Adverse Childhood Experiences (ACEs) Study Kaiser Permanente and Center for Disease Control, 1998 The Study: 17,000, mostly white, college-educated, employed adults were screened for 10 prominent childhood traumatic experiences as a part of their routine health care at Kaiser. Participants received one point for each type of trauma. The Results: 70% of the 17,000 people experienced at least one type of trauma resulting in an “ACE score” of one; 87% of those had more than one. ACE scores of 4 or more resulted in four times the likelihood of depression, 12 times the risk of suicide. ACE scores were also directly correlated with early initiation of smoking and sexual activity, adolescent pregnancy, and risk for intimate partner violence. Eighteen States have since conducted ACE surveys with similar results. A person with an ACE score of 4 is 260% more likely to have COPD, 240% more likely to have Hepatitis, and 250% more likely to have a sexually transmitted disease than a person with an ACE score of 0. A male child with an ACE score of 6 has a 4600% increase in the likelihood of becoming an IV drug user when compared to a child with an ACE score of 0.

Early Death Disease, Disability and Social Problems Adoption of Health-Risk Behaviors Social, Emotional and Cognitive Impairment Disrupted Neurodevelopment Adverse Childhood Experiences ACEs Conceptual Framework Early Death Diabetes Overeating Depression Sexual Abuse Early Death Retaliation and Imprisonment Weapon Possession and Self-Medication Hospitalization and Discharge to the Street Physical Assault (Shot/Stabbed)

A Working Definition of Trauma Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being. SAMHSA, 2013

Situations that can be traumatic: o Physical or sexual abuse o Abandonment, betrayal of trust (such as abuse by a caregiver) o Neglect o The death or loss of a loved one o Life-threatening illness in a caregiver o Witnessing domestic violence o Automobile accidents or other serious accidents o Bullying o Life-threatening health situations and/or painful medical procedures o Witnessing or experiencing community violence (e.g. shootings, stabbings, robbery, or fighting at home, fights at school, in the neighborhood, or at school) o Witnessing police activity or having a close relative incarcerated o Life-threatening natural disasters o Acts or threats of terrorism (viewed in person or on television) o Living in chronically chaotic environments in which housing and financial resources are not consistently available

Examples in the Correctional Environment An unexpected inmate or peer death at work via suicide or following an assault An inmate or colleague being seriously harmed in the institution Threats to family members or colleagues by an inmate An inmate disclosing traumatic experiences or reporting details of a traumatic crime

Acute, Chronic and Complex Trauma Single Incident Crime Victim Serious Accident Natural Disaster Repeated Prolonged Trauma Domestic Violence Abuse (Physical or Sexual) War Acute Trauma Chronic Trauma

General Statistics 60% of adults report experiencing abuse or other difficult family circumstances during childhood. 26% of children in the United States will witness or experience a traumatic event before they turn four. Four of every 10 children in American say they experienced a physical assault during the past year, with one in 10 receiving an assault-related injury. Nearly 14% of children repeatedly experienced maltreatment by a caregiver, including nearly 4% who experienced physical abuse. More than 13% of children reported being physically bullied, while more than 1 in 3 said they had been emotionally bullied. 1 in 5 children witnessed violence in their family or the neighborhood during the previous year. In one year, 39% of children between the ages of 12 and 17 reported witnessing violence, 17%reported being a victim of physical assault and 8% reported being the victim of sexual assault. 1 in 3 girls and 1 in 6 boys are victims of sexual abuse

Trauma History Among Inmates SAMHSA’s GAINS Center found that inmates have experienced a high prevalence of trauma. Men reported the following rates of trauma: Lifetime Physical Violence- 86% Lifetime Trauma Witnessing: 61% Lifetime Sexual Trauma- 26% Female inmates reported similarly high rates of trauma including: Lifetime Physical Violence- 91% Lifetime Trauma Witnessing: 65% Lifetime Sexual Trauma- 75%

Post Traumatic Stress Disorder Risk Factors: Having hsitory of mental illness Sustainig an injury during the traumatic event Having little or no social support after the event Added stress after the event, such as the loss of a loved one, job or home Protective Factors: Seekign out support from other people, such as friends or family Finding a support group after a trauamtic event Feeling good about one’s actions in the face of danger Being able to act and respond effectively despite feeling fear Having a coping strategy, or a way of getting through and learning from it

Evidenced Based Treatment Seeking Safety is present-focused therapy to help people attain safety from trauma/PTSD and substance abuse. The treatment is available as a book, providing both client handouts and guidance for clinicians. The treatment was designed for flexible use. It has been conducted in group and individual format; for women, men, and mixed-gender; using all topics or fewer topics; in a variety of settings (outpatient, inpatient, residential); and for both substance abuse and dependence. It has also been used with people who have a trauma history, but do not meet criteria for PTSD. Seeking Safety consists of 25 topics that can be conducted in any order. e.g., Safety, PTSD: Taking Back Your Power, When Substances Control You, Honesty, Asking for Help, Setting Boundaries in Relationships, Getting Others to Support Your Recovery, Healthy Relationships, Community Resources, Recovery Thinking, Taking Good Care of Yourself, Commitment, Respecting Your Time, Coping with Triggers, Self-Nurturing, Red and Green Flags, Detaching from Emotional Pain (Grounding), Life Choices, etc.

Secondary Traumatic Stress and Related Conditions Compassion Fatigue: A less stigmatizing way to describe secondary traumatic stress, has been used interchangeably with the term. Vicarious Trauma: Refers to the changes in the inner experience of the therapist resulting from empathic engagement with a traumatized client. Compassion Satisfaction: Refers to the positive feelings derived from competent performance as a trauma professional. It is characterized by positive relationships with colleagues, and the conviction that one’s work makes a meaningful contribution to clients and society. Burnout: Is characterized by emotional exhaustion, depersonalization, and a reduced feeling of personal accomplishment. While it is also work- related, burnout develops as a result of general occupational stress. Secondary Traumatic Stress: Refers to the presence of PTSD symptoms caused by at least one indirect exposure to traumatic material.

Strategies to Build Resilience Organizational Clinical Supervision Trauma Caseload Balance Enhance Physical Safety of Staff Workplace Self- Care Groups Flexible Scheduling Incorporate STS training into EBP training for Clinical Staff Create External Partnerships with STS Intervention Providers Train Organizational Leaders and Non-Clinical Staff on STS Organizational Implementation and Assessment Provide Ongoing Assessment of Staff Risk and Resiliency Individual Use Supervision to Address STS Increase Self- Awareness of STS Maintain Healthy Work-Life Balance Exercise and Good Nutrition Practice Self-Care Stay Connected Develop and Implement Plans to Increase Personal Wellness and Resilience Continue Individual Training on Risk Reduction and Self-Care Use EAPs or Counseling Services as Needed Participate in a Self-Care Buddy System