education and Workforce Development
http://www.ncswtraumaed.org/
Chadwick Center for Children and Families
http://www.chadwickcenter.org/CTISP/ctisp.htm
THANK YOU!
Stephanie Sundborg
ssund2@pdx.edu
Trauma Informed Oregon website
traumainformedoregon.org