Trauma Resiliency Model

Transcription

1 Bill Cross PhD LMFT

2 Moral Injury is the damage done to one s conscience or moral compass when one perpetrates, witnesses, or fails to prevent acts that transgress one s own moral and ethical values/codes of conduct/understanding.

3 Trauma Resiliency Model Adapted by Elaine Miller- Karas from the original work of Elaine Miller- Karas and Laurie Leitch

4 The Trauma Resource Ins5tute A Nonprofit CorporaEon Our Vision To create resiliency informed and trauma informed individuals and communiees. Our Mission A commitment to bring wellness skills, based on cunng edge neuroscience, to our world community, one person at a Eme, one community at a Eme.

5 Resilience Resiliency Is an individual s and community s ability to iden4fy and use individual and collec4ve strengths in living fully in the present moment, and to manage the ac4vi4es of daily living. (2013) Miller- Karas

6 What Are the Two Resiliency Models? v The Trauma Resiliency Model (TRM): v A skills-based course for clinicians. v Focused on stabilization of the nervous system. v Designed to reprocess traumatic experiences. v Community Resiliency Model (CRM): v A set of 6 wellness skills that can be taught to community members. v Focused on stabilizing the nervous system. v A triaged system of care. 6

7 What is the Community Resiliency Model? v Set of six Wellness Skills v Resets the natural balance of the nervous system v Brings awareness to a person s ability to come back into his or her Resilient Zone Resilient Zone

8 Trauma4c/Stressful Event or Stressful/Trauma4c Triggers Stuck in High Zone Edgy Irritable Mania Anxiety & Panic Angry outbursts Pain Resilient Zone Depression/Sadness Isolated Exhaus=on/Fa=gue Numbness Stuck in Low Zone Graphic adapted from an original graphic of Peter Levine/Heller, original slide design by Genie EvereW 8

9 Some have a very shallow Resilient Zone where even small stressors bump you out of the Zone. Resilient Zone Some have a deep Resilient Zone where there is a higher tolerance for a wide range of stressors. Resilient Zone

10 Who can TRM Treat? TRM can be used: v To treat any person who has survived a traumatic event where they perceived threat of death or injury to themselves or others. v With immediate as well as past trauma. v To treat complex trauma as well as single event trauma. v For practitioner self care to reduce burnout resulting from secondary traumatization. v Across cultures. v To treat children and adults.

11 CRM Key Concepts It is about biology - not human weakness.

12 Primary Focus of TRM: Biology vs. Mental Weakness v v v Responses to trauma and stress can have a major effect on the mind, body and spirit. TRM practitioners use observation and knowledge of patterns within the nervous system. TRM helps individuals track sensations connected to their well-being (their resilience).

13 An Elegant Design: The Capacity to Heal The human body - mind has the inner capacity to heal and restore itself and has a wisdom that words cannot speak. There is hope: the brain is plastic it is changeable 13

14 Skills of the Trauma Resiliency Model 14

15 What are the 9 Skills of TRM?* * TRM includes some of the skills of Somatic Experiencing TRACKING Refers to the practitioner s and client s monitoring of sensations RESOURCING & RESOURCE INTENSIFICATION Using positive or neutral factors to create non-traumatic sensations GROUNDING Being fully present in the moment SHIFT AND STAY Shifting to a resource and staying in the resource state TITRATION* Working with small increments of arousal GESTURING/SPONTANEOUS MOVEMENT Bringing awareness to spontaneous gestures/movements that are self-soothing HELP NOW! Strategies to get back to the R-Zone PENDULATION* Alternating between traumatic and resource sensations COMPLETION OF SURVIVAL RESPONSES* 15 Trauma Resource Ins5tute

16 Community Resiliency Model Skills TRACKING Paying attention to sensations RESOURCING & RESOURCE INTENSIFICATION Using posieve or neutral life experiences to create pleasant or neutral sensaeons GROUNDING Being fully present in the moment GESTURES & MOVEMENTS Bringing calming & proteceve movements to awareness HELP NOW!! Strategies to get back to R- Zone SHIFT AND STAY Shi[ing to a resource and staying in the resource state Trauma Resource Ins5tute

17 Community Resiliency Model Skills THE BASIC THREE TRACKING Paying attention to sensations RESOURCING & RESOURCE INTENSIFICATION Using posieve or neutral life experiences to create pleasant or neutral sensaeons GROUNDING Being fully present in the moment Trauma Resource Ins5tute

18 Completed Research Developing the Evidence Base Katrina Study Journal of Social Work v The treatment group showed statistically significant gains in resiliency indicators and decreases in posttraumatic stress disorder symptoms. China Study-International Journal of Emergency Mental Health v 97% believe that biologically-oriented TRM training will be very to moderately relevant or useful for their work with the Chinese earthquake survivors Research Underway v Preliminary unpublished data showing decrease in depression scores after 3 three 20 minute CRM interventions, delivered over a period of 7 days. Haiti-HelpAge Population (Citron, Dust & Karas) v Loma Linda University, Department of Social Work, Ivory Coast Study v County of San Bernardino, TRM-Community Resiliency Model-Innovations and VEP projects, State of California (Miller-Karas, Citron & Leitch) v Family Medicine Primary Care Study. Mary Lynn Barrett, MPH, Family Practice Residency Program. Asheville, NC v El Paso/Juarez Mexico Study, University of Northern Colorado v Walter Reed Hospital, study completed

19 Mental Health Services Act-Innovation Project-2013 v From a wide community: v African-American, Latino, Asian Pacific Islanders, LGBTQ, Native American and High Risk Youth, Veterans & ranged in age from years. v Statistically significant decreases in: v The average number of depression, hostility, anxiety, and somatic symptoms. v Statistically significant increases in the average number of symptoms related to: v Relaxed, contented, somatic well-being, and friendly indicators.

20 3-6 Month Follow-up v 3-6 month follow-up data received from 57 trainees across the underserved groups indicated that over 90% either completely or somewhat agree that the CRM skills were useful in: v Managing stress (95%) v Having better self control (96%) v Helping get through hard times (92%) v All used the skills frequently, with 93% reporting they were using the CRM skills daily, and 7% indicating a few times a week. 20

21 Trauma Resiliency Model (TRM) Survey Results 8/20/12 v Collected from the staff of the Department of Behavioral Health, (DBH) San Bernardino County: v Serves the underserved population with mental health challenges within the largest county in the U.S. v Over 500 of their staff (case managers, social workers, counselors, psychologists, psychiatrists) have been trained by in-house TRM Trainers. v The survey was conducted by the training center of DBH to determine the staff s perceptions of the usefulness and effectiveness of the Trauma Resiliency Model. (242 Respondents) 90.0%$ 80.0%$ 70.0%$ 60.0%$ 50.0%$ 40.0%$ 30.0%$ 20.0%$ 10.0%$ 0.0%$ 83.3%# 16.7%# Do#you#use#the# TRM#techniques?# 76.5%# 61.0%# 39.0%# 23.5%# At#work?# Outside#of#work?# Yes# No# 100.0%$ 90.0%$ 80.0%$ 70.0%$ 60.0%$ 50.0%$ 40.0%$ 30.0%$ 20.0%$ 10.0%$ 0.0%$ 91.0%# 9.0%# Do#you#find#TRM#useful?# Yes# No# 3.6%& 23.0%& Do&you&find&TRM&effec8ve?& 10.8%& 20.1%& 42.4%& All&the&8me& Most&of&the&8me& Some8mes& Rarely& N/A&

22 In The Zone How o[en have you been in your Resilient Zone today? Never Occasionally SomeEmes Frequently All the Time

23 THE BODY HAS A WISDOM THAT WORDS CANNOT SPEAK Slides by Miller- Karas&Leitch 2011(c)