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Welcome & Housekeeping Defining Trauma

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Welcome & Housekeeping Defining Trauma 4/27/2021 TRAUMA INFORMED CARE IN HOMELESSNESS AND HOUSING SUPPORT WELCOME & SERVICES HOUSEKEEPING An Introduction 12 A deeply distressing and disturbing event that has an emotional impact. ‐ Loss, Combat, Relationship, Accident …How we RECOVER and RESPOND may determine if we experience ‐ Acute Stress DEFINING TRAUMA ‐ Post Traumatic Stress ‐ Full Recovery 34 TRAUMA IS… • Widespread “Trauma is when we have encountered an out of control, • Frequently found within people with substance use disorders and/or mental illness. frightening experience that has disconnected us from all sense • Found amongst all races, ethnicities, ages, income strata, and life experiences of resourcefulness or safety or coping or love”. • Found to have the possibility of long‐term effects in impaired neurodevelopment, (Tara Brach) immune system responses, and chronic physical and behavioural health risks • Found to increase substance use disorders, mental illness, and chronic illness 56 1 4/27/2021 WHAT IS POST TRAUMATIC STRESS DISORDER? Post‐Traumatic Stress Disorder (PTSD) is one specific type of response to trauma. “Trauma‐informed care is a strengths based framework that is It is a psychiatric diagnosis based on an individual experiencing symptoms from three grounded in an understanding of and responsiveness to the impact of “symptom clusters” including: trauma, that emphasizes physical, psychological, and emotional safety •intrusive recollections, • avoidant/numbing symptoms, and for both providers and survivors, and that creates opportunities for •hyper‐arousal symptoms. survivors to rebuild a sense of control and empowerment.” (Hopper, Bassuk, & Olivet, 2010) 78 WHAT IS TRAUMA INFORMED? TRAUMA INFORMED A trauma-informed approach incorporates the four “Rs”: A trauma‐informed perspective views trauma related symptoms and behaviors as an individual’s best and most Realizing the prevalence of trauma resilient attempt to manage, cope with, and rise above his or Recognizing how it affects all individuals involved with the her experience of trauma. program, organization or system, including its own workforce WHAT’S WRONG WITH YOU WHAT HAPPENED TO YOU Resisting re-traumatization Responding by putting this knowledge into practice 910 VIEWING TRAUMA IN A TRAUMA-INFORMED TRAUMA INFORMED SYSTEM We want to anticipate that people have experienced it. Your client’s worst behavior is often their best defense mechanism “In a trauma-informed system, trauma is viewed not as a single, We are conscious of people’s past trauma and don’t perpetuate it, especially since we discrete event, but rather as a defining and organizing represent institutions that can feel a lot like jail. experience that forms the core of an individual’s identity. The “Trauma‐specific services” and “trauma‐informed care” are sometimes used interchangeably far-reaching impact, and the attempts to cope with the Both provide care for people exposed to traumatic stress. aftermath of the traumatic experience, come to define who the Trauma‐specific services are clinical interventions trauma survivor is.” Trauma‐informed care addresses organizational culture and practice. (Harris & Fallot, 2001) 11 12 2 4/27/2021 EXAMPLES OF TRAUMA Interpersonal External • Childhood abuse •War • Sexual assault • Being the victim of a crime • Elder abuse • Sudden death of a loved one •Domestic abuse • Suicidal loss • Torture and forcible • Sudden and unexpected loss of job, housing, and/or confinement relationship • Natural disasters • Accidents EXAMPLES OF TRAUMA • Living in extreme economic poverty 13 14 HELPING SYSTEMS CAN RE-TRAUMATIZE Examples include: •Seclusion and restraints in mental health systems •Removal of children in child welfare systems •Invasive procedures in medical systems •Harsh disciplinary practices in school systems • Intimidation practices in criminal justice systems IMPACTS OF TRAUMA 15 16 3 DISCRETE COMPONENTS TRAUMA CHANGES EVERYTHING 1.Event ‐ one time or recurring Trauma changes the rules of the game: •Sense of self is reconstructed 2.Experience ‐ whether the event is experienced as scary or •Sense of others is reconstructed threatening • Beliefs about the world change ‐ often incorporating or based upon the horrific event or events 3.Effect ‐ long‐lasting and life altering Life choices are informed by the trauma. Coping strategies are informed by the trauma. 17 18 3 4/27/2021 WHY DOESN’T TRAUMA IMPACT EVERYONE ALL TRAUMA HAS 3 KEY ELEMENTS THE SAME WAY? •Circumstances of the traumatic event • Genetics 1.It was unexpected. •Previous life experience(s) • Availability of supports 2.The person was unprepared. • Response right after the traumatic event 3.There is nothing the person could have done to stop it from •How social services respond to the long term impacts happening. 19 20 ! " WHAT IS HAPPENING IN THE BRAIN In the brain, when confronted with triggers, the left frontal cortex shuts down (speech) and autonomic arousal on the right side (emotion) lights up. People cannot create a coherent narrative of what happened or is happening. # $ % & ' $ Hippocampus shrinks. Old memories and new memories are indistinguishable. Norepinephrine and cortisol gets over‐produced resulting in hyper‐vigilance and amygdala over‐ activation. ( * ) + * Inability to distinguish false threat from real threat. Directs muscles to prepare for emergency. Heart races. About 70% of brain‐bound oxygen is diverted to muscles. , - % - + * ! ( *& ) ( $ ) ! $ . & ) ) ) ) / ) & ) ) ) ) & $ ) 21 22 PROLONGED TRAUMA IS LIFE TRAUMA AND SUBSTANCE USE THREATENING DISORDERS • Higher risk of cardiovascular disease. “THEY DIDN’T KNOW THEY WERE TRAUMATIZED. THEY THOUGH THEY WERE JUST ADDICTS. THEY DIDN’T REALIZE THAT THEY WERE • Liver enzymes place you at greater risk for Type 2 diabetes. USING THE ADDICTION TO SOOTHE A DEEP PAIN THAT WAS ROOTED IN TRAUMA. THE ADDICTION IS THE PERSON’S • Release of cortisol impacts the immune system making you at UNCONSCIOUS ATTEMPT TO ESCAPE FROM THE PAIN.” greater risk of viral infections and other illness. (DR. GABOR MATÉ) • Sleep, especially deep REM, is compromised and meaning of life events cannot be processed and sorted. Insomnia is common. 23 24 4 4/27/2021 TRAUMA INDUCED ADDICTION CAN START A SELF-MEDICATING RESPONSE TO AT A YOUNG AGE TRAUMA • Young people that experience trauma are 3x more likely to form a substance use Self‐medicating through use of substances can be a relatively early trauma response disorder than those without a comparable trauma experience When PTSD goes undetected and without supports, people are more likely to • Addiction recovery studies show 7 out of 10 young people in recovery have develop a substance use disorder trauma in their history Substance use disorders and PTSD are comorbidities • Peer‐reviewed published literature shows a strong relationship between those that experience repeated or exacerbated trauma at a young age and those that use specific substances. (Khoury et al, 2010) 25 26 SUD & PTSD TRAUMA AND ACUTE STRESS DISORDER Amongst people with a Substance Use Disorder (SUD), Post Traumatic Stress Disorder (PTSD) is ASD represents a normal response to stress. one of the most common co‐occurring mental disorders found in people participating in substance use treatment Symptoms develop within 4 weeks of the trauma and can cause significant People in treatment for PTSD may use a wide range of substances for different effects levels of distress. People in treatment for PTSD AND SUD tend to have a more severe and complex profile than Most individuals who have acute stress reactions never develop further those with just one of these disorders impairment or PTSD. PTSD places people at significantly increased risk of suicidality, with or without major depression Acute stress disorder is highly associated with the experience of one specific trauma rather than the experience of long‐term exposure to chronic traumatic stress. 27 28 TRAUMA AND POST TRAUMATIC STRESS DIFFERENCES BETWEEN ASD & PTSD DISORDER PTSD is the most commonly diagnosed trauma‐related disorder The primary difference is the amount of time the symptoms have been present. ASD resolves 2 days to 4 weeks after an event, whereas PTSD continues beyond the 4‐week period. Symptoms of PTSD can be debilitating over time The diagnosis of ASD can change to a diagnosis of PTSD if the condition is noted within the first 4 weeks after the event, but the symptoms persist past 4 weeks. Important to remember that PTSD symptoms are represented in a number of other mental ASD diagnosis requires 9 out of 14 symptoms from five categories, including intrusion, negative mood, dissociation, illnesses, including major depressive disorder, anxiety disorders, and psychotic disorders avoidance, and arousal. These symptoms can occur at the time of the trauma or in the following month. DSM‐5 identifies four symptom clusters for PTSD: presence of intrusion symptoms, persistent Studies indicate that dissociation at the time of trauma is a good predictor of subsequent PTSD avoidance of stimuli, negative alterations in cognitions and mood, and marked alterations in ASD is a transient disorder, meaning that it is present in a person’s life for a relatively short time and then passes. In contrast, arousal and reactivity. Individuals must have been exposed to actual
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