TRAUMA INFORMED TRAUMA SENSITIVE Texas Association by alicejenny

VIEWS: 4 PAGES: 80

									TRAUMA INFORMED/TRAUMA
 SENSITIVE TREATMENT OF
  VICTIMS OF CHILDHOOD
      SEXUAL ABUSE

    PRESENTED BY: BEVERLY ENGEL



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          Trauma-Informed Services

    Trauma-informed services involve
     understanding, anticipating, and
     responding to the issues, expectations,
     and special needs of a person who has
     been victimized.

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At a minimum, trauma-informed services
should endeavor to do no harm—to avoid re-
traumatizing survivors or blaming them for
their efforts to manage their traumatic
reactions.


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          Trauma Specific

 Trauma specific treatment is based
   upon empowerment of the survivor
  and the creation of new connections



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   Instead of isolation, there is a focus on
    relationships,
   Instead of coercion, there is a focus on
    persuasion,
   Instead of authoritarian control, there is
    a focus on mutuality.



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“Trauma-specific” services are designed to
  treat the actual consequences of trauma.

    Examples of trauma-sensitive treatment
    approaches include:

   Grounding techniques which help trauma
    survivors manage dissociative symptoms.


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   Desensitization therapies which help to
    render painful images more tolerable .

   Behavioral therapies which teach skills for
    the modulation of powerful emotions.


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Treatment programs designed specifically
  for survivors of childhood trauma are
  consistent on several points:

   The need for respect, information,
    connection and hope for clients.




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    The importance of recognizing the
     adaptive function of “symptoms”.

    The need to work in a collaborative,
     empowering way with survivors of
     abuse
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It is important to become aware of the dynamics
   that characterize abusive relationships—in
   particular:

1.   Control/domination—feeling powerless
2.   Hierarchical boundaries—feeling less than
3.   Isolation/confinement—feeling trapped
4.   Silence/secrets—questioning reality



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5. Being unheard or invalidated—feeling
    unimportant or invisible.
6. The reconstruction of reality— questioning
    her perceptions or her very sanity.
7. Betrayal—feeling unsafe and unable to trust




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Make certain that the same dynamics are not
being unwittingly replicated in the helping
relationship.

For example:

   In a trauma informed setting both parties
are acknowledged for bringing valid sources
of information and expertise to the
relationship.



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   Providers have information and expertise to
    offer victims, but victims also have information
    to share with providers.


   Avoid talking down to the victim or conveying
    to her in any way that you are more important
    than she is or that what you have to say is
    more important than what she has to say.


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   Putting victims in secluded rooms or
    being in a small room with a victim can
    re-traumatize victims and may trigger a
    flashback.




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It is important to inform the victim about
  exactly what is going to happen.

For example, if you are going to do an intake or
  take a history on the client, explain to her in
  advance the nature of the intake, the length
  of the process and how she can signal you if
  she is unable to continue the interview.


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   Keeping victims fully informed can help them
    with their trust issues.
   Knowing what is going to happen ahead of
    time helps them to feel safe.
   Making sure that you do what you say you
    are going to do will help prevent a victim
    from feeling betrayed.




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   Make sure that you listen to what
    the victim is saying and that you
    take what she is saying seriously,
    even if it doesn’t seem to make sense.




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   The more they feel heard and their
    experiences validated they will calm down.

   Victims are accustomed to having what they
    say minimized, discredited or ignored
    so active listening can be a corrective
    experience for them.




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      TRAUMA INFORMED/TRAUMA
        SENSITIVE TREATMENT OF
     VICTIMS OF CHILDHOOD SEXUAL
                 ABUSE


   Trust what the victim tells you—especially
    when she tells you about her abuse experiences.
    Even if it seems unlikely that it happened or that
    it happened in the way she is describing it, it
    very well may be true.



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   There may be some distortion in what she is
    saying—we all have different perceptions of
    things that happen--but on the other hand,
    some of the most extreme and outrageous
    experiences described by victims often turn
    out to be true.




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     Key Elements in Trauma
    Informed/Trauma Sensitive
            Treatment




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   Collaboration
   Education
   Adaptive
   Safety Focused
   Empowerment focused
   Interpersonal skills development


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       Collaboration




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   Trauma-Informed Systems are based on
    collaboration between the victim and the
    service provider.

   Instead of assuming you know what is best
    for the victim, ask her what she wants and
    what would help her to feel comfortable and
    safe. This helps her to begin to establish
    trust in you.

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   A victim knows her own responses, needs and
    history better than anyone else. By respecting
    her knowledge and insights about what she
    needs in order to bring order and healing to her
    life, the provider allows for a truly collaborative
    partnership.

   As much as possible, consumers need to be
    offered options and choices rather than be
    directed or told what to do.


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   Service providers need to work on adopting a
    collaborative tone versus an authoritarian
    one. It is important to stress that you and the
    client are working together. You are not the
    expert, you are not the one in control.



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           EDUCATION




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   The impact of trauma narrows the person’s life,
    constricting choices, undermining self-esteem,
    taking away control, and creating a sense of
    hopelessness and helplessness.

   Trauma-Informed Systems stress the
    importance of service providers being educated
    about the effects of trauma on an individual’s
    emotional development and behavior.

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   This education enables service providers to
    re-frame their basic assumptions about the
    behavior of consumers who were trauma
    victims and helps them to begin to treat
    victims with more dignity, respect and
    compassion.




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   Making the important connection between a
    trauma victim’s behavior and their trauma
    experience will help service providers
    become more compassionate and less
    impatient, judgmental and angry at their
    behavior.



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   For example, understanding that often
    behaviors initially perceived as combative
    and/or reflecting a lack of motivation can
    actually be reactions to fear can help
    advocates to respond differently, which in
    turn allows the traumatic reactions to subside.




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     AN ADAPTIVE MODEL




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   In trauma-informed settings, symptoms are
    seen as adaptations rather than pathology.

   Every symptom helped a survivor in the past
    and continues to help in the present—in some
    way.




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   An adaptation model emphasizes
    resiliency in human responses to stress.
    It helps survivors recognize their own
    strengths and inner resources, rather
    than defining themselves by weakness
    and failure.




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TRAUMA-INFORMED SERVICES ASSUME
 THAT PEOPLE ARE DOING THE BEST
 THEY CAN AT ANY GIVEN TIME TO
 COPE WITH THE LIFE-ALTERING AND
 FREQUENTLY SHATTERING EFFECTS OF
 TRAUMA.

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            SAFETY




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   Safety is of the utmost importance in trauma-
    informed, trauma sensitive programs. It is the
    basis from which all “rules” should be created.

   Creating safety includes such things as allowing
    participants to set their own pace in groups and
    to determine when and how they share their
    trauma stories.


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   Safety also includes anticipating crises. For
    example, many victims of child sexual abuse
    are frequently flooded with painful memories
    and many are self-destructive in some way.



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         EMPOWERMENT




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   Empowering victims is one of the major goals
    of trauma sensitive treatment. This occurs by
    counselors focusing on client’s strengths
    versus “problems.”

   It also occurs by working collaboratively with
    clients, encouraging them to create their own
    goals, treating them with respect and the
    understanding that the client knows what she
    needs.
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   Empowerment is also accomplished by
    providing clients with psycho-educational
    material that will help them to learn to
    regulate their emotions, self-soothe, and
    create healthier relationships




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    INTERPERSONAL SKILLS




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   Focusing on interpersonal skills can help
    clients increase their self-knowledge, self
    esteem, self trust, expression of needs and
    desires, clear communication, limit setting,
    accurate perceptions of others and honest
    labeling, establishment of safe boundaries and
    mutuality and reciprocity.


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    AN INTEGRATIVE APPROACH




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   It is assumed that trauma, substance abuse,
    and mental health interact within a single
    individual.

   Therefore approaches to recovery must be
    holistic approaches.




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Integrative explanations include:

   Primary trauma is a stressor that may trigger
    substance use and the development of
    psychiatric symptoms.

   Trauma symptoms such as flashbacks or
    nightmares are stressors that may trigger
    substance use or result in a psychiatric
    diagnosis.


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   Substance use and certain psychiatric
    symptoms may have evolved as coping
    strategies at a time when options were
    limited.




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   STRENGTH BASED APPROACH




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   The trauma-informed system values a
    strengths-based approach to assessment and
    intervention that highlights the assets of the
    survivor.

   Instead of being defined by her problems, the
    consumer is described as having capacities
    and abilities.



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   Understanding that strengths can be
    invisible or even undermined if they are
    not acknowledged and supported,
    counselors and advocates point out the
    strengths they see in the survivor, thus
    helping her to gain more of a sense of
    well-being, competence, and self-
    esteem.
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   The experience of having a sense of
    competence sets in motion a further change,
    helping survivors to appreciate their own
    abilities.

   For example, it can be enormously beneficial to
    have a survivor develop an inventory of her
    positive qualities.



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  PSYCHO-EDUCATIONAL PROGRAMS




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   Instead of presenting yourself as the
    “expert,” it can be empowering to share
    information in a psycho-educational program
    that is both interactive and flexible enough to
    accommodate what the survivor thinks is
    important.




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   In such an educational program, past abuses
    are linked to current coping strategies, and
    current symptoms are reframed as attempts
    to cope with past abuses.

   Psychoeducational programs are most
    effective in group settings where consumers
    can learn from each other as well as staff,
    and staff can learn from the survivor’s
    perspective.



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   A group-based psycho-educational program
    also helps survivors trust their own
    perceptions of reality and receive validation
    for correct perceptions.




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   Why Isn’t Trauma Reported?




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   In spite of the fact that a majority of
    individuals receiving mental health, substance
    abuse and abuse recovery services have a
    history of trauma, many do not report their
    trauma experiences to counselors or intake
    workers.




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Reasons for this omission can include:

   Fear of being disbelieved or blamed.
   Shame at being victimized and attendant
    vulnerability.
   Childhood experiences of abuse may not be
    readily remembered.


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    UNIVERSAL SCREENING




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   Because of both under-reporting and under-
    recognition, trauma-informed service systems
    have adopted universal screening, asking all
    consumers about trauma as part of the initial
    intake or assessment process.




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   Trauma screening refers to a brief,
    focused inquiry to determine whether
    an individual has experienced specific
    traumatic events.




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WHY PROVIDERS DO NOT ASK ABOUT
            TRAUMA




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   Lack of training or uncertainty about how to
    respond to the information
   Belief that it will be “too upsetting” for
    trauma survivors
   Feeling ill equipped to respond helpfully




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PRIMARY PURPOSES OF SCREENING




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   To determine appropriate follow-up and
    referral, including urgent responses to
    imminent danger and trauma-specific
    services.

   It communicates to all consumers that the
    program believes that abuse and violence are
    significant events and that staff are willing to
    discuss trauma with survivors.



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   Even if a trauma survivor decides not to
    talk about such experiences at this early
    stage, staff have increased the possibility
    of later disclosure by communicating their
    recognition of and openness to hearing
    about painful events.



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   And perhaps most important, by
    recognizing that a consumer has a history
    of trauma, staff can better understand
    the behavior of a survivor




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 YOU CAN CONTRIBUTE TO CLIENT’S
       SENSE OF CONTROL BY:




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   Maximizing consumer choice and control
    in the screening process (trauma
    sensitive). This is especially crucial for
    individuals whose experiences of powerlessness
    and lack of choice have been pervasive. You
    can contribute to the consumer’s sense of
    control by doing the following:




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   Being clear about the steps, the process and the
    reasons for the screening (“I would like to ask
    you some questions about…”); (“We have found
    that many people who come here for services
    have been physically or sexually abused at some
    time in their lives).”




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   Because this can have such important
    effects on people’s lives, we ask
    everyone about whether they have ever
    been a victim of violence or abuse.

   Give permission to not answer the
    questions or to delay the interview.


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  SAMPLE TRAUMA SCREENING




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        SENSITIVE TREATMENT OF
     VICTIMS OF CHILDHOOD SEXUAL
                 ABUSE



1.   At any time in your life have you witnessed
     someone being injured or killed due to an
     unnatural event such as a shooting, stabbing,
     or hit-and-run accident?



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   2. At any time in your life have you witnessed
    a physical or sexual assault against a family
    member, friend, or other significant person?

   3. At any time in your life has someone
    touched you sexually when you did not want to
    be touched?

   4. At any time in your life has anyone forced
    you to have sex when you did not want to?


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   5. At any time in your life has anyone slapped,
    pushed, grabbed, or shoved you?

    6. At any time in your life has anyone choked,
    kicked, bit or punched you?

   7. At any time in your life has anyone
    threatened you with, or actually used, a knife,
    gun or other weapon to scare or hurt you?

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   8. At any time in your life, have you been
    afraid that a specific person (whether it was
    someone you knew well or not) would hurt
    you physically?




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          SUMMARY




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A TRAUMA SENSITIVE/INFORMED APPROAH IS
CHARACTERIZED BY:

   1. Safety from physical harm and re-
    traumatization.

   2. An understanding of clients and their
    symptoms in the context of their life
    experiences and history and culture.


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   3. Open and genuine collaboration between
    provider and consumer at all phases
    of the service delivery.

   4. An emphasis on skill building and
    acquisition rather than symptom management.




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   An understanding of symptoms as attempts
    to cope.

   A view of trauma as a defining and
    organizing experience that forms the core of
    an individual’s identity rather than a single
    discrete event.

   A focus on what happened to the person
    rather than what is wrong with the person.

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