September 24, 2009 IVAT Conference, San Diego, CA exhibited by Kaite Slack, MSW & Dee-Dee Stout, MA, CADC-II A Perfect Fit: MI in Trauma-Informed Work with WomenSlide 2
What are Trauma Informed Services? Different types and levels of administration are affected by staff comprehension of the effect of interpersonal savagery and exploitation on an individual " s life and advancement. (Elliot, et al, 2005)Slide 3
Making the Connections Punishment/Incarceration Poverty Sexual Orientation Context/Isolation Mental Health Substance Use Disability Age Experience of Loss HIV/AIDS Violence/Trauma Resilience Racial Discrimination Public approach Systemic segregation Access to human services Partnership/Friendship MotheringSlide 4
The Connections As numerous as 2/3 of ladies with substance utilize issues have a simultaneous psychological well-being issue (e.g., PTSD, tension, sorrow) (Zilberman, et al., 2003) Many ladies with substance utilize issues have encountered physical and sexual mishandle either as kids or grown-ups (Ouimette, et al., 2000; Martin et al., 1998)Slide 5
The Connections Poor/vagrants will probably have verifiable or potentially current encounters of savagery (between 84-92%) (Bassuk, et al., 1996) Mothers of youngsters w/FADS report genuine histories of viciousness, abnormal states MH issues, controlling accomplices who don\'t need them to stop drinking (Astley, S. J., Bailey, D., Talbot, C., & Clarren, S. K. , 2000) Violence amid pregnancy is reason for a greater number of passings in PG than any single therapeutic entanglement (Liebschutz et al., 2003)Slide 6
Recreating Dynamics of Power & Control Interactions with suppliers can replicate progression of force effectively experienced in a lady\'s relationship Ignoring issues of wellbeing or talking about security incorrectly Minimizing ailments (mental and physical) Giving unseemly conclusions/names that pathologize Ignoring setting of mishandle, neediness, bigotry on wellbeing Expecting consistence Being not as much as minding and strong Shame/judgment basic to proceeded with utilization of substancesSlide 7
Trauma-Informed Services… Sees the entire individual, understanding the setting of all practices/adapting techniques Provides aware & precise sympathetic listening to best enter the universe of the customer Focus is on the customer – not the manifestations, conduct or issues - & lessening of indications not treating a sicknessSlide 8
10 Principles of Trauma-Informed Services Recognize the effect of viciousness and exploitation on improvement and adapting methodologies Identify recuperation from injury as an essential objective Employ a strengthening model Strive to expand a lady\'s decisions and control over her recuperation Are situated in a social joint effort Elliot et al. (2005). Injury educated or injury denied: standards and usage of injury educated administrations for ladies Journal of Community Psychology, 33(4), 461–477.Slide 9
10 Principles of Trauma-Informed Services Create a climate that is aware of survivors\' requirement for wellbeing, regard, and acknowledgment Emphasize ladies\' qualities, highlighting adjustments over side effects and flexibility over pathology The objective is to minimize the potential outcomes of retraumatization Strive to be socially skilled and to see every lady with regards to her background and social foundation Solicit customer input and include customers in planning and assessing administrationsSlide 10
Trauma-Informed Approach Competence display; concentrate on qualities Sees injuries in setting of customer\'s life Appreciates that recuperation is close to home & must be characterized by customer not Staff is a guide not fixer; customer is Change Agent Treatment is driven by customers\' needsSlide 11
The Dynamics of Abuse Going back or remaining with a damaging accomplice are a piece of the change procedure Our errand as specialists is to concentrate on practices our customers can control and those that they address . This approach is unmistakable from conventional manhandle survivor treatment in which the clinician expect " privileging leaving " From S. Wahab, Minute (2004) Vol. 11, No.1Slide 12
Privileging Leaving The concentration of treatment is to engage women to leave Practitioners, offices, frameworks advance & frequently expect that ladies will leave damaging circumstances We unexpectedly re-make control differential of harsh connections From S. Wahab, Minute (2004) Vol. 11, No.1Slide 13
Privileged Leaving Reasons for not leaving Lack of assets Lack of inspiration Cultural issues Values frameworks Others? From S. Wahab, Minute (2004) Vol. 11, No.1Slide 14
Leaving or Not Leaving Inconsistent with customer focused work Imposes " one size " esteem Places " leaving " as the objective conduct may not be craved result Resistance can be made Assumes specialist/professional knows best Leaves customers in " one-down " (deficiency) position – not the master of their life From S. Wahab, Minute (2004) Vol. 11, No.1Slide 15
Leaving or Not leaving: Binary thinking No investigation or engagement in multi-social practices of their condition No affirmation of fruitful techniques & strategies of customers From S. Wahab, Minute (2004) Vol. 11, No.1Slide 16
How would we be able to give fruitful treatment to injury/mishandle survivors? How might we give decision and in the meantime control customers toward picking a suitable conduct to focus for change?Slide 17
Motivational Interviewing Creates an ideal atmosphere for change Addresses inner conflict and resistance Uses arrange particular abilities and methodologies to propel individualsSlide 18
MI as apparatus in the injury educated treatment tool stash We may need our customers to chip away at their injury issues, and additionally carry on with a brutality free life, however we can\'t force these progressions. At the point when experts force their qualities, will as well as motivation, the possibility of distancing the customer increments, and resistance shows up. It additionally keeps us from gaining from our customers. From S. Wahab, Minute (2004) Vol. 11, No.1Slide 19
Integrated Framework: Guiding PrinciplesSlide 20
MI as instrument in the injury educated treatment tool compartment MI helps us to bolster customers in assessing their security, decisions and assets. MI permits us to be promoters with survivors rather than supporters for survivors. It keeps us from making presumptions about what the customer needs, and permits us to help them assemble inspiration and abilities to settle on the best decisions for themselves. From S. Wahab, Minute (2004) Vol. 11, No.1Slide 21
Principles of Motivational Interviewing Express Empathy Develop Discrepancy Roll with Resistance Support Self-EfficacySlide 22
MI Principles in Trauma-Informed Services Build Empathy and Rapport Emphasis is on entire individual – how you lead your life. Talk about what they need to address " How would I be able to all the more completely comprehend this individual? " Focus not simply on working Agency message gets to be " your conduct bodes well given your conditions. " customers start to see their practices as adapting and overcome, not neurotic or undesirable; no character abandons here MI stays away from showdown to " separate " dissent. Such mediations can trigger recollections of injury/mishandle. Need is on decision and self-governanceSlide 23
Persuasion Exercise Let\'s check whether this works… One speaker and one audience (NOT your supervisor) SPEAKER: Topic- - Something about yourself you truly… Want to change Need to change Should or should change Have been pondering changing But you haven\'t done yet (irresoluteness)Slide 24
Persuasion Exercise Let\'s check whether this works… LISTENER: 1. Clarify why the individual ought to roll out the improvement. 2. Give no less than 3 particular advantages that would come about because of rolling out the improvement. 3. Underscore that it is so imperative to change. 4. Induce the individual to do it! On the off chance that you meet resistance, rehash the above. (This is NOT Motivational Interviewing) 5. SWITCHSlide 25
Common Reactions To Not Feeling Listened To… Angry Oppositional Discounting Defensive Justifying Not comprehended/heard Procrastinate Disengaged HelplessSlide 26
A Taste Of MI One speaker and one audience (NOT your supervisor) SPEAKER: Topic- - Something about yourself you truly… Want to change Need to change Should or should change Have been considering changing But you haven\'t done yet (inner conflict)Slide 27
A Taste Of MI LISTENER: 1. Listen deliberately with the objective of comprehension the problem. 2. Give no guidance. Ask these four open inquiries and listen with intrigue: 1. Why might you need to make this change? 2. In what manner may you go about it with a specific end goal to succeed? 3. What are the three best motivations to do it? 4. Outline what you listened. 5. Ask, "What will you do next?" 6. SWITCHSlide 28
Understood Want to talk all the more Liking the specialist Open Accepted Respected Engaged Able to change safe Empowered Hopeful Comfortable Interested Want to return helpful Common Reactions to Being Listened To…Slide 29
SPIRIT… Collaboration Ambivalence is ordinary Evocation Autonomy TECHNIQUES… Open-finished inquiries Affirm Reflect Summarize Motivational InterviewingSlide 30
Ambivalence MI offers an approach to comprehend – standardize - irresoluteness in change Need to move from "Why isn\'t she spurred?" to "For what is she inspired?" (Miller & Rollnick, 2002)Slide 31
Traps to Avoid Question-answer trap: The Interrogation Expert trap: You are a specialist however no way on earth. Early concentration: Too much data too soon Labeling: Labeling customer as " survivor " before customer is eager/ready to perceive self as surviving misuse or injury Blaming: Occasionally we coincidentally " accuse the casualty. "Slide 32
COLLABORATING Safety Planning Health Issues Parenting Substance Use Limit center to territories she CAN control ie: Wahab, S. (200
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