227 – Trauma Informed Care: A Sociocultural Perspective
Counselor Toolbox

 
 
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Trauma-Informed Care
A Sociocultural Perspective
Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP
Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery
Objectives
~ Define “What is Trauma”
~ Explore why trauma informed care is important
~ Learn the 3 key elements to a trauma informed approach: Realizing, recognizing and responding
~ Identify trauma informed intervention and treatment principles
~ Learn how to anticipate the interplay between treatment elements and clients' trauma histories
~ Identify the cross-cutting factors of culture

What is Trauma
~ Traumatic events are those which the person experiences a threat of death, serious injury to self or self concept or threat to the physical integrity to self or another.
~ Events may be:
~ Human-made, such as a mechanical error that causes a disaster, war, terrorism, violence or neglect
~ “Traumatization can also occur from neglectwhich is the absence of essential physical or emotional care, soothing and restorative experiences from significant others,particularly in children.” (International Society for the Study of Trauma and Dissociation, 2009)
~ Products of nature (e.g., flooding, hurricanes, tornadoes).
What is Trauma
~ Trauma can occur at any age or developmental stage, and often, events that occur outside expected life stages are perceived as traumatic (e.g., a child dying before a parent, cancer as a teen, personal illness, job loss before retirement).
~ Individuals may experience the traumatic event directly, witness an event, feel threatened, or hear about an event that affects someone they know.
~ It is not just the event itself that determines whether something is traumatic, but also the individual’s experience of the event.

What is Trauma
~ Just because something does not DSM V criteria for ASD/PTSD does not mean it wasn’t traumatic
~ Trauma is something that:
~ Overwhelms our coping capacity
~ Affects the whole self
~ Physical
~ Emotional
~ Intellectual/Cognitive
~ Spiritual
~ Interpersonal

Why Is Trauma Informed Care Important
~ National Comorbidity Study 61 percent of men and 51 percent of women reported experiencing at least one trauma in their lifetime
~ National Epidemiologic Survey on Alcohol and Related Conditions, 71.6 percent of the sample reported experiencing trauma
~ In a survey at the Alachua County Jail, 99% of female inmates reported having experienced trauma
Why Is Trauma Informed Care Important
Why Is Trauma Informed Care Important
~ Improve screening, assessment, treatment planning,
~ Decrease the risk for retraumatization.
~ Enhance communication between the client and treatment provider, thus decreasing risks associated with misunderstanding the client’s reactions and presenting problems or underestimating the need for appropriate referrals
~ Improved cost effectiveness because services are more appropriately matched to clients from the outset.
~ Ensures the implementation of decisions that will optimize therapeutic outcomes and minimize adverse effects on the client and, ultimately, the organization.
~ Clients and staff are more apt to be empowered, invested, and satisfied if they are involved in the ongoing development and delivery of services.
Why Is Trauma Informed Care Important
~ To increase clinician self-awareness of trauma triggers
~ To increase clinician awareness of the variety of emotional, behavioral, interpersonal and physical symptoms of trauma
~ To provide appropriate responses to trauma related reactions or symptoms
~ To prevent the clinician from delving too deeply too quickly and unwittingly harming the client
~ To aid the client in developing a safety net to prevent further trauma
~ To provide clinicians with trauma-specific resources and referrals
~ To enable clinicians, regardless of setting to provide quality care regarding trauma related issues which may be contributing to other presenting problems or trigger a relapse.
3 Key Elements to TIC
~ Realizing the prevalence of trauma
~ Recognizing how trauma affects all individuals involved with the program, organization, or system, including its own workforce
~ Responding by putting this knowledge into practice
TIC Principles
~ TIC begins with the first contact a person has with an agency
~ Requires all staff members (e.g., receptionists, clinical staff, administrators, peer supports, board members) to recognize that the individual’s experience of trauma can greatly influence his or her
~ Receptivity to and engagement with services
~ Interactions with staff and clients
~ Responsiveness to program guidelines, practices, and interventions.
~ TIC includes program policies, procedures, and practices to protect the vulnerabilities of those who have experienced trauma and those who provide trauma-related services.
TIC Principles
~ Promote Trauma Awareness and Understanding
~ Recognize the prevalence of trauma and its possible role in an individual’s emotional, behavioral, cognitive, spiritual, and/or physical development, presentation, and well-being
TIC Principles
~ Recognize That Trauma-Related Symptoms and Behaviors Originate From Adapting to Traumatic Experiences
~ Influence how individuals respond to the environment, relationships, interventions, and treatment services,
~ Shape the assumptions that clients/consumers make about
~ Their world (e.g., their view of others, sense of safety),
~ Their future (e.g., hopefulness, fear of a foreshortened future)
~ Themselves (e.g., feeling resilient, feeling incompetent in regulating emotions)
TIC Principles
~ Trauma Related Symptoms cont…
~ Agitation/irritability/hostility
~ Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
~ Hypervigilance
~ Hyperarousal (Easily startled)
~ Self-destructive behavior
~ Social isolation
~ Feelings of detachment or estrangement from others
TIC Principles
~ Trauma Related Symptoms cont…
~ Avoiding reminders of the event
~ Flashbacks
~ Fear, severe anxiety, or mistrust
~ Depression: Loss of interest or pleasure in activities, guilt
~ Emotional numbness
~ Sleep: Insomnia or nightmares
~ Difficulty concentrating
~ Chronic Pain
~ Between 15% and 35% of people with chronic pain also have PTSD, according to the U.S. Department of Veterans Affairs.
TIC Principles
~ View Trauma in the Context of Individuals’ Environments
~ Many factors contribute to a person’s response to trauma
~ Whether it is an individual, group, or community-based trauma.
~ Individual attributes
~ Developmental factors (including protective and risk factors)
~ Life history
~ Type of trauma, specific characteristics of the trauma, amount and length of trauma exposure
~ Cultural meaning of traumatic events
~ Number of losses associated with the trauma
~ Available resources (internal and external, such as coping skills and family support)
~ Community reactions (Supportive, dismissive, blaming…)

TIC Principles
~ Minimize the Risk of Retraumatization or Replicating Prior Trauma Dynamics
~ What practices might retraumatize a rape survivor? Someone who was in a serious car accident? Someone who was molested by a pastor/priest? Someone who was a survivor of a home invasion? Someone who survived a house fire?
~ What things in your agency takes away power or puts providers in a dominant position
~ What things in your agency contribute to a lack of safety
~ What things in your agency may make the client feel misunderstood, dismissed

TIC Principles
~ Create a Safe Environment
~ Physical (privacy, safety from others, safety from restraint, safety from having kids taken away)
~ Emotional (Prepare clients for attending a group session in which another client expresses anger appropriately in a role play, discuss methods for deescalating traumatic stress reactions instead of telling the client to not talk about it)

TIC Principles
~ Identify Recovery From Trauma as a Primary Goal
~ Bridge the gap between their mental health and substance-related issues and the traumatic experiences they may have had
~ Support Control, Choice, and Autonomy
~ Not every client who has experienced trauma and is engaged in behavioral health services wants, or sees the need for, trauma-informed or trauma-specific treatment.
~ Appreciating clients’ perception of their presenting problems and viewing their responses to the impact of trauma as adaptive
TIC Principles
~ Create Collaborative Relationships and Participation Opportunities
~ Build collaboration beyond the provider–client relationship. Building ongoing relationships across the service system, provider networks, and the local community
~ Ensure client/consumer representation and participation in behavioral health program development, planning, and evaluation as well as in the professional development of behavioral health workers.

TIC Principles
~ Familiarize the Client With Trauma-Informed Services
~ Introduce clients to program services, activities, and interventions in a manner that expects them to be unfamiliar with these processes is essential
~ Explain the value and type of trauma-related questions that may be asked during an intake process
~ Educate clients about trauma to help normalize traumatic stress reactions
~ Discuss trauma-specific interventions and other available services
~ Incorporate Universal Routine Screenings for Trauma
~ View Trauma Through a Sociocultural Lens

TIC Principles
~ Use a Strengths-Focused Perspective: Promote Resilience
~ Coping Skills and stress management
~ Social Support
~ Positive Characteristics and Strengths
~ Accomplishments
~ Foster Trauma-Resistant Skills
~ Clients are the experts on their own lives and have learned to adapt to survive
~ Hardiness: Commitment, Control and Challenge
~ Demonstrate Organizational and Administrative Commitment to TIC
~ Develop Strategies To Address Secondary Trauma and Promote Self-Care
~ Provide Hope—Recovery Is Possible

Interplay Between Treatment Elements and Clients' Trauma Histories
~ To better anticipate the interplay between various treatment elements and the more idiosyncratic aspects of a particular client’s trauma history, you can:
~ Work with the client to learn the cues he or she associates with past trauma.
~ Obtain a good history.
~ Maintain a supportive, empathetic, and collaborative relationship.
~ Encourage ongoing dialog.
~ Provide a clear message of availability and accessibility throughout treatment.

The Socio-Ecological Approach
~ Here are the three main beliefs of a social-ecological approach:
~ Environmental factors greatly influence emotional, physical, and social well-being.
~ A fundamental determinant of health versus illness is the degree of fit between individuals’ biological, behavioral, and sociocultural needs and the resources available to them.
~ Prevention, intervention, and treatment approaches integrate a combination of strategies targeting individual, interpersonal, and community systems.

Cross-cutting factors of culture
~ Some populations and cultures are more likely than others to experience a traumatic event or a specific type of trauma.
~ Culture influences not only whether certain events are perceived as traumatic, but also how an individual interprets and assigns meaning to the trauma.
~ Viewed through a cultural lens, a child's or family's subjective perceptions of the trauma experience can sometimes be quite different from a provider's.
~ Some traumas may have greater impact on a given culture because those traumas represent something significant for that culture or disrupt cultural practices or ways of life.
~ Culture determines acceptable responses to trauma and shapes the expression of distress. It significantly influences how people convey traumatic stress through behavior, emotions, and thinking following a trauma.
~ Trauma symptoms vary according to the type of trauma and the culture.
~ Culture affects what qualifies as a legitimate health concern and which symptoms warrant help.
~ In addition to shaping beliefs about acceptable forms of help-seeking behavior and healing practices, culture can provide a source of strength, unique coping strategies, and specific resources.
Cross-cutting factors of culture
~ View RELATIONSHIPS through a Culturally-Sensitive Trauma-Informed lens
~ Understand your role as a provider within this family's world.
~ Gain a better understanding of the roles and dynamics within this family.
~ Consider and facilitate the inclusion of others (extended family, clergy, healers) when treating patients.
~ View ASSESSMENT through a Culturally-Sensitive Trauma-Informed lens
~ The manifestation and expression of psychological states differ depending on personal, familial, and cultural beliefs and practices.
~ Listen to and use the family's own terms during assessment and treatment planning
~ Trust in / comfort with the provider has been shown to be associated with increases in patient disclosure in some cultural groups.
~ View TREATMENT through a Culturally-Sensitive Trauma-Informed lens
~ Healing comes in many different forms; your ideas, beliefs, and values may differ from the family's.
~ Be sure you have integrated the family's understanding of diagnosis, prognosis, and healing into your treatment planning.
~ Consider each family's resources and barriers to help-seeking and utilization of supportive services within the community.
Summary
~ Trauma Informed Care requires clinicians to look at
~ The individual and their adaptive responses
~ The family and social supports and their response to the trauma
~ The organizations and individuals involved with the individual and their responsiveness
~ The community and it’s responsiveness/reaction
~ The individual’s culture and its conceptualization and prescribed reactions to the trauma

Summary
~ Trauma informed care requires clinicians to
~ Conduct universal screenings
~ Explore traumatic symptoms as adaptive responses
~ Maintain a high level of personal awareness and self-care
~ Work with the client, family and community to develop a partnership in treatment
Resources
~ Data Collection Offers Opportunities for Unpacking the Refugee Experience (2017) (PDF)
~ At Intersection of Trauma and Disabilities: A New Toolkit for Providers (2016) (PDF)
~ Trauma and Mental Health Needs of Immigrant Minors, Part one (2015) (PDF)
~ Trauma and Mental Health Needs of Immigrant Minors, Part Two (2015) (PDF)
~ Racial Disparities in Juvenile Justice Call for Holistic Approach (2014) (PDF)
~ Linguistic Competency: a Conversation with Lisette Rivas-Hermina (PDF)
~ Clinicians Not Immune to Impact of Border Violence (PDF)
~ Helping Latin-American Immigrant Pregnant Women Exposed to Trauma: Reflections on Mirroring (PDF)
~ Working with Immigrant Latin-American Families Exposed to Trauma (PDF)
~ Working with Immigrant Latin-American Families Exposed to Trauma: Long Version (PDF)
~ Implementing Cultural Competence (PDF)
~ The Organizational Journey toward Cultural and Linguistic Competency: Part One (PDF)
~ The Organizational Journey toward Cultural and Linguistic Competence: Part Two (PDF)
~ The Organizational Journey toward Cultural and Linguistic Competence: Part Three (PDF)
~ The Organizational Journey toward Cultural and Linguistic Competence: Part Four (PDF)
~ For Immigrant Families, Language Opens Door to Healing from Trauma (PDF)
~ Trust and Acceptance Can Encourage LGBTQ Youth to Disclose Abuse (PDF)
~ Preventing Youth Suicide in Montana’s Indian County (PDF)
~ Conversations about Historical Trauma: Part One (PDF)
~ Conversations about Historical Trauma: Part Two (PDF)
~ Conversations about Historical Trauma: Part Three (PDF)