1. Trauma Care and Developmental Disabilities: Trauma informed Care

2. What is Trauma? Three key elements:
Individual trauma results from an event, series of events, or set of circumstances that is experienced
by an individual as overwhelming or life-changing and that has profound effect on the individual’s psychological development or well-being, often involving a physiological, social, and/or spiritual impact.
-SAMHSA experts 2012
The experience of violence and victimization including sexual abuse, physical abuse, severe neglect, loss, domestic violence and/or the witnessing of violence, terrorism or disasters
DSM IV-TR (APA, 2000)
Person’s response involves intense fear, horror and helplessness
Extreme stress that overwhelms the person’s capacity to cope.
The experience of interpersonal violence including sexual abuse, physical abuse, severe neglect, loss, and/or the witnessing of violence, terrorism, urban violence, war/combat, motor vehicles accidents and disasters
Events that are shocking, terrifying and/or overwhelming to the individual
Results in feelings of horror, fear, helplessness
Trauma occurs when an external threat overwhelms a person’s internal and external positive coping resources
Before moving to the next slide, ask participants to talk with their partner about what they think trauma is? Flipchart responses so they can see what they already know.

3. Why Trauma Informed Care?
Under Reporting
>Estimated 1 in 30 instances of sexual abuse against a person with a developmental disability are successfully reported
>1 in 5 for the general population
>Estimated only 3% of sex abuse cases are reported for this population
James, 1988 Valenti-Hein and Schwartz, 1995
Higher Incidents of Abuse for People with Any Disability
>1.2 to 2 times more likely to suffer from maltreatment than their nondisabled peers
>3 to 4 times as likely to be neglected
>4 times more likely to be the victims of crime
Sobsey, 1996 Westat, Inc., 1993; Goldson, 2002
Higher Incidents of Abuse for People with Developmental Disabilities
>Meta-analysis shows people with developmental disabilities suffer 2.5 to 10 times the abuse and neglect of non-disabled peers
>More than 90% of adults reported sexual abuse within their lifetime
>49% of that sample reported 10 or more abusive incidents
Valenti-Hein & Schwartz 1995

4. SAMHSA’s Four R’s 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;
Resists re-traumatization, and
Responds by fully integrating knowledge about
trauma into policies, procedures, practices, and
settings.

5. Principles of a Trauma Informed Approach
Safety
Trustworthiness and Transparency
Collaboration and mutuality
Empowerment
Voice and choice
-Fallot 2008, SAMHSA, 2012
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 5

6. Why is Trauma-Informed Care Important?
We need to understand:
The life situations that may be contributing to the persons current problems.
That current problems faced by the people we serve may be related to traumatic life experiences.
There is heightened sensitivity to situations that remind us of the people, places or things involved in our traumatic event.
These reminders, also known as triggers, may cause a person to relive the trauma and view our organization as a source of distress and not as a healing and welcoming environment!
And that:
We might unintentionally cause harm by practices, policies and activities that are insensitive to the needs of individuals receiving services.
Re-victimizing or re-traumatizing someone unintentionally is a real possibility
None of us are immune from adverse experiences in the present or the past.
Understanding trauma also means recognizing that our personal traumatic experiences or the stress associated with working in human services may impact our emotional and physical well-being as well as our work success and satisfaction.

7. National Council for Behavioral Health Learning Community
National collaborative
Year-long process
Guided by TIC experts
Social learning
NHS is participating in the National Council for Behavioral Health’s Trauma-Informed Learning Community. The learning community is …
National Collaborative – the learning community is a collaborative of approximately 30 providers nation wide interested in implementing trauma informed care.
Year-Long process – the learning community is a year long process that is intended to help providers launch a successful trauma-informed care initiative. Although the learning community spans a year, it is understood that this is only the beginning of the transformation of becoming a trauma-informed organization. The transformation may take several years.
Implementation Science – the National Council’s TIC Learning community is based on implementation science that outlines distinct methods and phases of a successful organizational change process.
Guided by TIC Experts – The learning community is guided by national TIC experts. The national council has formed a trauma-informed care team to provide on-going consultation through monthly webinars, consultation calls, and other means such as the sharing of articles and tools.
Social Learning – through the TIC Learning Community, NHS will be learning through collaboration with all other providers who are implementing, or who have implemented, trauma-informed care. NHS participates in events to learn/share about TIC implementation, group consultation calls, an list serve, etc.

8. NHS TIC Initiative Overview
Core Implementation
Team
Pilot Sites
Organizational Self-
Assessment
Goal Setting
Progress Monitoring
Sustain and Spread
NHS is committed to a culture of compassion and safety where everyone thrives!

9. Locations – Adult Training Facilities
NHS Northeastern PA (NEPA) – Carbondale, PA
NHS Capital Region – Harrisburg, PA
NHS Virginia – Richmond, VA
NHS Cambrian Hills – Portage, PA
These are licensed facility based service programs where people with ID come to learn daily living skills, pre vocational skills, have community inclusive opportunities
Like size individuals, 6 – 7 staff

10. Kick-off Training Defining trauma Understanding ACES Resilience
Trauma Informed care
Compassion in our work and world
overview of kickoff training
Participants, Staff, Managers (all levels)** important they attended
paradigm shift – not what is wrong but what happened, not what is wrong, but what is strong

11. Organizational Self-Assessment
Distribute and review the OSA in its’ entirety. Or click on the link on the slide to view online in SurveyMonkey.
The OSA is due by October 4th.
Must be completed via Survey Monkey

12. 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
Provide a brief introduction to the 7 Domains of TIC. We will take a brief look at each of these now in turn. You will learn more about each domain when we review the Organizational Self Assessment. 12

13. Service Recipient Survey
Distribute and review the Service Recipient Survey in its’ entirety. Or click on the link on the slide to view online in SurveyMonkey.
Due by October 31st.
Can be completed via hardcopy or SurveyMonkey

14. Staff Survey
Distribute and review the TIC Staff Survey. Or click on the link on the slide to view online in SurveyMonkey.
The staff survey is due by October 31st.
Must be completed via Survey Monkey

15. Implementation Methods
Local TIC Advisory Committee
Routine meetings
Variety of activities
All local Advisory committees have staff, individuals and managers included
Activities are being scheduled and having impact ton culture of the centers

16. NHS NEPA
Domain 5 - A safe and secure physical and emotional environment
Trauma Tree
Worksheets with trauma related topics
Community service

17. Staff and Individuals

18. NEPA Trauma Tree created by staff and individuals

19. The Tree blossoms

20. Inspirational quotes

23. NHS Capitol Region Domain 3 – Trauma Educated and Responsive Workforce
Biweekly staff meetings
Individual monthly supervisions
Quarterly trainings relevant to trauma
Creating fun activities

25. More activities

26. Monthly Supervisions

27. NHS Virginia
Domain 5 - A safe and secure physical and emotional environment
ID’s with safety plans
Therapy ball
Trauma tree – word of the day
Use of ABLE link to find quotes and imagery

28. Virginia group

29. Therapy ball activity

30. Group activities

31. Therapy ball activity 1st each day!

32. NHS Cambrian Hills
Domain 5 -A safe and secure physical and emotional environment
Security system
Begin the day with positive comments
Inspirational words/quotes
ID’s with safety plans
Community outreach
IDD Awareness Month activity

33. NEPA kick off group

34. Building wall of words

36. Holly leading the group discussion of the inspirational words

37. Advisory group and watching Inside out

38. Outcomes Culture change Satisfaction differences
Measuring success of goals

39. Trauma-Informed Care
Global KPIs – Turnover (Pilot Sites)

40. Trauma-Informed Care
Global KPIs – Workers Comp (Total Net Incurred)

41. Trauma-Informed Care
Global KPIs – Staff Satisfaction (Organizational Culture Survey)

42. TRAUMA INFORMED CARE IS
FOR ALL OF US

43. Questions?