Trauma Informed Care

The Trauma Informed Care initiative at Foundations was built upon the existing four cornerstones of care: 1) No unsafe practices, 2) Exceptional customer care, 3) Superior clinical services and, 4) Watchful best practices. These foundational practices were seminal in the creation of the Trauma Advisory Committee (TAC). TAC’s task is the enhancement of the trauma-aligned services and care at the facility throughout all programs. Fully comprised of members from every department including consumer and stakeholder input, the TAC meets biweekly to ensure treatment and services are aligned with the following values: Safety at all times, trust and transparency in all interactions, empowering voices and choices, peer support practices and sensitivity to culture, history, and gender. These values are part of the key principles SAMHSA (2014) developed which are now integrated within all programs at Foundations. These values also reflect Foundations’ commitment to developing practices which bring awareness across all programming practices regarding the effects of neurodevelopmental disorders and complex trauma, which many children and families experience, and which frequently are not part of treatment. Studies show that between 10% and 14% of children have experienced complex trauma and polyvictimization with 33-75% developing PTSD (Copeland et al. 2007). These children may struggle with many symptoms frequently described as “externalized” or “internalized” but are really responses to trauma which are overlooked in the pathways to post-traumatic stress disorder. In fact, many children and families receiving ongoing mental health services have been exposed to multiple and in some cases, severe forms of trauma including repeated and ongoing events, not just a single traumatizing event. The mission at Foundations is to promote care which has the capacity to assess and, treat interpersonal trauma and expressions resulting from long-term or complex trauma, during critical developmental periods (Lanius et al., 2011).

Recognizing how cumulative trauma in conjunction with the peak onset for disorders around 14 years of age (Kessler et al. 2005), informs how these experiences impact the progression of care and support for patients and their family support system. This awareness ensures practices which do not re-traumatize; and the facility meets advanced trauma competence and proficiency levels. Many agencies engage in trauma-informed care but lack the sustained commitment required to maintain active and robust trauma-aligned services and fall in the “trauma pre-competence” continuum (Isaacs-Shockley, et al., 1996). The biology of trauma, including long-term potentiation of memory in the hippocampus and poor self-regulation, is now well understood including changes in the structure of brain functions and why presenting symptoms must be carefully assessed in order to recognize the effects of trauma and chronic stress events. Frequently referred to as the “cognitive triad” (Beck, Rush, Emery, 1979) trauma changes how someone sees themselves, how they see the world around them and, their views about their future. The following changes have been enacted by the committee reflecting the values and trauma competence practices:

  • Enhanced daily sensory programming and expansion of experiential services with art, music, and recreational therapies, community engagement and volunteering as core activities
  • Group therapy schedules were shifted to late day and early evening to provide support due to prevalence of subthreshold trauma symptoms and activation of trauma triggers
  • Clinical programming on weekends using full-time therapy staff who also work during the week for a consistent and safe, trustworthy experience and in providing ongoing stability and care versus part time staff who are lesser known to the patient
  • Training of all staff on the impact of complex trauma and how to recognize these symptoms resulting in trauma-informed competencies, including secondary trauma and good self-care
  • Universal screening using trauma researched assessment tools and doctoral level therapists who can provide these screenings and assessments
  • Trauma-focused therapy such as: Eye Movement Desensitization and Reprocessing (EMDR), Dialectical Behavioral Treatment (DBT), Anger Replacement Training (ART), Trauma Focused Cognitive Behavioral Therapy (TF-CBT), and Seeking Safety group therapy
  • Doctoral level supervision across all programs ensuring high treatment fidelity and trauma aligned services and care
  • Providing Telehealth family sessions to enhance opportunities for face to face family therapy and treatment driven by family involvement
  • Realignment of service resulting in lower treatment caseloads and integration of services reducing the number of different professionals a patient and their family is required to interact with

 

References:

Beck, A.T., Rush, A.J. Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

Copeland, W.E., Keeler, G., Angold, A., & Costello, E.J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64, 577-584.

Isaacs-Shockley, M., Cross, T., Bazron, B., Dennis, K., Benjamin, M. , 1996: Framework for a culturally competent system of care. In Stroul, B. (ed): Children’s mental health: Creating system of care in a changing society. Baltimore: Brookes,23-29.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Wlaters, E.E. (2005).Lifetime prevalence and age of onset distributions of DSM-IV disorders in the in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.

Lanius, R.A., Bluhm, R.L., & Frewen, P.A. (2011). How understanding the neurobiology of complex post-traumatic stress disorder can inform clinical practice: a social cognitive and affective neuroscience approach. Acta Psychiatrica Scandanavica, 124(5), 331-348.

Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication. Rockville, MD: Substance Abuse and Mental Health Services Administration , 2014.

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