trauma past, trauma present: looking at addiction through a trauma informed lens

Trauma Past, Trauma Present:Looking at Addiction through a Trauma Informed Lens

Allison Sampson Jackson, PhD, LCSW, LICSW, CSTOPFamily Preservation Services of VA

Providence Service Corporation

Defining Trauma: a traumatic event, either witnessed or experienced,

representing a fundamental threat to one’s physical integrity or survival

responses involve intense fear, helplessness or horror the meaning of the event may be as important as the

actual physical act/experience what we want to emphasize is that it is an individual's

subjective experience that determines whether an event is or is not traumatic

http://www.lisaferentz.com/

Key Component of TraumaIs the experience of loss!Loss of: boundaries safety trust power and control innocence protection attachment possessions consistency/predictability sense of self/body image

http://www.lisaferentz.com/

Exposure to Violence in Childhood

46 million of 76 million children are exposed to violence, crime and abuse each

Finkelhor, D., et al. (2010). Trends in childhood violence and abuse exposure: evidence from 2 national surveys. Archives of Pediatric and Adolescent Medicine, 164(3), 238–242.

Information and slide part of Dr. Allison Sampson's Trauma

Presentation

Trauma impacts learning and academic outcomes

Decreased IQ and reading ability (Delaney-Black et al., 2003)

Lower grade-point average (Hurt et al., 2001)

More days of school absence (Hurt et al., 2001)

Decreased rates of high school graduation (Grogger, 1997)

Increased expulsions and suspensions (LAUSD Survey)

Impact of being in Child Welfare System for Foster Care Children

• 25% will be incarcerated within first 2 years of aging out of the system

• More than 20% will become homeless • Only 58% will have a High School Diploma• Less than 3% will have a college education by age of

25• Many will re-enter the system as parents • For children under age of 5, increase likelihood of

developmental delays 13-62% compared to 4-10%

1) Conradi, L. (2012) Chadwick Trauma Informed System Project p. 54

2) Leslie et. al. (2005). Developmental and Behavioral Pediatrics 26(3), 177-185

The breakdown per child is:

• $32,648 in childhood health care

costs• $10,530 in adult medical costs

• $144,360 in productivity losses

• $7,728 in child welfare costs

• $6,747 in criminal justice costs

• $7,999 in special education costs

1 year of violence=

124 billion dollars

in recovery costs

223,400,000

317,572,282

223,400,000

ACE SCREEN

• Alcoholism and alcohol abuse• Chronic obstructive pulmonary

disease (COPD)• Depression• Fetal death• Health-related quality of life• Illicit drug use• Ischemic heart disease (IHD)• Liver disease• Risk for intimate partner violence• Multiple sexual partners• Sexually transmitted diseases

(STDs)• Smoking• Suicide attempts• Unintended pregnancies• Early initiation of smoking• Early initiation of sexual activity• Adolescent pregnancy

Unlocking the Brain

At least for today…3 brain levels-they each speak a different language

Brainstem-housekeeping of the

Body, sleeping, eating, breathing

Limbic-smoke alarm, implicit memories

Cortex-planning, logic, reason, judgment

A Person’s Response to Perceived Danger

Trauma Event

Danger Response

Fight Flight FreezeAggression Run Away Dissociate

Verbal attack Substance Abuse Non-emotionality

Slide from Ellen Williams, LCSWCenter for Child & Family Services

Looking Through The Eyes of a Traumatized Child- How it looks to Us….

Slide from Ellen Williams, LCSWCenter for Child & Family ServicesServices

How it looks to The Traumatized Child

Slide from Ellen Williams, LCSWCenter for Child & Family ServicesServices

The Hand Model of the Brain

http://www.youtube.com/watch?v=DD-lfP1FBFk

The Handy Model

Trauma and the Brain Hippocampus-remembers the facts but

not the emotions.

It records the time-frame of significant events, the start, the middle, the end of an event and sends the facts to the cortex-the thinking part of the brain (logic, reason, common sense).

Chasing BehaviorsAgitation

Traumatic EventDepressio

Intrusive Memories

Nightmares

Hopelessness

Numbing

Insomnia

Shame & Self-Hatred

Panic Attacks

Substance Abuse

Somatic Symptoms

Eating Disorder

Self-Destructiv

e Behavior

Dissociation

Poor Impulse Control

Defiance

Withdrawal

Slide by Trish Mullen, Chesterfield CSB

We must ……

Respond to the need ….

Not react to the behavior

Resilience Trumps Aces

From Trish Mullen, Chesterfield Community services Board

TRAUMA AND ATTACHMENT

ATTACHMENT

INFORMATION AND SLIDE PART OF DR. ALLISON SAMPSON'S TRAUMA PRESENTATION

Many argue that these early relationships (experiences) shape neuronal circuits which regulate emotional and social functioning

ATTACHMENT’S PURPOSESIEGEL, 1999

Evolutionary Level – biological Infant Survival (Bowlby)

Mind Level – biological and social • Caregiver’s brain helps child’s brain to organize regulation• Caregiver’s brain teaches child self-soothing • Child experience of safety allows for exploration

ATTACHMENT’S PURPOSE

Experience of safety is encoded in child’s implicit memory and provides secure base from which to grow and access higher levels of information processing

TRAUMA AND THE BRAIN

UNDERSTANDING “WHY” …

• http://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm

BRAIN AND STRESS

• When stress is predictable and moderate, stress can facilitate resiliency and enhance memory

• When stress is unpredictable and severe, stress can create vulnerability and memory impairment

• Severe and chronic stress in childhood via multiple traumas from caregivers can impact affect regulation, interpersonal relationship skills, and states become traits (fight/flight/freeze… disassociation or hyper arousal)

TYPES OF STRESS

INFORMATION AND SLIDE PART OF HARRIS (2013) BUZZ ON BRAIN AND BABIES PRESENTATION

Positive Stress Tolerable Stress Toxic Stress

Normal and essential part of healthy development

Body’s alert systems activated to a greater degree

Occurs with strong, frequent or prolonged adversity

Brief increases in heart rate and blood pressure

Activation is time limited and buffered by caring adult

Disrupts brain architecture and other organ systems

Mild elevations in hormonal levels Brain and organs recover Increased risk of stress-related disease and cognitive impairment

Example: Tough test at school or a playoff game

Example: Death of a loved one, divorce, natural disaster

Example: abuse, neglect, caregiver substance dependence or mental illness

Unaddressed RepeatedProlongedIntense

Effective Intervention Early Detection Parental Resilience Social –emotional buffering

THREE PARTS OF THE BRAIN …

• Brain Stem• Limbic Brain

• Cerebral Cortex

STRESS AND THE BRAIN

Sensory Thalamus Amygdala

“The Guard Dog”

Emotional Stimuli Emotional Response

Sensory Cortex

“Wise Old Owl”

LOW ROAD

Smoke Detector Activated

SUD SCALE 3 to 6

Smoke Detector Off

SUD Scale 6 to 3

Self- Regulation

THE CALM PERSON

HIPPOCAMPUS

Working

Model adapted by Allison Sampson from Ledoux (1996, page 164) and utilizing terms from van der Kolk’s work and Goldie Hawn’s Book (2011) 10 Mindful Minutes

Sensory Thalamus Amygdala

“ The Guard Dog”

Emotional Stimuli Emotional Response

HIGH ROAD

Sensory Cortex

“Wise Old Owl”

LOW ROAD

Smoke Detector Activated

SUD SCALE 6 to 10

Smoke Detector Misfires

SUD Scale stays at 8

Lack of Regulation

THE TERRIFIED PERSON

Hippocampus

Shrunken

Model adapted by Allison Sampson from Ledoux (1996, page 164) and utilizing terms from van der Kolk’s work and Goldie Hawn’s Book (2011) 10 Mindful Minutes

VULNERABILITY MOUNTAIN

What does this mean for children who have experienced trauma?

EXPERIENTIAL EXERCISE

ATTACHMENT AND BRAIN … WHAT WE ALREADY KNOW

• Review of the exercise … what did you notice about caregiver touch between the two sets of pictures …

• What do you think the implicit memories are about caregiving relationships ? About authority figures? About their ability to be safe ?

The needs of the adults and caregivers with trauma ….

are no different

CROSS-GENERATIONAL TRAUMA HENDRICKS (2012) CHAPTER 12 OF CREATING TRAUMA INFORMED CHILD WELFARE SYSTEMSUSING TRAUMA INFORMED SERVICES TO INCREASE PARENTAL PROTECTIVE FACTORS

Women who have experienced trauma are more likely to self- medicate with a substance (55-99%) (1)

Intergenerational transmission of trauma (Depression, PTSD) (2)

Unresolved childhood trauma can lead to reenactments with partners in adult relationships and/or with their children (3)

Unresolved childhood trauma can lead to difficulty forming secure attachments with their children (4)

Childhood trauma can result in parenting styles that include threats & violence (2)

Childhood sexual abuse survivors can miss “red flags” of sexual abuse with their own children due to avoidance of trauma memories themselves (2)

1) Najavits, Weiss, & Shaw (1997) The American Journal on Addiction, 6 (4), 273-2832) Hendricks, A. (2012). Using Trauma-Informed Services to Increase Parental Factors (pp. 89-91)3) Walker (2007) Journal of Social Work Practice, 21 (1), 77-87. 4) Main & Hess (1990) In M. Greenberg, D. Cicchetti, & E. Cummings (Eds.), Attachment in the preschool

years: Theory, research, and intervention (pp. 121-160)

BIG PICTURE WITH CAREGIVERS

• Often the caregivers … are the kids we as a system “missed”

• They come to us with their own trauma histories

• Successful outcomes with our clients means successful work with the family

• Screening all caregivers and finding them services is critical to the prevention/treatment/reduction of recidivism for children entering the juvenile justice system

CROSS-GENERATIONAL TRAUMA HENDRICKS (2012) CHAPTER 12 OF CREATING TRAUMA INFORMED CHILD WELFARE SYSTEMSUSING TRAUMA INFORMED SERVICES TO INCREASE PARENTAL PROTECTIVE FACTORS

Caregiver functioning following a child’s exposure to trauma is a major predictor of child’s functioning (1 & 2)

If we want to improve a child’s outcome, we must address parent’s trauma history … failure to do so can result in (2) …

- Failure to engage in treatment services - An increase in symptoms - An increase in management problems - Retraumatization - An increase in relapse - Withdrawal from service relationship - Poor treatment outcomes

1) Linares et al (2001) Child Development, 72, 639-6522) Liberman, Van Horn, & Ozer (2005) Development and Psychopathology, 17,

385-396 3) Hendricks, A. (2012) pp. 91

A PERSON’S RESPONSE TO PERCEIVED DANGERTrauma Event

Danger Response

Fight Flight FreezeAggression Run Away Dissociate

Verbal attack Substance Abuse Non-emotionality

Slide from Ellen Williams, LCSWCenter for Child & Family Services

CHASING BEHAVIORS

Agitation

Intrusive Memories

Nightmares

Hopelessness

Numbing

Insomnia

Shame & Self-Hatred

Panic Attacks

Substance Abuse

Somatic Symptoms

Eating Disorder

Self-Destructiv

e Behavior

Dissociation

Defiance

Withdrawal

Slide by Trish Mullens, Chesterfield CSB

WE MUST ……

Respond to the need ….

Not react to the behavior

PARADIGM SHIFT

What does TIC look like?

Information and slide part of Dr. Allison Sampson's Trauma Presentation

Core areas of focus in Complex TraumaCourtois, C. & Ford, J. (2009), Introduction (p.2)

Self-Regulation Affect Regulation Disassociation (difficulty in being “present”) Somatic Dysregulation

Self-Identity Impaired Self-Concept Impaired Self-Development

Co-regulation Secure working model of caring relationship Disorganized Attachment Patterns

Creating a Culture for TICFive Core Values (Fallot, 2009)

1) Safety2) Trustworthiness3) Choice (and Voice !!) 4) Collaboration5) Empowerment

We can offer CAPPD to those with work with … http://www.multiplyingconnections.org/

Phase Oriented Care

Understand what good trauma treatment looks like …

Phase Oriented Treatment “ Gold Standard”

Phase I: Safety and Stabilization Phase 2: Trauma ReprocessingPhase 3: Reintegration

Handout on questions to ask Mental Health Providers

Resource http://www.nctsnet.org/nccts/nav.do?pid=ctr_top_trmnt_prom

Phase Oriented Treatment for Trauma (Herman 1992, Janet 1889) from Courtois, C. “Treating Complex Traumatic Stress Disorders”)PHASE ONE: Safety and Stabilization

Personal and Interpersonal Safety Established: Education/Support/Safety Planning

Enhance Client’s ability to manage extreme arousal (hyper/hypo)

Active engagement in positive/negative experiences (deal with automatic avoidance behaviors, self awareness of avoidance, increase coping skills and use of coping skills)

Education (psychotherapy, trauma, skills to be learned) Assess and develop relationship capacity (decrease

avoidance of relationships or negative thoughts about relationships, build support network, define client’s attachment network)

Phase Oriented Treatment Phase Oriented Treatment for Trauma (Herman 1992, Janet 1889) from Courtois, C. “Treating Complex Traumatic Stress Disorders”PHASE TWO: Trauma Reprocessing Disclosure of traumatic memories, development of an

autobiographical narrative (identify emotions connected to trauma memories, grieve and mourn losses, resolution of relationships when appropriate, increased awareness, increase interpersonal and self-regulation skills)

Supporting client in maintaining functioning and not getting lost in memories or seeing themselves as “disabled”, need to affirm strengths, promote positive self-esteem, and internal and external resources now available to them

PHASE THREE: Re-Integration Growth and period and reengagement in life Can be time of client realizing losses, discover of unresolved

developmental deficits, fine tuning of self-regulation skills

Replacing Coping Behaviors Phase One Work

Chasing BehaviorsAgitation

Intrusive Memories

Nightmares

Hopelessness

Numbing

Insomnia

Shame & Self-Hatred

Panic Attacks

Substance Abuse

Somatic Symptoms

Eating Disorder

Self-Destructiv

e Behavior

Dissociation

Defiance

Withdrawal

Slide by Trish Mullens, Chesterfield CSB

Respond to the needDon’t react to the behavior

Post Traumatic Growth Typically 30-70 percent of survivors say that they have experienced positive changes of one form or another

• Construct meaning from what happened

• Survivor and thriver stories

• What to do with the “broken vase” ?

Post Traumatic Growth http://ptgi.uncc.edu/

Posttraumatic growth tends to occur in five general areas.

Sense that new opportunities have emerged from the struggle, opening up possibilities that were not present before.

Changes in relationships with others (ex: closer relationships with some specific people, increased sense of connection to others who suffer)

Increased sense of one’s own strength – “if I lived through that, I can face anything”

Greater appreciation for life in general Experience a deepening of their spiritual lives, however,

this deepening can also involve a significant change in one’s belief system

Resilience http://acestoohigh.com/

Resilience Factors (APA website) Caring/Supportive Relationships (primary) Capacity to make realistic plans and take steps to

carry them out A positive view of yourself and confidence in your

strengths and abilities Skills in communication and problem solving The capacity to manage strong feelings and impulses

Examples Protective Factors

Families who thrive

Targeting Change One tool …

When in their upstairs brain Support folks you work with in developing goals based on

their motivation … what do they want for their life today, what do they hope for, “magic wand questions”, what is their goal each day !!!

Collaborative Planning with Consumers… Interviewing for hopes Brain storm how to get there Creating a plan where they have a support system and access

to skills that will help them reach their goal Respecting their boundaries/contracting

LET’ PRACTICE ….

Skill Building

Replacing Coping Skills

Steps to replacing coping behaviors Identify current self-regulation strategies Help consumer make meaning out of why they chose

these strategies (ex: brain, ACE score, etc) “Magic Wand” question … focus of change Teach about the skills needed to build self-regulation Focus work on building resilience and new coping

strategies like a muscle Track progress with something like the diary card Frame replacing coping behaviors as a journey, it

will take time

Dialectical Behavioral Therapy – Informed DBT was developed in the late 1970s by Dr. Marsha Linehan and colleagues

Main goals: cope with stress, regulate emotions, improve relationships with others

Learning new behaviors -- which can be anything a person thinks, feels or does

Validation – the push for change can feel like it invalidates the pain that a consumer feels, validation is critical to helping consumer move forward i.e. the unhealthy coping strategy makes sense given your

experience, even though it is not the best approach to solve the problem

Dialectical Behavioral Therapy – Informed Dialectics (opposites) Dialectics makes three basic assumptions:

all things are interconnected change is constant and inevitable and opposites can be integrated to form a closer

approximation of the truth In DBT, the work is focused on resolving seeming contradictions between self-acceptance and change in order to bring about positive changes for an individual

DBT – Informed Skills

- Self Regulation - Mindfulness- Interpersonal Relationship Skills- Distress Tolerance Skills

Accept and Change

Vulnerability Mountain

Self Regulation Self-Regulation (“sunscreen”) Relaxation and Grounding Exercises Bilateral Movement Attunement Exercises Guided Imagery

http://www.healthjourneys.com/Store/Products/Healing-Trauma-PTS-Health-Journeys/19

Self-Care Plan (daily practice)

Mindfulness – art of being present in the moment Mindfulness Scale (MAAS) Mindfulness Exercise (sheet) – breathing, “one thi

Mindfulness Principles Mindfulness at UCLA http://marc.ucla.edu/

Self Awareness “knowing your skin” Educate children and adults about their triggers and trauma responses

o Wise old owl (Hawn Foundation)o Guard Dog (Hawn Foundation)o Smoke Detector (Van der kolk)o Alarm System ( ARC book pp.316-318)o Light Switch (“Please Explain Anxiety to Me”)

Teach and practice with them identification of feelings and needs Engage them in “Behavioral Experiments” where the try something different Teach about Thought Distortions (“thought distortion box”) so they can

begin to recognize thoughts they tell themselves that take them down to “Distress Valley”

Supporting beliefs that child or adult deserves “good” things Recognizing “bumps in the road” don’t mean “a crash”

Teaching About the Brain Upstairs/downstairs brain teaching practice

Using of multiplying connection tools (amazing brain pamphlets)

Partnering with Parents

Now you practice ………

Interpersonal Effectiveness Skills Self Help Tools

http://www.dbtselfhelp.com/html/interpersonal_effectiveness_ha.html

EX: Cheerleading statements (connected to building positive self-identity)

“Cheerleading statements are statements that people make to themselves in order to give themselves permission to ask for what they need or want, to say no, and to act effectively”

ACTIVITY Can you build some cheerleading statements with your neighbor ??

DISTRESS TOLERANCE

Distress tolerance skills (taken from the Accepts skills … DBT informed)o Activities (physical and mental) – mental vacation, bi-lateral movement (walking), temperature change

o Contributing – helping others gets you out of yourself and your stress (smiling, give compliment, invite someone to coffee, hold a door, do a favor)

o Comparisons – Bringing perspective to current situation, what skills have helped you cope before (have helped your children cope before) … validate yourself

o Emotions – Seek out activities that create feelings that are OPPOSITE from the painful ones you are experiencing (listen to music, favorite movie, work on a project --- favorite hobby)

o Push Away – Put away distressing memories in a “lock box” or in the “parking lot” for a little while … can do this in writing or mentally

o Thoughts – distract your thoughts with “one-thing” exercises, read something inspiring, “just worrying exercise”

o Sensations – Any physically vigorous activity or actively awakening senses (brisk walk, cold bath/hot bath, splash cold water on face, lotions on your wrist, strong taste, bold colors (Mandela), music)

Pederson, L. (2012). The Expanded Dialectical Behavioral Therapy Skills Training Manual . Eau Claire: CMI Education Institute, Inc. pp. 45-50

PRACTICE Using the ACCEPTS Model …

turn to your neighbor and think through activities that will fall under 2 of these categories that you could use with consumers you work with …

Skill building resilience starts with you …

Who is taking care of you ??

Presentation

Mirror Neurons

Impact of Working with Victims of Trauma

• Trauma experienced while working in the role of helper has been described as:– Compassion fatigue– Countertransference– Secondary traumatic stress (STS)– Vicarious traumatization

• Unlike other forms of job “burnout,” STS is precipitated not by work load and institutional stress but by exposure to clients’ trauma.

• STS can disrupt child welfare, police and juvenile justice workers’ lives, feelings, personal relationships, and overall view of the world.

Healing the hero

https://www.youtube.com/watch?v=FdaJYEraGG0&feature=em-upload_owner

Produced by Trish Mullen, LPCChesterfield CSB

Impact of Chronic Stresshttp://www.helpguide.org/mental/stress_signs.htm

raise blood pressure suppress immune system increase the risk of heart attack and stroke contribute to infertility speed up the aging process (life expectancy) create vulnerability for anxiety and depression obesity skin conditions (ex: eczema) sleep problems digestive problems

Presentation

Vicarious Trauma’s Impact Personally(Yassen, 1995)

Emotional Roller coaster Overwhelmed Depleted

Behavioral Negative coping mechanism Difficulty sleeping Absent- mindedness

Presentation

Cognitive Spaciness Apathy Perfectionism Minimization

Personal Impact … (Yassen, 1995)

Spiritual Hopelessness Anger at a Higher Power

Physical Aches and pains Impaired immune system Breathing difficulties

Presentation

Interpersonal Withdrawn Intolerance Loneliness Projection of anger

and blame

Professional Impact (Yassen, 1995)

Performance of Job Tasks

Decrease in quality and quantity

Increase in mistakes Avoidance of job

Presentation

Morale

Dissatisfaction Negative attitude Detachment

Professional Impact (Yassen, 1995)

Interpersonal Withdrawn from

colleagues Impatience Poor communication Staff conflicts

Presentation

Behavioral Tardiness Absenteeism Faulty Judgement

Managing Stress

• Request and expect regular supervision and supportive consultation.

• Utilize peer support.

• Consider therapy for unresolved trauma, which your work may be activating.

• Practice stress management through meditation, prayer, conscious relaxation, deep breathing, and exercise.

• Develop a written plan focused on maintaining work–life balance.

Perry and Cost of Caring http://childtraumaacademy.com/cost_of_caring/index.html

Lesson 3: Self-Care Strategies for Combating Secondary Trauma

http://www.childtraumaacademy.com/cost_of_caring/lesson03/page03.html

Self-Care Strategies for Combating Secondary Trauma: An overview

Below, please find a few of the possible, positive ways you can address stress. Jot down the things you do (or will begin making a point to do) in order to better care for yourself. List additional items within each column.

Physical Psychological Emotional Workplace

Sleep well

Eat well

Exercise

Walk/Jog

Others:

Self-reflect

Read for pleasure

Say "No"!

Solitude

Others:

See friends

Praise yourself

Meditate

Others:

Take breaks

Set limits

Get peer support

Get supervision

Use vacations

Others:

Presentation

Self-Care

“Whether you and I and a few others will renewthe world some day remains to be seen.

But within ourselves we must renew it each day.”

—Hermann Hesse

Self-care Strategieshttp://www.compassionfatigue.org/pages/Top12SelfCareTips.pdf

The best strategy to address compassion fatigue is to develop excellent self care

strategies, as well as an early warning system that lets you know that you are moving into the

caution zone of Compassion Fatigue.

Self Care: Need Options

Time and Connection: 10 second exercises 2 minute exercises 5-10 minute exercises 20-30 minute GI, Walking Meditation http://www.healthjourneys.com/default.asp (Belleruth Naparstek)

Trish Mullen, LPC

Brain Gym 94

0-10 0-10

Before Brain Gym After Brain Gym

Practice Figure 8 with whole right arm/left armFigure 8 with both armsCross crawl (opposite right hand to bent left knee, then left hand to bent right knee)

Self Care Apps Provider Resilience GPS for the Soul Mediation Oasis Apps Mindfulness Training System IChill App (Peter Levine) Narrative Therapy Questions (Narrative Q’s) Brain Wave http://socialwork.buffalo.edu/resources/self-care-starter-kit.html Flipagram (example) http://flipagram.com/f/nGbakYX6B5

NCTSN Self Care Inventory

Pocket TM … by Trish Mullen, LPC

Challenge:

Working with children who are in their downstairs brain and getting them back up to their upstairs brain … when we all use primarily upstairs techniques in our work …

Self care targeted to the right brain and lower brain …

HAPPY PLACE

http://youtu.be/up_WSAYmn-s

Caring For Yourself

Creating Internal Awareness

Creating Awaresness

Window of Tolerance

Pat Ogden101

Using Grounding Techniques to Stay in the Window of Tolerance

Mental GroundingPhysical GroundingSoothing GroundingSomatic Grounding

Najavitis, L.M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. NY: Guilford.

Practice Examples Distress Tolerance

“Down Stairs Brain” Temperature Change Grounding by looking up Bi-lateral movement Butterfly taps Compassion Hold

“Dig where the ground is soft” Chinese proverb

Conclusion: “Dig where the ground is soft” Chinese proverb

Instead of picking your trickiest area, pick the issue that you can most easily visualize improving on. (e.g.: “making a commitment to going for a walk every lunch time vs. getting rid of my difficult supervisor”).

You may not notice it right away, but making one small change to your daily routine can have tremendous results in the long term. Imagine if you started walking up two flights a stairs per day instead of using the elevator, what might happen after three months?

Together we can make a difference

Becoming Trauma Informed is a process …

https://www.youtube.com/watch?v=7wK2io3Z2KM&feature=em-upload_owner

THANK YOU ……

Dr. Allison Sampson-Jackson

Family Preservation Services, Inc

804-432-0056

aajackson@provcorp.com

http://www.vscsw.org/continuing_education/

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