1. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

2. The Science of Traumatic Stress and Principles of Trauma-Informed Care: Building an Effective Response Across Systems Presented by Joshua Arvidson, MSS., LCSW Director, Alaska Child Trauma Center at Anchorage Community Mental Health Services Regional Director, Complex Trauma Treatment Network

3. #1: Impact of trauma is significant and observable. It lives in the brain and the body – and is as real and relevant as other brain/body-based phenomena.

4. What is “Trauma”?: “Overwhelming demands placed upon the physiological system that result in a profound felt sense of vulnerability and/or loss of control.” R.D. Macy R.D. Macy

5. 5

6. Talking about the brain in a straightforward and client-friendly manner

7. Arvidson, 2012 Physiology of the Human Stress Response Threat Activation of Threat Appraisal and Response System Increased Limbic System Activity Alarm system “flood” Survival Response Fight, Flight or Freeze Survival Oriented Behavior Post-Stressor Continued Arousal Difficulty Modulating

8. Arvidson, 2013 Physiological Changes in Brain Structure and Function, Decreased Volume of Amygdala and Hippocampus, Prioritization of Stress Pathways Adaptation of Brain Processes and Structure Significant challenges to Regulatory Capacity, Dysregulation, State and Trait Characteristics. Chronic Exposure to Stress Hormones Hypervigilance, Hyper and Hypo Arousal, Survival (as opposed to developmental) based orientation. Trauma turns a learning brain into a surviving brain. Physiological (and subsequently behavioral) Adaptations

9. 9 Joshua Arvidson, 2011

10. 10 Joshua Arvidson, 2011

11. 11 Joshua Arvidson, 2011

12. Action Step: Trauma education and awareness building

13. #2: Trauma has an impact across multiple domains of human functioning.

14. Traumatic Stress and Stress Response Adaptation Contribution to Presenting Challenges

15. Functional Domains Impacted by Complex Trauma: Attachment and Relationships Biology Affect regulation Dissociation Behavioral control Cognition Self-concept and world view Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Sprague, C., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J., Mallah, K., Olafson, E., van der Kolk, B. (2007). Complex Trauma in Children and Adolescents. Focal Point, 21 (1), 4-8. Regional Research Institute for Human Services, Portland State University.

16. Action Step: Trauma Informed: Our Goal Trauma informed care should be distinguished from trauma-specific treatment. The latter involves specialized treatments that some individuals also may need, to address complex trauma-related consequences. Trauma informed care, in contrast, is not highly specialized and can be provided in multiple settings by committed professionals who understand trauma without the expertise to offer trauma- specific treatment, which can be offered as needed by designated staff or through referral. Trauma informed care should be distinguished from trauma-specific treatment. The latter involves specialized treatments that some individuals also may need, to address complex trauma-related consequences. Trauma informed care, in contrast, is not highly specialized and can be provided in multiple settings by committed professionals who understand trauma without the expertise to offer trauma- specific treatment, which can be offered as needed by designated staff or through referral. Gordon R. Hodas MD Gordon R. Hodas MD Courtesy, Dr. R. Moss

17. Adapted from, NCTSN Complex Trauma Taskforce 2005 Trauma Informed Care Trauma-Specific Interventions (Trauma-Focused)

18. #3: The Trauma Paradox

19. Traumatic Experience Trauma related adaptations Increase in Risk for Re-Exposure Chronic Levels of Stress without Adequate Resources to Deal with and Mitigate Impact Long-term adaptations that impair functioning and increase long- term risk for re- exposure

20. Action: Improve access to care/adapt systems to improve retention and get services to those who most need them.

21. #4 Trauma has the Ability to Reproduce Itself. Traumatic Experience Physiological Dysregulation Emotional Harm Relational Harm Adaptations I.E. Substances Relational Re- enactments Behaviors Adaptations impair potential protective factors and increase risk for re-exposure

22. Trauma and Adult Outcomes. Alcohol Abuse Attempted Suicide Anxiety Kessler National Comorbidity Survey reported in: Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D.,... Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256, 174-186.

23. Implications for Action Intervention can have a positive impact at any point in the cycle and at any point in the lifespan. Intervention can have a positive impact at any point in the cycle and at any point in the lifespan. Intervention must take into account the function of trauma adaptations. These functions may need to be replaced. Intervention must take into account the function of trauma adaptations. These functions may need to be replaced.

24. #3: Trauma Impacts the Whole Being

25. Person Person in Context Adaptations to Trauma Building Resilience and Restoring Functioning Stress Related Symptoms

26. Because trauma impacts the whole being, trauma-informed care is as much about being as it is about doing. More important than what you do, is how you do it and who you are. It is less a specific set of interventions, and more about attending to the entire person. This includes who they are and what they have experienced, but also who they want to be and where they want to go. When one is heard, understood and valued, one is no longer alone. This is when trauma begins to lose its power to determine one’s life course.

27. Community Awareness Theory of Change: Reduces Shame, Mobilizes Local Resources, Promotes Prevention, Embeds Prevention in Social Systems, Changes Cultural Norms Informed Systems Theory of Change: Systems are Aware of Trauma and Respond in ways that Support Healing and Recovery (Resiliency) Focused Interventions Theory of Change: Impact of Trauma is Mitigated, Improving Outcomes and Reducing Transgenerational Transmission Trauma Informed Care State Decrease ACES Increase Resiliency Economic Effects of Trauma Reduced: Unemployment, Incarceration, Domestic Violence, Abuse,Substance Abuse

28. J. Arvidson 2013