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Trauma-Informed Systems and Tiered Supports April 4, 2019

Center for Trauma Informed Innovation | Truman Medical Centers [email protected] | ctii.eventbrite.com 1

Trauma-Informed Systems

And

Tiered Supports

Dena Sneed, OTR/L

Director

Objectives

• Participants will recognize the impact of trauma on

brains, bodies, and behaviors, both in themselves

and those they serve

• Participants will be familiar with the Missouri Model

for Trauma-Informed Care and Trauma-Informed

Schools

• Participants will consider practical applications of the

principles of Trauma-Informed Care

Primary supporting slide What is Trauma?

Individual trauma results from an event, series of

events, or set of circumstances that is

experienced by an individual as physically or

emotionally harmful or life threatening and that

has lasting adverse effects on the individual’s

functioning and mental, physical, social,

emotional, or spiritual well-being

SAMSHA



Private Event Trauma

• Secrecy & shame

• Power imbalance

• Sense of hopelessness

• Sense of isolation

• Sense of irretrievable loss

Public Event and

Community Trauma • Shared experience

• Lack of judgment

• Sense of helplessness

• Forces beyond control

• Sense of irretrievable loss

Systemic Trauma

• Pervasive/Historic vs. Single Event Based

• Layers of awareness

• Power imbalances

• Sense of hopelessness AND helplessness

• Includes racism, sexism, any type of

discrimination



Traumatization occurs when

both internal and external

resources are inadequate to

cope with external threat,

either real or perceived.

van der Kolk, 1989

Primary supporting slide Internal Resources

Hope

Self-worth

Intellect and

critical thinking Faith

Optimism

Creativity and

self-expression

Resourcefulness and

problem-solving skills

Sense of self

or identity

Health

Primary supporting slide External Resources

Food

Shelter

Supportive

Relationships

Community

Money and

Resources

Access to

Services

Mentors and

Role Models

Caregivers



A collaborative effort of Kaiser Permanente and

the Centers for Disease Control

Vincent J. Felitti, M.D. & Robert F. Anda, M.D.

The Relationship of Adverse

Childhood Experiences (ACEs)

to Adult Health Status

Impact on health



Fight

Escalate defense or

offense

Confront the threat

Flight

Avoid the threat

Run or escape

Freeze

Paralyzed by shock or fear

Retreat within,

collapse, or dissociate

Human Stress Response Behaviors

Primary supporting slide Flipping Your Lid

Primary supporting slide



Impact on brain function

• Sustain attention and engage in work tasks

• Learn and communicate information

• Recognize cause and effect

• Manage self and resources to achieve a goal

• Self-regulation

• Take another's perspective

• Show empathy

and all of these affect learning.

Impact on behavior

• Reactivity

• Impulsivity

• Aggression

• Defiance

• Withdrawal

• Perfectionism

• Appeasement

Summary of impacts

• Trauma damages our sense of control,

understanding, and purpose

• Trauma shapes neuro-physiological development

• Trauma affects physical, social, and emotional

health and wellbeing over the lifetime



What do we do?

We change the question

“What’s wrong with you?” becomes

“What happened to you?”

We understand all behavior has meaning

Recognize symptoms as survival skills

We create a trauma-sensitive

culture

Safe, nonjudgmental, collaborative, relational

Trauma-Informed Care

The How:

compassionate service delivery

Sensitive practices that can be

implemented anywhere by anyone

Trauma-Specific Treatment

The What:

specific clinical services

Therapeutic interventions

implemented by trained clinicians



Trauma-Informed Culture

• Realizes the prevalence of trauma

• Recognizes how trauma affects people

• Responds by infusing knowledge about trauma

and recovery into policies, procedures, and

practices

• Resists re-traumatization

http://www.samhsa.gov/nctic/trauma-interventions

Primary supporting slide Missouri Model: Developmental Continuum

Trauma Aware

Understand the prevalence and impact of trauma on clientele and staff

Trauma Sensitive

Prepare for change by exploring the implications of core TIC principles in daily practices and the environment

Trauma Responsive

Implement TIC principles into procedures to transform work environment and client interaction

Trauma Informed

Cultivate organizational culture of resilience, embed TIC principles throughout environment and policies

Trauma-Informed Care Principles

Safety

Trustworthiness

Choice

Collaboration

Empowerment



Safety

Trustworthiness

Choice



Collaboration

Empowerment

Resilience



Safety

Trustworthiness

Choice

Collaboration

Empowerment

Resilience

Applying the

Principles of Trauma

Informed Care in

Practice

Head-Heart-Gut

Check-in



Primary supporting slide

[email protected]

ctii.eventbrite.com

Thank you!

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