Mainstreaming trauma

Abstract

Paper presented at the 'Psychological Trauma-Informed Care Conference', Stirling University, Stirling, 4 June, Presentation explores the implications for wider social policy of adopting a trauma informed perspective and argues that the existing awareness ( as of 2014) of the diverse aspects of trauma and its implications within specialist services needs to be shared across society if the transformative possibilities of a new narrative are to be fully realized.

Full text

Why We Have to Mainstream: New
Understandings of Trauma
Dr Brodie Paterson
University of Stirling
October 2014

Health'Leadership'
Magellan Health Services, Inc./ACMHA: The College for Behavioral Health Leadership

From Ameliorative
To
Transformative
Intervention(s)

Political Implications?
Economic Inequality
Alcohol Pricing?
Bedroom Tax?
Education /Parenting Classes / Health Visitors /
Adoption?
Criminal Justice?

Trauma-Informed
The term describes a
System development
model that is grounded
in and
directed by a complete
understanding of
how trauma exposure
affects service user’s
neurological, biological,
psychological and
social development.
(Adapted from
NASMHPD definition,
2004)

Trauma Informed Approaches
•Focus is on what
happened to you
in place of what is
wrong with
you(Bloom, 2002)

Types of Trauma Resulting in Serious Problems:
•Are much more often not a “single blow” event e.g.
rape, natural disaster
•Are interpersonal in nature: intentional, prolonged,
repeated, severe
•Physical Abuse, Severe neglect, Emotional Abuse (
you ruined my life!!)
•Witnessing violence, repeated abandonment,
sudden and traumatic separation and loss
•Occur in infancy childhood and adolescence
•(SAMHSA 2012)

Sensitisation
•Experience creates a “processing template” through
which all input is filtered.
•A sensitized neural response results from repetitive
neural activation or experience.
•The system becomes more sensitive with use.
•Once sensitized, the neural activation can be
elicited by even minor stress (Perry et al., 1995).
The child can be responsive to what appears to
others as something inconsequential.

Potential Attachment / Trauma
Related Behaviour(s)
§Control issues Impulsivity & poor goal directed
behaviour
§Poor ability to modulate, tolerate, or recover from
extreme emotional states ( emotional hijack)
§Poor ability to recognise own emotions
§Poor capacity to assess risk
§Struggle with empathy and trust
§Struggle with accepting responsibility
§Poor self esteem
© CALM Training Ltd. 11

SAMHSA 2014
•recognise the presence of trauma in those
who use those who services and the services
themselves
•realise the significance of the issues
associated with it,
•respond by becoming ‘trauma informed’. and
reduce the risk of approaches that may
•re-traumatise victims

CALM Ongoing Projects
•Trauma Informed Residential
Childcare.
•Trauma Informed School
•Trauma Informed Professional
Education

Organisations are not machines
They are living organisms
whose influence may be
benign or therapeutic but
must be recognised,
understood and consciously
managed as otherwise it can
undermine any therapeutic
initiative

15
Parallel Processing 1
Service User The Organisation
Feeling unsafe Fear of service users and
management
Problems with managing anger and
aggression
Chronic frustration and anger.
Feelings can be vented towards
services users
Learned helplessness Feelings of helplessness in the face of
complexity of service user problems
dysfunction of the culture
Hyper arousal Increasingly crisis orientated service
leading to feelings of hyper-arousal
amongst staff and a climate of anxiety

16
Parallel Processing
Hyper vigilance Increased emphasis on control
measures leading to more
conflict with service users
Memory problems
disassociation
Experienced staff leave taking
with them the memory of
previous approaches
Poor communication skills Communication breaks down
between teams and between
disciplines increasing levels of
frustration

17
Parallel Processing
Service User The Organisation
Poor conflict resolution skills Interpersonal conflicts increase
generating further hostility that is
mirrored by relationships between
service users
Problems with relationships Te a m s become fragmented and
split leading to inconsistent
management and possibly more
aggression from service users
Poor self esteem Emotional exhaustion leads to
burnout and an inability to
emotionally engage decreasing
clinical effectiveness.
Staff feel deskilled.

Staff Are Not Machines
BAD
POOR SOUL
INDIVIDUAL
JUDGEMENT
MAD

FEELING THOUGHT CONSEQUENCE
BAD >
Anger
Fear
“They can’t get
away with that”
“He needs to learn
he can’t do that”
Punishment
Unplanned ignoring
MAD >
Guilty
Frustrated
“I don’t know what
to do”“we can’t go
on like this” “they
need to sort him
out”
Unplanned ignoring
Avoidance
Inconsistent
POOR SOUL>
Pity
“its not his fault”
“its just how he is”
“there Is no point”
Spoil
Don’t follow Plan
Give up 19

Attribution and Emotion
•Perceptions that the behaviour is
a) Controllable by the person
b) Internally caused ( actor/observer)
•Associated with
a) Higher levels of anger
b) Lower optimism
c) Less willing to help
•(Dagnan & Cairns, 2005;
•Dagnan & Weston, 2006; Wanless & Jahoda, 2006).
•Confirmatory bias
a) Looking to confirm view child / adult will fail

21
Violence
Feeling unsafe Hypervigilance
and hyperarousal
Anger and aggression problems
Learned helplessness
Poor
communication
and conflict
resolution skills
Poor empathy
PARALL EL P ROCESSES:
STAFF & SERVICE USERS

(From Kinniburgh, Van der Kolk and Spinazzola 2005)
Trauma Recovery ARC Model

CALM PRACTICE MODEL
23
Consistency
Predictability
Lower anxiety
Behaviour
© CALM

Sanctuary Model
• Safety ( Physical, Moral, Cultural)
• Emotions ( Emotional Regulation)
• Loss ( grieving anger)
• Future ( resilience building)
( Bloom 2007)

TIC Principles
•Recognition
•Recovery
•Empowerment
•Choice and Control
•Relational
•Collaboration
•Safety
•Strengths Based
•Minimise retraumatisation
•Culturally competent
•Collaborative design

Trauma for teachers
•Understand developmental
age
•Tea ch mi ndfu lly
•Help children to comply
with requests.
•Structure and Consistency.
•Time in, not time out
•Support parents and carers
•Natural Consequences
•Structure choices
•Support carers
•Maintain role

Impact of Trauma
on Learning
•Affect dysregulation
•Shame
•Reduced cognitive
capacity
•Difficulties with
memory
•Language delays
•Need for control
•Attachment difficulties
•Poor peer relationships
•Unstable living
situation

My World

A trauma informed classroom
•Safe place to talk, as well
as people that you feel safe
talking to
•How are you feeling chart?
•Community meeting sign
•Community meeting chart
or board
•Quote of the day
•Goals and supports

Parallel Processing and the School

Values Led Education
•Nonviolence
•Democracy
•Open Communication
•Social Learning
•Social Responsibility
•Emotional Intelligence
•Growth and Change
(Alexandria Connally)

Trauma Informed
UG Professional
Education
Incorporation of Concept
Recognition of Prevalence in Students
Development of Undergraduate Prog
Development of Post Grad Modules
Development of Research Strand

!
Spokane Study
Teaching trauma is not the same as trauma informed teaching
neither is it the same as implementing a trauma
informed curriculum (Carello, & Butler 2014)

Barriers

Conclusion
Behaviour of traumatised children
and adults is pain-based. It is not
that they won’t behave like other
people, but that they can’t.