1. Good morning and welcome to Day 2 Please sit where ever you would like regardless of your colored dots (: We will break out later this morning and help you find where you need to be !!

2. 2014 TRAUMA & YOUTH: UNDERSTANDING THE IMPACT OF TRAUMA AND SHARED LEARNING COLLABORATIVE Sponsored by the Virginia Department of Criminal Justice Services In partnership with: The Virginia Departments of Behavioral and Developmental Services, Education, Juvenile Justice, and Social Services

3. 3 Day Two TIC Systems of Care

4. 4 Take Aways from Day One Lets share with the person sitting next to you something you really took away from yesterday Can we get some folks to share with the big group??

5. 5 Shifting to TIC Culture Paradigm Shift http://www.bing.com/videos/search?q=Youtube+get+service&FORM=VIRE 3#view=detail&mid=D1306385777FFF2C6D3AD1306385777FFF2C6D3A TIC Systems of Care http://gucchdtacenter.georgetown.edu/TraumaInformedCare/Module2. html

6. 6 Trauma and Human Service Systems Within and between human service organizations we witness fight flight and freeze … When we think about where this comes from … it is very similar to the experience of our clients We bring in our own ACE scores Our environments are stressful, demanding and sometimes abusive Budget Cuts Higher Caseloads Increase paperwork demands Higher expectations for outcomes and evidence informed practices Constantly changing regulations Vicarious Trauma with and through our clients

7. 7 So we develop coping behaviors to survive within and between the systems Remember … the “problems” we see in our clients are often their solutions to coping with stress and trauma Our challenges in and between our systems are often the way we cope within and between our agencies Fight/Flight/ Freeze can be our coping behaviors too

8. 8 Cross-System Challenges Adversarial Relationships Blaming other people or departments for … Lack of Communication Avoiding Communication with certain People or Agencies Staying close only to those in “our circle” Doing nothing (waiting for the storm to pass)

9. 9 Cross System Challenges can also be because of … Lack of Knowledge Lack of Awareness Lack of True Collaboration Lack of Resources

10. 10 Trauma Present … Trauma Informed Knowledge and Literature applies to school professionals at all levels … -Clients -Families -Caregivers -Professionals -Systems we work in -Systems with which we engage every day

11. 11 Creating a Culture for TIC Five Core Values (Fallot, 2009) 1)Safety 2)Trustworthiness 3)Choice (and Voice !!) 4)Collaboration 5)Empowerment We can offer CAPPD to those with work with … http://www.multiplyingconnections.org/… http://www.multiplyingconnections.org/

12. 12 Henry Emotional Chain of Custody

13. 13 So how do we work together to help the “Henry’s” and his family get to recovery ? Becoming a Trauma Informed Youth and Family Service System

14. 14 Definition of Trauma-Informed Child- and Family-Service System A trauma-informed child- and family-service system is one in which all parties involved recognize and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers, and service providers. Programs and agencies within such a system infuse and sustain trauma awareness, knowledge, and skills into their organizational cultures, practices, and policies. They act in collaboration with all those who are involved with the child, using the best available science, to facilitate and support the recovery and resiliency of the child and family Source: National Child Traumatic Stress Network. Retrieved from http://www.nctsn.org/resources/topics/creating-trauma-informed-systemshttp://www.nctsn.org/resources/topics/creating-trauma-informed-systems

15. 15 Definition of Trauma-Informed Child- and Family-Service System, Continued A service system with a trauma-informed perspective is one in which programs, agencies, and service providers: 1.routinely screen for trauma exposure and related symptoms; 2.use culturally appropriate evidence-based assessment and treatment for traumatic stress and associated mental health symptoms; 3.make resources available to children, families, and providers on trauma exposure, its impact, and treatment; 4.engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma; 5.address parent and caregiver trauma and its impact on the family system; 6.emphasize continuity of care and collaboration across child-service systems; and 7.maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff resilience.

16. 16 Trauma Informed Organizational Assessment Examining where as an organization you score on the NCTSN Youth and Family Service System Domains Examining where as an organization you score on the NCTSN Youth and Family Service System Domains Creating Cultures of Trauma-Informed Care (CCTIC): A Self- Assessment and Planning Protocol Roger D. Fallot, Ph.D. and Maxine Harris, Ph.D. July, 2009 Creating Cultures of Trauma-Informed Care (CCTIC): A Self- Assessment and Planning Protocol Roger D. Fallot, Ph.D. and Maxine Harris, Ph.D. July, 2009 NCTSN’s Trauma System Readiness Tool (TSRT) NCTSN’s Trauma System Readiness Tool (TSRT National Council Organizational Assessment Survey (OSA) and TIC Learning Collaborative National Council Organizational Assessment Survey (OSA) and TIC Learning Collaborative

17. 17 SOAR Work For Today

18. 18 Review of Screening Tools

19. 19 Screening Administered to Everyone in Group Brief Easy to Complete Gives ‘Yes’ or ‘No’ Information Focused on a Specific Topic Assessment In-Depth Requires Training Administered to Targeted People Gives Unique Client Picture Informs Treatment Completed Over 1-3 Visits Psychological Evaluation Even More In-Depth Completed by Psychologists (typically) Gives Very Specific Information Screening in TIC Youth and Family Serving Systems

20. 20 Screening Trauma-informed screening refers to a brief, focused inquiry to determine whether an individual has experienced specific traumatic events or reactions to trauma and if they need trauma- focused mental health treatment. Completed by individuals who work directly with children – may include child welfare, juvenile justice, school personnel, as well as attorneys. Usually includes questions regarding a child’s exposure to trauma and his/her symptoms. We often screen, even if we don’t use a specific tool or process.

21. 21 Common Examples of Screening

22. 22 Trauma-Related Needs Screening The 3 E’s Event Domestic Violence Neglect Physical Abuse Sexual Abuse Community and School Violence Traumatic Grief Experience Reactions that are specific responses to trauma Avoidance of triggers Intrusive thoughts Nightmares about the event Effect Symptoms that may be strongly related to trauma (but not necessarily) and may develop over time Generalized Anxiety Behavior Problems Depression Adapted from Griffin, E., (2012). Presentation at the NIDA/ACYF experts meeting on trauma and child maltreatment.

23. 23 Trauma Screening Brief, focused inquiry to determine whether an individual has experienced specific traumatic events or reactions to trauma Done by front-line workers such as child welfare workers, CSU officers, or designated members of a school system (ex: school counselor) Usually includes questions regarding exposure to trauma and related symptoms Assists workers in understanding the child’s and family’s history and potential triggers Directs trauma-informed case planning Positive screen may trigger referral for comprehensive trauma mental health assessment

24. 24 Polytrauma Screening Tool Language in the Checklist was adapted from the National Child Traumatic Stress Network’s (NCTSN’s) Child Welfare Trauma Referral Tool 4 and reviewed by mental health experts Clinical terms that may appear in clients’ case files or that users may hear from mental health experts are listed, along with “translations” into non-clinical language or examples of specific behaviors that attorneys or others may notice in a client. These terms, and users’ decisions about whether they apply to a particular client, are simply a way to inform their thinking about the client and to help users consider the possible impact of past traumatic experiences.

25. 25 Polytrauma Screening Tool. The Checklist can be used for clients of any age. Using the Checklist is not intended to result in a numerical score but instead should allow users to think about clients and their needs in a more trauma informed way. After completing the Checklist, users should also review the Flowchart below for general guidance on immediate and long-term steps to take based on the information they have. There is no set number of “yes” answers to the Checklist questions above that determines which children need treatment and which do not Checklist can help users determine whether a child should be seen by a mental health professional who can make a determination of further needed actions

26. 26 Users may wish to complete it several times, at regular intervals during a case or after particular milestones or case events. Entering a juvenile detention facility Removal from home or a foster care placement Conflicts with or negative developments involving a child’s family members Any experience of change (even after period of stability) Engagement in a court process can be a traumatic experience for a child or serve as a trigger for past traumatic experiences Polytrauma Screening Tool

27. 27 Los Angeles Symptom Checklist (Adolescent Version) 43 items Free Available in Spanish and English Simple language with short phrases Focuses on experiences and effects, no event items Symptom checklist tool that includes 17 PTSD symptom items as well as items related to abusive drinking, partner problems, and excessive eating 1 study that reported appropriate levels of reliability and measure appeared to detect distress and PTSD as a function of trauma exposure among 639 adolescents

28. 28 Trauma Screening for Parents Many birth parents have histories of trauma (in childhood and adulthood). Trauma can impact parenting and protective capacities. Awareness of parental trauma history helps workers better understand parents and link them to appropriate services. Examples of screening tools for parents: Life Events Checklist: http://www.ptsd.va.gov/PTSD/professional/pages/assessments/assessment- pdf/life-event-checklist-lec.pdf http://www.ptsd.va.gov/PTSD/professional/pages/assessments/assessment- pdf/life-event-checklist-lec.pdf Trauma Recovery Scale: http://www.psychink.com/rfiles/CFScalesMeasures.pdfhttp://www.psychink.com/rfiles/CFScalesMeasures.pdf

29. 29 What Can a TIC Youth and Family Serving Workers Do? Use trauma screening tools with children and families. Gather a full picture of trauma exposure and impact. Identify immediate needs and concerns. For children at risk of medical trauma, use the Medical Trauma Assessment & Action Form.Medical Trauma Assessment & Action Form. Ensure that families are referred for culturally appropriate trauma assessment and treatment when needed. Gain a better understanding of the range of available programs and treatment approaches. Identify and interview individuals or agencies. Request regular, ongoing assessments.

30. 30 Practice We want you as a team to get to know the screening tools that are provided here Your team will spend some time reviewing these two tools in your handouts Pick one that you would like to work with as a team REMEMBER – all systems of care can you the child welfare referral tool given we all are responsible for improving the welfare of children

31. 31 Family Preservation Services Group Helpers, Raise Your Hands

32. 32 Practice Let’s look at the Trina Case Scenario Individually, think about this case and practice using one or both of the screening tools with Trina’s case

33. 33 Report Out What did you like about the screening tool? What was difficult about the tool? How did it make you think differently about your service planning?

34. 34 Action Learning One

35. 35 GOALS Focusing on Domain One, Screening, we now want to move from using screening as an individual service worker to a collaborative team !!

36. 36 SOAR PLANNING Moving through the first page of your SOAR, think through your agency’s role in supporting youth and family healing Share your responses to the questions along the SO portion of the continuum so that everyone in your group can hear each agencies strengths and opportunities for growth around a case like Trina’s

37. 37 Additional Thoughts Think about what information you have and DON’T need to ask the client about to complete the screen Do some discussion of who in your individual agency would use the screening tool? When would you use it? Could their be collaboration between agencies to use the same tool and share information? What information are you missing? What kind of referral would you make for Trina? How would this information impact your case plans for Trina?

38. 38 SOAR PLANNING Now move to the “AR” As individual agencies and a collaborative system of care, what actions do you want to take in your communities around screening and assessment? What results do you expect from these actions?

39. 39 Report Out What did you find to be the strengths of the tool you used in your group? What opportunities did it create for collaboration? Interagency case planning? What were the challenges? Could you picture using the tool in your work?

40. 40 Action Learning Two

41. 41 GOALS Focusing on any of Domain’s 2-7, work as a collaborative team through one other domain Your group should pick a domain and move through the same process you just did with screening with this domain

42. 42 SOAR PLANNING Moving through the domain page of your SOAR, think through your agency’s role in supporting youth and family healing Share your responses to the questions along the SO portion of the continuum so that everyone in your group can hear each agencies strengths and opportunities for growth around a case like Trina’s

43. 43 SOAR PLANNING Now move to the “AR” As individual agencies and a collaborative system of care, what actions do you want to take in your communities around this TIC domain? What results do you expect from these actions?

44. 44 Report Out What did you find to be the strengths of the tool you used in your group? What opportunities did it create for collaboration? Interagency case planning? What were the challenges? Could you picture using the tool in your work?

45. 45 Skill building resilience starts with you … Who is taking care of you ?? Information and slide part of Dr. Allison Sampson's Trauma Presentation

46. 46 Mirror Neurons

47. 47 Impact of Working with Victims of Trauma Trauma experienced while working in the role of helper has been described as: – Compassion fatigue – Countertransference – Secondary traumatic stress (STS) – Vicarious traumatization Unlike other forms of job “burnout,” STS is precipitated not by work load and institutional stress but by exposure to clients’ trauma. STS can disrupt child welfare, police and juvenile justice workers’ lives, feelings, personal relationships, and overall view of the world.

48. 48 STS Signs and Symptoms Avoidance (including of certain clients) Preoccupation with clients/client stories Intrusive thoughts/nightmares/flashbacks Arousal symptoms Thoughts of violence/revenge Feeling estranged/isolated/having no one to talk to Feeling trapped, “infected” by trauma, hopeless, inadequate, depressed Having difficulty separating work from personal life Sound familiar?

49. 49 Strategies to Address STS Personal strategies, such as respecting one's own limits and maintaining time for self-care activities. Professional strategies, such as balancing caseload, having supervision and support available. Organizational strategies, such as sufficient time off and safe physical space.

50. 50 Healing the Hero https://www.youtube.com/watch?v=FdaJYEraGG0 &feature=em-upload_owner Produced by Trish Mullen, LPC Chesterfield CSB

51. 51 Impact of Chronic Stress http://www.helpguide.org/mental/stress_signs.htm  raise blood pressure  suppress immune system  increase the risk of heart attack and stroke  contribute to infertility  speed up the aging process (life expectancy)  create vulnerability for anxiety and depression  obesity  skin conditions (ex: eczema)  sleep problems  digestive problems Information and slide part of Dr. Allison Sampson's Trauma Presentation

52. 52 Vicarious Trauma’s Impact Personally (Yassen, 1995)  Emotional  Roller coaster  Overwhelmed  Depleted  Behavioral  Negative coping mechanism  Difficulty sleeping  Absent- mindedness  Cognitive  Spaciness  Apathy  Perfectionism  Minimization Information and slide part of Dr. Allison Sampson's Trauma Presentation

53. 53 Personal Impact … (Yassen, 1995) Spiritual Hopelessness Anger at a Higher Power Physical Aches and pains Impaired immune system Breathing difficulties Interpersonal Withdrawn Intolerance Loneliness Projection of anger and blame

54. 54 Professional Impact (Yassen, 1995) Performance of Job Tasks Decrease in quality and quantity Increase in mistakes Avoidance of job tasks Morale Dissatisfaction Negative attitude Detachment

55. 55 Professional Impact (Yassen, 1995) Interpersonal Withdrawn from colleagues Impatience Poor communication Staff conflicts Behavioral Tardiness Absenteeism Faulty Judgment

56. 56 Managing Stress Request and expect regular supervision and supportive consultation. Utilize peer support. Consider therapy for unresolved trauma, which your work may be activating. Practice stress management through meditation, prayer, conscious relaxation, deep breathing, and exercise. Develop a written plan focused on maintaining work–life balance.

57. 57 Perry and Cost of Caring http://childtraumaacademy.com/cost_of_caring/index.html http://childtraumaacademy.com/cost_of_caring/index.html

58. 58 “Whether you and I and a few others will renew the world some day remains to be seen. But within ourselves we must renew it each day.” —Hermann Hesse

59. 59 Self-care Strategies The best strategy to address compassion fatigue is to develop excellent self care strategies, as well as an early warning system that lets you know that you are moving into the caution zone of Compassion Fatigue http://www.compassionfatigue.org/pages/Top12SelfCareTips.pdf

60. 60 Self Care: Need Options Time and Connection: 10 second exercises 2 minute exercises 5-10 minute exercises 20-30 minute GI, Walking Meditation http://www.healthjourneys.com/default.asphttp://www.healthjourneys.com/default.asp ( Belleruth Naparstek)

61. 61 Brain Gym

62. 62 Practice Cross crawl (opposite right hand to bent left knee, then left hand to bent right knee)

63. 63 Performance Management How do other professions like the NFL and SWAT handle stress ??

64. 64 Linearity and Oscillation

65. 65 Vulnerability Mountain

66. 66 Self Care Apps Provider Resilience GPS for the Soul Mediation Oasis Apps Mindfulness Training System IChill App (Peter Levine) Narrative Therapy Questions (Narrative Q’s) Brain Wave http://socialwork.buffalo.edu/resources/self-care-starter- kit.html http://socialwork.buffalo.edu/resources/self-care-starter- kit.html Flipagram (example) http://flipagram.com/f/nGbakYX6B5 http://flipagram.com/f/nGbakYX6B5 NCTSN Self Care Inventory

67. 67 Provider Resilience

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71. 71 GPS for the Soul

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75. 75 FLIPAGRAM Example http://flipagram.com/f/nGbakYX6B5

76. 76 Heidi Hanna’s Jumpstart Process (30 minutes in the morning) 1)Movement 2)Mindfulness – “Setting Intentions” 3)Motivation 4)Meditation 5)Mirth – EX: Finding the Humor in things

77. 77 Heidi Hanna’s Recharge Process 1)Balance – 1 minute – deep breathe 2)Build – 1 minute – gratitude 3)Boost – 1 minute – intention

78. 78 Pocket TM … by Trish Mullen, LPC Challenge: Working with children who are in their downstairs brain and getting them back up to their upstairs brain … when we all use primarily upstairs techniques in our work Self care targeted to the right brain and lower brain http://youtu.be/up_WSAYmn-s

79. 79 Caring For Yourself

80. 80 Creating Internal Awareness

81. 81 Creating Awareness

82. 82 Using Grounding Techniques to Stay in the Window of Tolerance Mental Grounding Physical Grounding Soothing Grounding Somatic Grounding Najavitis, L.M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. NY: Guilford.

83. 83 “Dig where the ground is soft” Chinese Proverb Conclusion: “Dig where the ground is soft” Chinese proverb Instead of picking your trickiest area, pick the issue that you can most easily visualize improving on. (e.g.: “making a commitment to going for a walk every lunch time vs. getting rid of my difficult supervisor”). You may not notice it right away, but making one small change to your daily routine can have tremendous results in the long term. Imagine if you started walking up two flights a stairs per day instead of using the elevator, what might happen after three months?

84. 84 Take Some Time to Think About What You Can Commit to Yourself 21 ways to reduce Stress Maintenance Self Care Worksheet

85. 85 Together We Can Make A Difference Becoming Trauma Informed is a process … https://www.youtube.com/watch?v=7wK2io3Z2 KM&feature=em-upload_owner

86. Allison Sampson Jackson, Ph.D. integrationsolutions@verizon.net 804-432-0056 86