Bill  Cross  PhD  LMFT  

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.    

Trauma  Resiliency  Model™    

www.communityresiliencymodel.com  www.traumaresourceinsEtute.com  

Adapted  by  Elaine  Miller-­‐Karas    from  the  original  work  of  Elaine  Miller-­‐Karas  and  Laurie  Leitch  

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.      

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.”    Miller-­‐Karas  (2013)  

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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.

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  Zon

e  

Trauma4c/Stressful  Event  or  

Stressful/Trauma4c  Triggers  

Stuck  in  Low  Zone  

Edgy  Irritable  Mania  

Anxiety  &  Panic  Angry  outbursts  

Pain  

Depression/Sadness  Isolated  

Exhaus=on/Fa=gue  Numbness  

Resilient  Zon

e  

Graphic  adapted  from  an  original  graphic  of  Peter  Levine/Heller,  original  slide  design  by  Genie  EvereW   8

Stuck  in  High  Zone  

Resilient  Zon

e  

Resilient  Zon

e  

Some  have  a  deep  Resilient  Zone  where  there  is  a  higher  tolerance  for  a  wide  range  of  stressors.  

Some  have  a  very  shallow  Resilient  Zone  where  even  small  stressors  bump  you  out  of  the  Zone.  

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.

CRM  Key  Concepts  

“It  is  about  biology  -­‐  not  human  weakness.”    

Primary Focus of TRM: Biology vs. Mental Weakness

v  Responses to trauma and stress can have a major effect on the mind, body and spirit.

v  TRM practitioners use observation and knowledge of patterns within the nervous system.

v  TRM helps individuals track sensations connected to their well-being (their resilience).

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…

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Skills  of  the    Trauma  Resiliency  Model  

What are the 9 Skills of TRM?* * TRM includes some of the skills of Somatic Experiencing

15   Trauma  Resource  Ins5tute      

GROUNDING Being fully present in the moment

 

TITRATION* Working with small increments of arousal

TRACKING Refers to the practitioner’s and client’s monitoring of sensations

PENDULATION* Alternating between traumatic and

resource sensations

COMPLETION OF SURVIVAL RESPONSES*

SHIFT AND STAY Shifting to a resource and staying in the

resource state

RESOURCING & RESOURCE INTENSIFICATION

Using positive or neutral factors to create non-traumatic sensations

HELP NOW! Strategies to get back to the R-Zone

GESTURING/SPONTANEOUS MOVEMENT

Bringing awareness to spontaneous gestures/movements that are self-soothing

Community  Resiliency  Model  Skills      

Trauma  Resource  Ins5tute      

GROUNDING  Being  fully  present  in  the  moment  

 

TRACKING Paying attention to sensations

GESTURES  &  MOVEMENTS  Bringing  calming  &  protecEve  movements  

to  awareness    

SHIFT  AND  STAY  Shi[ing  to  a  resource  and  staying  in  

the  resource  state  

RESOURCING  &  RESOURCE  INTENSIFICATION  

Using  posiEve  or  neutral  life  experiences  to  create  pleasant  or  neutral  sensaEons  

HELP  NOW!!    Strategies  to  get  back  to  R-­‐Zone  

Community Resiliency Model Skills THE BASIC THREE  

 

Trauma  Resource  Ins5tute      

GROUNDING  Being  fully  present  in  the  moment  

 

TRACKING Paying attention to sensations

RESOURCING  &    RESOURCE  INTENSIFICATION  

Using  posiEve  or  neutral  life  experiences  to  create  pleasant  or  neutral  sensaEons  

Developing the Evidence Base Completed Research 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

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 22-75 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.

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.

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0.0%$10.0%$20.0%$30.0%$40.0%$50.0%$60.0%$70.0%$80.0%$90.0%$

Do#you#use#the#TRM#techniques?#

At#work?# Outside#of#work?#

83.3%#76.5%#

61.0%#

16.7%#23.5%#

39.0%#Yes#

No#

20.1%&

42.4%&

23.0%&

3.6%&10.8%&

Do&you&find&TRM&effec8ve?&

All&the&8me&

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Some8mes&

Rarely&

N/A&0.0%$10.0%$20.0%$30.0%$40.0%$50.0%$60.0%$70.0%$80.0%$90.0%$

100.0%$

Do#you#find#TRM#useful?#

91.0%#

9.0%#

Yes#

No#

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)

In  The  Zone  

How  o[en  have  you  been  in  your  Resilient  Zone  today?                

Never          Occasionally      SomeEmes      Frequently      All  the  Time              1              2              3          4                  5  

Slides by Miller-Karas&Leitch 2011(c)

THE  BODY  HAS  A  WISDOM  THAT  WORDS  CANNOT  SPEAK  WWW.TRAUMARESOURCEINSTITUTE.COM  WWW.COMMUNITYRESILIENCYMODEL.COM