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Trauma-informed care

2016

Hello,

Where can I learn more about Trauma-Informed Care? I am trying to gather data on different organizations around the world that utilize a Trauma Informed Approach and also where I may be able to find more information on the history of this approach.

Any and all information is helpful !

Thank you,

Nicole West

...

Hi Nicole,

I think a valuable resource which places emphasis on collaboration, non-violence, client centered approach is:

Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care” by Carrie Clark, Catherine C. Classen, Anne Fourt, Maithili Shetty

It is a good guide for agencies, policy makers and for individuals who work with people who have long term, relational, overwhelming or traumatizing experience.

Best,

Rochelle
...

Hi Nicole

The Australian Childhood Foundation have some great resources around Trauma Informed Practice and the Neurobiology of complex trauma along with some great online training modules.

http://www.childhood.org.au/for-professionals/smart-online-training

Hope this helps.

Anne
...

Hi Nicole,

Here are some solid starting points:

Dr. Bruce Perry is an international expert on trauma-informed care. His website is www.childtrauma.org and offers a lot of information (downloadable resources).

He is brilliant and has developed an approach called the NeuroSequential Model of Therapeutics. A must-read book is “The Boy Who Was Raised as a Dog”.

Bessel van der Kolk is also an expert on trauma. His recent book is “The Body Keeps the Score” is excellent. His website is www.traumacenter.org

A national resource is the National Child Traumatic Stress Network (www.nctsn.org). This website offers a ton of information on evidence-based strategies.

Also, one approach that has been popular in residential settings is the Sanctuary Model, which can be found in a book by Sandra Bloom.

Bob Foltz


Try this book: Anglin, J. P. (2002). “Pain, Normality, and the Struggle for Congruence: Reinterpreting Residential Care for Children and Youth”

Regards,

Vesna


This sounds interesting. Where did you hear about this practice? It sounds like it could fit into the inter-generational trauma of the first nations.

Lisa


Hi Nicole,

I've been a bit obsessed by trauma informed care for a while now. I'm currently doing a Churchill Fellowship that's researching models for care settings. I'm particularly interested in turning the theory into practical and tangible guidance for staff and the milieu

Some good places to start are the Neuro-sequential model of care (Perry), Sanctuary Model (Bloom), Jasper Mountain in Oregon (Ziegler), ARC model (Blaustein) and I could go on.

There are an infinite number of websites out there too. Let me know if you me to point you in the right direction.

I'm really interested in other people's experiences with this so would love to hear from folk.

Also, I'm off to Scandinavia to visit trauma informed places and am looking for recommendations of places to visit, all would be appreciated.

Thanks.

Dan Johnson


Where are you looking?

I work for Norwood Child and Family Resource Centre in Edmonton, AB. We are a trauma informed organization, meaning that every member of our staff is trained and practices this approach to working with our families.

We were trained by ECDSS (Early Childhood Development Support Services) here in Edmonton which is a great organization and may be a good resource for you to contact about the history of Trauma Informed Care or they would be able to point you in a direction.

Caitlin


Hello Nicole,

Your question is great timing!

As an Educator here at Relationships Australia South Australia, our team has developed a 1 day training program – which coincidently I delivered yesterday: Trauma Informed Practice for frontline workers.

Much of the content of this program is based on the work of the Australian Childhood Foundation – and the FREE course they developed – SMART Online – Strategies for Managing Abuse-Related Trauma.

The other best practice resource coming out of Australia, it the Blue Knot Foundation (formally ASCA). They have developed a suite of resources for professionals working with people from trauma backgrounds.

Blue Knot’s Practice Guidelines for working with trauma have been officially endorsed – please see below taken from their website:

The Practice Guidelines for the Treatment of Complex Trauma & Trauma Informed Care and Service Delivery have been officially recognised as an Accepted Clinical Resource by The Royal Australian College of General Practitioners.

I hope you find these resources useful.

Cheers,

Deanna


Hi Nicole,

Here is a great place to start: http://childtrauma.org/

Dr. Bruce Perry is the Senior Fellow of this academy. Look him up for more awesome resources. I recommend his book, “The Boy Who Was Raised as a Dog”.

I also recommend Howard Bath and “The Three pillars of Trauma Informed Care”. And, Dr. Robert Foltz

http://togetherthevoice.org/presenter/robert_foltz

You can also do a search of Trauma-informed Care on CYC-net to get a ton of resources. Hope this helps!

Nancy


Hi Nicole (and everyone else), 
 
It is great you are interested in this area as it is a field that is rapidly growing, and in Canada, following the outcome of the Truth and Reconciliation Report one of the recommendations on the Wellness Continuum Framework is trauma-informed care and treatment so we will only continue to see this grow in the years to come. You can also learn more about this on Health Canada’s website. We regularly provide training to indigenous populations and organizations providing support to them. 
 
Many wonderful resources have already been mentioned but I’ll list a few more that you and others may find helpful: 
 
Our treatment centre, the Attachment and Trauma Treatment Centre for Healing (ATTCH) is modelled after Bessel van der Kolk’s treatment model and was one of the first of it’s kind that I know of in Canada. Information about our treatment approach is explained on our website but essentially we encompass holistic and integrative best practice and evidence informed treatment approaches to heal the wounds of trauma and attachment dysregulation. 
 
The organization Bessel founded, The Trauma Centre at JRI has a wealth of free journal articles which can be accessed at http://www.traumacenter.org/products/publications.php
 
All of our staff are trained in the Attachment, Self-Regulation, and Competency model  (ARC) which is recommended by the American Academy of Paediatrics as a recommended treatment for trauma and youth, as well we are trained in the Sensorimotor Arousal Regulation Treatment model (SMART). Both of these trainings were offered at our week long annual trauma and attachment conference in 2015. They also have a new book based on the ARC model called Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency is an excellent resource, especially for residentially based programs. 
 
Our organization specializes in trauma-specific treatment and provides training across Canada and abroad to help people become trauma informed or learn to deliver trauma-specific (i.e., conduct trauma therapy) in their organization. A list of more recent trainings can be found here: http://www.attachment-and-trauma-treatment-centre-for-healing.com/custom-trainings.html 
 
We also offer a trauma and attachment certification program which focuses on integration and regulation of the nervous system, brain, mind, and body. Trauma disrupts the integrative capacities of our brains and body and as such practices which increase integration help people to heal most efficiently. As we specialize in trauma our program combines the wealth of research in trauma, attachment, and neuroscience to create a comprehensive and practical program. We have trained several thousand since opening in 2013, including a lot of work with indigenous populations. You can learn more what people are saying here: http://www.attachment-and-trauma-treatment-centre-for-healing.com/what-people-are-saying-about-our-certification-trainings.html 
 
Certified Trauma Integration Practitioner – training to become a certified trauma informed professional (open to all background and educational levels)
 
Certified Trauma Integration Clinician – training to provide trauma specific treatment (masters degree or equivalent):

Day 1 Understanding the Foundations of Trauma and Attachment (same training for CTIP and CTIC program, examples are just different according to audience)
Day 2 Phase-Based Clinical Applications to Promote Healing and Integration of Trauma and Attachment Dysregulation (CTIC stream only)

We also hold an annual conference bringing in leading experts in the field of trauma and attachment to Niagara Region, Ontario: http://www.attachmentandtraumaconference.com Details about our 2016 conference will be available soon. 
 
Ruth Lanius and Paul Frewen our of Western University are conducting some of the world’s leading research re the neuroscience of trauma. They are hosting a phenomenal conference in Spring of 2017: http://www.schulich.uwo.ca/psychiatry/about_us/events/2017/brain_mind_and_body_conference.html
 
The National Child Traumatic Stress Network is a leader in trauma research and offers a wealth of free tip sheets, handouts, and information for you to learn more and share with various professionals (child welfare, courts, schools etc.,) in your communities. 
 
Linda Curran has an excellent book 101 Trauma-Informed Interventions: Activities, Exercises and Assignments to Move the Client and Therapy Forward offering various treatment activities that are based on best practice. We use many of these at the core of our treatment program (as does the Trauma Centre as outlined in Bessel's books, trauma centre research, and talks I have attended).  Here are some quick and essential facts:
 
We have an abundance of highly sound research that demonstrates the long-lasting effects of adverse childhood experiences measured by the Adverse Childhood Experiences scale. The Adverse Childhood Experiences Study examined the impacts of early childhood trauma on adult health and functioning on 17,000 people (Felitti & Anda, 2009). The results were shocking clearly indicating that adverse childhood experiences (ACES) are common; of the 17,000 HMO Members: 

• 1 in 4 exposed to 2 categories of ACEs; 
• 1 in 16 was exposed to 4 categories; 
• 22% were sexually abused as children; 
• 66% of the women experienced abuse, violence or family strife in childhood.

This study correlated ACE scores against health outcomes and the results of this study, as well as many longitudinal studies, have demonstrated a direct relationship between our early adverse experiences and later life health outcomes in many domains as indicated by a multitude of sources (Burke Harris, 2014; Felitti & Anda, 2009; Centre for Disease and Control, 2014):

•  ACE studies calculate that for each adverse childhood experience risk for early initiation of substances increased 3-4 times; 
•  ACEs account for 1/2 to 2/3 of serious substance use; 
•   ACES increased the likelihood of sex before 15 for girls and the risk for impregnating a teenager for males; 
•   There is an increased prevalence of Mood Disorders, Anxiety Disorders, Substance Use Disorders, Post Traumatic Stress Disorder (PTSD), Suicidality, and Impulse Control Disorders; 
•   ACES increase the likelihood for being both the victim of or perpetrator of intimate partner violence; 
•   ACES are also attributed to an increased risk for Ischemic Heart Disease, Stroke, Chronic Obstructive Pulmonary Disease (COPD), Diabetes, and Sexually Transmitted Diseases; 
•   ACES are also attributed to impaired worker performance inclusive of absenteeism, job performance, and financial problems.

The Childhood Adversity Narratives (CAN Narratives) provides a wealth of current information regarding ACES and the effect on children as well as implications later in life. I would highly recommend taking a few minutes to review this and share it.

Burke-Harris (2014) indicates that ACES have a dose-response relationship between ACES and health outcomes. The higher your ACES score the worse your health outcome largely due to the neurological and physiological implications that these early adverse experiences have on the developing brain. Repeated HPA activation (such as in the case of childhood physical or sexual abuse, domestic violence exposure etc) causes our stress activation response system to shift from being adaptive / life saving to maladaptive/health damaging. Children are exceptionally sensitive to repeated stress exposure and activation because their brains and bodies are just developing. High doses of adversity impact the developing immune system, the developing brain, the developing hormonal system, and the way our DNA is read and transcribed.

Burke-Harris (2014) quotes Dr. Robert Block, former president of the American Academy of Paediatrics “Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.” Putnam, Harris, Lieberman, et. al., (2015) indicate that relationships of this magnitude are rare in epidemiology demonstrating that we need to recognize this as the public health crisis that it is and as one that is treatable. We therefore need to implement services for education, early intervention, and prevention and certainly trauma-informed.

What is exciting is that this has created a shift in the US – and in Canada as well. The American Academy of Paediatrics has a great new resource: Helping Foster and Adoptive Families Cope with Trauma and lots of good resources to help physicians support families. 
 
You can learn about the The ISTSS Expert Consensus Treatment Guidelines For Complex PTSD In Adults is important for understanding best practices approaches for treating trauma. Although geared towards adults the framework is completely applicable to children and youth (as most of the experts on the panel work with all ages and we regularly adapt strategies to it all ages). 
 
Other books, training programs, and resources include:
 
Links to training, trauma resources and programs, as well as research articles can be found at the National Centre for Trauma and Loss in Children 

Dr. Bruce Perry has several articles and resources that can be found on his website Child Trauma Academy

Dr. Daniel Siegel offers brilliant insight into neurology, attachment, regulation and mindfulness. We would highly recommend The Whole Brain Child and Parenting from the Inside Out as essential readings for parents and professionals.  We were thankful to hear him speak at our 2013 Trauma and Attachment Conference!

Peter Levine also offers a myriad of resources regarding trauma and healing at the sensory and body level as vital to healing.  We have found his books to offer great insight a few include Trauma Through a Child’s Eyes, Waking the Tiger, Healing Trauma Through Yoga. We are thrilled to include mind-body regulating strategies as part of our every day treatment at ATTCH!

Dr. Allan Schore also has many excellent resources (books and journal articles) to provide insight into the impact of attachment on development and regulation.  He is a wealth of information and his more recent book the Science and Art of Psychotherapy is highly recommended for any clinicians.

Daniel Hughes provides valuable insight to how to create healthy attachment relationships with children.  Some of our favourites are: Attachment-Focused Parenting, Attachment Focused Therapy Workbook, Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children. 

Dr. Gabor Mate has some excellent resources on attachment and parenting, ADHD, and addictions. There are a multitude of video resources in varied lengths available on you tube, as well he has several books that are full of insightful and empowering information.

Please find a link to the blog entry Lori recently completed for the National Institute for Trauma and Loss in Children.  There are several great blog entries created by professionals on various topics  focusing on trauma.
 
Sorry, I had meant to send a quick reply but as you can see this is a topic I am passionate about :) I could go on as there are so many amazing resources but have to get to work! I hope this is helpful, if you want to connect 1:1 re: any further questions you have you can reach me at lori@attch.org
 
Wishing you wonderful day and thank you for the interest you have in this area, it is so needed. 

Lori
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