Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
Jan 19, 2016
Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
The Science of Traumatic Stress and Principles of Trauma-Informed
Care: Building an Effective Response Across Systems
Presented by
Joshua Arvidson, MSS., LCSWDirector, Alaska Child Trauma Center at
Anchorage Community Mental Health ServicesRegional Director, Complex Trauma Treatment
Network
#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.
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
5
Talking about the brain in a straightforward and client-friendly manner
Arvidson, 2012
Physiology of the Human Stress Response
Threat
• Activation of Threat Appraisal and Response System
• Increased Limbic System Activity• Alarm system “flood”
Survival Respons
e
• Fight, Flight or Freeze• Survival Oriented Behavior
Post-
Stressor
• Continued Arousal• Difficulty Modulating
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
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Joshua Arvidson, 2011
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Joshua Arvidson, 2011
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Joshua Arvidson, 2011
Action Step: Trauma education and awareness building
#2: Trauma has an impact across multiple domains of human functioning.
Traumatic Stress
and Stress
Response
Adaptation
Contribution to
Presenting
Challenges
Functional Domains Impacted by Complex Trauma:
Attachment and RelationshipsBiologyAffect regulationDissociationBehavioral controlCognitionSelf-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.
Courtesy, Dr. R. Moss
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.
Gordon R. Hodas MD
Adapted from, NCTSN Complex Trauma Taskforce 2005
Trauma Informed
Care
Trauma-Specific
Interventions (Trauma-Focused)
#3: The Trauma Paradox
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
Action: Improve access to care/adapt systems to improve retention and get
services to those who most need them.
#4 Trauma has the Ability to Reproduce Itself.
Traumatic Experience
Physiological Dysregulation
Emotional Harm
Relational Harm
AdaptationsI.E. SubstancesRelational Re-enactmentsBehaviors
Adaptations impair potential
protective factors and
increase risk for re-exposure
Trauma and Adult Outcomes.
0
5
10
15
20
25
Perc
en
t W
ith
Healt
h P
rob
lem
(%
)
0 1 2 3 4 or more
ACE Score
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.
Implications for Action
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.
#3: Trauma Impacts the Whole Being
Person
Person in Context
Adaptations to
Trauma
Building Resilience
and Restoring Functioni
ng
Stress Related
Symptoms
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.
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 Interventio
ns
• 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
J. Arvidson 2013
• Focus: Specialized and evidence supported treatment and intervention for individuals impacted by trauma. Focus is restoring functioning and supporting recovery.
• Target Audience: Individuals for whom more intensive and specialized services are needed than those provided by trauma-informed systems (i.e. complex post-traumatic stress, severe functional challenges)
• Outcome: Establishing Safety, alleviation of trauma-related distress.
• Goal: Recovery and restoration for those impacted by complex post-traumatic stress.
Trauma Focused
Intervention
• Focus: Training on impact of trauma on the lives of service recipients and relevance to the system’s service and desired outcome.
• Target Audience: Systems serving working with individuals impacted by trauma, both systems that serve high-risk for exposure to trauma (child welfare, juvenile justice, court systems) and systems that serve as initial points of contact and can promote resilience and protective factors (education, primary care, pediatrics etc.)
• Outcome: Service systems understand trauma and its relevancy to their work.
• Goal: Systems engage with consumers in ways that promote resilience and recovery.
Trauma Informed Systems
• Focus: Public awareness and community education.• Target Audience: Community members (broad) with
targeted focus to key audiences. • Outcome: Increased awareness.• Goal: De-stigmatizing, improved identification (and access to
supports) for community members impacted by trauma. Primary and secondary prevention efforts embedded in social systems (families, community organizations and communities).
Trauma Aware
Community
Policy and Planning: Goal and Initiative
AlignmentTargeted Training and Partnerships with Supervisors Administrators and Programs
Universal Training on Trauma for Workers
J. Arvidson 2013