1. Becoming Trauma Informed © tiffany couch

2. Trauma Informed Care Trauma-informed care is both a philosophy and a way of providing services based on compelling research over the past 20 years. The research indicates that exposure to trauma is not only dramatically more prevalent than previously known, but also closely linked to many detrimental medical, psychological and social outcomes throughout an individual's lifespan. Exposure to adverse experiences is especially harmful during childhood when the brain is in a rapid stage of development. Immediate behavioral health interventions offer real hope for minimizing negative consequences, but even in situations where the traumatic experiences occurred long ago, new and evidence-based practices can be helpful.

3. The Adverse Childhood Experiences “ACE” Study The Adverse Childhood Experiences “ACE” Study This is Anna at age one and a half This is Anna years later – in a mental institution What happened? The tragic consequences of unaddressed Childhood Trauma

4. What is the Adverse Childhood Experiences (ACE) study? CDC and Kaiser Permanente Collaboration CDC and Kaiser Permanente Collaboration Over a decade long, 17,000 people involved. Over a decade long, 17,000 people involved. Looked at effects of adverse childhood experiences over the lifespan. Looked at effects of adverse childhood experiences over the lifespan. Largest study ever done on this subject Largest study ever done on this subject

5. Adverse Childhood Experience* ACE Categories (Birth to 18) Abuse of Child Abuse of Child Emotional abuse Emotional abuse Physical abuse Physical abuse Contact Sexual abuse Contact Sexual abuse Trauma in Child’s Household Trauma in Child’s Household Environment Environment Alcohol and/or Drug User Alcohol and/or Drug User Chronically depressed, emotionally Chronically depressed, emotionally disturbed or suicidal household disturbed or suicidal household member member Mother treated violently Mother treated violently Imprisoned household member Imprisoned household member Not raised by both biological Not raised by both biological parents parents (Loss of parent – best by death (Loss of parent – best by death unless suicide, - Worst by unless suicide, - Worst by abandonment) abandonment) Neglect of Child Neglect of Child Physical neglect Physical neglect Emotional neglect Emotional neglect * Above types of ACEs are the “heavy end” of abuse. *1 type = ACE score of 1 Impact of trauma and health risk behaviors to ease the pain Neurobiologic Effects of Trauma Disrupted neuro-development Disrupted neuro-development Difficulty controlling anger/rage Difficulty controlling anger/rage Hallucinations Hallucinations Depression - other MH Disorders Depression - other MH Disorders Panic reactions Panic reactions Anxiety Anxiety Multiple (6+) somatic problems Multiple (6+) somatic problems Sleep problems Sleep problems Impaired memory Impaired memory Flashbacks Flashbacks Dissociation Dissociation Health Risk Behaviors Smoking Smoking Severe obesity Severe obesity Physical inactivity Physical inactivity Suicide attempts Suicide attempts Alcoholism Alcoholism Drug abuse Drug abuse 50+ sex partners 50+ sex partners Repetition of original trauma Repetition of original trauma Self Injury Self Injury Eating disorders Eating disorders Perpetrate interpersonal violence Perpetrate interpersonal violence Long-term consequences of unaddressed trauma (ACEs) Disease and Disability Ischemic heart disease Ischemic heart disease Cancer Cancer Chronic lung disease Chronic lung disease Chronic emphysema Chronic emphysema Asthma Asthma Liver disease Liver disease Skeletal fractures Skeletal fractures Poor self rated health Poor self rated health Sexually transmitted disease Sexually transmitted disease HIV/AIDS HIV/AIDS Serious Social Problems Homelessness Homelessness Prostitution Prostitution Delinquency, violence, criminal Delinquency, violence, criminal Inability to sustain employment Inability to sustain employment Re-victimization: rape, DV, bullying Re-victimization: rape, DV, bullying Compromised ability to parent Compromised ability to parent Negative alterations in self perceptions and relationships with others Negative alterations in self perceptions and relationships with others Altered systems of meaning Altered systems of meaning Intergenerational trauma Intergenerational trauma Long-term use of multiple human Long-term use of multiple human service systems service systems

6. Severe and persistent emotional problems Severe and persistent emotional problems Health risk behaviors Health risk behaviors Serious social problems Serious social problems Adult disease and disability Adult disease and disability High health, behavioral health, correctional and social service costs High health, behavioral health, correctional and social service costs Poor life expectancy Poor life expectancy For example: The higher the ACE Score, the greater the likelihood of :

7. Emotional Problems 2/3 rd (67%) of all suicide attempts 2/3 rd (67%) of all suicide attempts 64% of adult suicide attempts 64% of adult suicide attempts 80% of child/adolescent suicide attempts 80% of child/adolescent suicide attempts All are attributable to Adverse Childhood Experiences

8. Substance Abuse 0 1 2 3 4+ Childhood Experiences and Adult Alcoholism ACE Score and Intravenous Drug Use N = 8,022 p<0.001

9. Sexually Transmitted Disease Sexually Transmitted Disease Liver Disease Liver Disease COPD COPD Ischemic Heart Disease Ischemic Heart Disease Autoimmune Disease Autoimmune Disease Lung Cancer Lung Cancer Higher ACE Score = significant rise in chronic health conditions:

10. Effect of ACEs on mortality Age Group 0 ACE 60% live to 65 4 ACE less than 3% live to 65

12. The financial burden to society of childhood abuse and trauma is staggering. The financial burden to society of childhood abuse and trauma is staggering. Annual Direct Costs: Hospitalization, Mental Health Care System, Child Welfare Service System and Law Enforcement = $33,101,302,133.00 Annual Direct Costs: Hospitalization, Mental Health Care System, Child Welfare Service System and Law Enforcement = $33,101,302,133.00 Annual Indirect Costs: Special Education, Juvenile Delinquency, Mental Health and Health Care, Adult Criminal Justice System, Lost productivity to Society = $70,652,715,359.00 Annual Indirect Costs: Special Education, Juvenile Delinquency, Mental Health and Health Care, Adult Criminal Justice System, Lost productivity to Society = $70,652,715,359.00 Total Annual Cost: $103,754,017,492.00 (Over $184 million dollars a day) Total Annual Cost: $103,754,017,492.00 (Over $184 million dollars a day) Economic Impact Study. (September, 2007). Prevent Child Abuse America Economic Impact Study. (September, 2007). Prevent Child Abuse America

13. What does it mean to be a Trauma-Informed Care Agency? In addition to evidence-based practices, a trauma informed agency examines every aspect of their management and service delivery systems to ensure they support healing. This includes having an appreciation for the high prevalence of traumatic experiences for all people in our society and particularly in persons who seek and/or receive behavioral health treatment.

14. What does it mean to create a culture of Trauma-Informed Care? Developing a culture of physical and emotional safety for everyone; clients, their families and staff alike. Having the belief and understanding that everyone is born with the capacity for progressive development, but that this capacity can be derailed by overwhelming life stressors and traumatic experiences. As a result of these events, individuals and systems may develop maladaptive coping skills that make sense in the context of the history. This is true for clients, their family members, as well as staff members at all levels of an agency. Surfacing and resolving conflicts Promoting and valuing honest communication. Respecting everyone's feelings and perspectives, even when they differ. Continued...

15. Creating a trauma-informed culture (cont.) Maintaining and supporting emotional regulation for self and others. Extending kindness and compassion while maintaining healthy boundaries. Working from a strength-based approach that honors the belief that everyone is doing the best he or she knows how. Having and cultivating a fun attitude with one another about whatever has to be done, as well as doing whatever has to be done with a sense of joy! Using group process, group problem solving, and creative problem-solving, whenever feasible, for resolution of shared problems.

16. We owe it to ourselves and our clients to be Trauma-Informed!

17. Sources/Resources ACE Publications: For comprehensive list see CDC ACE Study website: Publications on Major Findings By Health Outcomes: This site was updated (March 1, 2010) and links to related articles on all subjects. http://www.cdc.gov/nccdphp/ACE/outcomes.htm ACE Publications: For comprehensive list see CDC ACE Study website: Publications on Major Findings By Health Outcomes: This site was updated (March 1, 2010) and links to related articles on all subjects. http://www.cdc.gov/nccdphp/ACE/outcomes.htm http://www.cdc.gov/nccdphp/ACE/outcomes.htm The Damaging Consequences of Violence and Trauma: See Trauma-Informed Resources : www.TheAnnaInstitute.Org The Damaging Consequences of Violence and Trauma: See Trauma-Informed Resources : www.TheAnnaInstitute.Orgwww.TheAnnaInstitute.Org Documents and articles on women and trauma: Presentation Bibliography in preparation. Available upon request: Ann Jennings, afj@gwi.net Documents and articles on women and trauma: Presentation Bibliography in preparation. Available upon request: Ann Jennings, afj@gwi.netafj@gwi.net Brett Wheeler, Co-Owner & COO, Access 2 Counseling - OKC

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