Chcmhs 007 Work effectively in trauma informed care Question 4 PDF

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Chcmhs 007 Work effectively in trauma informed care Question 4...

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CHCMHS007: Work effectively in trauma informed care Question 4.2 You may need to conduct further research. What is trauma? Including the following:  Prevalence in the general population and with service users 

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Trauma is prevalent in Australian society, with 57% of the population reporting exposure to traumatic events in their lifetime. Post-traumatic stress affects 2.8% of people who have experienced trauma. Men are more likely to experience trauma than women, with the exception of sexual assault. However, females are more vulnerable to post traumatic stress than males. Most people (50% - 80%) who enter mental health services will have experienced complex trauma as well as interpersonal violence. When you start looking at the population of people with mental health disorders it becomes even more significant; 90% of public mental health clients had been exposed to trauma according to research. Most have multiple experiences of trauma. 34% - 53% of people seeking services in mental health systems of care report childhood sexual and/or physical abuse and up to 81% report some kind of victimisation. Up to 97% of homeless women with serious mental illness have experienced severe physical and sexual abuse, around 87% of those individuals reporting these experiences as both children and adults. Vulnerable women can find it difficult to end abusive relationships, find it difficult to exercise their rights and difficult to find someone who believes their story. Between 5% -10% of Australian children experience physical abuse, around 11% experience emotional maltreatment and between 12% - 23% witness family violence. Between 7% -12% of girls experience penetrative sexual abuse (4% - 8% for boys), and 23% -36% experience non – penetrative sexual abuse (12% - 16% for boys). There is insufficient research to accurately estimate the prevalence of child neglect in Australia. Indigenous Australians are particularly affected by traumatic events. Loss and unresolved emotional distress related to racism, loss of land and culture, family separations, deaths in custody, suicide and early death of family members are endemic and their impact is widespread. For example, 22% of all prison inmates are indigenous men; indigenous women are 45 times more likely to be the victim of domestic violence than non-indigenous women and indigenous children experience higher rates of neglect than non-indigenous children. Similarly, 70% - 90% of refugees will have experienced pre-migration events which are traumatic, including human rights violations, dispossession, war, organised violence, torture, sever harassment, witnessing the execution, rape or torture of friends or family members, and other threats to life. These trauma experiences can impact on mental health during resettlement. The issue of trauma is painful. The realisation that the majority of mental health services users will have been exposed to or experienced significant trauma in their lives can feel overwhelming for workers.

 Definitions including complex trauma and its impacts 

Answer provided in the assessment booklet.

 The developmental impacts of those affected 

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Children all over the world are exposed to traumatic events such as natural disasters, abuse, domestic violence, community violence, and war. In Australia common adverse childhood experiences include abuse (emotional, physical and sexual) and neglect (emotion and physical), exposure to domestic violence or relational stress (e.g. separation and depression), alcohol and other substance abuse, mental illness or criminal behaviour in the household. Peer to peer violence including bullying and sibling abuse is also significant. If these adverse experiences are extreme and repetitive, and occur during critical periods of brain development, alteration or impairment to the major neuroregulatory systems can occur, creating lifelong neurobehavioral effects, meaning childhood trauma can alter brain development and as a result, affect human function, behaviours and health outcomes across a lifeline. While our brains continue to develop throughout our lives, most critical structural and functional organisation of the brain take place during pregnancy before we are born and during early childhood. By the age of 3 our brains are 90% as large as they will be in adulthood (at the same age, the body is only 18% of adult size). Through this period, important molecular processes establish the neuronal organisation and function of the rain and these processes occur in a sequential way i.e. the brain develops from the least complex structure (the brainstem) to the most complex areas (limbic and cortical). The simpler structures controlling the basic regulatory functions of the body (respiration, cardiac function) are predominantly developed in the womb and the more complex structures, which impact on future emotional, cognitive, behavioural, social and physiological function, develop during early childhood. The functional and organisational capacities of the adult brain reflect the quality, quantity and pattern of the somatosensory experiences of early childhood. An experience in adulthood may alter the function of the organised brain, whereas an experience in childhood determines the organisation of the brain – the brain adapts to the environment the child is being raised in. just as positive experiences and supportive, enriching environments impact on brain development, so too does adverse experiences and impoverished environments. How the brain is influenced or altered in response to adverse experiences depends on the nature, frequency and developmental timing of the adverse event/s, because brain development is more sensitive at sometimes than at others. The younger a child is when they experience or endure trauma and/or neglect, the more pervasive their problems will likely be. For example, neglect of an infant or young child causes distress for the chid because their needs are not being met; lack of physical and emotional stimulation can cause pervasive developmental delay, such as delays in language acquisition, fine

Certificate IV in Alcohol and Other Drugs CHCMHS007: Work effectively in trauma informed care (200048718) Rebecca Jones

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and gross motor delays, attention problems and hyperactivity, impulsivity, dysphoria and disorganised attachment and will result in difficulties with cognitive, behavioural, social and emotional functioning. As they grow up, people neglected as infants or children will have developed less capacity to manage later or concurrent stressors. The fact that neglect is often accomplished by exposure to other traumatic events compounds the problems. A number of studies have linked adverse early childhood experiences to a variety of negative health outcomes and behaviours which are physical, behavioural and psychological. Physical outcomes include obesity, chronic disease, chronic pain, cardiovascular disease. Negative behavioural changes include engaging in risk taking behaviour, entering into dysfunctional relationships, aggression and hostility. Psychological consequences of childhood trauma include interpersonal and relational difficulties, shame, embarrassment, guilt, avoiding care (or increased use of care), low self-esteem and cognitive and perceptual disturbances. The ability to form healthy relationships is highly dependent on learned social skills. Children’s social skill learning is directly related to the characteristics of their environments, disordered environments = dysfunctional skills. Violence teaches withdrawal, anxiety, distrust, over-reaction and/or aggression as coping behaviours, extreme behaviours are rooted in dysregulated emotional states. Child maltreatment has the most significant impact on children and the adults they become. Clear relationships exist between child abuse and a range of mental disorders including clinical depression, anxiety disorders, post-traumatic stress disorder, psychotic disorders, bipolar disorder, eating disorders, substance misuse disorders, reactive attachment disorders, sexual dysfunction disorders, personality disorders and dissociative disorders. The higher the number of adverse childhood experiences, the greater the likelihood of later smoking and substance abuse, suicide attempts, risk taking sexual behaviour, hallucinations, panic, impaired memory and poor anger control. The effects of trauma are cumulative, so the ore severe and prolonged the abuse, the greater the risk of developing a mental disorder. Childhood trauma also impacts on the clinical course of the metal disorder, e.g. in depression, a trauma history increases the likelihood of early onset, higher levels of co-morbidity, increased duration of illness, more frequent relapse and/or reduction of the likelihood of remission. In addition, people with mental disorders and a history of childhood trauma receive more medication, spend more time in seclusion, have higher global symptom severity, are more likely to try and kill themselves and engage more frequently in deliberate self-harm than people with a mental disorder but no trauma history.

 Dynamics of interpersonal violence and its relationship to trauma 

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The World Health Organisation defines interpersonal violence as any behaviour within an intimate relationship that causes physical, psychological, or sexual harm to those in a relationship, it also identifies that interpersonal violence can be subdivided into two different categories of violence - Family and intimate partner violence – including child abuse, neglect and elder abuse. Community violence – including youth violence, rape or sexual assault by an acquaintance or stranger, random acts of violence, violence in institutional settings. Interpersonal violence occur when a person uses physical force or other forms of power, against another person that is likely to result in injury, psychological harm or death. It includes threats of violence (for example emotional abuse or stalking) as well as actual acts of violence. It is often used by one person in an attempt to control the other person. It can be perpetrated by persons who are known (husband/partner, friend, work colleague or parent) or by strangers. However, more often than not, it is people who are known to the person who is traumatised that enact such deeds. Interpersonal violence is more likely to involve a man acting in a violent way towards a woman; however, this should not be taken to mean that women cannot cause harm to men or that violent acts do not involve two people of the same gender. Acts of violence can be carried out against children, young adults and elderly. Interpersonal violence includes child maltreatment, intimate partner violence, sexual violence, youth violence and elder abuse. It might occur in the home, in public, in the workplace and in institutions such as schools, hospitals and residential care facilities. Intimate partner violence is one of the most common forms of violence against women and refers to ‘any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship’. Women from CALD communities, Indigenous women and women with a disability are all at greater risk of experiencing intimate partner violence. Most women who experience intimate partner violence, experience a number of different types of abuse and most do not disclose their experience due to fear, isolation, shame and lack of support, despite accounting for over one third of presentations to hospital emergency departments. Abuse can be severe and escalating, where the woman is terrorised and threatened and experiencing multiple types of abuse (known as ‘battering’), or more moderate, where occasional eruptions occur. History of family violence is a powerful risk factor for intimate partner violence by men having been abused as a child is one of the risk factors associated with experiencing intimate partner violence by women. Pregnancy an also be a trigger point for intimate partner violence. Alcohol misuse is a common feature of domestic violence incidents – both in men and women. Drinking increases the severity of aggression, anger and violence. Alcohol is a feature in around 50% of all partner violence situations, 73% pf partner physical assaults and 44% of intimate partner homicides. Aboriginal and Torres Strait Islander intimate partner homicides account for 20% of all partner homicides and in 87% of these cases, alcohol has been consumed. Intimate partner violence is the leading cause of death, disability and disease in women aged 15 – 44 years. Survivors are more likely to experience chronic pelvic pain, reproductive health problems, headaches and back pain, and to engage in high rates of smoking, drinking and substance abuse after the violence. Like other forms of trauma, there are strong associations between intimate partner violence and depression, anxiety, alcohol abuse, substance abuse, attempted suicide and somatisation.

Certificate IV in Alcohol and Other Drugs CHCMHS007: Work effectively in trauma informed care (200048718) Rebecca Jones

 Coping and managing the impact of trauma  As children those who live in chaotic environments and experience trauma can find it difficult to form healthy relationships, 

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their social skills, learning may be impaired, they may be withdrawn, anxious, mistrusting, or they may use aggression or over-reaction as a coping behaviour. Many people who have suffered trauma use protective defences to cope with that trauma. Often, they deny that interpersonal violence occurred, minimise it or dissociate so they are able to cope with their situation. These strategies keep the survivor from knowing just how terrible things actually are but also prevent the person’s ability to seek and receive help. If they cannot admit to themselves that something bad happened or if they convince themselves that what happened to them was really not that bad, they cannot openly and honestly talk to others about it. Instead they have developed a habit of covering up so that they are able to survive. People who have suffered trauma often blame themselves. They feel like they have been mistreated because they are not good enough, smart enough or pretty enough. Unfortunately, for these reasons they do not want to talk about the abuse they have suffered. They feel like it is their faut and therefore do not want to draw attention to their deficiencies. They often feel that they can stop hurt being inflicted again by changing themselves in some way. Strategies that can be helpful for a person who has experienced trauma might include:  Reaching out and connecting with others, especially those who may have shared the stressful event  Talking about the traumatic experience with empathic listeners  Crying  Hard exercise like jogging, aerobics, bicycling, walking  Relaxation exercise like yoga, stretching, massage  Laughter with friends and family  Prayer and/or mediation; listening to relaxing guided imagery; progressive deep muscle relaxation/hot baths  Music and art  Maintaining a balanced diet and sleep cycle as much as possible  Avoiding over-using stimulants like caffeine, sugar, or nicotine  Committing to something personally meaningful and important everyday  Hugging those you love, pets included  Writing about the experience A person’s reaction to interpersonal violence is not always straightforward. Survivors might feel especially confused if some aspects of the abuse felt enjoyable, exciting and sensually stimulating. Think about men who are raped. They are sometimes forced into a state of physical arousal. This does not mean the individual wants to be raped, this response, is generally involuntary, but men can have a great deal of difficulty in accepting this. Possible mixed emotions of love for the perpetrator and hate for what they have done might also inhibit disclosure. Fear of punishment from the perpetrator is a barrier that can occur even when incidents of interpersonal violence have ceased. Perpetrators might have or might be actively and aggressively attempting to block the persons access to help. Children who have been sexually abused are often told that their parents will be harmed if they tell anyone what has happened. Fear of the perpetrator’s punishment can prevent a person from disclosing their experience and ultimately inhibit access to help.

 The potential for and re-causes of re-traumatisation, in particular in accessing or receiving services 

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Re-traumatisation is the re-experiencing of sensations and/or emotions experienced at the time of a single or multiple traumatic events/history from the past. Re-traumatisation is generally triggered by reminders of previous trauma – sensations, images, sounds, situations and body feelings, which might or might not be potentially traumatic in themselves. Mental health professionals and peer workers in particular might have their own trauma experiences and working with people who need help overcoming trauma can cause re-traumatisation in workers. The individua might say something that sends the worker back to their own trauma experience, have injuries similar to the ones the worker has had or describe situations that are all to familiar. Being aware of the possibility of re-traumatisation and developing self-care strategies in managing re-traumatisation are an important aspect of this work. Supervision should be provided to people working with trauma survivors when they themselves have experienced trauma. A supervisor might be able to recognise symptoms that suggest the worker is being re-traumatised or that suggest the worker is being re-traumatised or that continued work with a client is not in their best interest. The supervisor might be able to see what the worker cannot or chooses not to see themselves. Vulnerabilities might mean that a worker cannot work with individuals with issues or experiences too close to their own. They might need to establish boundaries as to the type of case they are able to work on if re-traumatisation becomes an issue. One of the key features of trauma informed care is to avoid re-traumatising the person through the practices of the service. For many people, being admitted to a mental health service places them at risk of witnessing or experiencing a traumatic event, and hence being re-traumatised. Some of these traumatising events include:  Physical assault  Sexual assault  Witnessing traumatic events  Being around frightening or violent patients

Certificate IV in Alcohol and Other Drugs CHCMHS007: Work effectively in trauma informed care (200048718) Rebecca Jones

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 Being secluded or restrained  Feeling medications are used as a threat or punishment  Unwanted sexual advances  Inadequate privacy The following quotations provide a consumer’s perspective on re-traumatising experiences of mental health care:  “I was crying, not fighting. One male staff was kneeling on my right shoulder. I was hurt, confused and scared.”  “Seclusion involves 5-6 guys chasing you down, holding you down - just like rape. So, you are terrified, and you try to get away from them and you strike out to protect yourself. Then they call you ‘assaultive’ and that follows you to the next hospital and they say to you ‘I hear you hit someone’”  “You are often force to be medicated when what you need is someone to talk to.”  “It’s extremely humiliating, awful, to be undressed in front of others especially those of the opposite gender.” Actions by staff or authority figures that are insensitive, neglectful, abusive or inappropriate and that invoke fear, distress, helplessness or humiliation for the consumer can also contribute to the admission being traumatic or re-traumatising.

Certificate IV in Alcohol and Other Drugs CHCMHS007: Wo...