Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

The Science of Traumatic Stress and Principles of Trauma-Informed

Care: Building an Effective Response Across Systems

Presented by

Joshua Arvidson, MSS., LCSWDirector, Alaska Child Trauma Center at

Anchorage Community Mental Health ServicesRegional Director, Complex Trauma Treatment

Network

#1: Impact of trauma is significant and observable. It lives in the brain and the

body – and is as real and relevant as other brain/body-based phenomena.

What is “Trauma”?:

“Overwhelming demands placed upon the physiological system

that result in a profound felt sense of vulnerability and/or loss

of control.”

R.D. Macy

5

Talking about the brain in a straightforward and client-friendly manner

Arvidson, 2012

Physiology of the Human Stress Response

Threat

• Activation of Threat Appraisal and Response System

• Increased Limbic System Activity• Alarm system “flood”

Survival Respons

e

• Fight, Flight or Freeze• Survival Oriented Behavior

Post-

Stressor

• Continued Arousal• Difficulty Modulating

Arvidson, 2013

• Physiological Changes in Brain Structure and Function, Decreased Volume of Amygdala and Hippocampus, Prioritization of Stress Pathways

Adaptation of Brain

Processes and Structure

• Significant challenges to Regulatory Capacity, Dysregulation, State and Trait Characteristics.

Chronic Exposure to

Stress Hormones

• Hypervigilance, Hyper and Hypo Arousal, Survival (as opposed to developmental) based orientation. Trauma turns a learning brain into a surviving brain.

Physiological (and

subsequently behavioral) Adaptations

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Joshua Arvidson, 2011

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Joshua Arvidson, 2011

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Joshua Arvidson, 2011

Action Step: Trauma education and awareness building

#2: Trauma has an impact across multiple domains of human functioning.

Traumatic Stress

and Stress

Response

Adaptation

Contribution to

Presenting

Challenges

Functional Domains Impacted by Complex Trauma:

Attachment and RelationshipsBiologyAffect regulationDissociationBehavioral controlCognitionSelf-concept and world view

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Sprague, C., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J., Mallah, K., Olafson, E., van der Kolk, B. (2007). Complex Trauma in Children and Adolescents. Focal Point, 21 (1), 4-8. Regional Research Institute for Human Services, Portland State University.

Courtesy, Dr. R. Moss

Action Step: Trauma Informed: Our Goal

Trauma informed care should be distinguished from trauma-specific treatment. The latter involves specialized treatments that some individuals also may need, to address complex trauma-related consequences. Trauma informed care, in contrast, is not highly specialized and can be provided in multiple settings by committed professionals who understand trauma without the expertise to offer trauma-specific treatment, which can be offered as needed by designated staff or through referral.

Gordon R. Hodas MD

Adapted from, NCTSN Complex Trauma Taskforce 2005

Trauma Informed

Care

Trauma-Specific

Interventions (Trauma-Focused)

#3: The Trauma Paradox

Traumatic Experience

Trauma related

adaptations

Increase in Risk for Re-Exposure

Chronic Levels of

Stress without Adequate

Resources to Deal with and

Mitigate Impact

Long-term adaptations that impair functioning

and increase long-term risk

for re-exposure

Action: Improve access to care/adapt systems to improve retention and get

services to those who most need them.

#4 Trauma has the Ability to Reproduce Itself.

Traumatic Experience

Physiological Dysregulation

Emotional Harm

Relational Harm

AdaptationsI.E. SubstancesRelational Re-enactmentsBehaviors

Adaptations impair potential

protective factors and

increase risk for re-exposure

Trauma and Adult Outcomes.

0

5

10

15

20

25

Perc

en

t W

ith

Healt

h P

rob

lem

(%

)

0 1 2 3 4 or more

ACE Score

Alcohol Abuse

Attempted Suicide

Anxiety

Kessler National Comorbidity Survey reported in: Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., . . . Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256, 174-186.

Implications for Action

Intervention can have a positive impact at any point in the cycle and at any point in the lifespan.

Intervention must take into account the function of trauma adaptations. These functions may need to be replaced.

#3: Trauma Impacts the Whole Being

Person

Person in Context

Adaptations to

Trauma

Building Resilience

and Restoring Functioni

ng

Stress Related

Symptoms

Because trauma impacts the whole being, trauma-informed care is as much about

being as it is about doing. More important than what you do, is how

you do it and who you are.

It is less a specific set of interventions, and more about attending to the entire person. This includes who they are and what they

have experienced, but also who they want to be and where they want to go.

When one is heard, understood and valued, one is no longer alone. This is when trauma begins to lose its power to determine one’s

life course.

Community

Awareness

• Theory of Change: Reduces Shame, Mobilizes Local Resources, Promotes Prevention, Embeds Prevention in Social Systems, Changes Cultural Norms

Informed Systems

• Theory of Change: Systems are Aware of Trauma and Respond in ways that Support Healing and Recovery (Resiliency)

Focused Interventio

ns

• Theory of Change: Impact of Trauma is Mitigated, Improving Outcomes and Reducing Transgenerational Transmission

Trauma Informed Care State

Decrease ACES

Increase Resiliency

Economic Effects of Trauma Reduced: Unemployment, Incarceration, Domestic Violence, Abuse,Substance Abuse

J. Arvidson 2013

• Focus: Specialized and evidence supported treatment and intervention for individuals impacted by trauma. Focus is restoring functioning and supporting recovery.

• Target Audience: Individuals for whom more intensive and specialized services are needed than those provided by trauma-informed systems (i.e. complex post-traumatic stress, severe functional challenges)

• Outcome: Establishing Safety, alleviation of trauma-related distress.

• Goal: Recovery and restoration for those impacted by complex post-traumatic stress.

Trauma Focused

Intervention

• Focus: Training on impact of trauma on the lives of service recipients and relevance to the system’s service and desired outcome.

• Target Audience: Systems serving working with individuals impacted by trauma, both systems that serve high-risk for exposure to trauma (child welfare, juvenile justice, court systems) and systems that serve as initial points of contact and can promote resilience and protective factors (education, primary care, pediatrics etc.)

• Outcome: Service systems understand trauma and its relevancy to their work.

• Goal: Systems engage with consumers in ways that promote resilience and recovery.

Trauma Informed Systems

• Focus: Public awareness and community education.• Target Audience: Community members (broad) with

targeted focus to key audiences. • Outcome: Increased awareness.• Goal: De-stigmatizing, improved identification (and access to

supports) for community members impacted by trauma. Primary and secondary prevention efforts embedded in social systems (families, community organizations and communities).

Trauma Aware

Community

Policy and Planning: Goal and Initiative

AlignmentTargeted Training and Partnerships with Supervisors Administrators and Programs

Universal Training on Trauma for Workers

J. Arvidson 2013