Everything is Connected

Frank Grijalva MSPH,MSCC

Midwest Trauma Services Network

Death

Early
Death

Disease, Disability
and Social Problems
Adoption of
Health-risk Behaviors
Social, Emotional, &
Cognitive Impairment
Adverse Childhood Experiences
Conception

Scientific
gaps

ACES and some takeaway

ACE study was triggered by treatment resistance
ACE study concretized treatment intuition for
many
ACES are about correlation not disease status
If the proper protective factors are in place ACE
exposures can be significantly influenced
ACES challenged the prevailing mentalist model of
behavior
Genetics load the gun, environment pulls the
trigger (Bruce Perry)

TIC is not the flavor of the month

Trauma informed care is the

compilation of the collective
science in response to observed
consequences of trauma
exposure over the last 100
years

MA Medicaid Enrollees

(Macy, 2002)

PTSD Period Prevalence by Age by Gender (n=19,775)

65%
60%
55%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%

F
M
F

F
M

F
M

M
F

5-12

13-18

19-25

26-34

35-44

ICDR All Rights Reserved Copyright 1995-2012

45-54

55-64

Perry on Trauma
The real crisis is coming. It is more relentless and
more powerful than the floodwaters. More
destructive than the 150 mile an hour winds. It will
destroy a part of our country that is much more
valuable than all of the buildings, pipelines,
casinos, bridges and roads. Over our lifetime, this
crisis will cost our society billions upon billions of
dollars. We understand broken buildings, we dont
understand broken children. (Perry, 2005)

What is
Psychological
Trauma?
Is it the same as
adversity and
suffering?
ICDR All Rights Reserved Copyright 1995-2011

The Human Stress Response Continuum

Psychological Trauma:
Overwhelming Demands
Placed upon the Physiological
System that result in a
profound felt sense of Loss of
Control, Vulnerability, and
Immobilization.
8
ICDR All Rights Reserved Copyright 1995-2011

Theoretical frameworks
Stanford Prison study
Milgrams Authority studies
Sapolskys Africa studies

Porges poly vagal theory

Hakomi therapy

The ARC model

The body keeps the score
Attorney Generals National Task Force on
Children Exposed to Violence

Trauma Theory
Sickness/Badness vs. Injury

Changing the fundamental question from:

Whats wrong with you?

to

Whats happened to you?

Children Exposed to Violence Task

Force
Trauma-informed care: is a new form of

evidence-based intervention
continuums and service delivery,
implemented by multiple service
providers, that identifies, assesses and
heals people and their support systems
injured by, or exposed to, violence and
other traumatic events.

Children Exposed to Violence Task

Force
: Services are considered trauma-focused when caregivers (such

as biological, foster, or adoptive parents, mentors, spiritual

advisors, coaches, or line staff in child- serving programs) or
professionals providing services (a) realize (understand) the
impact that exposure to violence and trauma have on victims
physical, psychological, and psychosocial development and wellbeing, (b) recognize when a specific person who has been
exposed to violence and trauma is in need of help to recover
from traumas adverse impacts, and (c) respond by helping in
ways that reflect awareness of traumas adverse impacts and
consistently support the persons recovery from them (adapted
from the 2012 SAMHSA [Substance Abuse and Mental Health
Services Administration] Working Definition of Trauma and
Guidance for a Trauma-Informed Approach).

Children Exposed to Violence Task

Force
Trauma-specific treatment: medical, physiological,

psychological and psychosocial therapies that are (a)

free from the use of coercion, restraints, seclusion, and
isolation (b) provided by a trained professional to an
individual, a family, or a group adversely affected by
violence exposure and trauma, and (c) designed
specifically to promote recovery from the adverse
impacts of violence exposure and trauma on physical,
psychological and psychosocial development, heath,
and well-being.
Key Issues- Safety-auto-regulation versus processing

Qualitative differential of
complex trauma
They do not see the world as you do
They are not generally safely or securely
attached so they are not compelled to an
internal motivation of trust and affiliation
Foreshortened sense of future
What you do has a survival quality for our
client regardless of sector.

Path of Maltreatments
Impact on Relationships
throughout Life
Mar. 20, 2012

Abusive or Neglectful
Parenting

Insecure Attachments,
Emotional
Dysregulation, Negative
Internal Working
Models

Poor Social
Functioning, Disturbed
Peer Relationships

Maladaptive Coping
Strategies

Psychological Distress

Adult Relationship
Dysfunction

Attorney Generals National Task Force on Children

Exposed to Violence

15

Considerations
According to the mentalist model, Americans

assume that outcomes and social problems are

individual concerns that reflect a lack of motivation
and personal discipline. As such, the use of
mentalist models by the public on issues related to
early childhood development has a narrowing effect
it boils complex interactions between individuals,
contextual determinants, systems and physiologies
down to either the presence or absence of individual
motivation and internal fortitude.
(Frameworks Institute)

Implementation

There is a difference
between knowing the
path and walking the
path (Morpheus)
The brain 5% carries out its function through the body 95%, knowing without
doing is meaningless.

Team
Juggle!!

Relational Functioning
Indicators

SELF-MANAGEMENT
Age-appropriate autonomy, emotional
self-regulation, persistence,
constructive time use

AGENCY
Planfulness, resourcefulness, positive
risk-taking, realistic goal-setting,
motivation

SENSE OF PURPOSE
Believing ones life is meaningfully
connected to a larger picture

CONFIDENCE
Positive identity and self-worth

POSITIVE
RELATIONSHIPS WITH
PEERS, SIBLINGS,
FAMILY, ETC.
Warmth, closeness, communication,
support, positive advice

ENVIRONMENTAL
AWARENESS &
BEHAVIOR
Knowledge, positive behaviors

RISK MANAGEMENT
SKILLS
Skills and knowledge to avoid drug and
alcohol use and risky sex

CRITICAL THINKING
Evaluation/analytical/problem-solving
skills

KNOWLEDGE OF
ESSENTIAL LIFE
SKILLS
Financial management, decisionmaking skills, home maintenance, etc.

SOCIAL INTELLIGENCE
Communication, cooperation, conflictresolution skills, trust, intimacy

Adapted from: Lippman, Moore, & McIntosh, 2011.

Mar. 20, 2012

Attorney Generals National Task Force on Children

Exposed to Violence

21

the Safety Wheel

ICDR All Rights Reserved Copyright 19952012

23

Victim

Persecutor
ICDR All Rights Reserved Copyright 1995-2012

Rescuer
24

Attachment Trajectories-(Resources)
Attachment to:
Primary Care Giver(s)
Significant Other
Self (Image, Rhythm, Integration)
Our Story (Narrative)
Peer Group
Your World View
Landscape
Daily Ritual(s) & Creativity
Anniversary Rituals
Entrainment Domains
ICDR All Rights Reserved Copyright 1995-2012

25

Its all here

The Child Welfare Trauma Training Toolkit. A comprehensive curriculum for
child welfare workers. n
Cops, Kids, and Domestic Violence. A DVD to train police officers in how to
reduce the traumatic impact for children of a domestic violence call.
Caring for Children Who Have Experienced Trauma: A Workshop for Resource
Parents. A comprehensive curriculum, taught by a mental health professional
and a foster parent mentor, to teach resource parents how to help the

traumatized children in their care. n

Psychological First Aid. A print and online evidence-informed approach to
enable first responders and volunteer workers to meet the immediate needs
and concerns of disaster survivors. n
Child Trauma Toolkit for Educators. A guide that provides school
administrators, teachers, staff, and parents with basic information about
working with traumatized children in the school setting. n
Ten Things Every Juvenile Court Judge Should Know about Trauma and
Delinquency. A technical assistance bulletin highlighting crucial facts judges
should know so they can best meet the needs of traumatized children involved
with the court system