The Trauma-Informed
Multdisciplinary Team
Jerri Sites, MA
Outreach Coordinator
What is Trauma?
Facts Every Team Member
Should Know
Trauma Defined
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.
-SAMHSA Trauma and Justice Strategic Initiative
Traumatic Events
Overwhelm
a victim’s
capacity to cope
Elicit feelings of
terror
Cause physiological
reactions
Cause a sense of
powerlessness
The ACE Study
Adverse Childhood Experiences Study
• 17,500 patients participated
• Dr. Vincent Fellitti - Kaiser Permanente
• Dr. Robert Anda - CDC
The 10 ACEs
1.
2.
3.
4.
5.
6.
Physical abuse
8. Parental incarceration
Emotional abuse
9. Parental separation or
divorce
Sexual abuse
10. Domestic violence
Physical neglect
Emotional neglect
(complete handout)
Mental illness in household
handout)
ACEs Outcomes
• Every “yes” = one point on the ACE score
• 67% of participants in the study had at least one ACE
• Over 20% experienced 3 or more ACEs
• 12.6% (1 in 8) had four or more ACEs
• The higher the ACE score, the worse the health outcomes of the
participant
ACEs Outcomes
Bottom line…
The more adverse life events individuals
childhood, the greater their risk of serious
behavioral health problems:
Chronic Disease
Depression
Alcoholism
Drug Abuse
Smoking
Severe Obesity
Sexual Promiscuity
Poor Anger
Suicide Attempts
Control
ACEs and the Brain
Exposure to adversity early in life affects
developing brains and bodies of children:
• Hippocampus - memory storage
• Prefrontal cortex - impulse control and
critical area for learning
• Amygdala – fear response center which
behavior
• Hypothalamus – stress response center
Dr. Nadine Burke’s Analogy
ACEs and the Brain
For people who have repeated adverse
experiences
• These systems are activated over and over
• They move from being adaptive or life-saving
maladaptive or health-damaging
• For children, high doses of adversity affects
• Brain structure and function
• Developing immune system
• Developing hormone system
Three Core Groups of
Post-traumatic Stress Reactions
1. Re-experiencing the event, including strong
physical & emotional reactions
• Have a hard time distinguishing new, safer
situation from the traumatic situation
• Overreacting to other things that happen,
as if danger were about the happen again
Three Core Groups of
Post-traumatic Stress Reactions
2. Avoidance
• Trying to avoid any situation, person or
place that reminds us of what happened
• May “forget” some of the worst parts of the
experience, while continuing to react to
reminders of those moments
Three Core Groups of
Post-traumatic Stress Reactions
3. Our bodies stay on “on alert”
• Trouble sleeping
• Become irritable or easily angered
• Startle of jump at noises
• Trouble concentrating or paying attention
• Physical symptoms (i.e. headaches,
stomachaches)
Let’s Recap…
Traumatic Stress Response Cycle
Source: Georgetown University Center for Child & Human Development. (n.d.). Stress and the
developing brain: The stress response. Retrieved from Center for Early Childhood Mental Health
Consultation website: http://www.ecmhc.org/tutorials/trauma/mod2_1.html
Let’s Recap…
Traumatic Stress Response Cycle
Let’s Recap…
Traumatic Stress Response Cycle
Past trauma causes the brain to interpret
minor events as threatening.
• The limbic system has a disproportionate
fear/emotional response to the experience
and sends signals to the brainstem.
• Cortisol and adrenaline are released,
increasing heart rate and respiration.
Source: Campbell, J.S.W. (n.d.). Trauma and the brain. Retrieved from the KidsPeace Institute
website: http://www.kidspeace.org/healing.aspx?id=2514
Let’s Recap…
Traumatic Stress Response Cycle
• Fight, flight, or freeze response occurs.
• Prefrontal cortex is skipped (lack of
reasoning), leading to impulsive reactions.
• Memories of the event can be foggy and
stored erratically.
Source: Campbell, J.S.W. (n.d.). Trauma and the brain. Retrieved from the KidsPeace Institute
website: http://www.kidspeace.org/healing.aspx?id=2514
Trauma can look different
for every kid.
What we see is
just the tip of the
iceberg.
What Trauma Can Look Like
what we can see with our eyes. . .
Hostility/
Coldness
Problems with
change and
transitions
Perceiving
danger
everywhere
Anger
Acting guarded
and anxious
What Trauma Can Look Like
what we can see with our eyes. . .
Physical &
emotional
reactivity
Difficulty
being
redirected
Rejecting
support from
peers &
adults
Difficulty
letting go –
holding
grievances
Behaving much
younger than
his/her age
Trauma affects the entire
family and the broader
systems in the child’s life
Traumatic Events
Often Generate Secondary Adversities
How can we make a difference?
• Recognize ACE in children and their families
• Offer services to support children and their families to
address ACE in an effort to prevent further negative
outcomes
• Create a system-wide trauma-informed response providing
trauma-informed care
ACEs Exercise
• Review case scenario
• Identify ACEs for:
Grandma
Jon and Julie
David
The 10 ACEs
1.
2.
3.
4.
5.
6.
Physical abuse
8. Parental incarceration
Emotional abuse
9. Parental separation or
divorce
Sexual abuse
10. Domestic violence
Physical neglect
Emotional neglect
Mental illness in household
7. Parental substance abuse
The good news…
In child cases,
the system’s response
has changed.
The Old Way
What do I need from this child/family for my
case/agency?
The New Way
What do this child and family need from our
community?
The Child/Family Centered Approach
and
Trauma-Informed Care
The Four R’s of the
Trauma-Informed Approach
(SAMSHA)
A program, organization or system that is traumainformed:
1. Realizes the widespread impact of trauma and
and understands potential paths for discovery
2. Recognizes the signs and symptoms of trauma in
trauma in clients, families, staff, and others
3. Responds by fully integrating knowledge about
about trauma into policies, procedures, and
4. Seeks to actively resist re-traumatization.
8 Essential Elements of a Trauma-Informed Juvenile
Justice System
(NCTSN)
1.
Trauma-informed policies and procedures
2.
3.
4.
5.
6.
7.
Identification/screening of youth who have been traumatized
Clinical assessment/intervention for trauma-impaired youth
Trauma-informed programming and staff education
Prevention and management of secondary traumatic stress
Trauma-informed partnering with youth and families
Trauma-informed cross system collaboration
8. Trauma-informed approaches to address disparities and diversity
Rainbow House Regional CAC
Protocol Updates
• Forensic Interviews
• Scheduling prioritization
• Pre-interview Form
• Interviews of children with problem sexual behaviors
• Child and Family Advocacy
• Mental Health Network Intake Form
• Mental Health Network
• Linkage Agreement
Essential Elements Exercise
How your MDT and community can address each of the
Essential Elements through agency policy and your MDT
protocol?
List three ways…
Let’s discuss!!!
How professionals interact
with children can have a
profound influence on the
course of the child’s posttrauma adjustment.
Sources
• ACE Study https://www.cdc.gov/violenceprevention/acestudy/about.html
• Morrison, et al; McSilver Institute for Poverty Policy and Research,
NYU; “Harnessing the learning community model to integrate
trauma-informed care principles in service organizations,”
NYU/Silver copyright 2015
Sources
• SAMSHA Trauma Interventions http://www.samhsa.gov/nctic/trauma-interventions
• SAMSHA’s Concept of Trauma and Guidance for a Trauma-Informed
Approach , July 2014 - http://store.samhsa.gov/shin/content//SMA144884/SMA14-4884.pdf
• NCTSN’s Essential Elements of a Trauma-Informed Juvenile Justice
System
http://www.nctsn.org/sites/default/files/assets/pdfs/JJ_factsheet_
bw.pdf
Concepts for Understanding Child Traumatic Stress
Responses in Childhood
Adapted from the NCTSN Core Curriculum on Childhood Trauma Task
Force (2012). The 12 core concepts: Concepts for understanding
traumatic stress responses in children and families. Core Curriculum
on Childhood Trauma. Los Angeles, CA, and Durham, NC: UCLA-Duke
University National Center for Child Traumatic Stress.
Thank You!
National Children’s Advocacy Center
• Jerri Sites – Outreach Coordinator SRCAC
• [email protected]
Rainbow House Regional Child Advocacy Center
• Brenda Berger and Sarah Heckman - Advocates
• [email protected]
• [email protected]