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Trauma-Informed Care


Title: Trauma Informed care Author: Barbara Last modified by: Milwaukee County Created Date: 10/6/2010 4:09:50 AM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Trauma-Informed Care

Trauma-Informed Care

Barbara Barnes, Claudia Meyer Martha Williamson
Trauma-Informed Care (TIC)
  • A change of practice to consumer- driven care
    based on hope, self-determination, and
    empowerment. TIC will stress the importance of
    listening to and hearing the lived experiences of
    trauma survivors.

System of the Lived Experience
  • First and foremost, a consumer-driven system
    means one which is guided by people with a lived
    experience. They know better than anyone else
    what helps and what hurts in recovery.
  • To transform the system to a recovery-based one,
    C/S/Xs (consumers/survivors/ex-patients) will
    need to almost completely redesign it. (Fisher,
    D., 2007)

  • STEP UP Consumer-Driven Services, Training,
    Evaluation Policy United for Power
  • S Services and supports need to be
    consumer-driven T Training needs to be
    consumer-driven E Evaluation and research needs
    to be consumer- driven P Policy and planning
    needs to be consumer-driven
  • (Prochaska, J., Norcross, J. DiClemente, C.,

The Stages of Change Model
  • The idea behind the Stages of Change Model (SCM)
    is that behavior change does not happen in one
    step. Rather, people tend to progress through
    different stages on their way to successful
  • Each person must decide for himself or herself
    when a stage is completed and when it is time to
    move on to the next stage.

Stages of Change
  • The stages of change are
  • Pre-contemplation (Not yet acknowledging that
    there is a problem behavior that needs to be
  • Contemplation (Acknowledging that there is a
    problem but not yet ready or sure of wanting to
    make a change).
  • Preparation/Determination (Getting ready to
  • Action/Willpower (Changing behavior).
  • Maintenance (Maintaining the behavior change).
  • Relapse (Returning to older behaviors and
    abandoning the new changes).
  • Transcendence -Eventually, if you "maintain
    maintenance" long enough, you will reach a point
    where you will be able to work with your emotions
    and understand your own behavior and view it in a
    new light. This is the stage of "transcendence.
    In this stage, not only is your bad habit no
    longer an integral part of your life but to
    return to it would seem atypical, abnormal, even
    weird to you.

Guiding Values in Trauma-Informed Care

Trauma-Informed Care Highlights
  • TIC allows services to be delivered in a way that
    will avoid inadvertent re-traumatization and will
    facilitate consumer participation in treatment.

Trauma-Informed Care Highlights
  • Increase understanding of trauma and its impacts
    on health, mental health and social well-being.
  • Raise awareness of the role of internal and
    external stigma as it affects the disclosure of
    childhood abuse experiences and as it exacerbates
    traumatic impacts over the life span and
    incorporate the stories of persons with lived
    experience of abuse and trauma.

Trauma-Informed Care Highlights
  • Trauma recovery must be consumer-driven be based
    on hope, self-determination, and empowerment and
    stress the importance of listening to and hearing
    the lived experiences of trauma survivors.
  • Care is peer driven and evaluated

Trauma-Informed Care Highlights
  • Incorporate trauma into the development of
    individualized plans of care for every adult and
    child with serious mental health and/or substance
    abuse problems. The plan should be developed in
    collaboration with the consumer, and should
    address trauma its impact on the individual the
    prevention of re-traumatization the provision
    of, or referral to, trauma-informed and
    trauma-specific treatment and supports and the
    integration of trauma, mental health and
    substance abuse in counseling and treatment

  • Individualized person-centered
  • Empowerment-based
  • Personal responsibility-based
  • Holistic
  • Peer support
  • Hope-based
  • Strength-based
  • Non-linear
  • Self directed collaboration
  • Dignity respect-based

Core Strategies for the Reduction of Seclusion
and Restraint
  • Six Core Strategies for the Reduction of
    Seclusion and Restraint. These include
    leadership toward organizational change use of
    data, workforce development use of S/R reduction
    tools consumer roles in inpatient settings and
    debriefing activities.

Procedures to Avoid Re-traumatization and Reduce
Impacts of Trauma
  • An effort should be made to reduce or eliminate
    any potentially re-traumatizing practices such as
    seclusion and restraint, involuntary medication,
    etc. Training should cover dynamics of
    re-traumatization and how some practices could
    mimic original sexual and physical abuse
    experiences, trigger trauma responses, and cause
    further harm to the person. Specific policies
    should be in place to create safety acknowledge
    and minimize the potential for re-traumatization
    assess trauma history address trauma history in
    treatment and discharge plans respect gender
    differences and provide immediate intervention
    to mitigate effects should interpersonal violence
    occur in care settings (Glover, R. W. ,2005).

Sensory Rooms
  • The use of sensory rooms as a tool in care.
  • A place to be calm
  • A place to be quiet
  • A place to remove stimuli
  • A place for therapy
  • A place to pray
  • A place to regulate emotions

Sensory Rooms
  • The sensory room can be useful for
  • Developing a therapeutic relationship.
  • Admission interview- set up the room with music,
    a blanket and a comfortable place for the patient
    to feel in control.
  • A relaxing place before bedtime.
  • A safe place for an agitated, anxious, and
    escalating client.
  • Meetings with a contact person or therapist.

TIC-Change of Culture at BHD
  • TIC helps all services at BHD join together to
    provide trauma-informed care by the inclusion of
    all employees.

TIC-Change of Culture at BHD
  • Acknowledge that trauma and compassion fatigue
    experienced by staff impacts their willingness to
  • Acknowledge that patient and staff safety have to
    be key point for staff.
  • Acknowledge that the management vs. front line
    staff attitudes and perceptions have to change.

Core Principles of Practice for Employees
  • Safety Ensure physical and emotional safety of
    staff throughout our system of care.
  • Trustworthiness Administration must consistently
    relay procedures and expectations.
  • Choice Enhance staff choice in the control of
    the day to day work.
  • Collaboration Maximize collaboration and sharing
    of power.
  • Empowerment Provide skill building, find ways to
    empower staff and provide needed resources.

Core Principles for Patients
  • Safety Ensure physical and emotional safety of
    patients throughout our system of care.
  • Trustworthiness Make tasks and expectations
    clear and maintain appropriate boundaries.
  • Choice Enhance patient choice and control
  • Collaboration Maximize collaboration and sharing
    of power with patients.
  • Empowerment Provide skill building, find ways to
    empower patients, and provide needed resources.

Consumer Care
  • Develop key trust points to
  • share with patients.
  • Be on time.
  • Take time to talk and listen.
  • Work together on a plan for expectations and
  • Inform consumers of changes in care before they

  • Be a model for change.
  • Use data to monitor change and inform practice.
  • Develop attitudes, behaviors and core
  • Assess risk for violence.
  • Be present on the units to model and witness
  • Use tools to teach self-management of illness and
  • Rigorously debriefing analysis of events that do
  • Complete inclusion of consumers in their own
  • Recognize peer support as a vital component of
    the spirit of recovery.

Unit Staff
  • Be open to change.
  • Assess for risk for violence and need for
    seclusion and restraint (BVC).
  • Use tools to teach self-management of illness and
  • Rigorous debriefing analysis of events that do
  • Complete inclusion of consumers in their own
  • Peer support is a vital component of the spirit
    of recovery.

TIC Teams
  • Each unit to have 2-3 TIC volunteers (RN, Peer
    Specialist, OT, PhD ).
  • Teams to be the go to persons in TIC values and
  • Each team to develop one TIC project from the
    guiding values list (see slide 25) with a
    timeline for action.
  • TIC committee to offer support, feedback,
    guidance e.g. literature search.

TIC Introduction to the Units
  • Roaming poster on each unit for one week.
  • Poster to describe core TIC values guidelines.
  • Staff to have a chance to take a risk assessment
    for compassion fatigue and take the time to be
    self trauma informed.
  • Staff can fill out a questionnaire about Trauma
    Informed Care and what positives and challenges
    there are in creating this system at BHD.
  • Staff to have a contact person for questions.

Circle of Care in TIC
Thoughts from Helen Keller
  • The extraordinary Helen Keller, despite being
    blind and deaf, achieved so much in her life. She
    once saidThe world is moved not only by the
    mighty shoves of the heroes, but also by the
    aggregate of the tiny pushes of each honest
    worker.Each of us is a honest worker caring
    and giving so much of ourselves to help others.
    If we all push a little we can move mountains and
    ourselves. We are so intertwined, we caregivers
    and care recipients, that rules and regulations
    that are aimed at helping them also help us, and
    rules and regulations that are designed to help
    us also help them.

  • Fisher, D. (2007) How consumers step up to design
    a truly recovery-based mental health system.
    National Council Magazine (3).
  • Glover, R. W. (2005) Special Section on Seclusion
    and Restraint Commentary Reducing the Use of
    Seclusion and Restraint A NASMHPD Priority.
    Psychiatric Services. 56 1141-1142 doi
  • Jennings, A. (2004) Models for Developing
    Trauma-Informed Behavioral Health Systems and
    Trauma-Specific Services. U.S. Department of
    Health and Human Services. Retrieved from
  • Prochaska, J., Norcross, J. DiClemente, C.
    (2009) Changing for Good A Revolutionary
    Six-Stage Program for Overcoming Bad Habits and
    Moving Your Life Positively Forward. Retrieved