1 Head Cornerstone Basics of Trauma-Informed CareKelsey Salazar, LPC, CSOTP Psychotherapist Scott Cox, LCSW Clinical Director

2 Defining trauma is easy… right?Origin of trauma DSM-5: “…exposure to actual or threatened death, serious injury or sexual violence in one of the following ways: Directly experiencing the traumatic event(s) Witnessing, in person, the event(s) as it/they occurred Learning the traumatic event(s) happened to a family member or close friend Experiencing repeated or extreme exposure to aversive details of traumatic event(s) First responders Police officers Child welfare professionals Psychotherapists

3 ALTERNATIVE DEFINITIONIs this our standard? Thinking outside of the DSM-5 “box” LIMITATIONS ALTERNATIVE DEFINITION DSM definition significantly underestimates the extent of trauma in the general population. It also fails to incorporate extreme emotional abuse, major losses/separations, degradation or humiliation, and coerced sexual experiences. An extremely upsetting experience that overwhelms an individual’s internal resources and produces lasting psychological symptoms. Briere & Scott (2015)

5 Different Types of TraumaType I: Single Event Type II: Recurrent/Ongoing Unexpected/“out of the blue” Single episode; not recurrent Polyvictimization (Finkelhor, Ormrod, & Turner, 2007) Often involves fundamental betrayal of trust Often occurs at critical developmental periods Terr (1991); Courtois & Ford (2014)

6 Traumatic Events Some examples Mass interpersonal violenceLarge-scale transportation accidents Natural disasters Fires Combat/war/terrorism Physical assault Rape/sexual assault Child abuse Intimate partner violence Torture Sex trafficking Life-threatening medical conditions Emergency worker exposure to trauma

7 Child Abuse Statistics

8 Child Abuse Statistics (cont.)National Illinois Last year, there were 702,000 child victims of abuse and neglect. That’s 9.2 victims per children in the U.S. More than 4 children die every day as a result of child abuse. Over 70% of children who die from child abuse are under the age of 3. More than 90% of juvenile sexual abuse victims know their perpetrator. 14% of all men and 36% of all women in prison in the U.S. were abused as children. This is about 2x the rate seen in the general population. Children who experience child abuse and neglect are about 9x more likely to become involved in criminal activity. In 2013, Illinois had 66,528 total referrals for child abuse and neglect. In 2013, 29,719 children were victims of abuse or neglect, a rate of 9.8 per children, representing a 7.5% increase from Of these children, 77.8% were neglected, 26.2% were physically abused, and 17.9% were sexually abused. The number of child victims has increased 8.3% in comparison to the number of victims in 2009.

9 Intimate Partner Violence StatisticsIn 2014, almost 65,800 intimate partner violence incidents were reported to Illinois law enforcement. Many others went unreported. Between July 2013 and June 2014, there were 84 domestic violence-related deaths in Illinois, including 15 children. 26.9% of domestic violence homicides in Illinois were committed with firearms, significantly less than the nationwide rate. 72% of all murder-suicides involve an intimate partner. 94% of the victims of these crimes are female. 1 in 3 women and 1 in 4 men in the U.S. have experienced some form of physical violence by an intimate partner.

10 Sexual Assault Statistics1 in 5 women and 1 in 71 men will be raped at some point in their lives. 46.4% of lesbian women, 74.9% of bisexual women, and 43.3% of heterosexual women reported sexual violence other than rape during their lifetimes, while 40.2% of gay men, 47.4% of bisexual men, and 20.8% of heterosexual men reported sexual violence other than rape during their lifetimes. Nearly 1 in 10 women has been raped by an intimate partner in her lifetime, including completed forced penetration, attempted forced penetration, or alcohol/drug-facilitated completed penetration. Approximately 1 in 45 men has been made to penetrate an intimate partner during his lifetime. 91% of victims of rape an sexual assault are female, and 9% are male. In 8 out of 10 cases of rape, the victim knew the person who sexually assaulted them.

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12 Trauma-Focused DiagnosisBrief Psychotic Disorder? Body Dysmorphic Disorder? Hoarding Disorder (i.e. food)? Dissociative Disorder? Dissociative Amnesia Depersonalization/Derealization Disorder Reactive Attachment Disorder Disinhibited Social Engagement Disorder Posttraumatic Stress Disorder Acute Stress Disorder Adjustment Disorder DSM-5

13 Trauma Symptoms Negative alterations in cognition and emotionsRe-experiencing Avoidance Numbing Re-enacting Arousal Depersonalization Derealization

14 https://www.youtube.com/watch?v=P_ESNG0zfZM&feature=youtu.be https://www.ted.com/talks/nadine_burke_harris_how_childhood_tra uma_affects_health_across_a_lifetime?language=en#t

15 Danger Response Syndrome Resilience Post Traumatic Growth Individual Survival Mode Protective Factors Danger Response Syndrome Resilience Post Traumatic Growth Storage and Retrieval Strength

16 Protective Factors Supportive family environmentNurturing parenting skills Stable family relationships Household rules and monitoring of the child Parental employment Adequate housing Access to health care and social services Caring adults outside family who can serve as role models or mentors Communities that support parents and take responsibility for preventing abuse

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18 Betrayal Trauma

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20 Experiential educationShall we process Enter your footer text here

21 Trauma-Informed Care Trauma Informed Care is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma.

22 Harris & Fallot, 2001, www.mhpod.gov.auComponents of Trauma-Informed Care Administrative commitment to change Hiring practices Staff training and education Review of policies and procedures Universal screening Physical and emotional safety Collaboration Trustworthiness Choice and control Empowerment and skill building Language Harris & Fallot, 2001,

23 Key Domains of Trauma-Informed CareEarly screening and comprehensive assessment – If the client isn’t talking, ask: “What’s happened?” (Don’t ask: “What’s wrong with you?”) Not everyone is ready to talk but we give them permission to talk when they are ready. Consumer driven care and services – Listen to the people who are coming to us for services. Ask them if you can improve your services. Ask what can we do to help you better? Trauma-informed, responsive and educated workforce – Everyone in the system from the receptionist through the doctor matters. Disrespect can be triggering. Emerging and evidence-informed best practices – We need to use universal precautions. We need to expect either childhood experience or a current trauma but once we ask what happened, we need to provide EBP assistance. Safe and secure environments – It is important for the clinician to make it safe for the client. The organization also needs to make the client feel safe and comfortable (or is the waiting room dingy and dark?). Create trauma-informed community partnerships – This is very important to include in our work. Reach out to other organizations such as schools, the juvenile justice system etc. We need to spread this information to our partners in the community. Develop a performance monitoring system – Develop a data collection system to demonstrate what are the outcomes that you are seeing.

24 Trauma Informed vs. Trauma Focused

25 What roles does intersectionality and culture plan in trauma informed care?

26 Questions?