Addressing Strategies and Techniques to Reduce Violence and Aggression through Trauma Informed Practices Brian R. Sims, M.D.

In 2012, there were an estimated 356,268 inmates with severe mental illnesses in U.S. prisons and jails. There were only 35,000 mentally ill individuals in state psychiatric hospitals.

Trauma-Informed Approach According to SAMHSA’s concept of a trauma-informed approach, “A program, organization, or system that is trauma-informed: Realizes the widespread impact of trauma and understands potential paths for recovery; Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and Seeks to actively resist re-traumatization."

SAMHSA Six Key Principles of a Trauma Informed Approach Safety Trustworthiness and Transparency Peer support Collaboration and mutuality Empowerment, voice and choice Cultural, Historical, and Gender Issues

Potential Traumatic Events Abuse Emotional Sexual Physical Domestic violence Witnessing violence Bullying Cyberbulling Institutional Loss Death Abandonment Neglect Separation Natural disaster Accidents Terrorism War Chronic Stressors Poverty Racism Invasive medical procedure Community trauma Historical trauma Family member with substance use disorder There is a very wide range of events that can potentially cause trauma. Trauma can be caused by events that the individual doesn’t remember, such as events that occurred in early childhood. Trauma can be caused by events that are well-intentioned and necessary, such as medical procedures. Trauma can be caused by an event that didn’t happen to the person but to a group that he or she identifies closely with—as in slavery or the Holocaust or the genocide of the Native American people. Over time, chronic stressors can accumulate to cause trauma.

Trauma in Adults: Mental Health 84%+ Adult mental health clients with histories of trauma (Meuser et al, 2004) 50% of female & 25% of male clients Experienced sexual assault in adulthood (Read et al, 2008) A very high percentage of people served in mental health settings have been exposed to potentially traumatizing events as children and/or as adults. The evidence is now strong that trauma plays a causal role in virtually all mental health conditions. Exposure to traumatic events increases the likelihood that people will use more mental health services and more intensive interventions. These statistics are so high that many mental health settings assume that every person they see may have had some form of trauma in their background, whether anyone knows about it or not. Expanded and additional statistics: 84%+ of adult mental health clients have histories of trauma (Meuser et al, 2004) 50% of female and 25% of male clients have experienced sexual assault in adulthood (Read et al, 2008) Content of hallucinations and delusions is often based on memories of childhood trauma (Read et al, 2008) Children who grow up in poverty are seven times more likely to develop schizophrenia (Read et al, 2008)

Trauma in Adults: Substance Abuse Up to 65% of all clients in substance abuse treatment report childhood abuse (SAMHSA, 2013) Up to 75% of women in substance abuse treatment report trauma histories (SAMHSA, 2009) A very high percentage of people who abuse substances have been exposed to potentially traumatizing events as children and/or as adults. Understanding the role of trauma is key to effective treatment. These statistics are so high that many substance abuse treatment settings assume that every person they see may have had some form of trauma in their background, whether anyone knows about it or not.

Trauma in Adults: Substance Abuse, cont. Over 92% of homeless mothers have severe trauma histories. They have twice the rate of drug and alcohol dependence as those without (SAMHSA 2011) Almost 1/3 of all veterans seeking treatment for a substance use disorder have PTSD (National Center for PTSD)

Essential Qualities and Characteristics to working with people affected by Trauma Empathy Compassion Able to talk openly Self-Aware Self Care and Wellness Flexible Comfortable with the Unknown Willingness to learn from clients Able to regulate your own emotions (Taken from The Trauma Informed Toolkit, second Edition)

Universal Precautions Experts recommend that all systems (e.g., medical, mental health, corrections) be trauma-informed and that professionals in these systems adopt “universal precautions” when working with individuals. Universal precautions means that we assume a trauma history is present with all individuals we interact with (and that we interact with them in a trauma-informed manner).

Trauma Informed Practice Principles Primary Inmate Contact Points Intake/Admissions and Screening Assessment and Classification Case Planning and Management Staff-Inmate Interactions Sanctions and Discipline Programming and Treatment Medical Services Mental Health Services Discharge, Transition, and Reentry

Women’s Prison Oahu HI Primary focus on healing Philosophy/Practice of Pu’uhonua

Contact Information Brian R. Sims, M.D. SAMHSA National Center for Trauma Informed Care Brian.sims@nasmhpd.org 703-682-5185