1. RHONDA CRAIG, MPA ANNE TAPIA, MSW Building Resilience

2. Why Build Resilience? Trauma impacts a majority of people in Developmental Disability & Mental Health systems Statistics are startling ranging from 20-70%, but all agree it is likely under-reported Impacts all areas:  Behavior  Functioning levels  Cognitive processing  Mental Health  Physical Health

3. “It is not our responsibility to identify necessarily the limits in our patients, but rather for us to identify the limits in the care that we give them. It is then, and only then, when we can go beyond them.” Albert Einstein

4. Trauma Impacts People in Predictable Ways: Impact on the brain (Schupp, 2004) Over time with repeated release of fight or flight chemicals:  The cortexes ability to plan, organize, and execute action while regulating emotions is damaged.  The amygdala is damaged & no longer accurately recognizes danger.  The hippocampus no longer effectively tracks memory, controls consciousness, or circadian rhythms.  The brainstem misfires causing enuresis, encopresis, digestive issues, impulsive aggression from an over active startle response.

5. Trauma Impacts People in Predictable Ways: Impact on development  50% of brain development occurs after birth (Putnam, 2004) Impact on social, psychological, and emotional regulation  Emotional development begins chemically in the brain at six months gestation (Schupp, 2004)  The ability to trust, and the brain chemistry connected with it, begin at one month of age.

6. What happens when we ignore trauma? Disregard of trauma and its impact causes additional trauma Constantly putting out fires Reactive rather than proactive Disregard of trauma causes our services to be ineffective

7. Trauma Responsive Services Shift from: What’s wrong with you? To: What happened to you and how can we help?

8. What Staff Are Saying “His file was 3 inches thick, and honestly, there’s some things about him that were scary to me. I had no idea what to do. Until we held the Biographical Timeline session, I had no idea what he had been through. Now I have a lot of respect for him as a survivor. Now I see also how his past is showing up today – and I know what to say and do to help him move forward instead of repeating the past”.

9. RESILIENCE PROJECT Target: Young adults served by Hamilton County DD Services:  Average ACE Score of SEVEN -- increases the likelihood of childhood and adolescent suicide attempts 51-fold and adult suicide attempts 30-fold, chronic pulmonary lung disease increases more than 390 percent; hepatitis more than 240 percent; depression more than 460 percent  Involved with multiple systems: DD, mental health, courts, JFS, APSI, etc.  “HOT SPOTS” of high cost -- and poor outcomes Intended Outcomes:  Build Five Resilience Factors: 1.)Positive experiences with people outside of abusive relationships, 2.) cohesive support group, 3.) external support system, 4.) self esteem, and 5.) autonomy  Decrease MUIs  Increase staff knowledge of trauma

10. RESILIENCE PROJECT COMPONENTS BUILD CROSS SYSTEM TEAM: County Board staff, Lighthouse resiliency-builder aide, DD provider staff, mental health system staff, Guardian, etc. OFFER TRAUMA TRAINING: Focus on PRACTICAL TOOLS that staff can use across settings: Five Resilience Factors, Safety Scripts, Affirmations, 3Ps, etc. CONDUCT TRAUMA-INFORMED BIOGRAPHICAL TIMELINE: What’s the trauma history? What does the person need? What will we DO across systems to build resilience? BUILD RESILIENCY FACTORS through intensive support from Lighthouse staff AND help all team members IMPLEMENT TRAUMA APPROACHES ACROSS SETTINGS REVIEW DATA AND OUTCOMES and make changes as needed during Monthly Team Meetings and Trauma- informed Supervision

11. RESILIENCE PROJECT: PRODUCTS PROJECT WORKBOOK  Streamlines and standardizes a complex process  Allows for dissemination and ease of implementation PROJECT OUTCOME DATA TO DATE  Change in Resilience Factors/First Year Data: Average increase = seven Resilience Factors  MUI Data/First Year Data: Average decrease = 37%  Change in Staff Knowledge of Trauma as measured by Retrospective Evaluations: 90% increase in understanding the 3 stages of trauma resolution and how to address them

12. Top 5 Resilience Factors 5. Autonomy (Agency)  What decisions can I make for my life?  How do I define power?  Is it power over or power with to have the power to achieve goals? 4. Self Esteem  Sense of Self – Personal Preferences (likes & dislikes)  Sense of Self Worth – When do you feel loved and valued?  Sense of Self-efficacy –  How do you affect change?  How do I make things happen?  How do I use & how do I want to use my powers of influence?

13. Top 5 Resilience Factors 3. External Supports  Can be a person, pet, fantasy  Or a spiritual or other belief system  What is my system of meaning?  How do I make sense of my world? 2. Affiliation (With a cohesive supportive group working toward a positive goal and/or recognition of your own acts that contribute to the greater good)  To what groups do I belong?  What are my circles of connection? 1. YOU! (Positive Experiences with safe adults, especially people in positions of authority.)  Who are the “adults” in my life? Who lets me “let go,” nurtures me?  Who gives me a sense of play?  Who tells me “well done!” and supports me?

14. The Five good things from mutually enhancing relationships 1. Zest 2. Clarity 3. Increased sense of worth 4. Creativity/Productivity 5. Desire for more connection

15. 3 P’s Predict Practice Plan B

16. Safety Script “This is a safe place and I won’t let anyone_________ you, so I can’t let you _________ because this is a safe place.”

17. MUIs That are Often OUT of the Individual’s Control MUIs That are Often WITHIN the Individual’s Control Accidental/Suspicious Death, Alleged Abuse – PHYSICAL Alleged Abuse – SEXUAL Alleged Abuse – VERBAL Alleged Neglect Exploitation (By Someone else) Failure To Report (provider failed to report incident) Misappropriation (provider misappropriated funds of the individual) Non Accidental / Suspicious Death Rights Code Violation Unapproved Behavior Support Attempted Suicide Law Enforcement Medical Emergency Missing Individual Peer-to-Peer Acts (something they did to someone else) Prohibited Sexual Relations Significant Injury Unscheduled Hospitalization MUI Categories

18. MUIs That are Often OUT of the Individual’s Control MUIs That are Often WITHIN the Individual’s Control HCDDS-MST, LYS-WAS and LPS-DBT MUI Change

19. Total Number of MUI Occurrences from Year Prior to Year One

20. Trauma-Informed Biographical Timelines An approach for building empathy and creating shared understanding of:  The person’s trauma history  Impact of that trauma on how the person experiences the world  Who the person IS today  What they NEED  WHAT WE WILL DO to help the person get what they need

21. Sample Biographical Timeline

22. Examples of Creative Approaches Goals for Marsha: 1. Seek opportunities to validate Marsha’s funny, caring, loving, and respectful nature, as well as opportunities to be around similar people who can offer positive healthy loving unpaid relationships. 2. Facilitate and further enhance Marsha’s life purpose through connection to healthy opportunities, and provide a reason to give good, healthy, positive attention and love to others. 3. Provide Marsha with direction, structure, and predictability.

23. Examples of Creative Approaches Goals for Tony: Seek opportunities for healthy, safe interactions with family

24. RESILIENCE PROJECT: MICHAEL’S STORY WHAT WE LEARNED IN THE TRAUMA-INFORMED BIOGRAPHICAL TIMELINE HOW STAFF HELPED BUILD RESILIENCE FACTORS CHANGE IN RESLIENCE FACTORS IMPACT ON QUALITY OF LIFE

25. What we have learned: Defining roles Communication from all team members  Administrative  Monthly team meetings with client supports  Trauma-Informed Supervision Transparency An overall objective to enhance the quality of the person’s life People are individuals & the team may not consider all aspects that the client finds important

26. Thank you! Any questions?

27. Contact Us: Rhonda Craig, MPA  Hamilton County Developmental Disability Services  Multi-System Team Supervisor  Rhonda.craig@hamiltondds.org Rhonda.craig@hamiltondds.org  513-746-9785 Anne Tapia, BA  Lighthouse Youth Services  School Based Services Program Director  atapia@lys.org atapia@lys.org  513-487-7157

28. References Putnam, F.W. (2004). Experience Dependent Maturation 0f Neuronal Systems. Schupp L. J. (2004). Assessing and Treating Trauma and PTSD, Eau Claire, Wisconsin: PESI, LLC.