Hi, my name’s Mandy Davis and I’m the Director of Trauma Informed Oregon. Welcome to module two, where we’ll be talking about why is trauma informed care so important to implement in your organization and in your systems or communities. During this module, we’re going to review a bit about the prevalence data.
And then we’re going to talk about how trauma, adversity and toxic stress affects how folks engage in our systems, and also affects us in doing the work to engage populations we serve. Now before we begin just a quick reminder of what we mean when we say trauma informed care.
So, we define that based on the Substance Abuse Mental Health Service Administration’s definition that a program, organization or system is trauma informed when one, it realizes the widespread impact of trauma and understands the potential paths for recovery. That it recognizes the signs and symptoms of trauma not only in those that we serve, but also in coworkers and in staff. And that it responds by fully integrating the knowledge about trauma into our policies, our procedures and our practice. And then finally, seeks to actively resist re-traumatization and the work we do.
So, remember when we use the word trauma, that we are kind of broadening our understanding of that to include experiences of systemic oppression and targeted violence. Experiences, such as ageism racism, ableism. Also remember that I’ll use the word trauma, adversity and toxic stress interchangeably as I talk about trauma informed care, because we believe that all three of those things have similar impacts on our ability to engage in services and on our wellness.
So, let’s talk about why trauma informed care is so important. Firstly, trauma is pervasive. So, we’re going to look at a few statistics about this. In a national sample, 60% of 0 to 17-year olds experienced or witness maltreatment, bullying or assault within the past year.
Children with disabilities are more than twice as likely to experience physical abuse than children without disabilities. Lesbian, gay, bisexual and transgender individuals experience higher levels of childhood sexual assault, childhood physical assault and emotional maltreatment compared to their heterosexual peers. 53% of sampled incarcerated women met criteria for lifetime post-traumatic stress disorder.
Over half of incarcerated men, 56% reported experiencing childhood physical trauma. Now, let’s look a little bit at some Oregon data where 62% of Oregonians who responded to the Adverse Childhood Experience question on a survey experienced at least one Adverse Childhood Experience. A higher Adverse Childhood Experience score was associated with increased tobacco use, increased risk of respiratory diseases, depression and suicide.
Now I want to take in some different data now. So, I want us to look at some data about providers, about our workforce, about each other. So for instance, 65% of social workers had at least one symptom of secondary traumatic stress. Almost 41% of surveyed licensed clinical social workers met criteria for post-traumatic stress disorder.
Nurses who do hospice work, of those, 79% have moderate to high rates of compassion fatigue. 82% of emergency room staff nurses met criteria for secondary traumatic stress. Immigration judges have higher burnout levels than hospital physicians and prison wardens. And in 2016, more officers died of suicide than from gunfire and traffic accidents combined.
Early childhood educators have 30-40% annual turnover rates. So, what the data shows us is that trauma is not uncommon. Adverse childhood experiences are not uncommon. So not only do the families and communities we work with have experiences of trauma, adversity, and toxic stress, but the data also shows us that those experiences are happening in our workforce and with our co-workers.
And it’s having an impact on the ability of our staff, our coworkers in our organizations to stay on the job. So, another thing we have to pay attention to is that trauma deferentially affects us, and what I mean by that is that we can all experience the same tragedy in the same moment in time, but we’re all going to have a different experience of that event, and we’re all going to have a different experience of healing from that event.
And those differences can be based on our age, our past experience of trauma or toxic stress, our current social support. It could be based on our ability, our mobility. It could be based on our race, our class and our gender. What’s important about those variables is they often are related to our ability to access the resources we may need post an event to restore and to heal.
So those variables may prevent us from getting what we need, for getting our basic needs met, or getting a house rebuilt. Or those variables may help us get what we need. But this is important, because a lot of times in our society, we like to connect. And so we like to say: “You’re experiencing a divorce. Well, so have I. Don’t worry about it or it will be fine, or get over it, or move through it.”
And so in trauma informed care, we want to appreciate that everyone has an individual experience with the events that affect them. So, we don’t want to make assumptions about what people are going to need and how people are going to move through that experience.
So next, we’re going to talk about how trauma affects how people approach services. So the way I want to talk about this is using Dan Siegel’s hand brain model, which is a great way to easily show the impact of trauma and toxic stress on our brain functioning. So right now, what I’d like you to do is hold your hand up.
I’d like you to tuck your thumb inside your hand and then wrap your fingers over your thumb. So what Dan Siegel teaches us is that this is a model of your brain. So, your thumb represents your amygdala, your threat sensor, your fight, flight or freeze, and your fingers represent your prefrontal cortex or your frontal lobe.
And your prefrontal cortex holds the functions, such as regulating your emotions, organizing information, decision-making, verbal processing, sequential ordering, know that you do this first and then that. So that’s all held within your prefrontal cortex functioning. So, what we know happens is that when we experience extreme stress or threat that we flip our lid.
And when flip our lid, we lose our ability to those prefrontal cortex functions like decision-making, verbal processing, making good rational decisions. Now so what I want you to think about for a minute is that at Trauma Informed Oregon and in trauma informed care, we believe that a lot of times, people are coming to our services with their lids already flipped.
So, think about if somebody’s coming to your school with their lid flipped or someone’s coming to get basic needs, or coming to get a service. Their lids may already be flipped as a result of the transportation to get to you, your lobby or waiting area. Maybe it’s the forms that you asked them to fill out.
Maybe it’s because of the stress and crisis that’s going on in their home at that time. Maybe it’s because they’re really nervous that you won’t give them what they need to survive. So, they’re coming in with their lids flipped and this is important to talk about for a second, because some of us have the job of helping people regulate this, to help try to prevent the lid from flipping.
Or that when it does, to help it regulate quicker after, but not everyone has that job. If you’re sitting in a lobby answering phones and checking people into appointments, your job is not to necessarily help people prevent them from flipping their lid.
So, it’s really important message for you to hear is that trauma informed care, sometimes include services, trauma specific services, which help people regulate. But what is most interested in doing is because many people are coming into our spaces with their lid flipped, if you apply trauma informed care, we believe it’ll help prevent you from flipping your lid.
Because when we flip our lids and it happens, it happens. When we flip our lid, we end up with what I call an amygdala-amygdala conversation. And if you have ever had those, they’re not very productive. So, this looks like someone coming in and saying, “I need bus tickets right now.”
And maybe you say, “I’m sorry, we don’t have any.” “I need bus tickets right now!” And all of a sudden, you flip your lid, because you feel threatened, burned out, stressed out. And you say, “no.” And so then we end up in amygdala to amygdala conversation. What’s most important for me that you understand about this is again, trauma informed care is going to mostly be about helping you and your colleagues stay in their whole brain for as long as possible.
Because when we get in amygdala to amygdala conversation, my concern is who often loses out is the person with the least amount of power. So, I’d like you to take a moment to start to think about different things, different variables that may flip somebody’s lid when they’re accessing your services.
So, we’ll talk about the way your lobby looks and the questions you ask, but I also want you to start to think about what you may represent for people. So think about your race, think about your visible gender. Think about your visible identities that may or may not be threatening to those that you serve.
Think about the emblem on your car. An activity to do is to ask the people in your life what was their first impression of you and also start to take note of your different identities, and the impact those identities have had on the people maybe you serve in your location, in your community or within your organization.
So, for example, I’m a short, white, Southern social worker, and I often work with families involved in child welfare. So, when I introduce myself and say, hi, my name is Mandy, I’m a social worker. I may follow-up with and I’m sorry for what my profession has often done to you, because I know something about the experience folks have had with social workers.
I want to think about that ahead of time. And finally, we believe that the service system or systems. And remember when I say that, I mean things, such as the healthcare system, the education system, self-sufficiency, child welfare. But that those service systems have often been activating or retraumatizing to populations, individuals and families we serve.
So take a moment to learn in your communities and for your populations how they have experienced your services. How your services have been provided, even where your services are provided, even the buildings in your community. To understand what might be some of those activating variables that may pop-up for folks that they may not even be aware of or that you may no longer be aware of.
In order to be effective stewards of trauma informed care, we have to be able to speak to why trauma informed care is important. So, let’s review some key points discussed by Dr. Mandy Davis. It’s an old myth that trauma only affects the weak and the vulnerable or that it’s obvious who has experienced trauma, and who has not.
Trauma and adversity are widespread. And so trauma informed care can be thought of as an engagement tool for all staff. Not just the clinician or the mental health professional. This is especially true when we consider that trauma differentially affects the more vulnerable. The factors, such as race, gender, age make access to resources more complicated and less accessible.
Likewise, we’re asked to consider that the very system that seeks to serve those in need has historically, and in some cases, even today, contributed to adversity and trauma for the individuals it serves. Trauma informed care invites us to remember that people react to both actual and perceived threat. And in some cases, we in our role might be perceived as a threat.
Trauma informed care is important, because an essential component of trauma informed care is inviting and utilizing the voice of the people or service user voice in both program design and implementation. So, as you continue to learn about trauma informed care, remember to always come back to this question. Why?
Why is trauma informed care important? Answering this question will allow for sustainability in your organizational change and will also allow for creativity of how trauma informed care looks in your specific area of work.