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

2. 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.

4. 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."

5. 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

6. 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.

7. 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)

8. 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.

9. 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)

10. 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)

11. 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).

12. 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

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

14. Contact Information
Brian R. Sims, M.D.
SAMHSA National Center for Trauma Informed Care