1. Trauma Informed Care Assisted Living Facility Limited Mental Health Training

2. Mission: Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Families, and Advance Personal and Family Recovery and Resiliency. Rick Scott, Governor Esther Jacobo, Interim Secretary Florida’s Planning Council Advocacy + Effective Planning Councils= Quality Services

3. Trauma It is likely that many of the people residing in Assisted Living Facilities have experienced trauma in their lives. The impact of this trauma is something that staff need to consider when making decisions about how to interact with ALF residents.

4. Definition of Trauma 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.

5. Types of Trauma Acute Trauma Chronic Trauma System Induced Trauma Comple x Trauma  The experience of multiple traumatic events  A single traumatic event that is limited in time  Both exposure to chronic trauma, and the impact such exposure has on a person  Traumatic removal from home, admission to a detention or residential facility or multiple placements within a short time

6. Exposure to Trauma  Trauma can occur from: –Being in a car accident or other serious incident –Having a significant health concern or hospitalization –Sudden job loss –Losing a loved one –Being in a fire, hurricane, flood, earthquake, or other natural disaster –Witnessing violence (what some call “vicarious violence”) –Experiencing emotional, physical, or sexual abuse

7. Exposure to Trauma

8.  Exposure to traumatic events make it more likely that people have….. chronic health conditionssubstance abusehigh risk situationsmental health symptomsfurther traumatization

9. Trauma Experience It is a person’s experience of the event, not necessarily the event itself that is traumatizing. It is important to get to know something about the trauma experience of the ALF residents in your facility so that you can make decisions about how to work with these residents for the best outcomes.

10. Trauma Informed Care  There has been a recent move toward developing systems that are “trauma informed.” This includes –Providing the foundation for a basic understanding of the psychological, neurological, biological, and social impact that trauma and violence have on people. –Incorporating proven practices into current operations to deliver services that acknowledge the role that violence and victimization play in the lives of most people, including ALF residents

11. Trauma Specific Interventions...  Are designed specifically to address the consequences of trauma in the individual and to facilitate healing. Treatment programs generally recognize the following: –The survivor's need to be respected, informed, connected, and hopeful regarding their own recovery –The interrelation between trauma and symptoms of trauma (e.g., substance abuse, eating disorders, depression, and anxiety) –The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers Exact text for this slide from: http://www.samhsa.gov/nctic/trauma.asphttp://www.samhsa.gov/nctic/trauma.asp

12. New Way of Thinking Rather than thinking about a person in terms of “what is wrong with you?” the trauma informed approach should focus on a different question – “what has happened to you? What happened to you? What is wrong with you?

13. Impact of Traumatic Events  Traumatic events that people have had in their lives can be “triggers” for harmful and difficult to manage behaviors  Behaviors that helped a person survive a crisis in the short term, can become habitual or have a long term impact  This is why screening ALF residents for trauma is so important

14. Triggers  We all have triggers!  People who have experienced trauma also have triggers, but they may be different from what we are used to from our own experience  This is why understanding each person’s unique triggers is so important  Knowing about then can help you to make decisions about how to work with each ALF resident

15. Triggers  Seeing, feeling, hearing, smelling something that reminds us of past trauma  The response is as if there is current danger  Thinking brain automatically shuts off in the face of triggers  Past and present danger become confused

16. Triggers Increased Chance for BAD Outcome Non Trauma Informed Response Trigger Increased Chance for GOOD Outcome Trauma Informed Response Trigger

17. Universal Precautions  Presume that every person in a treatment setting has been exposed to abuse, violence, neglect, or other traumatic event(s). Part of the universal precautions is asking: What happened to you?

18. Trauma Screening  As front line staff if you learn that someone has had trauma experience you can speak with your ALF administrator or other senior staff about having a trauma screen/assessment done for that person

19. Trauma Informed Screening  Trauma-informed screening involves training that is beyond the scope of this training for front line staff for ALFs with Limited Mental Health Licenses.  It is helpful for front line ALF staff to know that such screening is possible. Ideally, ALF administrators will seek out this training and implement screening and assessment.  An online training recorded “webinar” is available on this topic at www.BakerActTraining.org

20. Trauma Screening –Knowing about a person’s history of trauma can help to create a plan about how to address their behavior. –The primary goal of trauma screening is avoid traumatizing persons further. –Screening also informs the personal safety plan and can inform decisions about appropriate services and treatment, detect potential for suicidality, and encourages a “partnership of safety” with the individual.

21. Assessment of Safety  Before screening for trauma, it is essential to determine a person’s: –safety from any current life-threatening circumstances –their medical and psychological stability –any substance impairment, and –current and available supports.