TALKING ABOUT TRAUMA GUIDE TO CONVERSATIONS AND SCREENING FOR HEALTH AND OTHER SERVICE PROVIDERS BLUE KNOT FOUNDATION Authors: Dr Cathy Kezelman AM and Pam Stavropoulos PhD empowering recovery from childhood trauma Talking about Trauma: Guide to Conversations and Screening for Health and Other Service Providers Talking about Trauma: Guide to Conversations and Screening for Health and Other Service Providers © 2018 Blue Knot Foundation Dr Cathy Kezelman AM President – Blue Knot Foundation Pam Stavropoulos PhD Head of Research – Blue Knot Foundation Blue Knot Foundation 2018 Talking about Trauma: Guide to Conversations and Screening For Health and Other Service Providers Kezelman C.A & Stavropoulos P.A. www.blueknot.org.au Blue Knot Helpline 1300 657 380 2 | Blue Knot Foundation www.blueknot.org.au Contents Blue Knot Foundation.........................................................................................................................4 Executive Summary .......................................................................................................................... 5 INTRODUCTION: Why do all services need to be trauma-informed? .................................................. 7 PART 1: TRAUMA AND ITS MANY FORMS .................................................................................... 10 1. What is trauma? Process, experience and the role of dissociation ......................................... 10 2. ‘Complex’ trauma is different from ‘single incident’ trauma (PTSD) ...................................... 16 3. Child to Adult: the complexity of childhood trauma ............................................................. 28 4. ‘Basic brain stuff’: Essential knowledge about trauma and the brain ..................................... 39 PART 2: BUILDING THE FOUNDATIONS TO TALK ABOUT TRAUMA ......................................... 54 Starting and responding to conversations: introducing the trauma-informed principles ........... 54 Application of trauma-informed principles and tips .................................................................. 57 Essential knowledge to becoming trauma-informed* ............................................................... 65 Effects of stress on the brain .................................................................................................... 66 Understanding the Stress Response .......................................................................................... 67 Tips to reduce distress............................................................................................................... 67 Hand model of the brain .......................................................................................................... 68 The window of tolerance .......................................................................................................... 69 Dimensions of safety: personal, interpersonal, environmental .................................................. 70 PART 3: HAVING THE CONVERSATION/S ..................................................................................... 72 A. For health professionals and health service providers ....................................................... 73 Engaging with clients ................................................................................................................ 74 Sample conversations ............................................................................................................... 79 B. For all service providers ....................................................................................................... 81 Both simple and challenging ..................................................................................................... 83 Service diversity ....................................................................................................................... 84 Service commonality ............................................................................................................... 84 Sample conversations .............................................................................................................. 84 Individual and systemic ............................................................................................................ 88 Key questions to consider ........................................................................................................ 88 Trauma sensitivity is ‘win-win’!................................................................................................. 89 Small changes can make a big difference ................................................................................. 89 Tips for conversations (Summary) ............................................................................................ 90 PART 4: SUPPORTING CONVERSATIONS AND SCREENING ......................................................92 Screening (questions to consider; includes guide, sample and tools) ....................................... 92 ‘What if…?’ Questions which arise ........................................................................................... 109 Tips for Conversations (Summary) .......................................................................................... 118 Core principles for conversations (summary) .......................................................................... 120 Tips for applying trauma-informed principles (summary) ........................................................ 121 BECOMING ‘TRAUMA INFORMED’: SUMMARY FOR SERVICES ................................................ 124 GROUNDING EXERCISES ............................................................................................................. 125 REFERRAL SERVICES AND CONTACTS....................................................................................... 126 REFERENCES ................................................................................................................................ 134 www.blueknot.org.au Blue Knot Foundation | 3 Talking about Trauma: Guide to Conversations and Screening for Health and Other Service Providers Blue Knot Foundation Blue Knot Foundation is Australia’s National Centre of Excellence for Complex Trauma, empowering recovery and building resilience for the five million adult Australians (1 in 4) with a lived experience of childhood trauma (including abuse), their families and communities. Formed in 1995, Blue Knot Foundation provides a range of services including: • specialist trauma counselling, information, support and referrals • educational workshops for survivors and their family members, partners and loved ones • professional development training for workers, professionals and organisations from diverse sectors • group supervision • consultancy • resources including fact sheets, videos and website information at www.blueknot.org.au • advocacy • research At the forefront of pioneering trauma-informed policy, practice, training and research, Blue Knot Foundation actively supported the work of the Royal Commission into Institutional Responses to Child Sexual Abuse and the people engaging with it. In 2012, Blue Knot Foundation released Practice Guidelines for Treatment of Complex Trauma and Trauma-Informed Care and Service Delivery www.blueknot.org.au/guidelines. These nationally and internationally acclaimed guidelines were a global first in setting the standards for clinical and organisational practice. In 2015, Blue Knot Foundation released an Economic Report, The Cost of Unresolved Childhood Trauma and Abuse in Adults in Australia to present the economic case for providing appropriate trauma-informed services for adult survivors. This publication was followed in 2016 by Trauma and the Law – Applying Trauma-informed Practice to Legal and Judicial Contexts. In 2018-19 Blue Knot Foundation is releasing its Talking about Trauma series. This is the second publication in this series. The first was Talking about Trauma – Guide to Everyday Conversations for the General Public https://www.blueknot.org.au/trauma-public For more information, visit www.blueknot.org.au. If you need help, information, support or referral, call Blue Knot Helpline on 1300 657 380 or email [email protected] between 9am-5pm Monday to Sunday AEST/ADST. 4 | Blue Knot Foundation www.blueknot.org.au Executive Summary As a society we are becoming increasingly aware of the prevalence of trauma and its devastating impacts. But many people feel poorly equipped to have conversations with people they know or suspect have experienced trauma. Many segments of society do not know how to ‘talk about trauma’ including within families, among friends, and by the general public. This also applies to service- providers including health services, who frequently engage with traumatised people seeking support is concerning indeed. Knowing how to ‘talk about trauma’ is essential to supporting traumatised people. It is also critical to establishing service systems which are ‘trauma-informed’ i.e. in which all professionals and personnel, regardless of qualification/s, occupation or skill base have a basic understanding of how overwhelming stress can affect the way we function as human beings and a working knowledge of how not to compound stress (‘do no harm’). It is important to distinguish between ‘treatment’ in the formal clinical sense (which is provided by qualified health professionals) and non-clinical ‘treatment’. The latter relates to empathic and respectful