Understanding the Role of Trauma in Recovery and Recidivism Na4onal Reentry Resource Center Behavioral Health Training Summit Aug. 4, 2015 New York, NY Council of State Governments Jus4ce Center | 1
Presenters Alyssa Benedict, MPH
The Na4onal Resource Center on Jus4ce Involved Women
Judge Dee Anna Farnell
Pinellas County Adult Drug Court, Clearwater, FL
Ann DePoole, LCSW
Therapist, WestCare, Clearwater, FL
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Learning ObjecGves • Review cuRng-‐edge research on trauma and its impacts • Explore best prac4ces for trauma interven4ons, services, and the development of a trauma-‐informed approach • Iden4fy specific considera4ons for u4lizing a trauma-‐ informed approach when working with individuals involved in the jus4ce system • Discuss the successes and challenges for grantees’ implementa4on of trauma-‐specific interven4ons, services, and a trauma-‐informed approach
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Trauma: Impacts and ImplicaGons Alyssa Benedict, MPH Execu4ve Director, CORE Associates coreassociatesllc@comcast.net 401-‐837-‐CORE
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What is Trauma? • Dis4nguishing between sources/events versus the experience of trauma • Trauma is caused by a stressful occurrence that is outside the range of usual human experience and that would be markedly distressing to almost anyone (Peter Levine) • The psychological symptoms of trauma are the result of changes that occur in the brain that are related to the brain’s response to the trauma
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What is Trauma?
Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically and emotionally harmful or threatening and that has lasting adverse effects on the individual’s physical, social, emotional, or spiritual well-being. (SAMSHA, 2012) Council of State Governments Jus4ce Center | 6
Trauma4c Events/Experiences • • • • • •
Serious threat to one’s life or physical integrity Serious threat or harm to one’s children, spouse, or other close rela4ves or friends Sudden destruc4on of one’s home or community Seeing a person who is or has been seriously injured or killed as a result of an accident or physical violence Natural disasters Mass interpersonal violence
• • • • • • • • • • •
Large-‐scale transporta4on accidents House or other domes4c fires Motor vehicle accidents War/torture Partner baeery Abuse and neglect Physical assault Rape and sexual assault Racism, sexism Marginaliza4on Vicarious trauma
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Gender, Culture, Class and Intersec4onality Considera4ons • What is considered trauma4c can be influenced by gender, culture, class • Exposure, responses influenced by one’s diverse iden44es and experiences Council of State Governments Jus4ce Center | 8
Psychological Effects • • • • • • • •
Irritability, anger Social withdrawal Restricted affect Nightmares Flashbacks Diminished interest Loss of self-‐esteem Guilt, shame, embarrassment
• • • • • • • • •
Loss of appe4te Depression Anxiety Numbing, apathy Detachment Difficulty concentra4ng* Loss of security trust Impaired memory Suicidal idea4on Council of State Governments Jus4ce Center | 9
Trauma Lives in the Body • Psychological • Neuro-‐Physiological • Embedded in the brain-‐body
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Deepening Our Understanding of Trauma’s Impact Human Stress Response vs. Trauma-‐Influenced Stress Response
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The Human Stress Response
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Example
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The Neuro-‐Physiology of Trauma Ø “A healthy nervous system, when confronted with a s4mulus, goes into a state of disequilibrium, then reorders at a higher level of integra4on. A nervous system that is disorganized by trauma has lost its ability to adapt to a normal level of s4mulus…” (Peter Levine)
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The Trauma-‐Influenced Stress Response
• Exposure to trauma4c events overwhelm the NS • Change the NS and impact ability to respond to stress • Ini4ally protec4ve; however, individuals may struggle with, or are unable to return to rest and relaxa4on. Council of State Governments Jus4ce Center | 15
Everything is a Snake in the Sand
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Survival “The ability to avert or live through a threatening event and remember what was learned from that event so that similar situa?ons can be avoided in the future.” (Robert Scaer, MD)
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Two Pathways of Fear (see Lisak) • Low road • Amygdala = fastest
• High road • Cor4cal Regions = more thorough analysis
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Why we Need the Low Road
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The Trauma-‐Influenced Stress Response
• For individuals in the system who have experienced trauma, the low road to fear can dominate Council of State Governments Jus4ce Center | 20
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Complex Trauma (see NCTSN)
• Exposure to mul4ple trauma4c events, invasive, interpersonal nature, and the wide-‐ranging, long-‐term impact of this exposure. • Usually begin early in life and can disrupt many aspects of development. Council of State Governments Jus4ce Center | 22
The Impact of Trauma on the Brain-‐Body • A network of neurons prepared to respond • The same cascade of neurochemicals that were triggered during the actual event • Reac4ons are not conscious or hysterical – are expected in light of evolu4on and governed by the low road of amygdala-‐based fear networks Council of State Governments Jus4ce Center | 23
Physiological, Physical Effects • • • • • •
Pain Nausea Headaches Insomnia Panic aeacks Hyper-‐arousal
• • • • • •
Injuries Vomi4ng Hyper-‐vigilance Startle response Persistent anxiety Chronic condi4ons
*ACE Study outcomes
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Trauma’s Impact: The ACE Study
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What Can We Do? Two Essen4al Areas of Research • The neuro-‐physiology of trauma • Trauma changes the brain and NS
• The neurophysiology of resilience • How we structure the environment, relate to survivors can facilitate neuro-‐physiological healing Council of State Governments Jus4ce Center | 26
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1. 2. 3. 4. 5. 6.
8 Steps Toward Becoming More Trauma Informed
Make a commitment to trauma-‐informed prac4ce Support and train staff Implement trauma-‐informed tools and services Adopt trauma-‐informed language and communica4ons Create trauma-‐informed spaces (offices, common areas) Revise exis4ng procedures to be more trauma-‐informed; implement new trauma-‐informed procedures 7. Implement strategies to help women manage difficult trauma symptoms (one-‐on-‐one; group) 8. Build a safe, trauma-‐informed environment (introduce strategies) Council of State Governments Jus4ce Center | 29
Be Inten4onal: The Principles of Trauma-‐Informed Care • • • • •
Safety Trust Choice Collabora4on Empowerment
(See Principles of Trauma-‐informed Care, Harris & Fallot, 2006) Council of State Governments Jus4ce Center | 30
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Elements of a Trauma-‐Informed Procedure • • • • • • • • • •
Tell her what procedure needs to take place and why. Briefly describe what the procedure entails (e.g. order of tasks). If there are different ways the procedure can be done safely, offer choices. Reassure her that you will conduct the procedure in a way that maximizes her safety and comfort. Invite her to ask any ques4ons and answer them (before you begin). Let her know that you would like to begin. Conduct the procedure with trauma in mind; use verbal cues along the way such as, “Now I am going to place the items from your purse onto the table.” Let her know that the procedure has been completed. Ask her how she is doing. Thank her for her coopera4on. Let her know what the next ac4vity is. Council of State Governments Jus4ce Center | 32
CORE Associates & Orbis Partners, Inc.
Phase I: Create RegulaGon • • • •
Hold on Elicit Acknowledge Review
Phase II: Create Resilience • • • • •
Reflect Explore Plan Affirm Individual Review Council of State Governments Jus4ce Center | 33
Conclusion
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The Neuro-‐Physiology of Healing • We have an innate capacity for healing • Neuroplas4city, building new pathways • Poten4al is the biggest in the context of rela4onship • Therapeu4c interac4ons change the brain (see Alan Schore, PhD) “It is the power of being with others that shapes our brains.” (Louis Cozolino, PhD) Council of State Governments Jus4ce Center | 35
NRCJIW Resources – cjinvolvedwomen.org
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The presentation was developed by members of The Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the CSG Justice Center, the members of The Council of State Governments, or the funding agency supporting the work. Citations available for statistics presented in preceding slides available on the CSG Justice Center web site. Council of State Governments Jus4ce Center | 37