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The Impact of Trauma on Women and Girls Across the Lifespan. Healthy Women, Healthy Hoosiers: Healthcare Practice Across the Lifecourse October 7, 2011.

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The impact of trauma on women and girls across the lifespan

The Impact of Trauma on Women and Girls Across the Lifespan

Healthy Women, Healthy Hoosiers: Healthcare Practice Across the LifecourseOctober 7, 2011


Michelle Hoersch, MSOffice on Women’s Health - Region VU.S. Department of Health and Human ServicesIllinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin


Office on women s health who we are
Office on Women’s HealthWho We Are

  • Established in 1991 to improve women’s health

  • Charge expanded to include girls

  • Focal point for women’s health activities in HHS


Owh vision mission
OWH Vision & Mission

VISION

All women and girls are healthier and have a better sense of well-being.

MISSION

Provide leadership to promote health equity for women and girls through sex/gender-specific approaches


Violence against women
Violence Against Women

Violence against women is so pervasive that the United Nations has addressed and defined violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life.”

(United Nations General Assembly, 1993).


Definition of trauma
Definition of Trauma

Trauma occurs when an external threat overwhelms a person’s internal and external positive coping resources.

Bloom & Fallot, 2009


Trauma
Trauma

  • A traumatic event is defined as one in which a person experiences, witnesses, or is confronted with actual or threatened death or serious injury, or threat to the physical integrity of oneself or others.

  • These events can include violence between people, abuse of any kind, neglect, institutionalization, disasters, or war.

    Sources: The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV) and SAMHSA-National Center for Trauma Informed Care


Trauma1
Trauma

  • Women who suffer from trauma carry it with them everywhere they go.

  • Despite the impact trauma has on the health of women and girls, it is rarely considered when delivering services


T rauma defined
Trauma Defined

Traumatic experiences come in many forms, and can leave

survivors with overwhelming feelings of loss, danger, and

helplessness.

They include:

• Unexpected loss of a loved one

• Accidents

• School violence

• Community violence

• Domestic violence

• Neglect

• Physical abuse

• Sexual abuse

• Man-made and natural disasters

• Terrorism


The adverse childhood experience ace study
The Adverse Childhood Experience (ACE) Study

What is the ACE Study?

  • It is a scientific research study analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.

  • An on-going collaboration between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente Health System.


What is an ace
What is an ACE?

Growing up experiencing any of the following conditions in the household prior to age 18

  • Recurrent physical abuse

  • Recurrent emotional abuse

  • Contact sexual abuse

  • An alcohol/and or drug abuser in the household

  • An incarcerated household member

  • Someone who is chronically depressed, mentally ill, institutionalized or suicidal

  • Mother is treated violently

  • One or no parents

  • Emotional or physical neglect


The numbers
The Numbers

  • Between 51% and 98% of public mental health clients diagnosed with severe mental illness have trauma histories.

  • An individual with an ACE Score of 4 or more was 460% more likely to be suffering from depression than an individual with an ACE Score of 0.

  • A person with an ACE Score of 4 is 260% more likely to have COPD than is a person with an ACE Score of 0.

  • There was a 250% increase in the odds of having a sexually transmitted disease between individuals with an ACE Score of 4 compared to individuals with an ACE Score of 0

  • Between two-thirds and 80% of all attempted suicides could be attributed to adverse childhood experiences



Findings
Findings

  • The impact of ACEs on adult health status is strong and cumulative. (2)

  • Of 17,337 study participants,

  • 16% of the men and 25% of the women reported being sexually abused as children. (1)

  • 25% of respondents had at 1 ACE (3)

  • 6.25% had 4 ACEs (3)

  • A person with a midrange ACE score of 4 is 390% more likely to have COPD than is a person with an ACE Score of 0. (3)

  • a person with ACE score >4 was 460% more likely to be depressed than a person with ACE score of 0 (3)

  • two thirds of suicide attempts could be attributed to adverse childhood experiences. (3)

1. Kaiser Permanente Press Release, Kaiser Permanente Research: Gender And Sexual Abuse Female Perpetrators More Common than Known Previously; Boys Abused Almost as Often as Girls. July 6, 2005.

2. Fellitte, Vincent J. MD, FACP, Robert F. Anda MD, MS, Dale Nordenberg, MD, David F. Williamson, MS, PhD, Alison M. Spitz, MS, MPH, Valerie Edwards, BA, Mary P. Koss, PhD, James S. Marks, MD, MPH, “Relationship of Childhood Abuse and Household Dysfunction to Mnay of the Leading Causes of Death in Adults” Am J Prev Med 1998;14(4).

3. Felitti, MD., Vincent J., The Permanente Journal Winter 2002/Vol. 6, No.1


From SAMHSA’s website: http://www.samhsa.gov/children/social_media_apr2011.asp


From SAMHSA’s website: http://www.samhsa.gov/children/social_media_apr2011.asp


From SAMHSA’s website: http://www.samhsa.gov/children/social_media_apr2011.asp


Graph shows relation between Adverse Childhood Experiences (ACE) Score and smoking status.

Felitti, MD., Vincent J., The Permanente Journal Winter 2002/Vol. 6, No.1


a male child with an ACE score of 6 has a 4600% increase in the likelihood of later using intravenous drugs

Graph shows relation between ACE Score and illicit use of injected drugs.

Felitti, MD., Vincent J., The Permanente Journal Winter 2002/Vol. 6, No.1 http://xnet.kp.org/permanentejournal/winter02/goldtolead.html


Region v focus on trauma
Region the likelihood of later using intravenous drugs VFocus on Trauma

Vision: To equip every health and social service provider and institution with the knowledge, resources, and support to provide services that are gender responsive and trauma informed so as to provide the best possible care for trauma-affected individuals.


History
History the likelihood of later using intravenous drugs

  • Grew out of work focusing on incarcerated women

  • Incarcerated women have a disproportionately high rate of trauma exposure.

  • If we can understand and ideally prevent trauma or at least provide trauma-informed interventions, programs and services, the well-being of these women and their families could be improved.


Early work
Early Work the likelihood of later using intravenous drugs

  • Gender- responsive trauma-informed trainings for leadership and staff of women's prisons and jails

  • Trauma-informed care trainings for health and social service providers

  • Stephanie Covington, Center for Gender and Justice Curricula: “Helping Women Heal”, “Beyond Trauma”


Region v trauma initiatives
Region the likelihood of later using intravenous drugs V Trauma Initiatives

Goal: To equip every health and social service provider and institution with the knowledge, resources, and support to provide services that are gender-responsive and trauma-informed.


  • The impact of violence, abuse, neglect, disaster, war, and other harmful experiences continues long after the traumatic event has ended.

  • The Office on Women’s Health has partnered with SAMSHA to host this a monthly webinar series that addresses the Impact of Trauma on Women and Girls Across the Lifespan.

  • The series was launched on November 2, 2010

  • We invite renowned speakers from all over the nation to speak for 45 minutes and then answer questions for the remaining 15 minutes.

  • Our trauma webinars are 1 hour in length and typically max out attendance at 2,400 individuals.

  • After the live broadcast, the webinars are available via archive for one year.


  • Special Topics/Populations other harmful experiences continues long after the traumatic event has ended. :

    • Clinical Services for women’s reproductive health

    • Incarcerated Women and Re-Entry

    • Dental Health Providers

    • Women Vets

    • Refugees & Immigrants

    • Trauma-Informed Practices for theCommunity Setting

  • Trauma-Informed Systems & Organizational Change

  • The ACE study - Life course effects of childhood trauma

  • Understanding the Importance of Sex and Gender in providing Trauma-Informed Services

  • Trauma-Informed Best Practices: What EVERYONE needs to know


  • Trauma informed services
    Trauma-informed Services other harmful experiences continues long after the traumatic event has ended.

    These are services that are provided for problems other than trauma but require knowledge about violence against women and the impact of trauma thereby increasing their effectiveness.


    Universal precaution approach
    Universal Precaution Approach other harmful experiences continues long after the traumatic event has ended.

    “Presume that every person in a

    treatment setting has been exposed to

    abuse, violence, neglect or other

    traumatic experiences.”

    http://www.health.vic.gov.au/chiefpsychiatrist/creatingsafety/ntac/module6.pdf


    Current work with sheela raja
    Current Work with Sheela Raja other harmful experiences continues long after the traumatic event has ended.

    • The Office on Women’s Health in Region V has partnered with Sheela Raja, PhD and Assistant Professor of Dentistry and Medicine at the University of Illinois at Chicago, to develop a new symposium.

    • The symposium will bring together academics, teachers, community providers, clinical service providers, state and local legislators, researchers, survivors, and students to discuss ways to collaborate and integrate trauma-informed care across disciplines.


    Trauma stewardship
    Trauma Stewardship other harmful experiences continues long after the traumatic event has ended.

    • The Office on Women’s Health Region –V has co-hosted two Trauma Stewardship trainings with Laura Van Dernoot Lipsky

    • The workshops explore the ways we reconcile the trauma we experience through our work.

    • Laura’s book is called Trauma Stewardship: An Everyday Guide to Caring for Self while Caring for Others

    • More information can be found at TraumaStewardship.com


    Incarcerated women re entry activities
    Incarcerated Women Re-Entry Activities other harmful experiences continues long after the traumatic event has ended.

    • JSI work-Advisory Council

      -Literature Review

      -Framework of Recommendations

    • National Summit- Spring 2012


    The federal partners mental health transformation committee on women girls and trauma
    The Federal Partners Mental Health Transformation Committee on Women, Girls and Trauma

    Purpose: Raise awareness and expand the common knowledge base among Federal Partners and collaborators regarding the prevalence and behavioral impacts of trauma on the lives of women and girls


    The federal partners mental health transformation committee on women girls and trauma1
    The Federal Partners Mental Health Transformation Committee on Women, Girls and Trauma

    • Roundtable I

    • Woman and Trauma Monograph

    • Roundtable II- December 6-7, 2011


    Intervention models
    Intervention Models on Women, Girls and Trauma

    • Addiction and Trauma Recovery Integration Model (ATRIUM)

    • Essence of Being Real

    • Risking Connection

    • Sanctuary Model

    • Seeking Safety

    • Trauma, Addictions, Mental Health, and Recovery (TAMAR) Model

    • Trauma Affect Regulation: Guide for Education and Therapy (TARGET)

    • Trauma Recovery and Empowerment Model (TREM and M-TREM)

    http://www.samhsa.gov/nctic/trauma.asp


    Resources
    Resources on Women, Girls and Trauma

    • The National Child Traumatic Stress Network

      http://www.nctsnet.org/

    • The Centers for Disease Control and Prevention on their website lists many of the publications that use the ACE study for their findings.

      (http://www.cdc.gov/ace/year.htm)

    • The Substance Abuse and Mental Health Services Administration www.samhsa.gov


    Michelle d hoersch ms office on women s health region v

    Michelle D. Hoersch, MS on Women, Girls and TraumaOffice on Women’s Health- Region V

    233 N Michigan Ave, Suite 1300Chicago, IL [email protected]


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