trauma & secondary trauma

TRAUMA & SECONDARY

TRAUMA

WELCOME

Off ered to you today as a result of a pilot partnership project between

Together Georgia and the

J.W. Fanning Institute for Leadership

Sandra Corbin, LCSW; Clinical Director, Multi-Agency Alliance for Children (MAAC)

Brian Bride, PhD; Social Work Director & Professor, Georgia State University

David Meyers, MSW; Public Service Faculty, J.W. Fanning Institute for Leadership

Welcome and Introductions Complex Trauma: Definitions &

Misdiagnoses Complex Trauma and the Caregiver LUNCH Secondary Trauma: Definitions Risk and Protective Factors Strategies for Self Care for the Practitioner Activity/Q&A

AGENDA

COMPLEX TRAUMA AND THE CAREGIVER

Sandra Corbin, LCSWClinical Director, Multi-Agency Alliance for Children (MAAC)

WHAT IS COMPLEX TRAUMA?

The term complex trauma describes the problem of children's exposure to multiple or prolonged traumatic events and the impact of this exposure on their development. http://www.nctsn.org/

Foster kids are often exposed to multiple traumatic events before and after entering foster care. Can you think of some examples?

LISA’S 911 CALL

http://www.youtube.com/watch?v=G_ht2vAYPoc

How does that make you feel?

What behaviors might Lisa exhibit after living through this?

ADVERSE CHILDHOOD EXPERIENCE (ACE) STUDY CDC.GOV

1995-97, ANDA AND FELITTI

ADVERSE CHILDHOOD EXPERIENCES 

Emotional Abuse

Physical Abuse

Sexual Abuse

Neglect

Emotional

Physical

Household Dysfunction

Mother Treated Violently

Household Substance Abuse

Household Mental Illness

Parental Separation or Divorce

Incarcerated Household Member

ADVERSE CHILDHOOD EXPERIENCES

“MIS”-DIAGNOSES WE OFTEN SEE

Anxiety DisordersConduct DisordersDepression/Mood RelatedADHDBehavior Disorders

PTSD DSM-5 DEFINITION

Posttraumatic Stress Disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related Disorders. This move from DSM-IV, which addressed PTSD as an anxiety disorder, is among several changes approved for this condition that is increasingly at the center of public as well as professional discussion.

PTSD DSM-5 DEFINITION

The diagnostic criteria for the manual’s next edition identify the trigger to PTSD as exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual:

directly experiences the traumatic event; witnesses the traumatic event in person; learns that the traumatic event occurred to a

close family member or close friend (with the actual or threatened death being either violent or accidental); or

experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related).

PTSD DSM-5 DEFINITION

The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the individual’s social interactions, capacity to work or other important areas of functioning. It is not the physiological result of another medical condition, medication, drugs or alcohol.

WHAT CAN WE DO???

COPING

Coping skills are essential to:Decrease anxiety

Regulate emotions

Have healthy alternatives available Lay the foundation for healing

COPING

You can:Make your home a safe placeInvolve the youth in their own safety planning

Learn DBT (most of the kids have learned it)

Translate terms into everyday languageCoach consistent useModel your own coping skills…What are some?

HEALING

When kids having consistent coping mechanisms in place, then the healing can begin.

Things you can do:Communicate good and concerning thingsAdvocate for an experienced therapistWork alongside the treating teamAsk what you can do at home to helpLearn about Evidenced Based PracticesDon’t add traumas (disruptions/police

interventions)

CHANGING

According to new research (Jim Casey Youth Opportunities Initiative), the brain is not done growing by the age of 3 like we thought.

Kids’ brains can reengage by way of positive/corrective experiences.

CHANGING - EXAMPLES

Examples:Actively involve kids in positive

activities/relationships (after school, church etc.)

Keep them connected to their existing connections- Partner with birth family

Help them develop a sense of belonging to a community (church, trips “home”, EmpowerMEnt).

Engage kids in their own planningBe strength based and positive

CHANGING - EXAMPLES

Examples:Get peer supportTrips/Cultural ExperiencesTake care or yourselfExpect a good team around youTalk to the therapistDon’t add to the trauma

(disruptions/police intervention)More???

REFERENCES

The Adolescent Brain- Jim Casey Youth Opportunities Initiative 2011

Adverse Childhood Experiences Study (cdc.gov)

developingchild.harvard.edu

The National Child Traumatic Stress Network (nctsn.com)

http://www.upworthy.com/heres-a-story-about-what-foster-care-is-like-for-an-abused-child-removed-from-her-home-2

CONTACT INFORMATION

Sandra L. Corbin, LCSW

Sandy scorbin@maac4kids.org 404-880-9323. www.maac4kids.org

LUNCH

TRAUMA-INFORMED

PRACTICE AND SECONDARY TRAUMATIC

STRESSOctober 2, 2014

Brian E. Bride, Ph.D., M.S.W., M.P.H.Professor and DirectorGeorgia State University School of Social Work

EXPOSURE

Acute Trauma refers to a single traumatic event that is limited in time, such as an auto accident, a gang shooting, a parent's suicide, or a natural disaster.

Chronic Trauma refers to repeated assaults on the child's mind and body, such as chronic sexual or physical abuse or exposure to ongoing domestic violence.

Complex Trauma is a term used by some trauma experts to describe both exposure to chronic trauma, often infl icted by parents or others who are supposed to care for and protect the child, and the long-term impact of such exposure on the child.

RE-EXPERIENCING SYMPTOMS

Recurrent and intrusive recollections of the event.

Recurrent distressing dreams of the eventActing or feeling as if the traumatic event

were recurringIntense psychological distress at exposure

to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

AVOIDANCE/NUMBING SYMPTOMS

Efforts to avoid thoughts, feelings, or conversations associated with the trauma.

Efforts to avoid activities, places or people that arouse recollections of the trauma.

Inability to recall an important aspect of the trauma.

Markedly diminished interest or participation in significant activities.

Feeling of detachment or estrangement from others.Restricted range of affect.Sense of a foreshortened future.In children – New fears of separation, being alone,

or darkness.

HYPERAROUSAL SYMPTOMS

Difficulty falling or staying asleep.

Irritability, frustration, or anger.

Difficulty concentrating.

Hypervigilance

Exaggerated startle response

DISTRESS AND IMPAIRMENT

Significant Distress

Impaired FunctioningFamilySocialEducational/Occupational

TRAUMA INFORMED APPROACH:

The Three RsRealizing the prevalence of trauma;

Recognizing how trauma affects all individuals involved with the program, organization, or system;

Responding by putting this knowledge into practice.

TRAUMA INFORMED APPROACH: Key Principles

Incorporation of trauma awareness;

Emphasis on safety;

Opportunities to rebuild control and empowerment;

Emphasis on strengths-based approaches rather than deficit-oriented models.

EVIDENCE-BASED TRAUMA INTERVENTIONS

Child-Parent Psychotherapy (CPP)

Trauma Affect Regulation: Guide for Education and Therapy (TARGET)

Trauma-Focused Cognitive-Behavior Therapy (TF-CBT)

Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

Parent-Child Interaction Therapy (PCIT)

Trauma and Grief Component Therapy for Adolescents (TGC T-A)

NEGATIVE EFFECTS OF EXPOSURE TO TRAUMATIZED POPULATIONS: What do

we call it?

Indirect trauma

Emotional contagion

Savior Syndrome

Cost of caring

Secondary victimization

Secondary traumatic stress

Compassion fatigue

Vicarious traumatization

Burnout

SECONDARY TRAUMATIC STRESS:What is it?

“A syndrome of symptoms nearly identical to PTSD except that exposure to a traumatizing event experienced by one person becomes a traumatizing event for the second person.” (Figley, 1999, p.11)

SECONDARY TRAUMATIC STRESS SYMPTOMS

Exposure

Intrusion

Avoidance

Hyperarousal

Distress/Impairment

COMPASSION FATIGUE

Conceptually identical to Secondary Traumatic Stress.

Introduced as a potentially less stigmatizing term.

Sometimes used to refer to the combination of secondary traumatic stress and burnout.

DEFINITION OF VICARIOUS TRAUMATIZATION

The transformation in the inner experience of the therapist that comes about as a result of empathic engagement with traumatic material. (Pearlman & Saakvitne, 1995, p.31)

Profound disruptions in the therapist’s frame of reference, that is, his basic sense of identity, world view, and spirituality. Multiple aspects of the therapist and his life are affected, including his affect tolerance, fundamental psychological needs, deeply help beliefs about self and others, interpersonal relationships, internal imagery, and experience of his body and physical presence in the world. (Pearlman & Saakvitne, 1995, p. 280).

BURNOUT

Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, determined by the dimensions of

exhaustion, cynicism, and ineffi cacy. (Maslach, Schaufeli, & Leiter, 2001)

PREVALENCE OF STS

Social Workers (N = 282) (Br ide, 2007) 55% met at least one of the core criteria for PTSD 24% scored above the clinical cutoff. 15% met the core criteria for PTSD.

Social Workers (N = 529) (Br ide & Lee, 2012) 48% met at least one of the core criteria for PTSD 15% scored above the clinical cutoff. 11% met the core criteria for PTSD

Substance Abuse Counselors (N = 225) (Br ide, Hatcher, & Humble, 2009) 57% met at least one of the core criteria for PTSD. 26% scored above the clinical cutoff. 19% met the core criteria for PTSD.

Substance Abuse Counselors (N = 936) (Br ide & Roman, 2011) 54% met at least one of the core criteria for PTSD. 16% scored above the clinical cutoff. 13% met the core criteria for PTSD.

PREVALENCE OF STS – cont’d

Domestic/Sexual Violence Social Workers (N = 154) (Choi, 2011) 66% met at least one of the core criteria for PTSD. 29% scored above the clinical cutoff. 21% met the core criteria for PTSD.

Child Welfare Workers (N = 187) (Bride, Jones, & MacMaster, 2007) 92% experienced some symptoms of STS. 43% scored above the clinical cutoff. 34% met core criteria for PTSD.

SUMMARY OF PREVALENCE STUDIES

Most service providers experience some symptoms of STS.

Most service providers have low levels of STS.

A significant amount of service providers have relatively high levels of STS.

CHILD WELFARE = the highest STS rates.

RISK AND PROTECTIVE FACTORS

Exposure to traumatized populations

caseload – size, compositionchild traumaseverity and type of trauma

RISK AND PROTECTIVE FACTORS

Demographic variablesAge, experience, gender, ethnicity, trauma history

Social SupportReliable alliance, helpfulness, discussion, satisfaction, cohesion

ROLE OF EMPATHY IN STS

Affective Sharing Capacity for an automatic or unconscious affective

response to others, which may include sharing emotional states.

Perspective Taking A cognitive capacity to take the perspective of

another.Self-Other Awareness

The capacity for temporary identification between self and other that ultimately avoids confusion between self and other.

Emotional Regulation The ability to change or control one’s own emotional

experience.

COMPASSION SATISFACTION & RESILIENCE

Observing and experiencing client recovery and growth

Increased empathy, insight, and tolerance Appreciation of life Personal growth Appreciation of relationships Improved spousal relations Improved parenting skills

ABCs OF SELF-CARE

AwarenessRecognize and identify STS symptoms.Monitor changes in symptoms over time.Recognize and monitor changes in functioning.

BalanceMake personal life a priority.Attend to your physical health.

ConnectionMake relationships with family and friends a priority.Honor your connection to your community.Revitalize your sense of life’s purpose and meaning.

Putting it All Together

ACTIVITY

Q & A

Workshop Evaluation

Ron Scroggy, Together Georgiaron.scroggy@gahsc.org

David Meyers, J.W. Fanning Institute for Leadership dmeyers@fanning.uga.edu 706-542-5062

THANK YOU!