Overview & self study guide to Trauma Informed Care with Links to source info & video links

1. Trauma Informed Care
(TIC)
Raising the Standard of Care Initiative
December 9,2015
Presented by Jose B. Ochoa, LCSW

2. Goal of In-service: Psycho-Education about TIC
• Recognize & Understand the Impact of Adverse Childhood Experiences can
have on human health & functioning. (6 & 7, 25-31)
• Understand that unresolved Trauma directly relates to poorer functioning
& health outcomes over the entire human lifespan. (20-24)
• Be aware that recovery from Trauma happens when it is appropriately
identified & addressed. (5, 25, 33-46)
• Be conscious of reducing & eliminating service system(s) re-
traumatization. (51)
• Comprehend Children’s Specialty MH Services role in the Context of the
larger Health Care System. (49-50)
• Understand the inherent risk for Secondary Traumatization Symptoms
(STS) in our Work with Children, & what we must do to minimize/eliminate
its effects. (52-54 & Worksheet)
• Provide you with a primary resource to learn & study, to be a skilled
behavioral health worker in a Trauma Informed Care System. (5-19)

3. On Becoming Trauma Informed

4. A Foundation of Healthy Child
Development
• A vital and productive society with a prosperous and sustainable future is
built on a foundation of healthy child development.
• Health in the earliest years—beginning with the future mother’s well-
being before she becomes pregnant—lays the groundwork for a lifetime of
the physical and mental vitality that is necessary for a strong workforce
and responsible participation in community life.
• When developing biological systems are strengthened by positive early
experiences, children are more likely to thrive and grow up to be healthy,
contributing adults. Sound health in early childhood provides a foundation
for the construction of sturdy brain architecture and the achievement of a
broad range of skills and learning capacities.
• Together these constitute the building blocks for a vital and sustainable
society that invests in its human capital and values the lives of its children.
http://pediatrics.aappublications.org/content/129/1/e232.full#sec-9

5. Trauma-Specific vs. Trauma-Informed
Definitions (SAMHSA, 2014)
Trauma-specific services: The term “trauma-specific services” refers to evidence-
based and promising prevention, intervention, or treatment services that address
traumatic stress as well as any co-occurring disorders (including substance use
and mental disorders) that developed during or after trauma.
Trauma-informed care: Trauma-informed care is a strengths-based service
delivery approach “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, and that creates opportunities for
survivors to rebuild a sense of control and empowerment” (Hopper, Bassuk, &
Olivet, 2010, p. 82). It also involves vigilance in anticipating and avoiding
institutional processes and individual practices that are likely to retraumatize
individuals who already have histories of trauma, and it upholds the importance
of consumer participation in the development, delivery, and evaluation of
services.
http://www.air.org/sites/default/files/downloads/report/Trauma-
Informed%20Care%20White%20Paper_October%202014.pdf

6. Hurt people hurt people!
“Hurt people hurt people. We are not being judgmental by separating
ourselves from such people. But we should do so with compassion.
Compassion is defined as a "keen awareness of the suffering of another
coupled with a desire to see it relieved." People hurt others as a result of
their own inner strife and pain. Avoid the reactive response of believing they
are bad; they already think so and are acting that way. They aren't bad; they
are damaged and they deserve compassion. Note that compassion is an
internal process, an understanding of the painful and troubled road trod by
another. It is not trying to change or fix that person.”-Will Bowan , Complaint
Free Relationships: Transforming Your Life One Relationship at a Time
Healing from trauma happens when the cycle of pain stops!-Jose O.

7. Hurt people hurt people
See also: Birth Parents with Trauma Histories
For your review-A Guide for Mental Health
Professionals.
See:
http://nctsn.org/sites/default/files/assets/pdfs/
birth_parents_trauma_resource_mh_profession
als.pdf

8. Core Components Found in Effective
Evidence-Based Trauma Treatment 1
The current research on treatment models for child traumatic stress suggests several
common elements found in effective evidence-based trauma treatment. Child welfare
staff should be able to identify these common elements in any proposed treatment
plan for children presenting with primary trauma issues:
• Parent support, conjoint therapy, or parent training: This may include
incorporating the birth parent(s) and/or resource parents in treatment as
appropriate. While the final decision regarding inclusion of the caregiver in
treatment should be made by a well-trained mental health professional, it is often
advantageous to incorporate the birth parent actively in the treatment process,
particularly if there is an active plan for reunification. (e.g. PCIT)
• Building a strong therapeutic relationship: The therapeutic relationship is
considered to be core to any effective treatment modality. Research has shown
that no matter which evidence-based practice a mental health provider is utilizing
with a client, it will not be effective if there is no relationship established.

9. Core Components Found in Effective
Evidence-Based Trauma Treatment (Cont.) 2
• Providing psychoeducation (i.e., information on
psychological principles that guide human behavior)
to children and caregivers:
Depending on the type of trauma experienced,
psychoeducation will focus on normal responses
to trauma, information about the traumatic
event, and information to help children
differentiate healthy vs. unhealthy behaviors
(e.g., good touch, bad touch).
See: http://tfcbt.musc.edu/

10. • Emotional expression and regulation skills: This may include
helping children increase their ability to identify various
feelings and develop coping mechanisms for managing
difficult feelings such as anger, sadness, or anxiety.
• Anxiety management and relaxation skills: The therapist will
often work with the child to help the child develop relaxation
skills. This will include practices such as visualization, deep
breathing exercises, progressive muscle relaxation, etc.
Core Components Found in Effective
Evidence-Based Trauma Treatment (Cont.) 3

11. Core Components Found in Effective
Evidence-Based Trauma Treatment (Cont.) 4
• Cognitive processing or reframing: Many children who have experienced a traumatic event
will blame themselves. For example, a child who has been sexually abused may
believe that he/she wore the wrong outfit that day. A child who has witnessed
domestic violence may blame himself/herself for the offender’s angry outburst.
Effective treatment will help the child identify the connection between his/her
thoughts, feelings, and behaviors (i.e., the cognitive triangle), and identify his/her
inaccurate thoughts and replace them with more helpful and accurate thoughts.
• Strategies that allow exposure to traumatic memories and feelings in tolerable doses so
that they can be mastered and integrated into the child’s experience:
The primary goal of trauma treatment is to help the child integrate the trauma
experience so that it is one of his/her many life experiences, not his/her defining life
experience. In order to integrate the trauma experience into his/her life, the child will
often complete a trauma narrative with his/her therapist that allows the child to tell
the story repeatedly, in tolerable doses while utilizing his/her relaxation techniques, so
that the event loses its power and ceases to raise his/her anxiety level. This may be
done through a number of creative ways chosen by the child, including writing a story,
writing a song, drawing pictures, etc. The child will then share this information with a
supportive caregiver to help validate his or her experience and encourage open
discussion of the trauma. For children who have experienced ongoing, complex
trauma, a life narrative can be created.

12. Core Components Found in Effective
Evidence-Based Trauma Treatment (Cont.) 5
• Personal safety training and other important
empowerment activities: Building on the psychoeducation
previously described, the therapist will work with the
child to develop healthy boundaries and ways to enhance
physical and psychological safety.
• Resilience and closure: At termination of treatment, the
therapist will focus on helping the child to identify his/her
strengths and areas of resilience that can be used to cope
with future adversity. Treatment closure should also include
helping the family prepare for and cope with reactions and
trauma reminders that may occur on the anniversary of the
traumatic event, since symptoms may return in the
presence of these reminders.

13. Core Components Found in Effective
Evidence-Based Trauma Treatment (Cont.) 6
Eye Movement Desensitization and
Reprocessing (EMDR) therapy is an integrative
psychotherapy approach that has been extensively researched
and proven effective for the treatment of trauma. EMDR is a set
of standardized protocols that incorporates elements from many
different treatment approaches. To date, EMDR therapy has
helped millions of people of all ages relieve many types of
psychological stress.
http://www.emdria.org/

14. https://www.thenationalcouncil.org/topics/trauma-informed-care/
Dr. Bruce Perry-Helping Children Recover From
Trauma (91 min.)

15. Culture and Trauma
• Culture can broadly be defined as a dynamic
pattern of language, beliefs, values, rituals, and
customs that characterize specific racial, ethnic,
religious, or social groups.
• Promoting trauma-informed treatments and
services in a culturally competent manner is
essential to raise the standard of care and
improve access to services for traumatized
children, their families, and communities
throughout the United States.

16. Culture and Trauma
Culture and trauma have a profound
bidirectional influence on each other.
Culture shapes attitudes towards traumatic
experiences (e.g., sexual abuse, illness,
accidents, physical abuse) as well as how
children and families respond to—and recover
from—trauma exposure.
http://www.nctsn.org/sites/default/files/assets/pdfs/CCG_Book.pdf

17. Culture and Trauma
In exploring the impact of trauma on diverse cultural groups,
it is important that terms such as culture, race, and ethnicity
do not become proxies for other variables, such as
socioeconomic status or acculturation.
Cultural competence seek to capture the complexity of these
issues and to include representatives of populations that are
often excluded from discussions of race and ethnicity, such as
youth with
• disabilities (e.g., deaf and hard of hearing)
• homeless youth
• lesbian, gay, bisexual and transgendered youth
• religious and spiritual youth
• and youth living in rural areas.

18. Cultureand Trauma
Trauma-Informed Care for Displaced Populations
A Guide for Community-Based Service Providers
http://www.familyhomelessness.org/media/405.pdf
Introduction
• Displaced children and adults represent a unique subgroup within the U.S. population. While displacement
can occur for a variety of reasons - war, natural disasters, extreme poverty, or persecution - individuals,
children, and families within this group face complex challenges as they leave their homelands and work
to establish a home in a new world. It can take decades to fully adjust (Clark, 2003). Common adjustment
issues include adapting to a new culture, language, climate or environment, and learning new customs,
while simultaneously maintaining family and cultural traditions.
• This Guide can be used by community-based organizations that work with families, children, youth,
unaccompanied minors, and individuals in various settings (e.g., outpatient settings, mental health,
transitional housing programs, shelters, and schools). Leaders within these organizations who are looking
to improve their effectiveness in engaging displaced populations can use this tool to begin the process of
integrating a trauma-informed approach.
Trauma-Informed Care for Displaced Populations: A Guide for Community-Based Service Providers includes:
1. Background information on displaced populations, trauma-informed care, and the creation of
the Trauma-Informed Organizational Self-Assessment for Displaced Populations.
2. The Trauma-Informed Organizational Self- Assessment for Displaced Populations.
3. Additional resources.

19. SAMSHA Treatment Improvement Protocol (TIP)
• http://www.integration.samhsa.gov/clinical-
practice/SAMSA_TIP_Trauma.pdf
• Those individuals who have experienced
repeated, chronic or multiple traumas are
more likely to exhibit pronounced symptoms
and consequences, including substance abuse,
mental illness, and health problems.

20. Prevalence of Trauma Across
Service Systems
Justice
• 96% of female offenders have experienced
trauma, often in the form of sexual abuse and
intimate partner violence (Jennings, 2008).
• 75%–93% of youth involved with juvenile
justice have experienced trauma (Justice
Policy Institute, 2010).

21. Prevalence of Trauma Across
Service Systems
Homeless
• 93% of homeless mothers have a lifetime history
of interpersonal trauma (Bassuk et. al., 1997;
Bassuk, E. L., Buckner, J. C., Perloff, J. N., &
Bassuk, S. S. (1998); Hayes, Zonneville, & Bassuk,
2013; Weinreb, Buckner, Williams, & Nicholson,
2006).
• 83% of homeless children have been exposed to
at least one serious violent event by age 12
(Buckner, Beardslee, & Bassuk, 2004).

22. Prevalence of Trauma Across
Service Systems
Mental and Behavioral Health
• 93% of psychiatrically hospitalized adolescents
have histories of physical and/or sexual and
emotional trauma (Lipschitz, Winegar,
Hartnick, Foote, & Southwick, 1999).
• 75% of clients in substance abuse treatment
settings report histories of significant trauma
(Jennings, 2004).

23. Prevalence of Trauma Across Service
Systems
Veterans
• 81%–93% of women veterans have been exposed
to trauma over their lifetimes (Zinzow, H.,
Grubaugh, A., Monnier, J., Suffoletta-Malerie, S.,
& Freuh, B. (2007).
Child Welfare
• 50% of children and youth in the child welfare
system have experienced trauma (National
Center for Children in Poverty, 2007).

24. Prevalence of Trauma Across
Service Systems
Education
• 25% of school-aged children have been exposed
to a traumatic event (APA, 2008; National Child
Traumatic Stress Network, 2008).
POPULATIONS
• http://www.nctsn.org/resources/topics/special-
populations-and-trauma (see 12 core concepts)
• http://www.nctsn.org/resources/audiences/prof
essionals/search-the-Literature

25. Dr. Nadine Burke Harris: How childhood trauma
affects health across a lifetime
Published on Feb 17, 2015
• Childhood trauma isn’t something you just get over as
you grow up. Pediatrician Nadine Burke Harris explains
that the repeated stress of abuse, neglect and parents
struggling with mental health or substance abuse issues
has real, tangible effects on the development of the
brain. This unfolds across a lifetime, to the point where
those who’ve experienced high levels of trauma are at
triple the risk for heart disease and lung cancer. An
impassioned plea for pediatric medicine to confront the
prevention and treatment of trauma, head-on.
https://www.youtube.com/watch?v=95ovIJ3dsNk

26. Adverse Childhood Experiences
Study (ACES)
The Adverse Childhood Experiences (ACE) Study is
one of the largest investigations ever conducted to
assess associations between childhood
maltreatment and later-life health and well-being.
The study is a collaboration between the Centers
for Disease Control and Prevention and Kaiser
Permanente's Health Appraisal Clinic in San Diego.
http://www.cdc.gov/violenceprevention/acestudy/

27. Adverse Childhood Experiences
Study
Kaiser Permanente’s groundbreaking Adverse
Childhood Experiences Study (ACE Study)
shows the long-term impact of trauma over
the lifespan. After surveying over 17,000
Kaiser members in the San Diego area, the
ACE Study found that 67% of all respondents
have experienced at least one ACE. It also
found that as the number of ACEs increases,
the risk for the physical, mental, and
behavioral health problems similarly
increases.

28. The ACE Pyramid

29. Impact of ACEs
How Do We Stop Childhood Adversity from Becoming a Life
Sentence. | Benjamin Perks | TEDxPodgorica (Capital of
Montenego)
Benjamin Perks is the UNICEF Representative to Montenegro and
United Nations Resident Coordinator a.i. (Chief UN Ambassador)
and also occasionally works for United Nations Staff College
training on Human Rights Based Approach to Programming.
https://www.youtube.com/watch?v=qp0kV7JtWiE
"It's something that's very common in trauma: difficulty in regulating emotions and behavior,"
she explains. "That's why a lot of these kids get in trouble with the classroom.“
Hilit Kletter, of Stanford University's School of Medicine
On Line ACEs Quiz: http://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-
learn-what-it-does-and-doesnt-mean

30. ACE Study Findings
• >1 in 6 men have experienced emotional trauma
• >80% of people in psychiatric hospitals have
experienced physical or sexual abuse
• >66% of people in substance abuse treatment
report childhood abuse or neglect
• >90% of women with alcoholism were sexually
abused or suffered severe violence from parents

31. Adverse Childhood Experiences
• http://www.cdc.gov/violenceprevention/acest
udy/
• https://www.youtube.com/watch?v=YG1N5eb
c-58
• http://www.acestudy.org/files/Gold_into_Lea
d-_Germany1-02_c_Graphs.pdf
• http://www.theannainstitute.org/ACE%20Stu
dy/ACE%20Overview%20Chart.pdf

32. Additional Trauma Statistics
• African-American babies are nearly 5 times more likely to die before reaching their first birthday than
white babies.
• Suicide attempts for Hispanic girls in grades 9-12 are 70 percent higher than for white girls in the same age
group.
• Lesbian, gay and bisexual adults are about 5 times more likely than heterosexual men and women to have
a mental illness in their lifetime such as those related to mood, anxiety or substance use.
• Death rates from suicide among Native Americans and Alaska Natives are 50 percent higher than among
whites.
• Up to 39 percent of all transgender people face some type of harassment or discrimination when seeking
routine health care. (http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf)
• Smoking rates are highest among Asian American women who have a mental illness.
• African-Americans are more likely than whites to be involuntarily committed for outpatient psychiatric
care.
These are just a few of hundreds of statistics that illustrate the price paid by those who are too often viewed as
less worthy. See slide 5.

33. What is Trauma-Informed Care?
• Trauma-informed care is an approach or framework
related to delivering services that acknowledges the
impact of trauma and attempts to create a sense of
safety within the program. Trauma-informed
transformation is a cultural shift, a move toward safety-
focused, strength-based, consumer-driven,
empowerment-rich programming that allows
consumers to take charge of their recovery, addresses
unsafe behaviors and prioritizes safety as a platform for
recovery.
• http://www.trauma-informed-california.org/

34. Who are trauma-informed services
for?
• “Trauma-informed care is an approach to engaging people
with histories of trauma that recognizes the presence of
trauma symptoms and acknowledges the role that trauma
has played in their lives.”
• This is a key definition to our understanding of trauma-
informed care as it relates to service provision. For too
long and with dire consequences, mental health, substance
abuse, domestic violence, child abuse intervention,
hospitals, and schools – among others – simply saw
challenging and unproductive behavior as a reflection of
the person’s character or lack there of. By becoming
trauma-informed, we can understand the context of the
behavior in order to see some of the historical and
interactive but less visible aspects of the behavior.

35. Types of Traumatic Stress
National Child Traumatic Stress Network
–
Child Trauma Home: Children can be exposed to a range of traumatic experiences.
Page Contents:
•Community Violence
•Complex Trauma
•Domestic Violence
•Early Childhood Trauma
•Medical Trauma
•Natural Disasters
•Neglect
•Physical Abuse
•Refugee and War Zone Trauma
•School Violence
•Sexual Abuse
•Terrorism
•Traumatic Grief
http://www.nctsn.org
http://www.nctsn.org/sites/default/files/assets/pdfs/ComplexTrauma_All.pdf

36. Trauma & Developmental Stages

37. Trauma & Developmental Stages

38. Trauma & Developmental Stages

39. Complex Trauma
Children experience complex traumatic stress when they have
had prolonged exposure to trauma
• physical or sexual abuse
Experience multiple traumatic events over time, or when
different traumatic events occur at the same time
• separation from a caregiver, followed by physical abuse,
neglect, etc.
Complex trauma profoundly impacts children’s physical,
emotional, behavioral, and cognitive development. It impairs
their ability to feel safe in the world and to develop sustaining
relationships.
http://files.eric.ed.gov/fulltext/ED535527.pdf (Pg. 13)

40. Complex Trauma

41. Complex Trauma

42. http://files.eric.ed.gov/fulltext/ED535527.pdf

43. Traumatic Stress & Adolescents
Adolescents are particularly challenged by reactions
that persist after traumatic experiences. They could:
• Be drivers or passengers in car accidents
• Be victims of rape, dating violence, criminal
assault
• Be present during school or community violence
• Experience the loss of friends under traumatic
circumstances
• http://www.nctsn.org/nctsn_assets/pdfs/edu_materials/Understanding_Child_Traumatic_Stress_Brochure_9-29-
05.pdf (pg. 9)

44. Recovering from Traumatic Stress
for ADOLESCENTS
Getting help is key!
• Cognitive-behavioral therapies have proven
effective in helping children with complex
traumatic stress.
http://www.nctsn.org/nctsn_assets/pdfs/edu_materials/Understanding_Child_Traumatic_Stress_Brochure_9-
29-05.pdf (pg. 10)

45. Treating the core problem of childhood
trauma.
• Liz Mullinar is the Founder of Heal For Life
Foundation
Asking about “What happened to you?”
https://youtu.be/svX3fEdVTLQ

46. Dr. Bruce Perry https://www.youtube.com/watch?v=uOsgDkeH52o
Child Trauma Academy website
FIRST THINGS FIRST
Neurosequential Model of Therapeutics (NMT) is a way to
organize a child’s history and current functioning. The goal of this
approach is to structure assessment of a child, the articulation of the
primary problems, identification of key strengths and the application
of interventions (educational, enrichment and therapeutic) in a way
that will help family, educators, therapists and related professionals
best meet the needs of the child.
Keep the Cool in School Campaign
http://teacher.scholastic.com/professional/bruceperry/ for list of articles.
http://childtrauma.org/

47. The paradox of trauma-informed care
Vicky Kelly
https://youtu.be/jFdn9479U3s

48. The effect of trauma on the brain and
how it affects behaviors John Rigg
https://www.youtube.com/watch?v=m9Pg4K1Z
Kws&feature=youtu.be

49. Trauma Intervention Across Service
Systems
http://www.air.org/sites/default/files/downloads/report/Trauma-
Informed%20Care%20White%20Paper_October%202014.pdf
• Behavioral Health and Health Care
U.S. Department of Health and Human Services’ (HHS) SAMHSA
• Veterans’ Administration (VA)
The VA’s focus is on providing veterans with access to high-quality, trauma-specific clinical services
• Justice SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation
• Juvenile Justice The U.S. Department of Justice (DOJ) Office of Juvenile Justice and
Delinquency Prevention (OJJDP)
• Child Welfare HHS’s Administration for Children and Families (ACF) Children’s Bureau
• Education Three trauma-specific interventions have been developed specifically for use in
schools and have empirical support for reducing trauma-related symptoms: cognitive behavioral
intervention for trauma in schools (CBITS), the multimodality trauma treatment (MMTT), and the UCLA
Trauma/Grief Program (Foa et al., 2009).
• Homeless Services United States Interagency Council on Homelessness (USICH),

50. TRAUMA-INFORMED PRIMARY CARE INITIATIVE
http://www.thenationalcouncil.org/trauma-informed-primary-care-initiative-learning-community/
“Trauma Screening is no longer the exception,
but now it is the expectation.”
The National Council for Behavioral Health in partnership with and sponsored
by Kaiser Permanente Community Benefit*

51. COMMUNITY RETRAUMATIZATION
• http://www.theannainstitute.org/COMMUNIT
Y%20RETRAUMATIZATION.pdf
Trauma Survivors Speak Out About How They
Are Re-traumatized Within Community Mental
Health and Substance Abuse Service Systems

52. What About You?
“In dealing with those who are undergoing great
suffering, if you feel ‘burnout’ setting in, if you feel
demoralized and exhausted, it is best, for the sake
of everyone, to withdraw and restore yourself. The
point is to have a long-term perspective.”
—The Dalai Lama
• http://508.center4si.com/SelfCareforCareGivers.pdf
• http://www.helpguide.org/articles/ptsd-trauma/emotional-and-psychological-
trauma.htm

53. Secondary Traumatic Stress
Fact Sheet for Child-Serving Professionals See:
• http://nctsn.org/sites/default/files/assets/pdfs/secondary_traumati
c_tress.pdf
• The development of secondary traumatic stress is
recognized as a common occupational hazard for
professionals working with traumatized children. Studies
show that from 6% to 26% of therapists working with
traumatized populations, and up to 50% of child welfare
workers, are at high risk of secondary traumatic stress or
the related conditions of PTSD and vicarious trauma.
• Self-Care Assessment Worksheet Handout Instructions

54. The Power of Listening
“The therapist got home after work feeling exhausted. Her 10
year old son asks “Mommy why are you so tired? The
therapist replies “Mommy worked hard today.” Her son laughs
and states “all you do is sit and listen to people’s stories.”
After contemplating this She replies: “I do extremely active
listening and that is hard work.”
William Ury, author of Getting To Yes With Yourself (& Other Worthy
Opponents)
• https://www.youtube.com/watch?v=saXfavo1OQo&feature=player_embe
dded#t=0
Education/Training:
• https://www.mindtools.com/CommSkll/ActiveListening.htm

55. Additional Resources
Caring for Children Who Have Experienced Trauma: A
Workshop for Resource Parents: Tips from Experienced
Trainers (2011)
http://learn.nctsn.org/enrol/index.php?id=67
http://www.nctsn.org/sites/all/modules/pubdlcnt/pubdlc
nt.php?file=http://www.nctsn.org/sites/default/files/asse
ts/pdfs/nctsn_resource_parent_curriculum_faqs.pdf&nid
=867
http://www.trauma-informed-california.org/trauma-
informed-training-and-consultation/

56. Trauma Training Modules (9 of 10) for
School Staff
By Katherine Halley of Madison Wisconsin School District
1. https://www.youtube.com/watch?v=elaLV_b8FXw&feature=youtu.be
2. https://www.youtube.com/watch?v=lJpafA1G148
3. https://www.youtube.com/watch?v=YQoQS4RFJRQ
4. https://www.youtube.com/watch?v=XKlmZobbGIw
5. https://www.youtube.com/watch?v=5LZJEreVlCo
6. https://www.youtube.com/watch?v=GwMrDDHdZIA
7. https://www.youtube.com/watch?v=-tyxCbK360Q
8. https://www.youtube.com/watch?v=yL51VuTkuI0
9. https://www.youtube.com/watch?v=-ghT4T2yFQs

57. Additional Resources: Relias Webinar
• http://go.reliaslearning.com/WBN2015-08-31Trauma-
InformedCareSystemsImplementationWebinar_On-demand-
Page.html?mkt_tok=3RkMMJWWfF9wsRonvajLdO%2FhmjTEU
5z16eQpUaO%2Bg4kz2EFye%2BLIHETpodcMTcNhNbrYDBceEJ
hqyQJxPr3BK9YN1N1rRhXhDw%3D%3D

58. Additional Resources
Core Components
Of Treatment

59. Definition of Trauma-Informed Screening
and Assessment
• Trauma-informed screening refers to a brief,
focused inquiry to determine whether an
individual has experienced specific traumatic
events
• Trauma assessment is a more in-depth
exploration of the nature and severity of the
traumatic events, the sequelae of those
events, and current trauma-related symptoms.
Harris & Fallot 2001

60. Lack of Trauma Screening and Assessment
• Many clinicians acknowledge that significant trauma
concerns are frequently overlooked in professional
settings. Harris & Fallot 2001, Cuzack, 2004
• Alarmingly high rates of childhood trauma exposure,
PTSD co-morbidity and current victimization exist
among people with severe mental illness treated in
public sector settings Rosenberg 2002; Cusack et al 2004; Mueser
1998; Kessler et al 1995; Goodman et al 2001; Hiday et al 1999, Hanson 2002,
• In spite of this, clinicians often don’t screen for abuse
or detect current or historic victimization in their
clinical caseloads. Briere & Zaidi 1989; Jordan & Walker 1994; Saunders
et al 1989; Wurr & Partridge 1996, Lipschitz et al 1996, Goodwin et al 1988,
Jacobson et al 1987, Rose et al 1991

61. Lack of Trauma Screening and Assessment
• Although the high prevalence of significant
psychological trauma among people/patients with
serious and persistent mental illness is well known,
and even where it is duly recorded in initial
psychiatric histories, such trauma is rarely reflected
in the primary (or secondary) diagnosis.
• A history of trauma, even when significant, generally
appears only in the category of “developmental
history”, and as such does not become the focus of
treatment. Tucker 2002

62. Consequences of Failing to Screen and
Assess for Trauma
• In public-sector settings, and especially,
institutional ones, instead of being diagnosed
with trauma-related syndromes, patients are
likely to receive diagnoses of schizophrenia,
psychosis NOS, borderline personality
disorder, and, in children, conduct or
oppositional-defiant disorder.
Tucker 2002

63. Underrecognition of Trauma by providers
• One possible obstacle to the routine assessment of
trauma in men and women with serious mental
illness is the absence of clear treatment guidelines
for these individuals. Clinicians may not address
trauma history in their patients simply because they
do not know what to do. Meuser et al 2002
• One of the major, but often unacknowledged
reasons, that children are currently not more actively
screened for possible trauma is that all states have
laws that require certain persons to report any and
all suspicions of child abuse or neglect to the proper
authorities under legal penalty for failure to do so.
Harris et al, 2004