ACES TOO HIGH

This excellent blog was brought to my attention.  It discusses Adverse Childhood Experiences (ACES) and how to reduce them.  

ACES TOO HIGH

Self-Reflection Puts Trauma Informed Advocacy First

In order to fully embed trauma-informed services philosophy at member domestic violence and sexual assault programs here in New Hampshire we formed a cohort of advocates representing eight different programs who share their experiences and knowledge about building trauma-informed programs and using the principles when working with survivors.  This is the first in a series (I hope) of posts written by members of the cohort.  Thank you, Tina E.!

Self-Reflection Puts Trauma Informed Advocacy First

As a shelter manager for a domestic violence agency, I recently had a very difficult experience turn into a learning opportunity for clients, an intern, as well as for me.  As we know, working on such an intimate level with women in crisis can be challenging, painful, and even rewarding, but ultimately it tests our ability to practice what we preach, trauma informed advocacy.

A recent change in our household dynamics shifted our shelter from a fairly peaceful environment of two families supporting each other, both far along in their journey of establishing safety and independence, to a contentious and somewhat unsafe situation.  A new resident arrived with her children and began confronting others in an aggressive manner and discussing inappropriate topics with teens in the house.  This was upsetting and definitively a trigger to our current residents.  Her mannerisms and demeanor were offsetting even to staff, putting us in a place of carefully promoting discussions of safety and healthy conflict resolution while tempering feelings of distrust or frustration. 

In our house meetings a conscious effort was made to encourage the more intimidated client to share her concerns and requests regarding her children.  We discussed the type of households families may come from and the fear and domination victims face when wanting to be heard, but emphasized that this was a safe opportunity to build positive communication skills.  Although the one resident was able to show a marked change in her ability to display healthy boundaries for herself, the newer resident appeared impassive, somewhat arrogant and claimed no responsibility for any of the actions described by the other residents.  Despite the lack of resolution, it provided a format for practicing appropriate assertiveness for clients and even a chance for staff to role-model this when the client pointedly confronted staff.

The teachable moment came at a subsequent house meeting, at which I will own my mindset with regards to our residents.  I was impressed with the client who was speaking up for herself and was concerned the aggressive resident was displaying power and control behaviors.  Honestly, I felt protective of the one client and expected more negativity from the other.  Although I truly believe I remained professional, I know that this preconceived notion did not take into consideration the “whys” for the behaviors in the first place.  During this next meeting I recognized an increased confidence in the client standing up for herself, but noticed that the tone of the meeting had become accusatory.  With five adults in the meeting and the power in the room shifting, I carefully looked at things from our new resident’s perspective and wondered if I was at all being led by any biases.  After one resident became more vocal, displaying her frustration, I took the opportunity to ask everyone to consider some things.   I requested first that rather than taking someone else’s behavior personally, we assume that the actions are not intended to be hurtful.  Secondly, we can recognize that our new resident came into an already established household.  Most importantly, I stressed that we really knew nothing about her story, her fears, her concerns and where she was in that moment of her journey.  We ended up discussing how coping mechanisms to trauma may include having control over her own life in whatever way a victim can and one person’s survival skills may look very different than another’s.

This conversation opened up some amazing dialogue and the fact that our residents found some common ground was a positive moment for all.  However, I know the most fundamental aspect of this was truly modeling the trauma informed perspective.  My acknowledgement that no matter how compassionate I believe I am, putting aside my presumptions to see each client as an individual victim of trauma is the key to the best practice of advocacy and that there is always room to grow.

                                                

Transforming Early Life Trauma by Christine Claire Reed

Please click on the link below and take time to read this excellent blog on how creative arts has helped a trauma survivor.  The more that we can offer our survivors as means of managing the effects, the more empowered they will feel.

Transforming Early Life Trauma

Taking a Different View - Trauma-Informed Services

Working with survivors of domestic violence can sometimes be challenging.  At times it seems as if they are working against us and sabotaging our efforts to help.  They don’t always fit the ideal description of a victim.  We may expect them to be timid, dis-empowered, fearful, and willing to accept any help we offer them to feel safe.  When they don’t respond to us in the way that we would like we may even feel manipulated, attacked, used, or we may even begin to doubt their stories or label their actions as symptoms of a mental illness.

When working with survivors of domestic or sexual assault who are challenging it is very important that we stand back and take a different point of view.  Instead of talking about a person’s behaviors or symptoms that are getting in the way of her being able to move forward, it is more helpful to ask “how are the effects of trauma impacting her ability to make changes, engage in services and move forward and how can we help to alleviate effects?”  In addition, it is helpful to ask ourselves what we are doing that may be re-victimizing or increasing the impact of trauma triggers.  This is the goal of being a trauma-informed organization.

One definition of trauma-informed services is:

When a program is trauma-informed, every part of its organization, management and service delivery system is assessed and potentially modified to include a basic understanding of how trauma impacts the life of an individual who is seeking services.  Trauma-informed organizations are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that their services and programs can be more supportive and avoid re-traumatization.

In able to provide trauma-informed services, advocates may sometimes need to take a breath and recognize their own trauma responses in order to be able to respond in a trauma informed way.  By thoughtfully working with someone to recognize when she has become activated emotionally and then assisting her in reducing her responses we are of more value as an advocate than if we become resistant or activated in return. 

This may be particularly challenging in working with shelter guests.  A guest can feel powerless in the face of living in a strange place with people she doesn’t know and feeling controlled by staff or other systems.  This will increase trauma responses and a domino effect may occur among the shelter guests, one or more guests’ actions creating a possible activating situation.  Ongoing discussion amongst staff and guests about the effects of trauma and regular activities to relieve stress are vital in being able to help everyone feel emotionally safe.

It can also be helpful to take time out from looking at the non-productive behaviors (trauma responses) that you may see in a survivor and start to actively seek and point out any positive actions the person may make.  We can often fall into the habit of focusing only on the negative and fail to recognize the efforts and strength it takes for a woman to move forward after years of abuse.  Each time we point out something someone does wrong only validates what she may have heard from an abuser or parent.  We can help change patterns by focusing our efforts on a person’s strengths.

How Childhood Trauma May Make the Brain Vulnerable to Addiction, Depression

Please click on the link below for an interesting article on how the brain is changed by childhood trauma and contributes to addiction and depression.


How Childhood Trauma May Make the Brain Vulnerable to Addiction, Depression

Acknowledging Race-based Trauma

As advocates working with diverse populations, it has become more important to develop an awareness of the additional trauma that survivors may experience due to their ethnic or racial backgrounds.  According to Robert Carter PhD in his 2006 article Race Based Traumatic Stress (http://www.psychiatrictimes.com/display/article/10168/51536), race-based traumatic stress injury can be a consequence of emotional pain that a person may feel after encounters with racism.  These can be understood in terms of specific types of acts such as racial harassment or hostility, racial discrimination or avoidance and/or discriminatory harassment, and aversive hostility. How encounters with racism are experienced depends on many factors associated with an individual's background, health, and cognitive processing. Thus, the person who interprets and appraises his racial encounter as extremely negative (emotionally painful), sudden, and uncontrollable, may exhibit signs and symptoms associated with the stress and possible trauma of racism.

I worked at a shelter program in Norfolk, Virginia for many years and, having grown up in northern Wisconsin, I was admittedly unaware of how generations of racism could affect people of color. I had an encounter with a young woman of color who was bright and doing extremely well in school in spite of being relocated from her home due to domestic violence.  We were having a discussion regarding her possible educational and career options.  I mentioned to her that I thought she could be anything that she wanted to be.  She looked at me with disgust and said “no, I can’t.  I’m black and I’m a girl.”  At twelve years old she had experienced enough sexism and racism for her to develop a limited viewpoint of her options even though her abilities were far above average.  I regret that I don’t know where she is now, but I hope that she found someone to nurture her strengths and resiliency in the face of diversity and that she was able to create dreams in spite of real and perceived limitations. 

There was a woman of color in the shelter around that same time who was about my age and had a son the same age as mine.  I remember thinking one night about our similarities when it suddenly struck me.  Even though we were both women and had teenage sons, our experiences of motherhood were completely different.  Yes, both of our sons were getting into all sorts of trouble and were sometimes engaging in risky behaviors.  However, the consequences for a young black man were much greater than what could possibly happen to my son just because of the differences in the color of their skin.  Her worries were greater and more real than mine. 

I also eventually grew to realize that even though we were both women, I could walk through a shopping mall without being followed by store clerks who were checking to make sure that I wasn’t stealing.  I could apply for a job without worry that my resume would be removed from a pile because my name sounded too ethnic or because I had attended a school that had a high black student population.  I also realized that if I did well or if I did badly, my race would not be considered a factor. 

As white advocates working with women of color it is very important that we be aware of their difference of experience and the effects of insidious and implicit and explicit racism.  In the same way that domestic and sexual assault, childhood abuse, and other forms of violence create a trauma response in the brain, exposure to racism can also create lack of trust, poor self-esteem, hyper-vigilance for fear of further abuse, a sense of despair over one’s future, and a fear of re-victimization.

In the same way that we believe and validate the traumatic experiences of the assaults on survivors, it is important that we validate and believe the experiences of racism and understand the effects this could have on their ability to engage and move forward.  Also, in the same way that we focus on strength, resiliency and empowerment to help victims of gender-based trauma, we can also assist survivors of race-based trauma in finding their great strength and resiliency by acknowledging and honoring their experiences rather than being afraid to address the underlying effects of racism. 

Vicarious Trauma and Advocate Responsibility

Vicarious trauma is real and can lead to poor morale and health in advocates who are regularly exposed to the trauma of others.  The effects of vicarious trauma can mirror the reactions that we see in victims of domestic violence and sexual assault – depression, difficulty planning and making decision, and problems following through with a course of action.  An advocate may become hyper-vigilant and have difficulty sleeping. 

In order to keep on providing good advocacy services, there is a high level of responsibility on the part of the advocate to manage her/his own trauma effects.  Hopefully, an advocate is working as a part of an organization that promotes good self-care but the mission of domestic violence or sexual assault organization cannot be fulfilled if it is spending all of its time managing the trauma of its advocates.  Advocates need to consider self-care a responsibility to themselves, their organizations, and to the victim/survivors who are seeking services.  Given that an advocate is expected to perform his/her duties and provide support as a part of employment, it is imperative that self-care be done pro-actively rather than be used as an excuse not to be available to a victim/survivor.

This is becoming increasingly important as agencies are expected to do more with less.  It is not fair to the agency, co-workers, and victims if an advocate decides that the effects of vicarious trauma are so bad that she cannot provide advocacy for an afternoon or a day.  In the same way that first responders and emergency personnel are expected to work through the stress, advocates may need to find a way to continue to provide support and perform work tasks even while dealing with the effects of trauma.  Yes, we expect our agencies to be trauma informed/responsive and have an understanding of the trauma that advocates experience. However, it is the advocate’s responsibility to create a plan to manage the effects of trauma during both work and off-work hours. 

Supervision can be used to discuss the effects of vicarious trauma and can also be used to determine whether or not an advocate is truly dealing with the effects of VT or is experiencing burnout or compassion fatigue.  It may be a time to explore boundary issues, grapple with organizational skills and managing workload, or re-define success or expectations.

For some people who continue to grapple with the stress of providing advocacy to victims of abuse, it may be necessary to self-reflect on whether this particular choice of occupation is a good fit.  Sometimes it is important to admit that it is time to move on and make other choices rather than continue to work in a job that affects your health and well-being and makes it difficult for you to fulfill the expectations and mission of the organization and the victims who seek help.  This does not mean that one has failed. It just means that there was not a good fit.  There are many jobs which I have not applied for because it would not be a good fit and a few jobs in which I worked that I eventually left because it was not a good fit.  By learning what fit and what didn’t I was able to make better career decisions that fulfilled me and used my talents.  I also know, however, that I am responsible for my own self care.

The following information is from The Headington Institute.  It is an outline for managing vicarious trauma for advocates and managers. 

Make a vicarious action plan

You probably wouldn’t set out to help the people you serve without a plan. Why not give yourself the benefit of that same approach? This exercise can be completed in 15 minutes, or you can spend more time on it. We strongly recommend that you repeat it at least every couple of months.

As you complete the exercise, you might like to refer back to the text of this module. For each question we’ve included links back to the relevant section. You can also follow this link to download a list of all the “Think about” questions in this module. If you have been taking notes in response to these questions, those notes will help you complete this exercise. 

1.     List your important risk factors for vicarious trauma. These are things that get in the way of you helping others. They come from three main areas:

a.     From personal factors (e.g., past and current stress in your life)

b.     From your situation (e.g., work-related factors)

c.     From the cultural context (e.g., discrimination and attitudes of intolerance)

2.     List any signs or symptoms of vicarious trauma that you are experiencing. Think about the following areas:

 .      Physical

a.     Psychological

b.     Behavior and relationships

c.     Worldview or frame of reference (spirituality, identity, and beliefs)

3.     What are things that you can do to cope better with these symptoms? (Hint: Think about how you can counteract your risk factors, and remember that good coping strategies for vicarious trauma are things that help you take care of yourself – especially things that help you escape, rest, and play.) How can you take care of yourself in the following areas:

 .      Physical

a.     Mental and emotional

b.     Behavior and relationships

c.     At work

4.     What steps can you take that can help you transform your vicarious trauma on a deeper level? (Hint: remember that transforming vicarious trauma means identifying ways to nurture a sense of meaning and hope).

 .      Outside work

a.     During work

5.     Pick two things you have listed in response to questions 3 or 4, and think about how you will put those into practice this week. Set two specific, realistic, goals by completing the sentence below (Hint: think about how, when, and where you achieve these goals and put that in your answer too):

This week I will ______________________ to help prevent or manage vicarious trauma. 

6.     What obstacles might get in the way of you doing the two things you identified in item 5, above?

7.     What might you to do overcome the obstacles listed above? What will support you in accomplishing your goals (Hint: think about people who can support you and how they might encourage you.

What managers can do

Are you a manager? Managers can take many steps to help lessen the impact of vicarious trauma on staff they are supervising. Here are some of them.

1.     Understand the psychological and spiritual impact of humanitarian work:

a.     Be alert to how the cumulative exposure to stressful and traumatic situations may be affecting staff.

b.     Regularly check in with staff about how they’re coping – do not wait for them to approach you with a problem.

c.     Support staff in seeking counseling or coaching if and when needed.

2.     Set a good example in the way that you care for yourself, including:

 .      Work at a sustainable and reasonable pace over time, and encourage staff you supervise to do the same;

a.     Openly value things and people outside of work (e.g., time spent with your family);

b.     Take allocated leave time;

c.     Acknowledge that humanitarian work can be challenging and that healthy work/life balance takes practice and intentionality.

3.     Especially during times of increased pressure or crises, look for ways to help staff keep current challenges in perspective by:

 .      Reminding staff of the bigger picture of the organization’s mission and purpose, and how this assignment or disaster response fits into that bigger picture; and

a.     Reminding staff of the value the organization places upon them both as people and the organization’s most important resources. Encourage staff to work in sustainable ways. If that does not appear possible in the short-term, encourage them to take extra time after the immediate impact phase is over to rest and regain equilibrium.

4.     Express concern for the general well-being of your staff and not just the quality of the work they are doing.

5.     Make sure that staff suggestions and feedback about their jobs and the organization are heard and valued – even if you are fairly sure they will not result in tangible change in the near future.

6.     Do not say or do things that would stigmatize staff who are struggling with vicarious trauma or other stress or trauma-related issues.

7.     Strive to stay positive, and to praise and acknowledge effort and results whenever possible.