Trauma and Recovery: Insights and Challenges
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From “What’s Wrong to What’s Happened”
Brad Hansen-bhansen@ftnys.org
DaphnneBrow-Dbrown@ftnys.org
Bill Gamble –billmhep@aol.com
Suzanne Hall-Westcott
shall_westcott@verizon.net,
People Recovering from Addictions
People involved in Mental Health Recovery
Youth with Behavioral Challenges and Their
Families
Expecting that people have experienced
trauma
Understanding the impact on individuals,
families and communities
Understanding the effects on people using
services, people who provide services, and
the organizations we work in
Understanding the connection between
trauma in the past and experiences in the
present
Understanding ways people cope in the face
of horror
Re-thinking the services and supports we
provide
Taking social action to change the conditions
Addressing disparities and historical trauma
as well as interpersonal trauma
Up to two-thirds of both men and women in substance
abuse treatment report childhood abuse or neglect.
(SAMHSA CSAT, 2000)
Teenagers with alcohol problems are 21 times more likely
to have been sexually abused than those without such
problems. (Clark et al., 1997)
Seventy-one to ninety percent of adolescent and teenage
girls and twenty-three to forty-two percent of adolescent
and teenage boys in a Maine inpatient substance abuse
treatment program reported histories of childhood sexual
abuse. (Rohsenow et al., 1988)
HMO adult members who had experienced multiple
childhood exposures to abuse and violence had a 4- to
12-fold increased risk of alcoholism and drug abuse, and
a 2- to 4- fold increase in smoking. (Felitti et al., 1998)
5
Studies show about 85% of people with
psychiatric diagnosis are trauma survivors
Similar rates among people with histories of
substance abuse, foster care placement,
homelessness, and incarceration
Nearly 100% of incarcerated women are
trauma survivors
Both staff and people using services may be
trauma survivors
1
Mueser et al, 2004;
2
Goodman et al, 1997;
3
Buhrich et al, 2006;
4
Moncrieff et al, 1996;
5
Greeson et
al, 2011;
6
Wallace et al, 2011.
6
8
Extreme stress brought on by shocking or
unexpected circumstances or events and
enduring conditions that overwhelm a
person’s ability to cope.
Results in feelings of helplessness, and
extreme fear and horror.
Threats are perceived as psychological
and/or bodily violation, threat of
death, or serious injury to self or a
loved one.
The event may be witnessed or
experienced directly by both
individuals and groups
9
•
Childhood sexual, physical,
emotional abuse, neglect, and
abandonment
•
Rape, sexual assault, trafficking
•
Domestic violence
•
Other violent crime
•
Catastrophic injury or illness, death,
loss, grief
•
Institutional abuse and neglect
•
Abuse using religion
•
War/terrorism/combat
•
Community and school
violence, bullying/hate crimes
•
Cultural dislocation or sudden
loss, displacement
•
Historical/generational targeted
violence
•
Chronic stressors like racism,
poverty
•
Natural disasters
•
Invasive medical procedures
•
A
n
y
m
i
s
u
s
e
o
f
p
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w
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r
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y
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o
r
g
r
o
u
p
o
v
e
r
a
n
o
t
h
e
r
Cave, Johnan, 2001
We may be
aware or
unaware.
Responses may
be visible or
invisible.
Information
from internal
and
sensory
sources
W
e
a
r
e
w
i
r
e
d
f
o
r
s
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r
v
i
v
a
l
…
F
i
g
h
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F
l
i
g
h
t
F
r
e
e
z
e
Cave. Curley 2015
For many of us who have
experienced abuse and
violence, our bodies and
brains are on constant alert
for danger
Reassurance that we are
safe may not help turn off
the alarm
Teaching people in distress
about trauma can help
Trustworthiness is
essential
11
“
At the core of traumatic stress is a
breakdown in the ability to regulate internal
states. This concept of self-regulation is
critical for understanding trauma and its
impact.
”
Bessel van der Kolk
20
13
13
N. Miller
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Survivors may be responding to the present
through the lenses of their past
Things survivors do to cope may be
misinterpreted by staff as “non-compliance”
Can lead to “punitive” responses by staff to
people who are struggling with trauma
responses
Sometimes people are unaware that their
challenges are related to trauma
14
Mental Health Empowerment Project
Leave people feeling powerless
Have lasting effects on the ability to trust
others and form intimate relationships
Impact relationships with self, others,
communities, and environment
Create distance between people
Be particularly damaging, especially when
inflicted by loved ones or trusted caregivers
16
Trauma survivors often have
sensitive “radar” for detecting
dishonesty and good reasons to be
sensitive to misuse of power and
authority.
How will this impact services?
Penney and Cave 2010
17
•
If, how, and when a person chooses to
talk about experiences is personal
•
Some may not label what happened as
“trauma”
•
Be aware of the words you use and be
prepared that other’s words may be
different
18
MARS (Medication-Assisted Recovery Services)
Trauma-informed approach relies on
connection
Connecting can be hard work
Many providers and peers supporters have
their own experiences with trauma
Self-awareness and self-care are essential
to avoid doing more harm; they
protectsour empathy and supports
effective connections
20
The Perspective of Staff
The Perspective of the Person in
Treatment
Helpful Resources --
https://store.samhsa.gov/shin/content/SMA06
-4055/SMA06-4055-A.pdf
Peer-delivered services
Self-help techniques
New medications
Emphasis on recovery
Understanding the relationship between
trauma and mental illness
Families Together in NY State
Unaware that toxic stress causes harm to a child’s
brain
emotional abuse by other parent/ partner
bullying
community violence
household substance abuse/ mental health
challenges
war & natural disasters
Exposure to these childhood experiences increases
the need for parents and caregiver to be educated on
the effects of childhood stressors
Increases the risk of :
Alcohol and substance abuse
Social, emotional and behavioral
health challenges
Physical health challenges
Unhealthy relationships….. and more
Teach parents to create:
Safe environments physically and emotionally
Help children to identify their feelings and
emotions
Healthy attachments and nurturing
relationships
Stable homes that meet a child’s basic needs
o
food
o
shelter
o
access to health care
o
education
Mental Health, Addiction
and Family Networks
Every service or program can work towards
becoming trauma-informed. This means
examining our environments, relationships,
and practices for anything that inhibits
physical or emotional safety, power
imbalances, and doing “for or to ” rather
than doing “with.”
Trauma-specific interventions are designed
specifically to address the consequences of
trauma for an individual and to facilitate
healing.
Are people currently safe? For example, all
trauma is not “post.” With domestic violence
there are current risks and potential for
coercion and undermining of recovery.
Providers may act with “power over”
intentionally or unintentionally, it can hinder
recovery by bringing about trauma reminders,
retraumatizing someone or revictimizing
someone
Healing is not a linear process
Safety
Collaboration
Shared power
Respect
Transparency
31
31
Parallel Process
Impact of stress and trauma on
organizations
Impact on staff who work there
Impact on people accessing services
Bloom, S. SAGE for Organizations, Warshaw, 2009
A small group of people could change the
world. Indeed, it’s the only thing that ever
has.
Margaret Mead
Explore the impact of trauma on individuals, families, and communities, uncover ways people cope with horror, and address disparities and historical trauma. Learn about the prevalence of childhood abuse in substance abuse treatment and the high rates of trauma among those with psychiatric diagnoses, substance abuse histories, homelessness, and more.
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Presentation Transcript
From Whats Wrong to Whats Happened Brad Hansen -bhansen@ftnys.org Daphnne Brow-Dbrown@ftnys.org Bill Gamble billmhep@aol.com Suzanne Hall-Westcott shall_westcott@verizon.net,
People Recovering from Addictions People involved in Mental Health Recovery Youth with Behavioral Challenges and Their Families
Expecting that people have experienced trauma Understanding the impact on individuals, families and communities Understanding the effects on people using services, people who provide services, and the organizations we work in Understanding the connection between trauma in the past and experiences in the present
Understanding ways people cope in the face of horror Re-thinking the services and supports we provide Taking social action to change the conditions Addressing disparities and historical trauma as well as interpersonal trauma
Up to two-thirds of both men and women in substance abuse treatment report childhood abuse or neglect. (SAMHSA CSAT, 2000) Teenagers with alcohol problems are 21 times more likely to have been sexually abused than those without such problems. (Clark et al., 1997) Seventy-one to ninety percent of adolescent and teenage girls and twenty-three to forty-two percent of adolescent and teenage boys in a Maine inpatient substance abuse treatment program reported histories of childhood sexual abuse. (Rohsenow et al., 1988) HMO adult members who had experienced multiple childhood exposures to abuse and violence had a 4- to 12-fold increased risk of alcoholism and drug abuse, and a 2- to 4- fold increase in smoking. (Felitti et al., 1998) 5
Studies show about 85% of people with psychiatric diagnosis are trauma survivors Similar rates among people with histories of substance abuse, foster care placement, homelessness, and incarceration Nearly 100% of incarcerated women are trauma survivors Both staff and people using services may be trauma survivors 1 Mueser et al, 2004; 2 Goodman et al, 1997; 3 Buhrich et al, 2006; 4 Moncrieff et al, 1996; 5 Greeson et al, 2011; 6 Wallace et al, 2011. 6
Extreme stress brought on by shocking or unexpected circumstances or events and enduring conditions that overwhelm a person s ability to cope. Results in feelings of helplessness, and extreme fear and horror. Threats are perceived as psychological and/or bodily violation, threat of death, or serious injury to self or a loved one. The event may be witnessed or experienced directly by both individuals and groups 8
War/terrorism/combat Childhood sexual, physical, emotional abuse, neglect, and abandonment Community and school violence, bullying/hate crimes Cultural dislocation or sudden loss, displacement Rape, sexual assault, trafficking Historical/generational targeted violence Domestic violence Other violent crime Chronic stressors like racism, poverty Catastrophic injury or illness, death, loss, grief Natural disasters Invasive medical procedures Institutional abuse and neglect Any misuse of power by one person or group over another Abuse using religion Cave, Johnan, 2001 9
We are wired for survival We may be aware or unaware. Responses may be visible or invisible. Information from internal and sensory sources Freeze Flight Fight Cave. Curley 2015
For many of us who have experienced abuse and violence, our bodies and brains are on constant alert for danger Reassurance that we are safe may not help turn off the alarm Teaching people in distress about trauma can help Trustworthiness is essential 11
At the core of traumatic stress is a breakdown in the ability to regulate internal states. This concept of self-regulation is critical for understanding trauma and its impact. Bessel van der Kolk 20
Arousal Hyperarousal Numbing Attention Dissociation Hyper-focus Emotion Absent Overwhelming 1 3 N. Miller
Survivors may be responding to the present through the lenses of their past Things survivors do to cope may be misinterpreted by staff as non-compliance Can lead to punitive responses by staff to people who are struggling with trauma responses Sometimes people are unaware that their challenges are related to trauma 14
Leave people feeling powerless Have lasting effects on the ability to trust others and form intimate relationships Impact relationships with self, others, communities, and environment Create distance between people Be particularly damaging, especially when inflicted by loved ones or trusted caregivers 16
Trauma survivors often have sensitive radar for detecting dishonesty and good reasons to be sensitive to misuse of power and authority. How will this impact services? Penney and Cave 2010 17
If, how, and when a person chooses to talk about experiences is personal Some may not label what happened as trauma Be aware of the words you use and be prepared that other s words may be different 18
Trauma-informed approach relies on connection Connecting can be hard work Many providers and peers supporters have their own experiences with trauma Self-awareness and self-care are essential to avoid doing more harm; they protectsour empathy and supports effective connections 20
The Perspective of Staff The Perspective of Staff The Perspective of the Person in Treatment The Perspective of the Person in Treatment Helpful Resources -- https://store.samhsa.gov/shin/content/SMA06 -4055/SMA06-4055-A.pdf
Peer Self New medications Emphasis on recovery Understanding the relationship between trauma and mental illness Peer- -delivered services Self- -help techniques New medications Emphasis on recovery Understanding the relationship between trauma and mental illness delivered services help techniques
Unaware that toxic stress causes harm to a childs brain emotional abuse by other parent/ partner bullying community violence household substance abuse/ mental health challenges war & natural disasters Exposure to these childhood experiences increases the need for parents and caregiver to be educated on the effects of childhood stressors
Increases the risk of : Alcohol and substance abuse Social, emotional and behavioral health challenges Physical health challenges Unhealthy relationships .. and more
Teach parents to create: Safe environments physically and emotionally Help children to identify their feelings and emotions Healthy attachments and nurturing relationships Stable homes that meet a child s basic needs o food o shelter o access to health care o education food shelter access to health care education
Mental Health, Addiction and Family Networks
Every service or program can work towards becoming trauma-informed. This means examining our environments, relationships, and practices for anything that inhibits physical or emotional safety, power imbalances, and doing for or to rather than doing with. Trauma-specific interventions are designed specifically to address the consequences of trauma for an individual and to facilitate healing.
Are people currently safe? For example, all trauma is not post. With domestic violence there are current risks and potential for coercion and undermining of recovery. Providers may act with power over intentionally or unintentionally, it can hinder recovery by bringing about trauma reminders, retraumatizing someone or revictimizing someone Healing is not a linear process
Safety Collaboration Shared power Respect Transparency
Parallel Process Parallel Process Impact of stress and trauma on organizations Impact on staff who work there Impact on people accessing services 3 1 Bloom, S. SAGE for Organizations, Warshaw, 2009
A small group of people could change the world. Indeed, it s the only thing that ever has. Margaret Mead
