Transcript Slides

April 21, 2016
HHQI UP Network Webinar
Long-Term Negative
Effects of Trauma
This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality
Improvement Organization supporting the Home Health Quality Improvement National Campaign,
under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S.
Department of Health and Human Services. The views presented do not necessarily reflect CMS policy.
Publication number 11SOW-WV-HH-MMD-042116A
Presenter
 Karen Yost, MS, LSW, LPC, NCC, ALPS, CSOTS, MAC
Chief Executive Officer
Prestera Center for Mental Health
 Free continuing education credits (1.5 hours)
– Nursing CEs (ANCC)
– Social Worker (NASW)
Long-Term Negative Effects of Trauma
This is Anna at age one.
This is Anna years later
in a mental institution.
What happened?
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An emotional shock that creates significant and lasting
damage to a person’s mental, physical and emotional growth
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Traumatic experiences can significantly alter a person’s
perception of themselves, their environment, and the people
around them. In effect, trauma changes the way people view
themselves, others and their world.
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Can impact safety, well-being, permanence
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Over 90% of mental health clients have trauma histories.
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In state hospitals, estimates range up to 95%.
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90% or more of women in jails and prisons are victims of physical or sexual
abuse.
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Up to 2/3 of men and women in substance abuse treatment report
childhood abuse or neglect.
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Similar statistics exist for foster care, juvenile justice, homeless shelters,
welfare programs, etc.
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25-30% of disaster survivors develop PTSD, but 100% will likely experience
some form of trauma.
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Children & women
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American Indian/Alaska Native
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Veterans
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Refugees and immigrants
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People who are homeless
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People who are institutionalized in mental health or criminal
justice systems
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Annual Direct Costs: Hospitalization, Mental Health, Child
Welfare Service System, Medical care = $361 billion.
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Annual Indirect Costs:
 Lost Productivity = $64.4 billion
 Special Ed, Juvenile Justice, Criminal Justice System
Economic Impact Study. Prevent Child Abuse America; Centers for Disease Control, The Ross Institute,
Economic Costs of Drug Abuse in the US (The Lewin Group)
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NOT a diagnostic category
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There is no universal definition of trauma. It is defined by the
person who has had the experience.
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An experience or series of experiences that elicits feelings of
terror, powerlessness, & out-of-control psychological arousal;
result in survival driven behaviors, thoughts, emotions, &
needs.
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Often misinterpreted & assigned as symptoms of disorders
(Depression, Bipolar Disorder, ADHD, Oppositional Defiant
Disorder/ Conduct Disorder, Attachment Disorder, etc.)
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These diagnoses generally do not capture full extent of
developmental impact of trauma.
Trauma can be:
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A single event
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A connected series of events
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Chronic lasting stress
Trauma is under-reported and under-diagnosed.
(NTAC, 2004)
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Acute Trauma: a single traumatic event
that is limited in time
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Chronic Trauma: the experience of
multiple traumatic events
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System-Induced Trauma: the traumatic
removal from home, admission to a
detention or residential facility or multiple
placements within a short time.
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Complex Trauma: both exposure to
chronic trauma, and the impact such
exposure has on an individual.
Acute
Trauma
Chronic
Trauma
Vicarious
Trauma
Complex
Trauma
System
Induced
Trauma
Loss of a loved one
Abandonment
Accidents
Homelessness
Community/school violence
Bullying, including cyberbullying
 Domestic violence
 Neglect
 Frequent moves
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Serious medical Illness
Physical abuse
Sexual abuse
Emotional/verbal abuse
Man-made or natural disasters
Witnessing violence
Terrorism
Refugee and War Zone trauma.
Trauma can occur at any age.
Trauma can impact anyone.
Bridging the gap between
childhood trauma and negative
consequences later in life
50% of study participants reported at
least one adverse childhood experience
25% reported at least two or more
untreated trauma
Adverse childhood experiences
increase the risk of:
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Heart Disease
Chronic Lung Disease
Liver Disease
Diabetes
Cancer
Immune Disease
Heart
Disease
Chronic
Lung
Disease
Immune
Diseases
Adverse
Childhood
Experiences
Liver
Disease
Cancer
Diabetes
Adverse childhood experiences
increase the risk of:
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Mental Illness
Relationship Problems
Behavior Problems
Poor Self-Esteem
Substance Abuse
Suicide
Mental
Illness
Relationship
Problems
Suicide
Adverse
Childhood
Experiences
Substance
Abuse
Behavior
Problems
Poor SelfEsteem
With an ACE Score of 4 or more, the
majority of adults are at significantly
higher risk factors for these diseases and
health risk behaviors.
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Adults with ACE score >4 are 460% more likely to have lifetime
history of depression.
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Adults with ACE score >5 are 16 times more likely to have
lifetime history of alcoholism.
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Male child with ACE score of 6 has 4,600% increase in
likelihood of later becoming IV drug user.
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Chronic trauma interferes with neurobiological development
and the capacity to integrate sensory, emotional and
cognitive information into a cohesive whole.
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Developmental trauma sets the stage for unfocused
responses to subsequent stress.
Bessel A. van der Kolk , MD
http://www.traumacenter.org/products/pdf_files/Preprint_Dev_Trauma_Disorder.pdf
Can cause impairments in many areas of development &
functioning, including:
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Attachment – difficulty relating to & empathizing with others;
believe the world to be uncertain & unpredictable; multiple
moves
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Biology – problems with sensation & movement, including
hypersensitivity to physical contact & insensitivity to pain;
physical symptoms & increased medical problems
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Mood Regulation – difficulty identifying & controlling emotions &
internal states
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Behavioral Control – poor impulse control, self-destructive
behavior, aggression, risk taking behavior
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Dissociation – feeling detached, as if observing something
happening to them that is not real
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Cognition – difficulty focusing & completing tasks or anticipating
future events; learning difficulties & problems with language
development
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Self-concept – feeling shame/guilt; low self-esteem, disturbed
body image
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Loss & Betrayal – loss of part(s) of their life; distrust of others
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Powerlessness – perceive self as victim; have no say in what
happens to them; unable to control their lives, etc.
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Serious consequences for normal development of children’s
brains, brain chemistry & nervous system
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Trauma-induced alterations in biological stress symptoms can
adversely effect brain development, cognitive & academic skills, &
language development.
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Result in increased levels of stress hormones (impacts response to
future stress)
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Affects “cross-talk” between brain’s hemispheres, including parts
that:
 regulate emotions
 manage fears, anxieties & aggression
 sustain attention for learning & problem solving
 control impulses & manage physical responses to danger
 allow realistic appraisal of danger & safety
 promote consideration of consequences of behavior
 allow ability to govern behavior & meet longer term goals
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Event – the event and circumstances, the threat, harm or potential
of harm
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Experience – individual perception of the event, development,
culture, shaped by feelings of powerlessness/guilt
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Effect – adverse effects (what, duration, severity), degree of ability
to cope, degree of support, any altering of neurobiological makeup and on-going health & well-being
This
A conditioned response that
happens automatically when
faced with a stimuli associated
with traumatic experiences
Not This
Seeing, feeling, hearing, smelling something that
reminds us of past trauma activates the alarm system...
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The response is as if there is current danger.
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Thinking brain automatically shuts off in the
face of triggers.
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Past and present danger become confused.
Trauma-Informed Care provides a new paradigm under
which the basic premise for organizing services is
transformed from...
“What’s wrong with you?”
to
“What happened to you?”
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Early Screening & Assessment of Trauma
Consumer Driven Care & Services
Trauma-Informed, Educated & Responsive Workforce
Trauma-Informed, Evidence-Based, & Emerging Best
Practices
Safe & Secure Environment
Community Outreach & Partnership Building
Ongoing Performance Improvement
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Awareness: Everyone understands the impact of trauma & cultural,
historical & gender issues
Safety: Ensuring physical and emotional safety
Trustworthiness & Transparency: Maximizing trustworthiness, making
tasks clear, and maintaining appropriate boundaries
Voice & Choice: Prioritizing consumer choice and control
Collaboration & Mutuality: Maximizing collaboration and sharing of
power with consumers
Empowerment: Prioritizing consumer empowerment and skill-building
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“Trauma-Informed Care is a strengths-based framework that is
grounded in an understanding of and responsiveness to the impact
of trauma, that emphasizes physical, psychological, and emotional
safety for both providers and survivors to rebuild a sense of control
and empowerment.” (Hopper et al, 2010)
“Trauma-informed organizations, programs, and services are
based on an understanding of the vulnerabilities or triggers of
trauma survivors that traditional service delivery approaches may
exacerbate, so that these services and programs can be more
supportive and avoid re-traumatization.” (SAMHSA)
 Community Connections – Creating Cultures of Trauma Informed Care
http://communityconnectionsdc.org/web/page/673/interior.html
 Trauma-Informed Organizational Toolkit http://www.familyhomelessness.org/media/90.pdf
 Trauma-Informed Care; Best Practices and Protocols for Ohio’s Domestic Violence Programs
http://www.odvn.org/images/stories/FinalTICManual.pdf
 Creating Cultures of Trauma-Informed Care; A Self-Assessment and Planning Protocol
http://www.annafoundation.org/CCTICSELFASSPP.pdf
 Shelter from the Storm: Trauma Informed Care in Homelessness Services Settings Article
http://homeless.samhsa.gov/ResourceFiles/cenfdthy.pdf
 Adverse Childhood Experience Study
http://www.acestudy.org/
 Community Re-Traumatization Article
http://www.annafoundation.org/COMMUNITY%20RETRAUMATIZATION.pdf
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Eyberg, S.M. (1988). Parent-child interaction therapy: Integration of traditional and behavioral
concerns. Child and Family Therapy, 10, 33-46.
Complex Trauma in Children and Adolescents. Focal Point, Winter/2007, Vol. 21, No.1.
www.rtc.pdx.edu.
National Registry of Evidence-based Programs and Practices. http://www.nrepp.samhsa.gov
Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services,
(2007) Update: Draft for Publication by SAMHSA/CMHS Ann Jennings, Ph.D
Criteria for Building a Trauma-Informed Mental Health Service System.pdf. Ann Jennings, Ph.D.
Blueprint for Action: Building Trauma-Informed Mental Health Service Systems: State
Accomplishments(pdf), (2007) States’ Reports on Trauma-Informed Activities Organized by
Individual States, Ann Jennings, Ph.D.
Blueprint for Action: Building Trauma-Informed Mental Health Service Systems: State
Accomplishments(pdf). (2007) States' Reports on Trauma-Informed Activities Organized to Trauma
Informed Criteria. Anna Jennings, PhD.
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Florida Dept. of Children & Families Children’s Mental Health, Jane B. Streit, Ph.D., Sr. Psychologist,
2010.
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National Child Traumatic Stress Network, Child Welfare Trauma Training Toolkit, 2008.
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http://www.cdc.gov/ace/prevalence.htm. The ACES Experience.
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Kerker & Dore (2006). Mental health needs and treatment of foster youth: Barriers and
opportunities, American Journal of Orthospychiatry, 76(1), 138-147.
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Pynoos & al., Issues in the developmental neurobiology of traumatic stress. Annals of the New York
Academy of Sciences, 821, 176-193.
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Perry, B. (2003). The cost of caring: Secondary traumatic stress and the impact of working with
high-risk children and families. The Child Trauma Academy.
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Pecora et al., Assessing the effects of foster care: Early results from the Casey National Alumni
Study. Casey Family Programs.
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The Economic Costs of Drug Abuse in the US 1992-1998. Report prepared by The Lewin Group
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Prevent Child Abuse America. Total estimated cost of child abuse and neglect in the United States:
Statistical evidence. Report funded by the Edna McDonnell Clark Foundation.
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The Ross Institute (www.rossinst.com)
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Centers for Disease Control and Prevention Study, published in the American Journal of Preventive
Medicine (June 2007).
Questions?
HHQI Resources
 Underserved Populations Best
Practice Intervention Package
(BPIP)
 Archived UP Webinars
– Compulsive Hoarding for Care Managers
(06/12/13)
Continuing Education
 HHQI University
 Free continuing education credits (1.5 hours)
– Nursing CEs (ANCC)
– Social Worker (NASW)
 Requirements
– Watch this webinar (1 hr)
– Complete a course, post-test, and evaluation (30 min)
– Download & print your certificate
 HHQI University Quick Start Guide & Continuing Education FAQs
 Contact [email protected] with any questions
Continuing Education Steps
Follow these steps to get your CE certificate:
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Register/log in to HHQI University.
Locate the Long-Term Negative Effects of Trauma course in the General course catalog.
Click on "Enroll" under the apple icon.
Click on "My Account" to launch the course.
Click on the green icon in the View column.
Click on the green icon in the Action column next to Lesson 1.
• Review the e-Learn content. (10 minutes)
• Watch the UP Networking webinar. (1 hour)
• Take the post-test. (10 minutes)
– After completing the e-Learn, click on the green icon in the Action column next to Lesson 2.
• Complete the course evaluation.
– After completing the evaluation, you can print your certificate from the "My Account" area
in HHQI University
Next UP Networking Event
 Delivering Culturally Confident Care: A 365 Approach
– July 21, 2016 at 2 pm (ET)
– Emeobong “Eme” Martin, BS, MPH
Project Manager
The Center on Health Disparities
Adventist HealthCare
HHQI National Webinar Event
 Patient Safety Culture: A Foundation for a QAPI Program
– May 17, 2016 at 2 pm (ET)
– Tina Hilmas, RN, BSN
Project Manager
Center for Patient Safety
– Registration will open to the public April 27
under the Webinars tab on HHQI website
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