Organizational Guidelines for Trauma Informed Care

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs register@allceus.com counselortoolbox. Hi there everybody and welcome to today's presentation on guidelines for training for Trauma Informed care. Yeah, I know this is kind of a overview of a meta concept, but it gives you an idea about some of the types of things that you or your organization will need to learn and will need to know in order to actually implement effectively implement a trauma informed care perspective. So we're going to review recommended guidelines for preparing your organization to become trauma informed. And I'm adding another class to our Trauma Informed care certification that actually goes through a checklist of all the different things that you really want to look at and assess in your organization to make sure that it is trauma informed from a clinical as well as an administrative perspective. But today we're just going to talk about the high level stuff. We're also going to review the core curricular elements for all staff and identify core concepts for understanding trauma. So core curricular elements in Trauma Informed Care ensures that all of the staff, not just your clinicians, your front desk staff, anyone who answers the phone, and your housekeeping staff even, are competent in engagement, rapport building and communication with persons who have trauma histories. We also recommend or recognize that most people have had trauma experiences in their life. So we're recognizing that when we're communicating with our staff members or with each other, that that person, that one of us or both of us may have had trauma experiences. So we're still focusing on making sure to provide a safe environment for working for recovery, et cetera. Training needs to cover a thorough assessment and a culturally sensitive and trauma informed differential diagnostic practice for mental health and somatic complaints. Well, okay, that was a lot of garbledygook. Basically, we need to make sure that when we're providing training to our staff and we're doing assessments that we are recognizing the cultural nuances. What behaviors are and symptoms are more common in certain cultures, what somatic complaints mean in certain cultures. Because some cultures tend to somaticize their mental health style because they see mental health as something much more difficult to talk about. So we need to understand, you know, what do these complaints mean, whether it's GI disturbances or difficulty sleeping, or whether it is depression or anxiety, what do those symptoms mean to that person? Training provides strategies for problem prevention resolution on an individual, family and community level. So we want to prevent re traumatization. We want to prevent problems that the person experiences. We want to prevent them from experiencing problems as a result of prior traumas. You know, if they have ingrained ways of reacting that in the past have protected them from trauma situations. We want to help them develop new skills and tools that can prevent them from encountering problems. What do I mean? If you've watched some of the other videos on Creating Sanctuary, Restoring Sanctuary we talk a lot about violence and verbal violence, verbal aggression, physical violence and even violence towards oneself in the form of self injury or addictive behaviors and a variety of other things can be ways that people cope with memories of trauma or cope with feeling unsafe. So we want to understand what do these behaviors do? How do these behaviors make this person feel safer or help them survive this moment? And then how can we prevent the problems created by these behaviors? How can we help them develop new behaviors so they don't have these ongoing problems? Training ensures establishment of an ongoing trauma informed structure. Ongoing, that means not just, you know, you go through one training and then bada bing, you're done. That means every year people are being trained in trauma informed care. Regular supervision happens that makes sure that you're implementing care in a trauma sensitive way and if you're implementing trauma specific interventions that you're using those to fidelity. It also means that everyone who's hired in the organization is trained and regularly retrained in trauma informed care. That supervision and employee evaluations reflect embracing trauma informed care. And we need to make sure that the organization has procedures to to monitor that all this stuff is happening. Training includes established interventions to diminish distress. So the sanctuary model is one of them and it's great. It's not necessarily just trauma informed, but it's a way to create a safe environment which doesn't re traumatize people. It's a fabulous model and you can get the book Restoring Sanctuary. You may even be able to find it at your local library and you can learn more about the sanctuary model. I also have two videos that will be and podcasts that will be coming out this week on the sanctuary model providing a high level overview. Another intervention that is really helpful. I've used it in my clinics before. Seeking Safety and Seeking Safety is actually a trauma informed intervention. A trauma specific intervention and it helps people with co occurring disorders and trauma histories become safer and establish a sense of personal efficacy and self esteem and develop healthy coping tools. Now the next couple are very cognitive in nature and they won't necessarily be appropriate for all clients. Acceptance and commitment therapy, cognitive processing therapy and Dialectical behavior therapy. All have pretty significant cognitive components to them, but all have very awesome techniques that can be used to help people develop psychological flexibility, learn how to be mindful, learn how to be aware of vulnerabilities, learn how to evaluate their cognitions and their reactions to determine whether they are currently safe, and learn how to deal with and prevent emotional dysregulation. Another trauma informed or trauma specific approach is compassion focused therapy for trauma. Now, there are a lot of trauma specific interventions out there, so these are not the only ones, but these are some of the more common ones that I've seen implemented and that a lot of clinicians are already at least moderately familiar with. So it's easier to implement in the long haul. Training ensures a full understanding of the local context and culture. So we don't want to assume that the clinic in rural Florida has the same expectations and needs and help seeking behaviors in their clients than a clinic in the middle of downtown New York City. But we want to understand what are the help seeking expectations of the population we're serving. What do they expect? Do they expect to see a physician and get medicated? Do they expect to see a counselor and talk about it? Do they expect it to be family therapy or individual? What do they expect? We want to understand their expectations about the duration of treatment, what obstacles they may have. Where I came from, you know, the University of Florida and Gainesville was, you know, pretty suburbanish. As soon as you got past that, it became very rural very quickly. Some of our surrounding counties had fewer than 5,000 people in the entire county. So resources were sparse out there. Transportation from those counties into Gainesville, you know, sometimes was an hour, hour and a half drive. And many of our clients didn't even have a car and there was no public transportation. So we needed to look at obstacles to treatment from a financial standpoint, from, you know, a transportation standpoint, from a child care standpoint. You know, if parents have kids at home, you know, how are, how can they attend treatment? Because you can't really do treatment really well if you've got a three year old running around in the session. You know, that was one of the obstacles that we would run into a lot of times during spring, summer and winter break with our clients because they would all of a sudden have their, have their children. We didn't want them to not come for two weeks or two months. So we needed to look at what can we do to facilitate this population maintaining engagement in treatment. We want to recognize their preferences for types of interventions, whether it's medication, family focused, cognitive, spiritual. Some cultures prefer to go with a spiritual healer or a natural healer of some sort. Some people will prefer eastern medicine techniques. Other people will prefer western medicine. We want to understand what is their preference, and we want to understand family and cultural attitudes about the involvement in the recovery process. Does the family need to be involved? Does the family want to be disengaged? Do they find it shameful? What are their cultural attitudes about the presenting issues? What are their cultural attitudes about trauma? What are their cultural attitudes about recovery? What are their cultural attitudes about us, the organization that often represents part of the system? If the system has caused their trauma, then we can be seen potentially as an organization or a body that might traumatize them in the future. So it's going to be a lot harder to develop trust. We need to recognize that traumatic experiences are complex. And this is one of those core concepts that we need to, you know, really wrap our head around. It's emotional. It creates feelings of anger, anxiety, depression, guilt, grief, lots of feelings associated with trauma. Physically, it activates the HPA axis. It can lead to brain changes, especially in young children, but even in older adolescents and adults. One of the things I want you to think about is the brain does not finish developing until about the age of 24. So we're taking these young people who are enrolling in the military, joining whatever you want to call it, when their brain is still very malleable and when the damage done to the brain is, it's so much easier to do damage to the brain, and we're sending them overseas, and then we're surprised when they have difficulty dealing with it or they end up developing PTSD or something else doesn't really make sense to me. We need to recognize that there is a physical component when the brain experiences trauma. Neurochemicals. Neurochemical balances change, wiring changes. Basically, it keeps people from getting enough sleep. It can cause all kinds of physiological changes. So we want to recognize the impact of trauma physically. We want to recognize the impact of traumatic experiences interpersonally. When somebody feels traumatized, they can blame other people. They can feel victimized by other people. They can feel frustrated or abandoned by others who they thought were supposed to help them. They can lose trust and faith in others, in the system and themselves. So there's a lot of potential impact interpersonally of trauma spiritually. A person's sense of connectedness and belongingness and purpose can be greatly impacted by trauma, and their environment can be impacted by trauma. You know, if because of a trauma Somebody has to leave their home. That can be additionally traumatizing if because of trauma, they don't feel safe where they're at, you know, that's trauma. So we need to look at all of the effects of trauma on the person. When we're doing our assessment and when we're providing care and when we're creating an environment that is trauma sensitive and trauma informed. We want to make sure that it's emotionally safe, that people feel physically safe, that people feel safe interpersonally. They don't feel like other people are out there that'll harm them, but they also don't. They also feel like staff and their, you know, groupmates or whatever are there to support them. We want to create an environment that is supporting and self regulating spiritually. We want to support people's idea of connectedness and we want to make sure the environment communicates hospitality and a welcoming feel. Traumatic trauma occurs within the context that includes the individual's personal characteristics, life experiences, and current circumstances. What's traumatizing to one person may not be all that traumatizing to another person based on any of these things. You know, if you have two people that are exactly the same, maybe their current circumstances are pretty darn similar to one another, but their life experiences up to now have been very different. And one person had a great home life, has a supportive family, and they've encountered challenges before and they've been successful at resolving them. The other person didn't have such a supportive family. They've had lots of traumas before and they always end up feeling disempowered and victimized. Well, both of those people are going to experience the current, whatever the current situation is probably very differently. One is going to expect disempowerment. One is going to expect that they can handle the situation, most likely. So some of the things that we want to look at, and this isn't all of them, we want to look at prior stressors in the last six months. How worn down and burnt out are they? And this includes physical stressors, like surgeries and illnesses, emotional stressors, interpersonal stressors, you know, relationship difficulties, breaking up with a spouse or losing a best friend, environmental stressors. And that could be everything from, you know, living in an environment where they don't get enough sleep because the neighbors are playing their stereo at all hours of the night, to living in an environment where they physically don't feel safe. We want to look at whether they have current mental health issues or a history of mental health issues. If they're currently Managing their mental health issues fine. Well, that's wonderful. That's great. However, if they have a history of mental health issues, we know that it's likely that current trauma and stress could trigger some of those mental health symptoms to come back. So we do want to be more acutely aware of that. We need to be aware of their cognitive developmental stage. Children, you know, up until about the age of 12, think differently than adults. Children are not little adults. They can't think abstractly. They can't think about hypotheticals or all the possibilities. They can think about what's in front of them and they can think about concrete things. So if you give them manipulatives, which is why we use manipulatives so much in the younger grades, young children, not only do they think concretely, they tend to think in all or nothing terms. There's very little gray area there. It's either I love you or I hate you. You'll protect me or you won't. I'm good or I'm bad. Succeeded or I failed. Children tend to think that way. So it's up to us as adults to help them see the middle ground. And children tend to be very egocentric. They take everything very personally. When parents get divorced, they feel like it's their fault. If the teacher is in a bad mood, they may think they did something wrong. So it's important to recognize how the person interprets what's going on. One other cognitive issue is comparative experiences. Somebody who's 10 in comparison to somebody who's 30 has very few experiences to gauge what's going on by. So it feels very much more overwhelming to a 10 year old than potentially to a 30 year old because a 30 year old has been through other things. Think about children and they have their first crush or their first love and then you know, that they break up or it's unrequited love. To a young adolescent, that can feel devastating. It can feel like the end of the world because they don't have anything to compare it to. They've never had their heart broken before. To somebody who's much older, yeah, it hurts, but it doesn't feel as all encompassing and life shattering as it does, you know, when you're younger a lot of times. So we need to recognize this because the way people interpret things is going to really affect how traumatic they see it. And whether they, they see it as something that is dealable and survivable, or whether they see it as something that is just going to completely crush them. We need to consider People's ability to meet their biological and safety needs. You know, what's traumatic for one person, you know, for a child. Children can't cook for themselves, they can't, you know, rent a house, they can't drive a car. So if something is very traumatic in their home, if they are in an environment where they feel stuck, it can increase the trauma. If they don't feel like they're ever safe. Social support is so important. They say that after a trauma There are basically two windows. The first 24 hours is. Well, the first four hours is the most crucial window. And if people receive social support in that first four hours, it tends to really help a lot with integrating the experience and helping them successfully resolve the trauma. The next window is 24 hours. And if they receive support within the first 24 hours from people, then a lot of times that again will help them experience the trauma as less oppressive and it improves their chances of successfully resolving the trauma. After about 24 hours, the brain has compartmentalized it because it doesn't want to deal with that crap anymore and, and stuffed it somewhere. So it becomes harder to integrate that experience into what's happened because it's now stored on a shelf somewhere. So we want to help people with social support integrate this information before it gets stored on their shelf. Proximity to a safe space When a trauma happens and it's closer to a place where somebody felt safe, it can be more devastating. So if a trauma happens and it's in your own house, that's more traumatic than something that even if it doesn't happen to you, that's more traumatic than something that may happen, you know, three blocks over. If it's something. I remember when I was in college, unfortunately, we had a serial killer on the loose. And when I first started college there, the whole campus felt safe. It felt like I was a place. It was a place I could go jogging at 10 o' clock at night with my headphones on and nobody would touch me because it was like my neighborhood. But then, you know, the, the whole serial killer thing, it became much less safe feeling. So people didn't walk around with their headphones on anymore and people didn't jog as much at night because this happened to in our safe space. So all of a sudden our sense of safety was just kind of shattered and we're like, okay, we're not safe here anymore. And current coping skills and tools. If the person has experienced things throughout their life and developed healthy coping skills and tools, they will likely respond better to trauma than someone who hasn't? So these are a few things that contribute to differentiating who is going to be more devastated from trauma or who is more likely to develop acute stress disorder than other people. Traumatic events often generate secondary adversities, life changes, and distressing reminders in people's lives. You know, whatever it is, let's think about a divorce. That can be traumatic. It may trigger housing changes. It may trigger loss of the ability to see your kids on a regular basis. Physical illnesses or injuries can be caused by a trauma. You know, the trauma may be a car accident, but that car accident may have broken your back, so you have chronic pain forevermore, or you're paralyzed. It can cause sleep difficulties. And let's actually go back up to physical illnesses. Even a non physical trauma, such as the hurricane coming through and people having to go to a shelter. That's a housing change. And it can cause physical illnesses because people are stressed out, so their immune system goes down. They're stressed out, so their stomach and their gi starts to get upset. They may have more frequent headaches. They will probably have increased sleep difficulties because their threat response system is turned up. They may experience mood changes. Well, if you're not sleeping well, if you're not feeling well and you're not sleeping in your own bed, I can certainly see how it might make you have some mood swings. There may be feelings of shame, guilt and anger, you know, shame about not being able to protect your family or about getting into the situation. People may feel guilty, and even if they didn't have anything to do with it. Again, let's think about the shelters. If they had to take their family and go to a shelter because of a natural disaster, you know, seeing how much it's upsetting the kids, you know, really cuts to the core of parents. And we feel guilty, we feel bad, we feel frustrated, we feel helpless. And that's, you know, on some levels, traumatizing to parents and anger, you know, and sometimes we'll stay with the hurricane example. Right now, people can feel angry at, you know, whatever caused the trauma, but they can also feel angry at other people for not helping. They can feel angry at themselves for whatever they feel they didn't do that they should have or they did that they shouldn't have. You know, a lot of this stuff and blaming and trying to make sense of what's going on can come out now. There's a loss of significant people or things, you know, after a, after the hurricane, you know, some people may have lost their entire house. Some people, you know, the Entire first floor was flooded. So even though the house is still standing, they lost all their mementos. Some people lost pets. Sometimes losses like plane crashes can cause the loss of a family member. And you know, that also may result in other people in the family just kind of backing off and going into seclusion for whatever reason because they have difficulty dealing with it. So there may be secondary losses. When people get divorced, for example, you know, you've got in laws on either side. When you get married, when you get divorced, you lose those in laws. You're probably not going to be calling your ex mother in law on the holidays. So that can feel very traumatizing. Visual, auditory and olfactory reminders. So what you see, what you hear and what you smell can trigger flashbacks and strong emotional reactions. So it's important to understand that these reminders are there. It can be in a TV show, it can be something innocuous in, you know, when you go into a place. I know at one point somebody was wearing a resistance vest in the gym and it looked like a bomb vest. You know, one of those vests that somebody wears when they've got a bomb strapped to them. And it was triggering for some people that were in this facility because the person had the resistance vest on, but it reminded them of something else that was much less safe. So it can trigger emotional reactions. We want to be aware that those are there. You know, if you're flipping through the channels on the TV and you happen to pause too long and Criminal Minds is on and somebody's screaming in agony because they're being tortured by a serial killer, that can trigger somebody's past memories. So just being sensitive to triggers and reminders that might exist and all of the reverberating impacts of trauma. You had this loss, but what, how else did this loss affect you? People exhibit a wide range of reactions to trauma and loss. Not everybody develops ptsd. Some people do. Some people have very strong grief reactions. Some people have very different grief reactions. Sometimes there's a disruption of attachment and or peer relationships. People try to withdraw because, you know, that loss was too painful. I don't want to risk losing anybody else, so I'm going to keep everybody I can at arm's length. There can be problems with emotional regulation. You know, that person is just really stressed out. And, you know, as you learn more about trauma and hypocortisolism and the brain changes that happen with ptsd, people who have a history of trauma and hypocortisolism often have symptoms of emotional regulation because Their body is conserving energy, conserving those excitatory neurochemicals that fuel fight or flee responses. It's conserving those until it sees that there's really, really an imminent threat. So normal things, you know, the person just doesn't even pay attention to. But when something happens that triggers them, they go from 0 to 260. There can be withdrawal or constant immersion in relationships. Sometimes instead of withdrawing from relationships and keeping people at arm's length, people have to be around somebody all the time. They feel like they need somebody to stay with them. And if they don't have somebody physically with them, they need to be on the phone or texting with somebody else all the time. They need that connection because they're so afraid of being isolated and abandoned. There can be a reduced level of functioning at home, school, work and in the community. When we are stressed, when our HPA axis, our threat response system is activated, our brain is not in that problem solving, higher order cognitive place. It's in protect me. It's in I'm going to do what I can to tread water and survive. So that energy is being devoted to survival, which means you're, you're going to have more difficulty concentrating, you're going to be more fatigued because you're not sleeping well. You're going to be more apathetic and less motivated to do things that are less essential to survival because your brain is focused on surviving. Even if that trauma is no longer present. It takes people a while to get back that energy. If they have been on for weeks or months, then it can be exhausting. I remember when my daddy died, he was in hospice care. And the last couple of months he was in hospice care at home. And my stepmother was just totally, totally exhausted by the end of it because it had been this long drawn out trauma as he went through the stages of passing. So we want to recognize that it may not be willful apathy. Reduced level of functioning can be a result of trauma and we want to recognize why that might be happening. And there can be exacerbation of pre existing mental health or addiction problems. So if somebody is holding it together pretty well, or seems to be, and a trauma happens, they may relapse, they may become clinically depressed, they may start having panic attacks again, or they may relapse in their addiction. This, if you view it in terms of any of these behaviors in some way somehow are an effort of the person to protect themselves and to survive the trauma. So we want to say, okay, you're trying to survive right now. Let me help you survive better. Safety is a core concern after trauma. Trauma can magnify concerns about dangers. So, you know, my children, even to this day, and, you know, it kind of breaks my heart a little bit, but they were very little when Hurricane Katrina happened. But my son does remember it. So every time there is a bad storm coming in, especially tropical depression or stronger, he becomes obsessed with the weather and whether it's going to hit where we have any family at. And he just, he focuses on that. No matter how much I reassure him that all of our family is very much inland, and a hurricane has never come that far inland and been more than like a Category 1, he has difficulty wrapping his head around that, even at 18. So trauma can magnify concerns about dangers because they get. People can get stuck on the fact that this was. It could be deadly. And I just hear deadly from all of the news stations. And that's what I'm focusing on. And it can. Trauma can make it more difficult to distinguish between safe and unsafe situations. Think about the child that grew up in a domestically violent home. You know, that was their normal. So it's hard for them to distinguish between safe and unsafe situations right now. People who have been through hurricanes, you know, may have difficulty differentiating between a hurricane that's safe to ride out and a hurricane that's. That's not so. Again, trauma can alter, and part of that depends on the person's prior experiences. Placing people in physically safe circumstances may not be sufficient to alleviate their fears or restore their disrupted sense of safety and security. So we need to ensure that people feel safe, but they need to feel emotionally safe, they need to feel cognitively safe, and they need to feel like they've got support. Traumatic experiences affect the family and broader caregiving systems. Family members or social support's own distress can impair their ability to support the traumatized person. If you have a person in your family who is a rape survivor, the family members may want to be there for that person, but they are so traumatized by what happened, their guilt for not protecting them, whatever is going on with them, that they have difficulty acknowledging and supporting the person who actually went, the primary traumatized person. This compounds the survivor's sense of reduced protection and security. It's like, okay, my family, who was supposed to be able to be there to help me through this, they can't even look me in the face right now. So what does that mean? That means I don't have anybody that has my back. And that means Maybe other people are looking down on me. Protective factors that can reduce the adverse impact of trauma. These are things we want to make sure we enhance in our families, in ourselves, and in our communities. High self esteem. You know, people need to think that, you know what, I'm not perfect, I make mistakes, but gosh darn it, I am really a nice person. I'm a good person, and I do have some skills, I have some talents, I have some things that I'm really good at. We want to instill self efficacy, the feeling that everybody has the ability to survive and to thrive in whatever way they want to so that they can achieve their goals. We want to encourage and make sure everybody possesses a repertoire of adaptive coping skills. You're not born with coping skills, you learn your coping skills. So if you learn dysfunctional coping skills, then that's what you're going to be using as an adult. If you learn adaptive coping skills, which I really wish they would teach in elementary and middle school health classes, just a little soapbox there. If you learn positive adaptive hope coping skills, then it's going to be easier to deal with the adverse impacts of trauma. If you learn psychological flexibility, if you learn how to reach out and get social support, positive, secure attachment really reduces the adverse impact of trauma. And yes, the primary attachment relationship, ideally, you know, was a good one that was secure, where the child felt that, you know what, Mom's got my back, you know, I can start trying to walk and if I fall, she's going to pick me up and, you know, not let me get too terribly hurt. Positive, secure attachment with that caregiver, trusting that there's a caregiver there, that's going to keep you safe. That's the first relationship that people have. Now, even if that one wasn't a great one. That doesn't mean the person is doomed. If they've developed a positive, secure attachment with somebody else, somebody who has been there, who has loved them for who they are despite some of their actions, then they start learning that, okay, everyone is not necessarily going to abandon me. Effective, reliable social support. And this goes beyond secure attachment, because we have those people that we have a strong attachment to that are there, they have our back, they are our rocks. But then we also want to make sure that we have friends, reliable social support that we can call on and we can go, you know what? I'm having a really bad day. Or I found out that the hurricane's coming this way and I need somewhere to bug out. Can I sleep on your sofa? Whatever it Is friends are there to provide that social support during that traumatic period and after In a supportive school, work and community environment. You know, when a trauma happens, it's important that these environments are supportive. When, you know, when my father was sick, my organization, my boss, my company was very respectful of what was going on. My colleagues were so supportive of what was going on, which helped me get through it. You know, I felt like I wasn't the only one, and I felt like my feelings were very validated when I was going through this process. You know, you don't have to go over and be over and above and get all gushy about it, but it's important to be there and say, you know what, I recognize this when things happen in our life and how can I support you to help you get through this? You know, my boss always knew that family was important to me. When my son was born, and he was born 11 weeks premature. So, you know, he was in the NICU, my boss was very supportive and understanding about me working remotely because I was working from the NICU every day. So those types of things really help people reduce the adverse impact of trauma in a community. You know, my mother is going through chemotherapy right now, and her church friends are regularly bringing over meals and stuff so her husband doesn't have to cook, and they help her with the shopping and things like that. So her community realized that they were going through a traumatic time and they have bonded together to support her and her husband during this time. So they don't feel like they're out there just floundering. They are getting all of their needs met and they know that there are people they can call on trauma and post trauma adversities can strongly influence development. So if it happens when people are younger, which it often does, if you look at the ACEs study, you can see regressive behavior when children are displaced either into foster care or into a shelter because of a hurricane or something. A lot of times we will see those children regress behaviorally. They may become more aggressive, they may start getting more hyper and running around. They may start thumb sucking again. You know, things that they had outgrown or you thought they developed behavioral control over, they start coming out again a little bit. We want to recognize that. What's the function? How does this protect this person when they start acting like that? They may be blowing off steam because they've got so much anxiety. They. They may be needing boundaries and limits set in order to have some sort of normalcy. There's a lot of reasons it can happen, but it does influence development and it can influence brain development and it can actually make permanent brain changes. If the trauma is significant or long lasting enough, there can be reluctance or inability to participate in developmentally appropriate activities. That's pretty self explanatory. And for children, developmental accelerations such as leaving home at an early age and engagement in precocious sexual behavior may also occur. I remember one young person that I worked with. Her home life was pretty chaotic. Her mother was substance abusing, dad was out of the picture. I can't remember if he was in jail or what, but she announced to me the first time I met her, she was 14. And she announced to me that she was in the process of trying to get pregnant because she could get an apartment as, as soon as she was 14 or she thought she could. And that was her goal because then she would have control over everything in her life and she wouldn't have to be in this traumatic, stressful environment. Sometimes people engage in precocious sexual behavior because they desperately need that connection and to feel loved and secure, and they think that's how to get it. So the reasons people do these vary from person to person. But again, look at the behavior in terms of a survival reaction to a trauma and then figure out what need is it meeting, what way is it helping this person feel safe or less upset or whatever, and what else could we help the person do instead in order to achieve their goals in a healthier, more productive way? Neurobiology underlies reactions to traumatic events. The capacity to appraise and respond to a danger are linked to neurophysiological pathways and neuroendocrine systems. The danger apparatus in our brain, our HPA axis, controls our appraisal of dangerous situations. You know, if the HPA axis doesn't think it's dangerous, you know, it sees the situation, checks with memories, it says, no, this is no big deal, then we're not going to get upset about it, which could be okay. But if it is actually a dangerous situation, then that could be, could be bad. It controls emotional and physical reactions. When the HPA axis gets activated, it causes a reduction in sex hormones, a reduction in serotonin, a reduction in melatonin, and an increase in glutamate and norepinephrine. The chemicals that are going to give it get us to fight or flee, which is going to trigger feelings of either anger or anxiety. And it controls our protective actions. It controls what we do. A lot of these are very centered in very primitive areas of our brain, because when we get to this place where we are just trying to survive and protect ourselves from something we perceive as really threatening. We're not thinking about it right now. It's the amygdala and some of the other more primitive aspects of our brain that are going to. You need to fight, you need to flee, you need to do something to get yourself into a safe place. Traumatic experiences evoke strong biological responses that can persist and in children, alter the normal course of neurobiological maturation when the brain is under stress. When the brain is regularly exposed to trauma or exposed to extreme trauma, it can alter the formation of the brain as it's supposed to. We've seen on brain scans that traumatic brain injury that's caused by something physical. We also see similar traumatic brain injuries that are caused by intense trauma. We see actual brain changes. We see actual changes in the HPA axis. We see changes in which areas of the brain light up when exposed to certain stimuli. The neurobiological impact of trauma experiences depends in part on the developmental stage in which they occur. It's going to be much more impactful, most likely if it occurs in a younger person than if it occurs in somebody over the age of 25, because remember, the brain is still developing up to the age of 25. It may be more traumatic to a person and thus have a stronger neurobiological impact on children under 12 who are still egocentric, dichotomous, and concrete in their thoughts than to an adolescent who has a few more life experiences and can also think more abstractly. And it also depends in part on the number and intensity of traumatic experiences. If somebody has a lot of chronic trauma, that's additive. You know, it's not just, oh, you know, and think about law enforcement officers or firefighters. They see trauma on the daily and they take that with them when they go to sleep at night. So those traumatic experiences can add up if they don't have healthy and effective ways of dealing with them. So trauma impacts the majority of people. They find that most people have been exposed to trauma. Around 70% have been exposed to some kind of trauma in their life. Creating a trauma informed organization means recognizing the sources and impacts of trauma that exist and how your staff, your clients, your families and community have been exposed to trauma and have been affected by trauma. A trauma informed organization prevents recapitulation or redoing trauma in an organization. We don't want to recreate that traumatic system and have clients come walking into it because that's, you know, you wouldn't do that. We want to explore current behaviors in terms of creative, ingrained ways of cultural coping with trauma in order to survive, and we want to make sure that staff are trained on how to maintain a culturally responsive, safe atmosphere in the organization and with referral sources. We want to educate clients families in the community about the impact of trauma because once they understand the impact and they can start better understanding the behavioral responses and then responding better in order to be more trauma informed themselves. Empower clients to choose, change and make sure your organization either implements themselves or has a very close relationship with an organization that has trauma specific interventions available to clients. Alrighty everybody, thanks for being with me and have a great weekend. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allceus.com podcastce CEUs. To sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor thank you.