Promoting Recovery With Trauma-Informed Practice, DH Esposito

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Content: APNA 27th Annual Conference Promoting Recovery With Trauma-Informed Practice Diane Esposito, ARNP, MSN, PMHCNS-BC
Session 3034: October 11, 2013
Disclosure · The presenter has no conflict of interest to disclose.
Objectives · 1. To apply concepts of recovery and traumainformed care to behavioral healthcare practice. · 2. Review standardized assessment tools for trauma. · 3. Discuss treatment strategies for trauma related behavioral health conditions.
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APNA 27th Annual Conference RECOVERY "Mental Health Recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential." (U.S.D.H.H.S., 2004)
Session 3034: October 11, 2013
10 Fundamental components of Recovery · 1. Self Direction · 2. Individualized and Person Centered · 3. Empowerment · 4. Holistic · 5. Non-Linear · 6. Strengths Based · 7. Peer Support · 8. Respect · 9. Responsibility · 10. Hope
Promote RECOVERY · R ­ Respect · E ­ Empathy · C ­ Caring · O ­ Ongoing · V ­ Victims and Victors · E ­ Encouragement · R ­ Regimen · Y - Yahweh
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APNA 27th Annual Conference Recovery Model · A shift in the paradigm of care of persons with serious mental illness from the traditional medical psychiatric model toward a concept of recovery. (Townsend, 2012) Away from terms of: Partial Response Positive Response Remission of Symptoms Recurrence of Symptoms Relapse Recovery Model · Toward core principles of trauma informed care: Awareness Safety Trustworthiness Choice Empowerment Collaboration Collaborative Practice · 1. Integrates Services · 2. Collaboration ­ NOT getting the client to agree with us · 3. Transform through empowerment · 4. Mental Wellness Esposito
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APNA 27th Annual Conference Promoting Recovery in Practice · 1. Shared Decision Making · 2. Joint Determination of Focus of Treatment · 3. Goals of Treatment: Decrease distress and Increase ability to fulfill life roles · 4. Minimize Coercion ­ with conflict resolution Fundamental Stages of Recovery · Establishing Safety · Reconstructing the traumatic story · Restoring the connection between the survivor and his/her community · (Herman, 1992) Goals of Trauma Therapy/Intervention · Promote internal integration of self · Establish healthy safe relationships · Support verbalization of the traumatic experiences · Promote reprocessing of the memories · Realistic reappraisal and acceptance · Enhance ability to trust Esposito
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APNA 27th Annual Conference Adverse Childhood Experiences Study ACES (Felitti et al, 1998) http://www.cdc.gov/ace/index.htm
Session 3034: October 11, 2013
ACES study · Adverse Childhood Events Emotional , Physical or sexual abuse Emotional or Physical Neglect Household Dysfunction Domestic Violence Substance Abuse Mental Illness in the home Divorce or Separation Family member incarcerated (Felitti et al, 1998)
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APNA 27th Annual Conference Trauma Exposure Assessment Tools Child and Adolescent · 1. Child Stress Disorders Checklist (Saxe & Enlow, 2010) http://www.healthcaretoolbox.org/pdf/CSDC_SF.pdf · 2. Life Events Checklist (Blake et. al., 1995) · https://downloads.va.gov/files/PTSDinfo · 3. Traumatic Events Screening Inventory (TESI) (Ford & Rogers, 1997) · https://downloads.va.gov/files/PTSDinfo · 4. Clinicain Administered PTSD Scale (CAPS) (Nader et. al., 1996) https://downloads.va.gov/files/PTSDinfo Trauma Assessment - Adults 1. Life Stressor Checklist ­ Revised (Wolfe & Kimerling, 1997) https://downloads.va.gov/files/PTSDinfo 2. Trauma History Screen THS (Carlson, 2005) https://downloads.va.gov/files/PTSDinfo 3. PTSD Checklist PCL (Civilian ­ Military ­ Specific) (Weathers, et. al., 1993) · PCL-C 4. Impact of Event Scale ­ Revised IES-R (Weiss and Marmar, 1997) · http://www.ptsd.va.gov Trauma Informed Practice Asks: · "Is trauma the problem?" · Primary Goals: Empowerment Recovery Resilience Collaboration Esposito
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APNA 27th Annual Conference Trauma Informed Practice · Memory identification, processing and regulation · Anxiety management/Relaxation therapy · Identify maladaptive cognitions DBT - CBT · Teach problem solving/coping skills · Medication management of symptoms · Commitment to trauma screening/assessment · Incorporates practices to avoid re-traumatizing · Staff education and treatment ­ Debriefing · Incorporates Safety Plans and de-escalation · Trauma Therapy ­ EMDR · Sensory Rooms Trauma Informed Practice · Universal Precautions · Reduce power differential · Positive reframing and giving choices · Balance containment and milieu safety · 24 hour path analysis ­ review of critical incident · Teach emotional regulation · Written crisis prevention plans · Individual safety plans · Behaviors viewed as coping or adaptations Safe and Supportive Environments · Information Sharing · Cultural Competence · Privacy and Confidentiality · Trauma Specialist on Staff · Utilize Debriefing and Clinical Supervision with all staff members · Safety and Crisis Prevention Plans Esposito
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APNA 27th Annual Conference Crisis Prevention Plan · Identify past traumatic experiences · List of potential triggers · Symptoms or behaviors when stressed · List of things that help to calm down · List of things NOT helpful when upset · List of people who are supports when upset · SAFETY PLAN · What to do if feeling threatened or unsafe Non Trauma Informed Practice · Control is emphasized · Locked, keys, uniforms, stern demeanor · Compliance is stressed · Coercion is frequently used · Labeling language "manipulation" etc · Patients blamed for their behaviors · Medical model with over diagnosis of ODD Bipolar Disorder Borderline Personality T-I-C Agency Assessment Trauma Informed Care Agency Assessment www.familyhomelessness.org/medical/90.pdf Is your agency providing `Trauma Informed Care'?
Session 3034: October 11, 2013
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APNA 27th Annual Conference References Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.G., Charnes, D.S., and Kean, T.M. (1995). The development of a clinician administered PTSD scale. Journal of Traumatic Stress, 8: 1, p 75-90. Life Events Checklist available from the National Center for PTSD website: http://www.ptsd.va.gov/professional/pages/assessments/assessment-pdf/lifeevent-checklist-lec.pdf Carlson, E., Smith, S., Palmieri, P., Dalenberg, C., Ruzek, J., Kimerling, R.,...Spain, D. (2011, June 23). Development and validation of a brief self-report measure of trauma exposure: The Trauma History Screen. Psychological Assessment, 23(2), 463-477. doi:10.1037/a00222294 Creamer, M., Bell, R., & Failla, S. (2003). Psychometric properties of the impact of event scale-revised. Behavior Research and Therapy, 41, 1489-1496. Diagnostic and Statistical Manual of mental disorders, IV-TR. (2000). Washington, DC: American Psychiatric Association. Felitti, V., Anda, R., Nordenberg, D., Williamson, D.Spitz, A.,, Edwards, V.,Koss, M., & Marks, J., (1998) Relationship of child abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experience (ACE) Study. American Journal of Preventive Medicine, 14: 4, p 245-258. Retrieved from http://www.ajpm-online.net/article/PIIS0749379798000178/abstract Ford, J.D. & Rogers, K. (1997). Empirically-based assessment of trauma and PTSD with children and adolescents. Paper presented at the annual convention of the International Society for Traumatic Stress Studies, Montreal, Quebec, Canada. Available from the National Center for PTSD website: http://www.ptsd.va.gov/professional/pages/assessments/tesi.asp Freyd, J. (1996). Betrayal Trauma: The Logic of Forgetting Childhood Abuse. Cambridge, MA: Harvard University Press. Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. (2009). TraumaInformed Organizational Toolkit. Rockville, MD: Center for mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National child traumatic Stress Network, and the W.K. Kellogg Foundation. Available at www.homeless.samhsa.gov and www.familyhomelessness.org Herman, J. (1992). Trauma and Recovery. New York: Basic Books. Horowitz, M. J. (1976). Stress Response Syndromes. New York: Aronson. Kubany, E., Haynes, S., Leisen, M., Owens, J., Kaplan, A., & Watson, S. (2000). Development and preliminary validation of a brief broad- spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire. Psychological Assessment , 12, 210-224. Lasiuk, G., & Hegadoren, K. (2006). Posttraumatic Stress Disorder Part I: Historical Development of the Concept. Perspectives in Psychiatric Care , 13-20. McHugo, G., Caspi, Y., Kammerer, N., Mazelis, R., Jackson, E., Russell, L., et al. (2005). The assessment of trauma history in women with co-occurring substance abuse and mental disorders and a histroy of interpersonal violence. The Journal of Behavioral Health Services and Research , 113-127. doi:10.1007/bf02287261 Nader, K., Kriegler, J., Blake, D., Pynoos, R., Newman, E., & Weather, F. (1996). Clinician Administered PTSD Scale, Child and Adolescent Version. White River Junction, VT: National Center for PTSD. Available from the National Center for PTSD website. http://www.ptsd.va.gov/professional/pages/assessments/caps-ca.asp Esposito
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APNA 27th Annual Conference
PTSD Alliance (Producer). (2000). Hope for recovery: understanding PTSD [Motion Picture]. (Available from the United States Department of Veteran Affairs website. http://www.ncptsd.va.gov/ncmain/ncdocs/videos/emv_hoperecovery_gp v.html?op
SSahxoertBF.Eor.,mK:aassfaomur--Aitdeam/mssc,aNle.,o&f tSraaxuem, aGt.ic(2s0tr1e0s)s.
The Child symptoms
Stress Disorders Checklistin children. General
hospital psychiatry, 32(3), 321-327. Available at:
http://www.healthcaretoolbox.org/pdf/CSDC_SF.pdf
Strand, V., Sarmiento, T., & Pasquale, L. (2005). Assessment and screening tools for trauma in children and adolescents: A review. Trauma Violence and Abuse , 55-78.
Townsend, M.C. (2012) Psychiatric Mental Health Nursing, (7th ed). Philadelphia, PA: FA Davis Company.
United States Department of Health and Human Services. (2004). National consensus statement on mental health recovery. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129
Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (1993). The PTSD Checklist (PCL)Reliability, Validity and Diagnostic Utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX. Available from the National Center for PTSD website: http://www.ptsd.va.gov/professional/pages/assessments/ptsd-checklist.asp Weiss, D. S., & Marmar, C. R. (1997). The impact of event scale-revised. In Wilson, J., Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford Press. Available from the National Center for PTSD website. http://www.ptsd.va.gov/professional/pages/assessments/ies-r.asp Wolf, J. & Kimerling, R. (1997). Gender issues in the assessment of Posttraumatic Stress Disorder. In J. Wilson & T.M. Keane (Eds) Assessing Psychological Trauma and PTSD. NY: Guilford. pp 192-238.
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DH Esposito

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