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.
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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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&
Most&of&the&8me&
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