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Trauma Informed Care & Effective Screening. Christine Heyen, MA Crime Victims’ Services Division Oregon Department of Justice Association of Public Health Nursing Supervisors Annual Conference May 9, 2012. Imagine a place that….

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trauma informed care effective screening

Trauma Informed Care & Effective Screening

Christine Heyen, MA

Crime Victims’ Services Division

Oregon Department of Justice

Association of Public Health Nursing Supervisors

Annual Conference

May 9, 2012

imagine a place that
Imagine a place that…
  • Asks “What happened to you?” instead of “What is wrong with you?
  • Understands past trauma can be triggered by experiences in the present
  • Is committed to supporting people as they heal
  • Leaves a person feeling edified
what is trauma
What is trauma?

Briere, J. (2006).  Dissociative symptoms and trauma exposure:   Specificity, affect dysregulation, and posttraumatic stress.  Journal of Nervous and Mental Disease, 194, 78-82.

what is trauma1
What is Trauma?
  • It can be a single event
  • More often than not it is multiple events over time (complex, prolonged trauma)
  • An interpersonal violence or violation, especially at the hands of an authority/trust figure is especially damaging
what does trauma do to us
What does trauma do to us?

Bessel A. van der Kolk , MD

http://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trauma_Disorder.pdf

ace study http www cdc gov ace index htm
ACE Studyhttp://www.cdc.gov/ace/index.htm

Adverse Childhood Experiences (ACE) Study

traditional approach vs trauma theory
Traditional Approach vs. Trauma Theory
  • Traditional approach
    • You are sick
    • You are bad
    • You are sick and bad
  • Trauma theory
    • You are not sick or bad
    • You are injured
what does tic offer
What does TIC offer?
  • Improves our desired outcomes
  • Supports trauma recovery by
    • Reducing re-traumatization
    • Providing “corrective emotional experience”
  • Decreases our own vicarious trauma or compassion fatigue
core principles of tic
Core Principles of TIC
  • Awareness: Everyone knows the role of trauma
  • Safety: Ensuring physical and emotional safety
  • Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries
  • Choice: Respect and prioritize consumer choice and control
  • Collaboration: Maximizing collaboration and sharing of power with consumers
  • Empowerment: Prioritizing consumer empowerment and skill-building
tic communication style
TIC Communication Style
  • Transactional
    • Focus on information exchange
  • Transactional with Social Talk
    • Mostly information exchange with some social talk (e.g. joking, comment on weather)
  • Interactional
    • Focus on rapport-building and interpersonal relationship integrated with the information exchange

https://nchdv.confex.com/nchdv/2012/webprogram/Session2199.html

tips for practicing tic
Tips for Practicing TIC
  • Use language the person recognizes
    • “Has your partner messed with your birth control?”
  • Meet the survivor “where they are”
    • If a person is not ready to talk, do not force the conversation. Rather keep the door open for a later time.
  • Consider the person’s cultural context
    • Avoid making assumptions – just ask!
tips for practicing tic1
Tips for Practicing TIC
  • Recognize adaptive behaviors serve a purpose
    • Why is a person chronically miss morning appointments? Is the morning the only time she can sleep? Does she have a traumatic brain injury that prevents her from remembering things?
    • Make adjustments to help that person succeed. Set appointment times for the afternoon.
  • Include everyone in your agency
    • From receptionist to treatment staff
    • Provide trauma training to every employee
how do we provide tic
How do we provide TIC?
  • Listen
    • What is the survivor saying to you?
    • What is the survivor not saying?
    • How is the survivor saying it?
  • Inform
    • What information do you have that may help her?
    • What will happen next in the process?
    • Why is the information important for her to have?
    • How can your services can help her?
how do we provide tic1
How do we provide TIC?

To the best of your ability and within your given time constraints:

  • Lose the labels
  • Let her tell her story
  • Give her time and space to tell her story
  • Let the survivor lead
  • Respect her voice and choice
  • Recognize the survivor’s comfort level
  • Consider the survivor’s perspective from her cultural context
quick easy
Quick & Easy
  • Offer support and validation
    • Communicate care and concern
    • Avoid passing judgement
  • Ask questions of the survivor
    • Find out if she is experiencing some kind of violence or coercion in her life
  • Listen to what she has to say
    • Resist interrupting her
    • Make sure your body language is receptive
  • Offer information and assistance
    • Give her a resource card, a phone number, or a website
    • Refer her to an advocate (warm hand-off)
    • Tell her you are available to her in the future
resources
Resources
  • Trauma and Trauma Informed Care
    • http://www.trainingforums.org/lms/
  • Trauma Informed Care – PowerPoint presentation by Mandy A. Davis, LCSW, Portland State University
    • http://www.doj.state.or.us/victims/pdf/trauma_informed_care_presentation_outline.pdf
  • Futures Without Violence
    • http://www.futureswithoutviolence.org/
resources1
Resources
  • Supporting health needs of women in shelter: Exploring traumatic brain injury and reproductive coercion
    • https://nchdv.confex.com/nchdv/2012/webprogram/Session2192.html
  • Violence and reproductive coercion: Assessment strategies for pregnant women, and client feedback to inform what works
    • https://nchdv.confex.com/nchdv/2012/webprogram/Session2199.html
  • The 6th Biennial National Conference on Health and Domestic Violence (March 29-31, 2012)
    • https://nchdv.confex.com/nchdv/2012/webprogram/meeting.html
resources2
Resources
  • Community Connections – Creating Cultures of Trauma Informed Care
    • http://communityconnectionsdc.org/web/page/673/interior.html
  • Trauma-Informed Organizational Toolkit
    • http://www.familyhomelessness.org/media/90.pdf
  • Trauma-Informed Care; Best Practices and Protocols for Ohio’s Domestic Violence Programs
    • http://www.odvn.org/images/stories/FinalTICManual.pdf
  • Creating Cultures of Trauma-Informed Care; A Self-Assessment and Planning Protocol
    • http://www.annafoundation.org/CCTICSELFASSPP.pdf
resources3
Resources
  • Trauma-Informed Care - PowerPoint
    • http://www.mhcc.org.au/ticp/research-papers/Risser-2008.pdf
  • Shelter from the Storm: Trauma Informed Care in Homelessness Services Settings - Article
    • http://homeless.samhsa.gov/ResourceFiles/cenfdthy.pdf
  • Adverse Childhood Experience Study
    • http://www.acestudy.org/
  • Community Re-Traumatization - Article
    • http://www.annafoundation.org/COMMUNITY%20RETRAUMATIZATION.pdf
contact information
Contact Information

Christine Heyen, MA

Oregon Department of Justice

Crime Victims’ Services Division

1162 Court Street NE

Salem, OR 97301

(503) 378-5303

Christine.p.heyen@doj.state.or.us