Trauma and Trauma Informed Practice PDF

Trauma and Trauma Informed Practice Catherine Cavaliere, PhD, OTR/L Dominican University, New York Occupational Therapy Program  Trauma A single event or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening...

Trauma and Trauma Informed Practice Catherine Cavaliere, PhD, OTR/L Dominican University, New York Occupational Therapy Program  Trauma A single event or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s physical, social, emotional or spiritual well-being ( SAMHSA, 2014) Individuals, families, communities Experience Individual -Perception – Response  Types of Trauma Complex Trauma Chronic exposure to multiple types of adverse episodes that occur within relational caregiver system and the subsequent challenges that emerge in surviving these experiences Adverse Childhood Experiences Traumatic event or situation/s that a person identifies as having directly experienced or observed from birth – 18 yrs. physical, emotional abuse; neglect; domestic violence; caregiver with a mental illness; caregiver with substance abuse; crime; imprisonment of caregiver; homelessness Adverse Community Environments Poverty; lack of opportunity; discrimination; violence  Types of Trauma Intergerational Trauma Parents with trauma histories struggle to nuture their own children creating a cycle of abuse and trauma Historical Trauma Multigenerational trauma experienced by a specific cultural, ethnic or racial group that have experienced discrimination, oppression, injustices, inequalities and microaggressions ** Racism not race is the risk factor Significantly impact community trauma, adverse environments and ACES Disparity in childhood trauma – 61% of Black; 51% of Hispanic ; 40% White  Neurodiversity and Trauma Neurotypical, Neuromajority,and Neurodiverse Internal Factors External Factors Sensory processing Societal systems Communication Cultural systems Information processing Family systems Emotional processing Task demands Physical environment Social environment  LGBTQIA+ and Trauma Systemic (historical) Religion; Government (military); hate crimes; conversion therapy Community Isolation and rejection from social/cultural groups – sports; religious Individual Daily interactions with family, peers  Stress State of tension causing anxiety or worry Stressor is a stimulus that triggers a stress response Types of stress: acute, chronic, traumatic Extensive research on links between trauma, stress, and disease ACES study – correlation between the number of ACES and negative health factors/likelihood of disease; social and economic conditions increase likelihood of experiencing an ACE.  Trauma, stress and health Medical- heart disease, chronic pain, respiratory disorders, cancer, STD Psychological – depression, anxiety, suicide, hallucinations Social- relationships, risk of perpetrating or being at risk for domestic violence Behavioral – sexual promiscuity, illicit drug use and teen pregnancy  Risk factors Individual and Family Community History of parental trauma Poverty Parental mental health disorder Lack of educational and economic Lack of parental attachment opportunity Parental Incarceration violence Homelessness Lack of health and other support services Systems Violence in the home Discrimination Parental death Oppression Neurodiversity Injustices Gender expression Inequalities  Protective Factors Individual and Family Community Secure attachment with Safe living environment caregiver Access to economic and Secure social relationships health support outside of the family Employment opportunities Food security Basic needs are met Stable housing Positive mental health of family Safe and nurturing childcare members and schools Parental employment Safe and engaging Education is valued and afterschool and enrichment supported programs  Resilience Resilience—the ability to recover and even thrive in the face of trauma, stress, or adversity *Protective factors support resilience  Impact of trauma Emotion regulation Self regulation Physiologic regulation Information processing (cognition; attention/focus; memory; EFS) Sensory processing Relationships Identity formation Self-actualization *Occupational engagement and actualization  Impact of trauma on ADL/IADL ADL IADL Feeding and eating Rest/sleep Dressing Education Bathing Work Brushing teeth Play Toileting Leisure Social Participation Health Management  OT Intervention **Felt SAFETY! Co-regulation Self-Regulation Relational Engagement Positive affect enhancement ( supporting positive mental health) Meaningful occupational engagement and actualization Exhibit 1.5/1.6  Polyvagal Theory: a theory of SAFETY Nervous system regulation Connection Co-regulation  PVT: 2 branches of the vagus nerve : Symbiosis Dorsal Vagus Ventral Vagus Connections below the Connections above the diaphragm- head and neck diaphragm- gut, heart, lungs- *Social Engagement System basic physiologic functions Developed later in response to human Homeostasis development Physical health Human experience Connectedness to others Protection Self Regulation *Survival Well-being Non-mylenated *Occupational engagement and actualization  Neuroception The ability to “sense “safety and danger Safety cues Social cues Environmental cues safety and danger- shrill sounds, smell of smoke, seeing a violent act Flee/stay Prolonged Stress- faulty neuroception Dorsal vagal activation vs ventral vagal – protection vs social connection Trauma VENTRAL VAGAL ( SAFE AND SOCIAL) Happy Content Attuned to others Connected to others At ease Playful Self- Aware This Photo by Unknown Author is licensed under CC BY-NC Productive  Sympathetic (Mobilized) On edge State Limited eye contact Hyper-vigalent Limited attention On the go Can’t sit still Anxiety Stress Threshold for sensation decreased/affected  Dorsal vagal (immobilized) Shut down Flat affect Blank stare Withdrawal Decreased arousal Under aroused Depression “The primary function of the regulation centers of the brain is safety” (Lynch &Mahler, p. 22)  Regulate, Relate, Reason Neurosequential Model of Therapeutics (NMT) Regulat Relate Reason e (Perry & Hambrick, 2008) Trauma-Informed Care- The 4 R’s as it relates to OT practice Realize the widespread prevalence and impact of trauma Education Recognize how trauma can impact individuals, families, communities Understand symptoms and impact on occupational engagement Respond to trauma therapeutically Support felt safety Support regulation Support relationships Support occupational engagement Resist re-traumatization Language Flexibility Trustworthiness and transparency Empowerment, voice and choice Partnership 3 Main Components of PVT Hierarchy Neuroceptio n Co- regulation