Elizabeth Hudson, LCSW Consultant to the Dept. of Health Services, Division of Mental Health and Substance Abuse Services Elizabeth.Hudson@wisconsin.gov. Trauma-Informed Care. Have you ever had a patient who was…. irritable or hostile? avoidant of medical appointments?
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Consultant to the Dept. of Health Services,
Division of Mental Health and Substance Abuse Services
Most people who have experienced traumas do not seek mental health services. Instead, they look for assistance and care in the primary care setting.
(Adapted from Dept.of Veteran Affairs, PTSD: Implications for Primary Care)
Roger Fallot, Wisconsin Trauma Summit, 2007
Refers to the individual’s (or family’s) perception of significant events or circumstances, past or present. These events or circumstances may result in a cluster of symptoms, adaptations, and reactions that interfere with the individual’s functioning.
(Modified from Report from Wisconsin Trauma Summit, 2007)
Result of traumatic experiences that are interpersonal, intentional, prolonged and repeated. Often leads to immediate and long-term difficulties in many areas of functioning.
Historical trauma is the
cumulative emotional and
psychological wounding over the
life span and across generations,
resulting from trauma experienced by
the individual’s social group.
Historical trauma generates such
responses as survivor guilt,
depression, low self-esteem,
psychic numbing, anger, victim
identity, preoccupation with
trauma, and physical symptoms.
(Brave Heart, 2005)
The overt and covert traumatic
events that occur in mental
health and other human service
These events are distressing,
frightening, or humiliating.
People (consumers and staff)
who are exposed to sanctuary
trauma may experience a cluster
of symptoms and reactions that
interfere with functioning.
Trauma occurs in layers, with each layer affecting every other layer. Current trauma is one layer. Former traumas in one’s life are more fundamental layers. Underlying one’s own individual trauma history is one’s group identity or identities and the historical trauma with which they are associated.
--- Bonnie Burstow
cases of child maltreatment and an additional 2,590
cases that were likely to have occurred.
The ACE Study identifies ‘adverse childhood experiences’ as growing up (prior to 18 years of age) in a household with:
(Felitti et al., 1998)
HIV and STIs
ACE Study - effects are neurological, biological, psychological and social in nature, including:
(Susan A. Storti, 2008)
Simple Trauma other layer. Current trauma is one layer. Former traumas in one’s life are more fundamental layers. Underlying one’s own individual trauma history is one’s group identity or identities and the historical trauma with which they are associated.
Complex TraumaTrauma Complexity Continuum
Adequate child development
No comorbid psychological disorders
A conditioned response that happens automatically when faced with a stimuli associated with traumatic experiences
Seeing, feeling, hearing, smelling something that reminds us of past trauma
Activate the alarm system
The response is as if there is current danger
Thinking brain automatically shuts off in the face of triggers
Past and present danger become confused
More reminders of past danger
Brain is more sensitive to danger
Interactions with others often serve as triggers
Roger Fallot, Wisconsin Trauma Summit, 2007
“Thank you very much for your concern for my family, but my priority is to care for YOU.”
“It sounds like there are several issues that we need to address. Because we only have 20 minutes for our visit today, we will not be able to address them all in one visit. Let’s identify the two highest priority items that you want to be sure we cover today, and then schedule a follow-up visit so we can continue working through this list of important issues.”
“My code of ethics does not allow me to enter into a romantic relationship with a patient. It is a very strict rule. However, I would like to continue working with you professionally around your medical problems. Will you be comfortable with that?”
Remember that the patient is coping in the best way he/she knows how, and may need the clinician’s help to begin to learn new patterns of interaction.
The person discloses she was recently in a car accident and she is having nightmares about familial abuse growing up as a child.