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* Trauma-informed care is a mind-shift more than anything else
* The primary aims of TIC are to:
* Raise awareness that ‘thorny’ presentations are usually traumaimpacted and are self-protective in nature
* Trauma frequently impacts relationships and self-perpetuation of
trauma cycles is common
* Emphasize re-traumatization prevention as much as possible
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* ACE Study (1999):
* Largest study of the short and long term impacts of cumulative
childhood trauma
* Over 17,000 HMO Members were interviewed and answered a
series of very specific questions about their childhood
experiences
* Groundbreaking findings on health and social effects of adverse
childhood experiences, with vast public health implications
* Replication in 8 other states, as well as Norway, China, Japan,
Jordan, the Phillippines, Canada, and the U.K.
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* ACE Study (1999):
* Three types of abuse (sexual, physical and emotional).
* Two types of neglect (physical and emotional).
* Five types of family dysfunction (having a mother who was
treated violently, a household member who’s an alcoholic or drug
user, who’s been imprisoned, or diagnosed with mental illness, or
parents who are separated or divorced
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ACE’s increase the risk of:
Heart Disease
Substance use & Alcoholism
Chronic lung disease
High blood pressure
Liver disease
Heart attack
Suicide
Impaired memory
Injuries
Smoking
HIV and STDs
Rape victimization
Depression
Domestic violence (victim and
perpetrator)
Hallucinations
Promiscuity (>50 partners)
Severe Mental Illness
Unintended and/or teenage pregnancy
Diabetes
Violence
Obesity
Anxiety
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* In New York:
* 95% of state hospital consumers
* 80% of the homeless
* 90% of women in jail
* 1600 veterans currently in homeless shelters or living on the
streets
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* The challenge:
* Transform two homeless shelters to become more traumainformed
* Do this in a system (NYC Dep’t of Homelessness) that frequently
expresses no interest in
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* Evaluation
* TIC-OSA
* Incidents
* ER visits
* Length of Stay (?)
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* Overview:
* STEPS (safety, trauma-informed, empowerment,
personal responsibility, strengths-based) materials
* Lots of training of ALL staff
* “Healing Neen” screenings
* Leadership Team + Localized TIC committees
* Peer to peer organizing
* Consumer Advisory Committee
* Increased communication with police & community
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* Other considerations
* Kickoff event w/ Tonier Cain
* Intake process, welcome letter, peer
orientation, etc
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* Training included:
* Mindfulness exercises seeing shelter life through the eyes of a
woman (Anna) with a trauma-impacted history
* … and how she may respond/react to “typical” human responses to
her oft-aggressive behavior
* Exercises examining one’s own (potential) trauma history
* A step-by-step process to shift relational frame in response to
thorny behaviors
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* TREDS:
*Take a breath / step back
*Relationship focus
*Empathic reflection
*De-escalation
*Supportive follow-up
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*Take a breath / step back
• Gather yourself
• Orient yourself to the room
• Let go of any need for immediate resolution
•  So you can focus on safety
• Look beyond the behavior to the hurt inside the person
• Do not take behavior personally
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* Relationship focus
• Recognize that all interactions present an
opportunity for healing
* AVOID ARGUMENTS
* Build and sustain trust
* Communicate understanding and acceptance
* Create safety and safe boundaries
* Cultivation of positive relationships requires patience, sensitivity
and a focus on the long view
* Example: “Getting into an argument will cause a power struggle
and that’s not helpful to anyone. In order to keep things safe, how
about you and I talk about how we can work together here.”
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* Empathic reflection
• Identify and validate feelings by reflection
• Identify and validate self-protective behaviors
• Model safety, normalize and accept feelings
• Examples:
• “You are feeling angry right now”
• “This is clearly important to you, and I’d like to know more about it.
However it’s important we approach this in a safe way.”
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*De-escalation
• Safety and boundary setting
• Feedback
• Responsibility
• Choice
• Elicit willingness to do something different
• Example: “I see you are upset. Our job right now is to make sure
everyone is safe. You have choice here. We can sit and talk about
what’s happening, or you can continue to yell. I can’t make this
choice for you, but I can tell you that the safer option is the first
one. At the end of the day, it’s your decision. C’mon let’s try and
figure this out together.”
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* Supportive Follow-Up
* Focus on breaking the cycle of reactivity
* Pro-active and persistent follow-up
* Emphasize values
* Addressing behaviors in a non-judgmental,
trauma-informed way and in light of client’s strengths and values
* Psycho-education and the spirit of recovery
* Example: “Hey I just want to say that I’m impressed by the choice that you
made yesterday. How are you feeling about it today?”
* Example: “Hey you are back. Can we check in for a minute? I want to see how
you are feeling about the way things played out. Staff called 911 because it is
crucial for everyone to feel safe. I’m hoping that you understand this and I’m
wondering if next time you feel upset we can figure out some safer choices”
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* Across the two shelters (one year pre/post):
* Statistically sig. increased fidelity in 3/7 TIC-OSA domains
* 24% reduction in psych ER visits
* 29% decrease in med ER visits
* 27% reduction in incidents involving physical aggression, property
destruction
* 36% reduction in foyer/security area
* 51% decrease in staff reliance on EMS in response to incidents
* 20% decrease in staff reliance on police in response to incidents
* 189% increase in staff reliance on internal capacity to respond to
incidents (neither police nor EMS called)
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* Anecdotal:
* Increased engagement & relationship building
* Increased peer to peer support, prevention
* Increased staff retention
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* Looking forward:
* Sustainment is critical & difficult
* Improve relations with DHS
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