Transcript: Early Interventions Secure Attachment Trust Acceptance Safety 36.2% were physically harassed Looking at the ACES study, the youth have faced: The importance of attachment cannot be underestimated Family Rejection "A Sweet Old Fashioned Notion" Age of Disclosure To Whom "It May Seem to You That I'm Acting Confused" “Coming out” is considered an integral part of a non-heterosexual identity (Cass, 1979). Danger and safety are core concerns in the lives of traumatized children Unsafe at home & school & community Increase in risk taking behavior Core Concept # 3 "Who Needs a Heart When a Heart When a Heart Can be Broken?" "I have to say..." = "You Must Understand" These youth are at higher risk of mental health problems The stigma and discrimination is widespread- from the streets to schools to home Homelessness (20-40%) & Legal Trouble & Dysfunctional Cognition's Attachment, Attraction & Emotion: "My Pulse Reacts" "There's a Name for It" The hardships that LGBTQ* youth face are explored through a trauma focused developmental lens. For many youth, a crippling hardship is the disruption of their primary attachment. This disrupted attachment is a traumatic experience. Prevention Core Concept # 5: Adolescence is a time of development An insecure attachment has negative effects Many LGBTQ* youth experiences are traumatic following a break in the primary attachment Core Concepts Safety and Security are paramount The protections that exist are not enough TRAUMA = LGBTQ* individuals are across all races, cultures, ethnicity's, & religions The literature is full of the facts and statistics: "I've Been Thinking About my Own Protection" 74.1% of LGBT students were verbally harassed Disruption in the Primary Attachment Traumatic events often generate secondary adversities, life changes, and distressing reminders in children’s daily lives Brittany Moro Verbal/Physical/Sexual Abuse Rejection--> Homelessness "I've Been Taking on a New Direction" “Being lesbian, gay, or bisexual in our culture requires living a life of multiple psychological identities. At the very least, lesbians, gay men, and bisexually identified people live in a predominantly heterosexual society that demands adherence to certain personal, relational, and social norms” (D’Augelli, 1994, p. 313). “Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection" 37 States have Marriage Equality Media: Coverage or Lack thereof? Pride & Prejudice Stigma Discrimination Homophobia Heterosexism Heteronormativity Minority Stress "What's Law got to do with it?" Adolescence identity formation is confusing enough "I've Read it Someplace" "It Scares Me to Feel This Way" Threat to survival Loss of control Helplessness Fear Trauma as Experienced by LGBTQ* Youth Title IX- bans discrimination based on sex, protects students at schools that receive federal funds Anti harassment policies Rights for youth in care Refrain:
Transcript: The DSM-IV defines trauma specifically as: Screening Tools Vicarious trauma can change the way you think about the world and yourself. It can cause people to question their worldview in a number of areas including: Changes in spirituality Changes in identity Changes in beliefs related to major psychological needs Hyper arousal symptoms Repeated thoughts or images regarding traumatic events, especially when you are trying not to think about it Feeling numb Feeling unable to tolerate strong emotions Increased sensitivity to violence Cynicism Generalized despair and hopelessness, and loss of idealism Guilt regarding your own survival and/or pleasure Anger Disgust Fear Inability to “switch off” from work when at home Activity Did You Know? Depression Despair and hopelessness Loss of important beliefs Aggressive behaviour toward oneself or others Self-blame, guilt, and shame Problems in relationships with others. Less interest or participation in things the person used to like to do Social isolation Problems with identity, and self-esteem. Feeling permanently damaged Physical health symptoms Alcohol and drug abuse Trauma in a Mental Health Setting Mentally re-experiencing the trauma can include: •Upsetting memories such as images or thoughts about the trauma •Feeling as if the trauma is happening again (flashbacks) •Bad dreams and nightmares •Getting upset when reminded about the trauma (by something the person sees, hears, feels, smells, or tastes) •Anxiety or fear, feeling in danger again •Anger or aggressive feelings and feeling the need to defend oneself •Trouble controlling emotions because reminders lead to sudden anxiety, anger, or upset •Trouble concentrating or thinking clearly People also can have physical reactions to trauma reminders such as: • Trouble falling or staying asleep •Feeling agitated and constantly on the lookout for danger •Getting very startled by loud noises or something or someone coming up on them from behind when they don't expect it •Feeling shaky and sweaty •Having their heart pound or having trouble breathing Has there been a traumatic story that one of you clients has told you that has stuck in your head? How did it affect you physically, psychologically and emotionally? What did you do to cope with those feelings? What resources did you use? Share in pairs or small groups and if comfortable share with the entire group. Known as indirect trauma, secondary trauma, compassion fatigue and empathetic strain Professionals who have opened their hearts and minds and have listened to stories of the worst of humanity can experience intrusive imagery, thoughts, physiological arousal, avoidance and anxiety affecting both their professional and personal lives. Physical and psychosomatic symptoms of vicarious trauma Torture and Trauma Model (1998) Discussion Up to 65 per cent of Australians are likely to experience or witness an event which threatens their life or safety, or that of others around them. This can be a car or other serious accident, physical or sexual assault, war or torture, or natural disasters such as the recent bushfires or floods. How serious the symptoms and problems are depends on many things including: -a person's life experiences before the trauma -a person's own natural ability to cope with stress, how serious the trauma was -What kind of help and support a person gets from family, friends, and professionals immediately following the trauma. If prolonged, these symptoms create a potential for a diagnosis of post-traumatic stress disorder (PTSD). Traumatic events, especially child and sexual abuse have also been shown to have a significant contribution to the onset of or exacerbation of psychotic symptoms or drug and alcohol dependencies. How does it effect the clinician on a personal level? What is Vicarious Trauma? Case Study Using the model, identify and discuss Mikey’s traumatic experiences and his response to these experiences. Then choose recovery goals to work on with him. Consider the recovery goals in the model, how could you integrate these goals into Mikey’s recovery plan? Discuss in small groups. Share with whole group. Avoidance Symptoms: • Natural disasters • Mass interpersonal violence • Large scale transport accidents •House or other domestic fires •Motor vehicle accidents •Rape and sexual assault •Stranger physical assault •Domestic violence •Torture •War •Child abuse •Seeking refuge •Vicarious trauma Coping with Vicarious Trauma Mikey is a 25 year old male of Sudanese Background. He was diagnosed with Schizophrenia at age 16. When he was 5 years old, his family fled Sudan and crossed the border into Egypt where they joined a Refugee camp. Before entering the camp, the military regime that occupied Sudan would forcibly remove people from their homes or kill them in brutal ways if they opposed the government. During his time at the refugee camp he was exposed to squalor, malnutrition, lack of adequate shelter and violence. He experienced a lack of
Transcript: Trauma Counselling a 6 day course summarized in 120 minutes What is trauma? Title "a deeply distressing or disturbig experience" or "a physical injury" Trauma: Definition Facts and statistics
Transcript: Work Experience Masters of Higher Education- University of Oklahoma Bachelor of Science- Texas Tech University Integrity encompasses many values for me, including honesty, respect, and accountability. Confidence University of Central Florida Assistant Academic Advisor - Football University of Oklahoma Graduate Assistant - Athletic Academics/IAA Gradaute Program Student Assistant - Varsity "O" Alumni Association Volunteer - Student-Athlete Development Texas Tech University Intern - Football Academics Student Athletic Trainer Calvalier Academic Services Team (CAST) Associate Athletics Director of Student Services - Adrien Harraway Assistant Director of Academic Affairs - Adam Brooks Director of Football - Natalie Fitzgerald Director of Men's Basketball - T.J. Grams Director of Olympic Sports - Heather Downs Director of Learning Services - Shelly Lovelace Tutoring Coordinator - Megan Maddox Tutors Academic Coordinators Megan Dailey Chase Gibson Dan Jacobs Kate Stephenson Administrative Assistant - Sheila Meek Study Hall Monitors Dedication to Diversity My morals and values are very important to the person that I am and how I live my life. Develop and empower all University of Virginia student-athletes to become independent lifelong learners and productive citizens by providing comprehensive and collaborative academic support services. Faith Diverse Community Mission Statement Partner with Office of Diversity and Equity Create a multicultural student-athelete organization that celebrates diversity Promoting Self-Improvement and community service Opportunity to get involved on campus with issues that effect themselves Continuing to learn and believe in my abilities. Trust Athletic Diversity Initiative like comment share like comment share University of Virginia Provide a safe and supportive environment for student-athletes Community Engagement Educational Opportunities Social & Professional Networking Help to increase retention Honor Be intentional in all the things that I do. Initiative Athletic Academic Affairs Office Integrity Craig Littlepage Athletic Director University of Virginia Goals Athletics Academic Coordinator Football University of Virginia Intentionality Respect like comment share like comment share Questions Core Values like comment share sha Teresa Sullivan President University of Virginia xs,d Maintain the upmost respect for myself, others and the work that I do. I am passionate about people and love to laugh. Growing up as a military brat, I learned the value of family at a young age. My faith is important to me and I try to treat others how I would want to be treated. I believe that I was put on this earth to help others figure out what they are passionate about and how they can achieve their goals in life. Thank you for your time and attention! Integrity Professional Mission Statement: To empower and motivate students to be successful in their lives through respect, self-confidence, and life long learning Honor Education Kierstyn Stevens About Me
Transcript: Ashley Campo, Jackie Lara, Evelyn Martinez, Annika Nichols, Kaitlyn Shelp & Sophie Vogt Trauma Case Study Client Introduction Demographics Nicholas Hernandez 15 years old Hispanic Able-bodied Cisgender male Middle-class SES 9th Grade Parents divorced when client was 6 Father absent since divorce Mother brought new boyfriend into home Boyfriend has been physically abusive for 3 months Presented at school with visible bruises Began to display erratic and uncharacteristic symptoms Teacher contacted DCF to report concerns Client History History Mother is client's largest protective factor Client enjoys drawing and carries a notebook Client has otherwise limited protective factors Protective Factors Protective Factors Emotional: Anxiety Shame Fear Guilt Physical: Bruises Nausea Sweating Hyperventilating Symptoms Presenting Symptoms Behavioral: Bedwetting Night terrors Avoidance, Argumentative, Withdrawal from friends Criterion A: Stressor • Direct exposure to physical violence Criterion B: Intrusion Symptoms • Nightmares • Emotional distress • Physical reactivity Criterion C: Avoidance • Trauma-related thoughts or feelings • Trauma-related external reminders Criterion D: Negative Alterations in Cognitions and Mood • Decreased interest in activities • Feeling isolated Criterion E: Alterations in Arousal and Reactivity • Irritability or aggression • Difficulty concentrating • Difficulty sleeping Criterion F: Duration • Symptoms last for more than 1 month. Criterion G: Functional Significance • Symptoms create distress or functional impairment Posttraumatic Stress Disorder Diagnosis NH is a 15-year-old male who came in for counseling to address concerns regarding anxiety and trouble sleeping. After further evaluation and assessment on the client’s symptoms, the counseling team learned that the client has been experiencing physical abuse from his mother’s boyfriend for the last nine months and began experiencing symptoms about two months ago. Client reported that the mother’s boyfriend only abuses him when the mother is not home, so the mother had no knowledge of this abuse. In regards to symptomology, NH has difficulty with anxiety, shame, fear, and guilt; he often feels nauseous, and begins hyperventilating and sweating, and he also has bruises on his torso and thighs; NH has also been experiencing night terrors, withdrawing from friends, has become more argumentative, and has been avoiding activities he used to enjoy; client also reports thinking that the abuse is his fault. Case Conceptualization Case Conceptualization Before the abuse began, the client reported feeling attached to the mother’s boyfriend, which may be a result of the client’s father being absent from his life since his parent’s divorce when he was 6-years-old. Client believes that the abuse is his fault and that he caused it because he feels as though he angered or bothered his mother’s boyfriend with how attached NH was to him. These thoughts are the reason why NH often has trouble falling asleep. When NH does fall asleep, he is often woken up from nightmares about the boyfriend coming home and abusing him. NH will wake up screaming and his heart races and very rarely can fall asleep again. NH also fears being alone in his home because he doesn’t know when his mother’s boyfriend is going to arrive home. Client has expressed that he has recently become more attached to his mother and tries to be around her as much as possible. NH has even made attempts to try and persuade his mother to change her work schedule so she can be around more. NH believes that if his mother is around more, the abuse will stop. Counselor may need to address the initial trauma of divorce before abuse trauma. Client guilt may impact treatment approach. Counselor could explore any potential links with the divorce and the abuse he is going through now and how he views both scenarios. Client age may present with lack of insight or understanding, as well as fear to disclose information. Client’s Hispanic background would be another aspect to explore in regards to how he views family, mental health, gender roles, and talking about problems. Cousnelor has potential for vicarious trauma. Implications Implications Art therapy could be considered for this client since he likes to draw and carries a notebook with him. Family counseling with mom is also a possibility with this client. Client will need to be assessed for suicidal ideation/risk due to his abuse, minimal social support, lack of sleep, and overall risk since he is a young teen and part of a minority group. Reframing techniques will likely need to be taught to address guilt, shame, and view of self. Counselor will seek supervision for any vicarious trauma concerns. Implications for Interventions Interventions Informal assessment and intake Rapport building Psychosocial Inventory Trauma Symptom Checklist for Children UCLA PTSD Index Behavior Assessment System for Children-2 Exploring trauma therapy Developing treatment
Transcript: Patient came in on a strecher Megan Lineberry, December 3rd 2011 Dad stayed in the room & was provided lead Patient History Patients arm was lying on top of a magazine Sponges were used to elavate the arm Patient was with dad Technical factors used, 60@% During the Exam Patient fell down a set of stairs Exam was altered by doing a cross-table lateral Male patient 7 years old The patient was very scared Expectations after seeing the patient Projection ordered was a forearm The only history given before meeting the patient was "injury" Conclusion Starting the Exam Trauma Presentation No repeats required
Transcript: Penetrating Trauma L2 DIRECT 18M stabbed to the R flank and RUE Pt arrives from scene via EMS s/p stabbing R upper arm laceration w/exposed muscle R thoracoabdominal stab @ 5th rib (-) loss of consciousness c/o severe R sided chest pain w/ dyspnea Awake, talking, diaphoretic on arrival 2 16G needles in L/R AC distal to wound --> 2L bolus fluid 18M stabbed to the R flank and RUE Primary Assessment ABC's A Airway maintence Spontaneous respiratory effort Airway patent, patient is able to talk, no obvious obstruction C-spine collar per EMS B Breathing and Ventilation Equal chest movement No tracheal deviation Normal resp effort Right breath sounds diminished No crepitus on palpation of the chest wall C Circulation Skin well perfused, cap refill normal Palpable central + peripheral pulses Controlled bleeding from R thoracoabdominal stab wound w/ pressure dressing RUE was neurovascularly intact Primary Assessment ABC's D Disability: neurological status GCS 15 AAO x3 Pupils 3mm B/L (+) movement and sensation x4 E Exposure and environment control Pt was fully exposed Log roll: chest, thoracic, lumbar, sacrum No paravertebral or spinal process tenderness or step offs Normal rectal tone and no blood D and E D and E F Full Vitals HR 103, BP 120/60, O2 sat 100 on RA, RR 24, temp 36.7C oral , pain 9/10 G Give comfort Warm blankets applied Pain was tx w/ morphine IV H Head to toe Well developed, moderate distress Head: NCAT Eye: EOMI, pupils equal, reactive to light, 3mm b/l Neck: FROM Resp: Diminished breath sounds R side, no crepitus, trachea midline, laceration R side ~5th rib Cardio: RRR, Normal S1, S2, no murmurs, rubs, gallops GI: soft, nontender, normoactive bowel sounds Neuro: AAOx3 STAT labs + T/C Secondary Assessment Secondary Assessment PMHx: None PSHx: None SHx: (+) tobacco, (+) EtOH Allergies: NKDA PMHx: None PSHx: None SHx: (+) tobacco, (+) EtOH Allergies: NKDA (+) Moderate R pleural free fluid (-) Pericardial effusion (-) Perisplenic (-) Pelvic free fluid (-) Perihepatic/Morison's pouch FAST exam FAST exam Tube Thoracostomy Initial supine CXR showed no HTX/PTX Indication = diminshed breath sounds on R, FAST findings, digital exam concerning for violation of pleura Placed chest tube 15min after arrival Initial output = 150mL Tube Thoracostomy >1,500 mL of blood loss on insertion OR >150-200 ml/hr over 3 hours Take to the OR Chest tube output Chest tube output Pleurovac 3 chambers: collection, water seal, suction Collection: collects fluid, blood, pus Water seal: one way valve, removing air from pleural space Leak = bubbles passing through the water seal fluid Suspect a leak, stop suction, ask pt to cough, look for air bubbles No bubbles = no leak Suction: suction until PTX resolves Tube to suction until PTX resolves, drain output decreases -- advance to water seal for 24 hrs -- CXR -- remove chest tube -- 4 hrs post CXR Pleurovac Radiology CT Head: (-) CT C Spine: (-) CT Chest, Abd, Pelvis: (+) XR R Elbow: (+) soft tissue injury, normal bone, joint Radiology LUNGS R lower lobe pulmonary lacerati... LUNGS R lower lobe pulmonary laceration Small right-sided pneumothorax R thoracostomy tube in place OSSEOUS Small avulsion fx of posterolateral R 8th rib Surgical Intervention Indications for surgery Persistent drainage from the stab wound and underlying muscles Concern for intercostal injury Concern for diaphragmatic injury Surgical Intervention Operation Right video-assisted throacotomy (VAT) to control bleeding, evacuate hemothorax, and washout Exploration of right thoracoabdominal stab wound No obvious intercostal artery bleeding Palpable fracture of 8th rib No diaphragmatic injury 1.5 cm lung laceration Right arm laceration repair measuring 7.5 cm EBL = 50mL Operation Preop Dx: Stab wound to thoracoabdominal region Postop Dx: Stab wound to the thoracoabdominal region, muscle bleeding 1.5 cm lung laceration 7.5 x 3 cm arm laceration and tendon laceration Diagnosis Diagnosis POD 1 Ancef CXR -- clear lungs, no PTX Chest tube output = 0 Regular diet POD 2 Ancef Chest tube to waterseal Pulmonary hygiene (clearing secretions, incentive spiro) OOBAT Chest tube output = 55ml CXR -- tiny right apical PTX Hospital Course Hospital Course POD 3 Chest tube output = 35 ml d/c chest tube CXR -- small/moderate PTX, scattered atelectasis POD 4 Persistent small R PTX hemodynamically stable, O2 sat 98-100% Pt discharged LABS LABS Chap. 192 Airway Management in Trauma Patients, Cameron's Surgery 11th ed. de Virgilio, C (2015) Stab Wound to the Chest. In Surgery a case based clinical review. References References
Transcript: Trauma Olivia Dorsett Date 1 What is trauma? What is Trauma? "Trauma is the emotional, psychological and physiological residue left over from heightened stress that accompanies experiences of threat, violence, and life changing events." (Trauma informed practice in schools, 2010) Simple Trauma Simple Trauma Involves experiences of events that are life threatening and/or have potential to cause serious harm, These are often single incidents and are short in duration. There is no stigma associated and the community response is normally supportive. Includes: car accidents, house fire, bushfire, earthquake, and cyclones, etc. Complex Trauma Complex Trauma Involves interpersonal threat, violence and violation. Often includes multiple incidents and is longer in duration. Can be associated with stigma and victims experience a sense of shame. Includes: child abuse, bullying, domestic violence, rape, war, imprisonment, etc. Developmental Trauma Developmental Trauma Children and young people are vulnerable to effects of trauma because their brain is still developing. A child's brain is so malleable still so the impact o trauma is faster to manifest. The child's development can slow down or be impaired by trauma. Due to children relying on adults, they are more intensely effected when adults cause harm to them. Includes: children who are neglected, abused, forced to live with FV, or high levels of parental conflict. Addressing Behaviours Behaviours If there are multiple causes of behaviour, there are multiple ways of addressing behaviour. Important to remember trauma informed behaviour is a survival mechanism. Be consistent! Strategies need to be implemented in the classroom, school yard, before and after school, and by all staff involved. Comfort Seeking Comfort Seeking Children that have a trauma background may seek comfort from those who they perceive to be 'safe'. Comfort seeking behaviour includes: seeking out physical attention from others, sitting close, engaging in parallel play, wanting to be fed, etc. Self Protection Self Protection Self protective behaviour can be initiated in response to uncertainty and unpredictability in the environment of traumatised children and young people. It is critical to understand how current behaviour relates back to past experiences of trauma. Includes: avoiding intimacy and building relationships, anger outbursts, etc. Trauma stages Child is startled by trigger or event Behaviour provokes reaction in others This reaction is percieved as a threat Child sub-cortical, right hemisphere enacts response Child is in a heightened state of arousal and stress In the classroom What to do? Sensory aids Clear expectations/boundaries and what the consequences are if not met. Consistency. Zones of Regulation "name it to tame it" Use of calm tone and slower speed of speech. "Heightended people, heighten people". Outside the Classroom Outside of the classroom Clear expectations and boundaries. Consistent consequences when the above are not met. This creates a safe environment through stability. Get all staff involved. Keep it consistent. Keep expectations simple and to a few, then increase as needed over time. Tips Tips When required support plans (behaviour management plans) can be great! Allow children to take breaks outside of the classroom to regulate -however set boundaries. Where, how much time, checking on safety? Support the use of other supports (i.e. well-being) Reassure you are there for the child. i.e. using the word 'we' ("why don't we do this together?"), "I'm here when you're ready to talk", etc. Extra Resources Extra Resources Toolkit: https://www.traumainformedpractice.com.au/uploads/2/4/4/4/24444506/toolkit_-_trauma_informed_practice_in_education.pdf Zones of Regulation: https://www.zonesofregulation.com/teaching-tools.html Making Space for Learning: https://professionals.childhood.org.au/app/uploads/2018/08/ACF325-Making-Space-For-Learning-Book-v4.pdf Emerging Minds: https://emergingminds.com.au/resources/trauma-sensitive-behaviour-management/ BRACE: https://earlytraumagrief.anu.edu.au/files/TRUSTBRACE_0.pdf Australian Child and Adolescent Trauma, Loss and Grief Network, https://earlytraumagrief.anu.edu.au/files/TRUSTBRACE_0.pdf Harris, R. (2016) Trauma Informed Practice in Education, https://www.traumainformedpractice.com.au/uploads/2/4/4/4/24444506/trauma_informed_practice_in_education.pdf Helping Students Recover After Trayma (2010), The Australian National Univeristy. https://earlytraumagrief.anu.edu.au/files/ACATLGN_TraumaResources_Classroom_D1.pdf Bibliography
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