1. Shifting our thought process to create a supportive and caring community

2. Introductions Kasey Kaepernick- B.S. Healthy Beginnings Manager/Trauma Informed Care Coordinator/ Waupaca Child Abuse Prevention Chair/Master ACEs Trainer Lisa Grasshoff -B.S. Waupaca County Industries Rehabilitation Manager

3. ReMoved

4. What is Trauma Informed Care? The ability to look at presenting problems and symptoms and consider if these are a result of past traumatic experiences.

5. “What has happened to you/this child” or “What is this family’s story?” NOT “What is wrong with you.”

6. What do you mean; “What has happened to you?” We understand that each person is an individual and that there is no cookie cutter way to serve people. We all come from somewhere and it doesn’t look the same. We understand the Adverse Childhood Experiences (ACEs) study and how that effects each individual person and the impact of trauma

7. ACE Calculator 1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? Or Act in a way that made you afraid that you might be physically hurt? _____Yes _____ No If yes enter 1 ________ 2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? Or Ever hit you so hard that you had marks or were injured? _____Yes _____ No If yes enter 1 ________ 3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? Or Attempt or actually have oral, anal, or vaginal intercourse with you? _____Yes _____ No If yes enter 1 ________

8. 4. Did you often or very often feel that … No one in your family loved you or thought you were important or special? Or Your family didn’t look out for each other, feel close to each other, or support each other? _____Yes _____ No f yes enter 1 ________ 5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? Or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? _____Yes _____ No If yes enter 1 ________ 6. Were your parents ever separated or divorced? _____Yes _____ No If yes enter 1 ________

9. 7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? Or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? Or Ever repeatedly hit at least a few minutes or threatened with a gun or knife? _____Yes _____ No If yes enter 1 ________ 8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? _____Yes _____ No If yes enter 1 ________ 9. Was a household member depressed or mentally ill, or did a household member attempt suicide? _____Yes _____ No If yes enter 1 ________ 10. Did a household member go to prison? _____Yes _____ No If yes enter 1 ________ Now add up your “Yes” answers: _______ This is your ACE Score (0-10).

10. 10Wisconsin ACE Interface 2014

11. 11 58% of Wisconsin adults reported growing up experiencing at least one ACE Of those 25% reported having 4 or more ACEs. Wisconsin ACE Interface 2014

12. 12Wisconsin ACE Interface 2014

13. 13Wisconsin ACE Interface 2014

14. 14Wisconsin ACE Interface 2014

19. Why ACEs? Why are we sharing this information with you today? What can you do with this knowledge?

20. So what is Trauma? The pervasive impact, including developmental consequences, of exposure to multiple or prolonged traumatic events. Complex trauma typically involves exposure to sequential or simultaneous occurrences of maltreatment, “including psychological maltreatment, neglect, physical and sexual abuse, and domestic violence…exposure to these initial traumatic experience often sets off a chain of events leading to subsequent or repeated trauma exposure in adolescents and adulthood.” Resulting in dysregulation, the loss of safety, direction, and the ability to detect and respond to danger cues.

21. Consequences of Trauma on World View No place is safe Other people are unsafe and cannot be trusted My own actions, thoughts and feelings are unsafe I expect crisis, danger and loss I have no worth and no abilities 21

22. Prevalence 56% of the general population reported at least one traumatic event. (Kessler,1996) 90% of mental health clients have been exposed to a traumatic event and most have multiple exposures. (Muesar,1998) 83% of females and 32% of males with developmental disabilities have experienced sexual assault. Of those who were assaulted, 50% had been assaulted 10 or more times. (Hand,1986) 97% of homeless women with mental illness experienced severe physical and/or sexual abuse.

23. Prevalence Continued Women in community samples report a lifetime history of physical & sexual abuse ranging from 36-51%, while women with substance abuse problems report a lifetime history ranging from 55-99%. (Najavits et. al., 1997) 75-93% of youth entering the juvenile justice system are estimated to have experienced some degree of traumatic victimization. (Healing Invisible Wounds, Justice Policy Institute) 92% of incarcerated girls reported sexual, physical or severe emotional abuse in childhood. (Healing Invisible Wounds, Justice Policy Institute)

24. Lisa’s Story

25. The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss and have found their way out of those depths- Elisabeth Kubler-Ross

26. "One of the greatest gifts you can give another human being who is going through adversity is hope." http://on.ted.com/i0Iox http://on.ted.com/i0Iox

27. So How Do We Create Hope?

28. Development of Resiliency Increase Individuals Capabilities Supportive and Positive Relationships Having a caring community Resiliency

29. Build Individual Capabilities I am worth it! What I do matters! People care about me! I can make a change and be the person I want to be!

30. Recognize Sparks! Sparks = Resiliency

31. SPARKS SPARKS A spark is something that gives your life purpose. It is an interest, a passion, or a gift -Dr. Peter Benson A spark is so powerful that small doses can help get you through.

32. SPARKS: Make you feel strong Make time fly Are something you look forward to Are easily learned Create an “in the zone” feeling Come naturally to you Make you feel fulfilled

33. Supportive and Positive Relationships Caring Competent Supportive Nurturing Trustworthy

34. Healing Happens in Relationships When we are threatened, our bodies prepare us to respond by increasing our heart rate, blood pressure, and stress hormones, such as cortisol. When a young child’s stress response systems are activated within an environment of supportive relationships with adults, these physiological effects are buffered and brought back down to baseline. The result is the development of healthy stress response systems. 34

35. Early Relationships Relationships are developed through the emotional bond between the child and caregiver. It is through this relationship that we learn to:  Regulate emotions/self-soothe  Develop trust in others  Freely explore our environment  Understand ourselves and others  Understand that we can impact the world around us  Begin to establish a worldview

36. Community of Care These types of Communities need: Public and private support Common language Compassion Champions

38. Where Do You Start? You need to change the culture of your organization!

39. Be the Light in a Life

40. You Need To Lay a Solid Foundation

42. Person Centered

43. Strength Based

44. Offering a Helping Hand

45. Partnering with the Client

46. Earning trust/Establishing a Relationship with Clients

47. Sharing Power

48. Promoting Safety

49. Respecting Human Rights

50. Welcoming

51. What is Waupaca County DHHS Doing? Understanding Adverse Child Experiences (ACEs) Engulfing Waupaca County DHHS practices in the Trauma Informed Care way. Using the parallel process in house Physical Changes to the Environment Policy Changes Peer to Peer talk In house trainings (multiple agencies in Waupaca Cty) Creation on TIC Committee

52. Continued… Using Organizational Effectiveness within WCDHHS Future Case Plan training Book Club: Good to Great Spirit Committee creation Secondary Trauma Training Speak Your Peace Elizabeth Hudson’s Trauma Informed Care Presentation Jonathan Cloud’s presentation on Sparks and Job Crafting There is much more

53. We are a nation of communities…a brilliant diversity spread like stars, like a thousand points of light in a broad and peaceful sky- President George H. W Bush

54. Reaching Out To The Community Saturation of Waupaca County New London Community: Civic Groups, School Administration Long Term Care Facilities School Nurses Future Groups: School Staff, local government, law enforcement, Court Services and Businesses Staff Orientation Park and Rec Department Wauapca County Caucus for Progress How can this impact our community? 54

55. Knock Down the Silos

56. “Creating a trauma-informed organization is a fluid, ongoing process; it has no completion date.” – A Treatment Improvement Protocol, Trauma-Informed Care in Behavioral Health Services, TIP 57 SAMHSA

57. So why adopt this TIC Philosophy? No person should have to feel hopeless, helpless, fearing for their life/survival and their safety. Trauma makes people feel that way. ……… We can make a difference, together!

59. Questions

60. Thank You Kasey Kaepernick, Healthy Beginnings Manager/Trauma Informed Care Coordinator, 811 Harding Street, Waupaca, WI 715-258-6395 kasey.kaepernick@co.waupaca.wi.us Lisa Grasshoff, Waupaca County Industries Rehabilitation Manager, 175 W Howard St., Manawa, WI lisa.grasshoff@co.waupaca.wi.us