Oregon Supported Employment Center for Excellence October 3, 2018 Trauma-Informed Approaches Using the Seven Domains of Trauma Informed Care Oregon Supported Employment Center for Excellence October 3, 2018

National Council Trauma-Informed Faculty Cheryl S. Sharp, MSW, MWT Exclusive Consultant for Trauma-Informed Services 30 years working with adult trauma survivors Exclusive consultant for National Council’s TIC learning communities, suicide prevention and crisis services Voice of lived experience as a family member and ex-patient Mother of four, grandmother of three, avid gardener, chef and reader

Paradigm Shift We begin to ask, “What happened to you?” rather than “What is wrong with you?” We have to ask, “What’s strong?” “What’s wrong?”

Trauma in the Context of Culture We don’t see things as they are; we see things as we are. Anais Nin 4

SAMHSA’s 8 Dimensions of Wellness The Substance Abuse and Mental Health Services Administration, also known as SAMHSA, understands that mental health is a part of a persons wellness and in order for people to recover from trauma, mental health issues or substance use issues, you must address all of the domains of wellness. If someone is financial unstable, it is hard for them to focus on their health. If they have no social connections or support system, it is hard for them to be emotionally well. All of these dimensions of wellness are interconnected and need to be addressed when working with individuals.

Behaviors as Adaptations   When clients no show or are difficult to engage Have personality conflicts at work Have very low or very high self esteem Don’t follow through on an agreed upon goal

Trauma-Informed Approaches

Principles of a Trauma-Informed Approach Safety Trustworthiness and Transparency Collaboration and Mutuality Peer Support Empowerment, Voice and Choice Cultural, Historical and Gender Issues Safety: throughout the organization, staff and the people they serve feel physically and psychologically safe; the physical setting is safe and interpersonal interactions promote a sense of safety. Trustworthiness and transparency: organizational operations and decisions are conducted with transparency and the goal of building and maintaining trust among clients, family members, staff, and others involved with the organization. Trauma-informed peer support and mutual self-help are key vehicles for establishing safety, building trust, enhancing collaboration, and maximizing empowerment. Collaboration and mutuality: there is true partnering and leveling of power differences between staff and clients and among organizational staff from direct care staff to administrators; there is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making. The organization recognizes that everyone has a role to play in a trauma-informed approach; one does not have to be a therapist to be therapeutic. Empowerment: throughout the organization and among the clients served, individuals’ strengths are recognized, built on, and validated and new skills developed as necessary. The organization fosters a belief in resilience and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma; builds on what clients, staff and communities have to offer rather than responding to their perceived deficits. Voice and choice: the organization aims to strengthen the clients’, family members’, and staff’s experience of choice and recognize that every person’s experience is unique and requires an individualized approach. The organization addresses cultural, historical, and gender issues; the organization actively moves past cultural stereotypes and biases, offers gender responsive services, Promotes the value of cultural connections, and recognizes Fallot 2008, SAMHSA, 2012) 8

But What Exactly Does Safety Mean? “We always recognized the importance of physical safety. Our refusal to tolerate violence of any sort constituted our best defense against any breach in physical safety. But a physically safe environment, although necessary, was not sufficient. So there had to be other kinds of safety, which I have termed psychological safety, social safety, and moral safety.” (Sandra L. Bloom, Creating Sanctuary, 2013)

Psychological Safety “Refers to the ability to be safe within oneself, to rely on one’s ability to self-protect and keep oneself out of harm’s way.” (Bloom, 2013) If you have never felt safe or remembered safety, how will you know it when it is present?

Social Safety “The sense of feeling safe with other people…There are so many traumatized people that there will never be enough individual therapists to treat them. We must begin to create naturally occurring, healing environments that provide some of the corrective experiences that are vital for recovery.” (Bloom, 2013)

Moral Safety The never-ending quest for understanding how organizations function in the healing process. An attempt to reduce the hypocrisy that is present, both explicitly and implicitly A morally safe environment struggles with the issues of honesty and integrity (Bloom, 2013)

A program, organization or system that is trauma-informed - SAMHSA’s Four R’s 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; resists re-traumatization, and responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings. A program, organization or system that is trauma-informed -

What Is a Trauma-Informed Approach? Safe, calm, and secure environment with supportive care System wide understanding of trauma prevalence, impact and trauma-informed care Cultural Competence Consumer voice, choice and advocacy Recovery, consumer-driven and trauma specific services Healing, hopeful, honest and trusting relationships

Working in a Trauma Informed Way Does not require disclosure of trauma; rather there is a recognition of the need for: Physical and emotional safety Choice and control in decisions affecting employment Avoiding confrontational approaches 15

The 7 Domains of Trauma-Informed Care Domain 1: Early Screening & Comprehensive Assessment of Trauma Domain 2: Consumer Driven Care & Services Domain 3: Trauma-Informed, Educated & Responsive Workforce Domain 4: Trauma-Informed, Evidence-Based and Emerging Best Practices Domain 5: Safe and Secure Environment Domain 6: Community Outreach and Partnership Building Domain 7: Ongoing Performance Improvement Domain 1 - Developing a respectful screening and assessment process that is routine, competently done and culturally relevant and sensitive and revisited over time Domain 2 - Involving and engaging people who are or have been recipients of our services to play numerous roles (e.g., paid employee, volunteer, members of decision making committees, peer specialists) and meaningfully participate in planning, implementing and evaluating our improvement efforts Domain 3 - Increasing the awareness, knowledge and skills of the entire workforce to deliver services that are effective, efficient, timely, respectful and person centered taking into consideration that service providers also have histories of trauma Domain 4 - Increase the awareness, knowledge and skills of the clinical workforce in delivering research informed treatment services designed to address the cognitive, emotional, behavioral, substance use and physical problems associated with trauma Domain 5 - Increase the awareness, knowledge and skills of the workforce to create a safe, trusting and healing environment as well as examining and changing policies, procedures and practices that may unintentionally cause distress and may re-traumatize (cause harm) those we serve. Domain 6 - Recognize that the people we serve may be part of and affected by a larger service system including housing, corrections, courts, primary health, emergency care, social services, education and treatment environments such as substance use programs. We have an opportunity to engage and increase the awareness of these other service providers to the principles and practices of trauma-informed care. In this way, our efforts are less likely to be undermined by other parts of the system. Domain 7 - The organization values a systematic approach to measuring performance on each of the core trauma-informed domains. Data is used to track, measure and analyze performance improvement in order to inform leadership and its core implementation team on areas needing improvement as well as guiding the process of sustainable change. 16

Stop Doing Start Doing Do More of What Do I/We Need to….? What Can I Do Next? Stop Doing Start Doing Do More of What Do I/We Need to….? 17

Contact Information Cheryl Sharp, MSW, ALWF, ITE Exclusive Consultant for Trauma-Informed Services cheryls@thenationalcouncil.org www.thenationalcouncil.org 252/670-0278