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Uva Trauma Presentation Template

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Trauma Presentation

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:

Trauma Presentation

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

UVA PRESENTATION

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

Trauma Presentation

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

Trauma Presentation

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

Trauma Presentation

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

Trauma Presentation

Transcript: Trauma Date 1 What is trauma? What is Trauma? “Trauma is the emotional, psychological, and physiological reactions caused by the prolonged and overwhelming stress that accompanies experiences of abuse, neglect and family violence” (Australian Childhood Foundation) What does this mean? Trauma is an event that overwhelms a person’s capacity to cope. Complex Trauma Complex Trauma Involves threat to the individual, i.e. 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. Neurobiology Neurobiology Children and young people are vulnerable to effects of trauma because their brain is still developing. Neurobiological research shows that damage to the brain of a child who has experienced trauma is due to the release of toxic stress hormones. Traumatic events occurring in the early years of a child’s life influence: • immune systems • how feelings are expressed and managed • behaviour and stress • how relationships are formed • communication skills • intelligence • physiological functions such as temperature and hormone production Behaviours Trauma causes behaviours that challenge – We call these pain-based behaviours. The body’s response to trauma is adaptive. Traumatised children will do anything to survive, not because they want to, but because they have to. They become disconnected from their feelings, push away memories of pain, and ultimately stop relying on relationships around them to protect them. They stop trusting and believing in others Even after the risks or danger is no longer present, children and young people cannot move on and forget what has happened to them. Their brains and bodies continue to react as if the stress or trauma is still continuing. Trauma-based behaviours are those strategies that the child or young person has relied on to survive and will use over and over in their daily lives, even when the abuse or violence is no longer present. Types of behaviours These behaviours have been typically described as fight/flight/freeze behaviour: In fight mode children and young people can react aggressively in order to frighten off the threat. Examples include fighting, swearing, intimidating and shouting. In flight mode children and young people may react by attempting to put distance between the threat and themselves by using strategies to escape. Examples include running away, hiding, or screening themselves from the view of the source of threat. In freeze mode children and young people can become immobilised and become very still. Examples include pretending to not listen, joining a group of others who are experiencing similar threat and distracting strategies to take attention away from themselves. Children and young people can also ‘shutdown’ in the face of threat and stress. At these times they can appear emotionally unavailable, unmotivated, and disintereste Remember – Children have learnt these fight/flight/freeze behaviours not because they want to but because they had to as a way of survival and keeping themselves safe. The big Question The question - So why do we see these behaviours present in a classroom where children are seemingly in a “safe” environment with a “safe adult”… The Answer Many traumatised children never truly feel safe (even after the threat may have passed). Traumatised children live in a constant state of vigilance and heightened alarm Remember trauma physically impacts the way brains develop. Even after the danger is no longer present, children cannot simply move on and forget what has happened to them Their brains and bodies continue to live in this altered state of fight, flight, freeze and they may continue to behave as if the threat is still there. Triggers Triggers As a result of this altered state, traumatised children and young people are easily triggered by seemingly minor or invisible issues. Their responses are often seen as ‘out of the blue’ or ‘over reactions’ to situations. They can seem to ‘go off’ for no apparent reason. These are known as trauma trigger. 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

Trauma presentation

Transcript: Trauma and the Body: A presentation by Colin Reid in completing of Psy 801 Mentor: Deborah Hickey, Ph.D., LMFT, RPT-S Event React Resolve Dysregulation of nervous system Harmful effects of long term exposure to stress hormones Physiological changes such as reduction in the volume of the hippocampus and activation of amygdala, causing distortion of time and intrusive memories "Trauma is in the nervous system, not in the event. It lies in the instinctual fear response that becomes stuck in our brain and nervous system." -Peter Levine Withdrawal Fearfulness Irritability Excessive shyness Clinging Emotional Outbursts Aggression toward others Acting out Nightmares Bed wetting Thrashing in bed/difficulty sleeping Easily startled Regressive behaviors Tummy/headaches Nausea Dread Somatic Experiencing is a form of therapy aimed at relieving and resolving the symptoms of post-traumatic stress disorder (PTSD) and other mental and physical trauma-related health problems by focusing on the client’s perceived body sensations (or somatic experiences). Introduced by Dr. Peter Levine in 1997 through his book "Waking the Tiger", inspired in part by his observations of animals in the wild, and how they deal with and recover from life-threatening situations. Non-exclusive and can be incorporated into different modalities and theoretical orientations, bodywork practices and psychotherapy Learn to contain sensations and feelings, restore a sense of center, and begin to restore body boundaries. You will begin to feel less betrayed and more supported by your body. Types of Exercise: Meditation, Tapping, Shower “ A Felt Sense is not mental experience but physical one, a bodily awareness of a situation or person or event. An internal aura that encompasses everything you feel and know about given subject as a given time.” (Levine, 2010) Paralysis The nine steps of Somatic Experiencing Trauma and the Body Addiction The fear of entering immobility Sympathetic Nine Step Method for Transforming Trauma Exploring sensation Step 5: Restoring active responses Establish an environment of relative safety - through a calm, compassionate and soothing presence. Step 7: Discharge The basics of a somatically informed approach to trauma Trauma Toolkit Healing trauma Anxiety Flight Talk therapy and Trauma Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. North Atlantic Books. Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. WW Norton & Company. Solomon, M. F., & Siegel, D. J. (2003). Healing trauma: Attachment, mind, body, and brain. New York: W.W. Norton. Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: W.W. Norton. Fight Trauma and Psychpathology Multiple levels of professional training are offered by the Somatic Experiencing Institute “Trauma arises when one's human immobility responses do not resolve; that is , when one cannot make the transition back to normal life, and the immobility reaction becomes chronically coupled with fear and other intense negative emotions such as dread, revulsion and helplessness. After this coupling has been established, the physical sensations of immobility by themselves evoke fear.” (Levine, 2010, p.68) Flight Fear of exiting immobility Body oriented therapy eg. Somatic experiencing, Body work eg. massage, Rolfing Physical practices eg. yoga, tai chi Body oriented mindfulness eg. breath meditation What is Somatic Experiencing? Sensations, Images, Thoughts, and Emotions Examples: Describing and Tracking Sensation, Conflict-free exercise Words describing bodily sensations: dense, breathless, queasy, heavy, nervous, flowing, electric, twitchy, bubbly, calm, energized, warm, light, cold, sweaty, block, disconnected, hollow, hot.. Trauma and the Body ADHD Discharge Nine steps adapted from Levine Also has 3 - Step models 12 phase models Traumatized state Step 6: Uncoupling fear from immobility Freeze Tracking Activation The Biology of Trauma Step 8: Engage self regulation to restore dynamic equilibrium and relaxed alertness Step 9 – Orient to here and now, contact the environment and reestablish the capacity for social engagement. Freeze - "playing dead" Discharge Bibliography: Neurobiology of Trauma Inhibited reaction Provide a corrective experience by supplanting the passive responses of collapse and helplessness with active empowered defensive responses. Step 4 – Titration Inhibited discharge "Resolve hyper-arousal states by gently guiding the discharge and redistribution of the vast survival energy mobilized for life preserving action while freeing that energy to support higher level brain functioning - the discharge of the energies is generally achieved through involuntary shaking and trembling." Step 3 – Pendulation & Containment Step 2: Exploration and Tracking Depression Signs of trauma Mr. Rogers Self Regulation & Reorient Mr. Rogers Establish pendulation

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