Health Care for the Homeless Honolulu Hawai’i June 28, 2013

 Stay positive  Informal  Interactive diverse management solutions (303) Matt Bennett, MBA, MA

 Have a basic understanding of the trauma informed paradigm as it relates to:  Self-care  Leadership/Culture  Trauma Informed Care  Trauma Treatment  Conceptualize the impact of trauma on client functioning  Conceptualize how you can utilize this research change the way you and your programs interact with clients

Excellence in care

TRAUMA INFORMED EXCELLENCE: THE PATH Trauma Specific Treatment Thrive: Self Care Trauma Informed Care Leadership & Culture The Goal: World Class Services

Science & Proven Methodologies

PhysicalSocialMind  Robustness  Having or exhibiting strength or vigorous health  Capable of performing with success under a wide range of conditions  Resiliency  The power or ability to return to the original form, position, etc.  Ability to recover readily from illness, depression, adversity, or the like.

Acestudy.org, 2013

Victim  When you hear the term trauma victim what does it mean to you?  What role does trauma play in the life of the victim? Survivor  When you hear the term trauma survivor what does it mean to you?  What role does trauma play in the life of the victim?

Stress & Trauma Negativity & Survival

Epigenetics!!!! Caring Environment: Genes are expressed that alter the regulation of the nervous system Qualities associated with emotional resiliency are reinforced GenesProteinsCellsTraits Environment Abusive Environment: Stress inhibits proteins that lead to the development & operation of brain areas associated with survival Decreases ability to manage stress in the future Shenk, 2010

Stress & Trauma Negativity & Survival Insecure/Disorganized Attachment

Power of Attachment Attachment provides the template for how we see all relationships Think how Windows allows us to operate software like Word, ITunes and internet browsers Our emotional, cognitive and social functions operate from our attachment experience Trauma = Virus in the system Bloom & Farragher, 2011

Stress & Trauma Negativity & Survival Insecure/Disorganized Attachment Automatic Response

Brain Structure & Processing Brainstem – Basic processes Limbic – Emotions & Survival Cortex – Guides us in the physical world Prefrontal Cortex – Thinking & Conceptualization Bottom-up information (sensations) meet top-down information (memories) to create or experience of the world Siegel, 2010

Hypo- arousal Habitual Hyper- arousal Fight/Flight Freeze Negativity & Survival Lifestyle Stress & Trauma Insecure/Disorganized Attachment Automatic Response

Retraumatization Mind’s attempt at integrating the experience into the personality As long as the trauma can not be put into words it will be relived through emotions and behaviors The emotions that are experienced are the emotions that need to be overcome in order to gain mastery over the trauma that they could not stop Bloom & Farragher, 2011 & Herman, 1997

Hypo- arousal Habitual Hyper- arousal Fight/Flight Freeze Lifestyle Stress & Trauma Negativity & Survival Insecure/Disorganized Attachment Automatic Response Safety & Trust

Relationship with Helper: Foundation for Focused Attention “Recovery can take place only within the context of relationships; it cannot occur in isolation. In her renewed connections with other people, the survivor re-creates the psychological faculties that were damaged or deformed by the traumatic experience.” – Judith Herman

Your Impact Achor, 2010; Murphy, 2008 Determinants of Successful Client Outcomes

Steps to Prevent Re- traumatization See the environment through the client’s eyes. Is the environment safe, calm and predictable or overly chaotic or rigid Do your procedures and program rules treat clients as you would want to be treated Help set client expectations of what their experience will be like in your program New situation elicit fear that can be associated with the fear of the traumatic experience Boundaries that define the helping relationship Program rules and expectations of the client Introduction to staff Bloom & Farragher, 2011; Rock, 2009 & Herman, 1997

Steps to Prevent Re- traumatization Build Safety Do what you say you will do Do it to the best of your ability Adhere to and model healthy boundaries Provide honest reflection Trust and respect client Go slow and go slower Re-traumatization occurs most often when the helper or program pushes the client beyond their sense of safety Check in often Bloom & Farragher, 2011; Rock, 2009 & Herman, 1997

Hypo- arousal Habitual Hyper- arousal Fight/Flight Freeze Lifestyle Focused Attention Emotional Regulation F.A.C.E.S Behavior Change Behavior Change Health & Wellness Negativity & Survival Insecure/Disorganized Attachment Safety & Trust

Focus Strategies Life Management Regain control of small aspects of life Build self efficacy Lowering stress not associated with trauma Reclaiming the Positive Counterbalance negative worldview with small infusions of positive thought Shift brain to the creation of new neuropathways Improves outcomes of the helping relationship Techniques Motivational Interviewing Solution Focused Therapy Mindfulness Etc….

Strategies toward Post Traumatic Growth

Hypo- arousal Fight/Flight Freeze Focused Attention Emotional Regulation F.A.C.E.S Behavior Change Behavior Change Health & Wellness Post- Traumatic Growth Post- Traumatic Growth Hope Negativity & Survival Insecure/Disorganized Attachment Safety & Trust Positivity & Logic Healthy Relationships

Client’s Journey of Post Traumatic Growth Establishing Safety Awareness & Management of Arousal States Internal Regulation Find Meaning Integration of Trauma into View of Self & World Maintain Safety Integration Prevent Future Trauma Returning Stronger & Wiser Post Traumatic Growth Courtois & Ford, 2009

Thank You!

 Acestudy.org  Achor, S. (2010). The Happiness Advantage. New York, NY: Crown Business.  Bloom, S. L. & Farragher, B. (2011). Destroying Sanctuary: The crisis in human service delivery systems. New York: Oxford.  Ford, J. D.; Courtois, Christine A. (2009). Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide (p. 90). Guilford Press. Kindle Edition.   J. Douglas Bremner. (2005). Does Stress Damage the Brain? W.W. Norton & Company: New York  Lewis, G. (2006). Organizational Crisis Management: The Human Factor. Boca Raton, FL: Auerbach Publications.  Miller, W. & Rollnick, S. (2002). Motivational Interviewing: Preparing People For Change.

 Ogden, P., Minton, K., Pain, C. (2006). Trauma and the Body. New York: W. W. Norton and Company.  Rock, D. (2009). Your Brain at Work: Strategies for overcoming distraction, regaining focus, and working smarter all day long. New York, NY: HarperCollins.  Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2007). Collaborative Treatment of Traumatized Children and Teens. New York: The Guiford Press.  Schwartz, T. (2010). The Way We Are Working Isn’t Working. New York: Free Press.  Shenk, D.. (2010). The Genius in All of Us. New York: Doubleday.  Siebert, A. (2005). The Resiliency Advantage. San Francisco, CA: Berrett- Koehler Publishers Inc.  Siegel, D. (2010). Mindsight: The new science of personal transformation. New York, NY: Random House.