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Trauma Dimensions

Why is it important to know and talk about Trauma Informed Care?

Thank you!

1. Physical harm

2. Psychological trauma

3. Social trauma

4. Historical trauma

5. Ongoing trauma

6. Vicarious or Secondary trauma

7. Systemic trauma

8. Acute/Non-acute

Yvette Lozano

Chief Program Officer, Director of Intervention Services

Fight - Flight - Freeze

Trauma Impact

What is trauma?

Fight

  • Crying
  • Hands in fists, desire to punch, rip
  • Flexed/tight jaw, grinding teeth, snarl
  • Fight in eyes, glaring, fight in voice
  • Desire to stomp, kick, smash with legs, feet
  • Feelings of anger/rage
  • Homicidal/suicidal feelings
  • Knotted stomach/nausea, burning stomach

yvette@peaceoverviolence.org

Fight - Flight - Freeze

Flight

  • Restless legs, feet /numbness in legs
  • Anxiety/shallow breathing
  • Big/darting eyes
  • Leg/foot movement
  • Reported or observed fidgety-ness, restlessness, feeling trapped, tense
  • Sense of running in place

Fight - Flight - Freeze

Freeze

  • Feeling stuck in some part of body
  • Feeling cold/frozen, numb, pale skin
  • Sense of stiffness, heaviness
  • Holding breath/restricted breathing
  • Sense of dread, heart pounding
  • Decreased heart rate (can sometimes increase)
  • Orientation to threat

Examples of Trauma

  • Developmental: having a baby, getting married, etc. (Could also be labeled as a "stressor")
  • Situational: rape, robbery, sudden death of a loved one
  • Child Maltreatment
  • Neglect
  • Physical Abuse
  • Psychological/Emotional Abuse
  • Domestic Violence
  • War-Related
  • School/Community Violence
  • Medical
  • Loss
  • Natural Disasters, etc.

Jasmine Barnes

Intervention Program Assistant

  • Low self-esteem
  • Negative thoughts and feelings
  • Withdrawn/Passive
  • Learning Disabilities
  • Brain Development
  • Neglecting self and putting others first
  • Depression
  • Aggression/rage
  • Lack of trust
  • Difficulty in relationships
  • Hyper-vigilance

jasmine@peaceoverviolence.org

Defining Trauma

- Trauma is an event(s): overwhelms the person’s perceived ability to cope; debilitates her/him through a central loss of control; creates the necessity for psychological defenses

- Trauma can be a life or death danger or a horrible physical/emotional injury or experience, assault, pain or illness.

- Trauma is a life organizing and life altering violation, betrayal, abandonment.

- Trauma immobilizes/overwhelms normal coping.

- Man-made or natural disasters are also types of trauma.

- It can be a witnessed or direct experience.

Childhood Traumas Included in ACES

ACES Study

  • Physical Abuse
  • Emotional Abuse
  • Sexual Abuse
  • Neglect
  • Dysfunction in the household (DV, substance abuse, mental illness/suicidal family member, marital discord, crime/prison)
  • ACES score 0-10

What difference would it make with a survivor if we provide a trauma-informed response approach?

Adverse Childhood Experiences

Dr. Vincent Felitti of San Diego Kaiser Permanente and Dr. Robert Anda from Center for Disease Control created a study that looks at the effects of childhood trauma on a person’s health and well-being, by taking experiences from under the age of 18.

ACES Scores

If ACE Score is 4+, likelihood immensely increases for:

  • - Heart Disease
  • - Smoking
  • - Suicide Attempts
  • - IV Drug User
  • - High Blood Pressure
  • - Alcoholism
  • - Diabetes
  • - Chronic Depression – likelihood of using antidepressants
  • - Childhood Experiences underlie later being raped
  • - Perpetrating DV
  • - Impaired worker performance
  • - Chronic obstructive pulmonary disease
  • - Fetal Death
  • - Health-related quality of life
  • - Ischemic heart disease
  • - Liver disease
  • - Financial stress
  • - Multiple sexual partners
  • - STD’s
  • - Unintended pregnancies
  • - Early initiation of sexual activity
  • - Adolescent pregnancy
  • - Poor academic achievement, etc.

In 1998, more than 17,000 Kaiser Permanente members took the Adverse Childhood Experiences survey.

Results showed that two-thirds of respondents had experienced one or more types of ACE.

The one on the left is a healthy 3-year-old American boy. The one on the right is a three-year-old Romanian boy who lived in one of the many Romanian orphanages that were known for severely neglecting children, thousands of whom were imprisoned in cribs and rarely given attention.

Trauma Informed Response

Trauma-informed approaches to care shift the focus from “What’s wrong with you?” to “What happened to you?”

Basic Counseling Skills

Active Listening

"Flipping your lid" means the prefrontal Cortex (fingernails) have very poor connection with the midbrain (thumb) and we're not able to access the logical, problem-solving part of our brain. Our emotions override our ability to think clearly.

  • Types of intervention (grounding, empowerment, CRM, etc.)
  • While making assessment utilize CI skills
  • Establish rapport and communication
  • Provide support, transparency
  • Active listening
  • Paraphrasing
  • Validate
  • Open ended questions
  • Explore options / Empower

Active listening sounds easy, but it requires skill and practice

There are a number of components of active listening such as:

  • Encouragement
  • Paraphrasing
  • Reflecting
  • Emotional labeling
  • Validating
  • Reassurance
  • Waiting

Active listening skills are essential for a crisis services provider. Good communication is the foundation of a solid relationship. These behaviors are done concurrently while attempting to remain objective, empathic and human.

1. Safety: physical and emotional, environment, support system, cultural consideration

2. Trustworthiness and Transparency: boundaries, offer explanation, follow through, consistency, cultural consideration

3. Peer support: choice, listen, gather input, offer choices, inclusion, cultural consideration

4. Collaboration and mutuality: equal partnership, shared power, connection, team work, accountability, cultural consideration

5. Empowerment, voice and choice: believe the person, build on strengths, teach skills, restore hope, cultural consideration

6. Cultural, Historical, and Gender Issues: language

ACTIVITY

Treating hidden wounds.

All behaviors stemming from trauma are coping mechanisms and should be approached as such.

Trauma Specific Intervention

Recognize the following:

• The survivor's need to be respected, informed, connected, and hopeful regarding their own recovery

• The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety

• The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers

• Importance of debriefing

Trauma and the Brain

Brain chemicals are triggered due to threat:

Trauma Informed Response

- Neurotransmitters activate the amygdala, which apparently triggers the brain's response to emotions to a stressful event. Neurotransmitters then signal the hippocampus to store the emotionally loaded experience in long-term memory. In primitive times, this combination of responses would have been essential for survival, when long-lasting memories of dangerous stimuli would be critical for avoiding such threats in the future.

Peace Over Violence

- When stress hormones, intended for an emergency, remain “switched on” for a long time they can slow the growth of nerve fibers in the areas of the brain (hippocampus) which links experiences to emotions, and then stores the memories of these experiences and emotions. Imagine the far-reaching effects of overexposure to stress hormones on the brain of a child which is still growing.

How would you define Trauma Informed Care?

- Some studies have shown that the hippocampus actually shrinks as a result of stress hormones over time.

Yvette Lozano, Chief Program Officer

Jasmine Barnes, Intervention Program Assistant

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