Trauma-Informed Community Health Workers_Elaine Zook Barge_4.23.13

© 2012 Eastern Mennonite University • www.emu.edu/star
Trauma-Informed Community
Health Workers
Elaine Zook Barge
CORE Group Spring Meeting 2013
April 24, 2013

Text
1980’s and 1990’s
El Salvador
Nicaragua
Guatemala

Presentation Outline
 Trauma-informed – why?Trauma-informed – why?
 The impact of trauma on theThe impact of trauma on the

BodyBody

BrainBrain

BehaviorBehavior
 Some tools for addressing trauma in the communitySome tools for addressing trauma in the community

Physiological - Fingerholds (Capacitar)Physiological - Fingerholds (Capacitar)

Meaning-making - Acknowledgement (Cabrera)Meaning-making - Acknowledgement (Cabrera)

Strategies for Trauma Awareness & ResilienceStrategies for Trauma Awareness & Resilience
(STAR)(STAR)
 DiscussionDiscussion

TraumaTrauma
From the Greek word “traumat”From the Greek word “traumat”
meaningmeaning woundwound
(n.)(n.) An experience that is emotionally painful,An experience that is emotionally painful,
distressful, or shocking and which may resultdistressful, or shocking and which may result
in lasting effects on the mind, body and spiritin lasting effects on the mind, body and spirit
of an individual or group.of an individual or group.

Violence – conflict – harm (trauma) are a
part of life for individuals, communities
and societies.
Violence
Conflict
Trauma

Trauma is often theTrauma is often the “elephant in the room”“elephant in the room”
for individuals, families, communitiesfor individuals, families, communities
and societies.and societies.

Living and Surviving in a Multiply-wounded Country
by Nicaraguan psychologist, Martha Cabrera
http://www.envio.org.ni/articulo/1629
 ““inventory of wounds”inventory of wounds” Created space toCreated space to
talk about pain because people needed to talktalk about pain because people needed to talk
about losses they have never voiced beforeabout losses they have never voiced before
 Factors for not processing the painFactors for not processing the pain

Insufficient timeInsufficient time

Cultural factorsCultural factors

Lack of community resources to deal w/ suchLack of community resources to deal w/ such
problemsproblems

Grassroots & social organizations who haveGrassroots & social organizations who have
minimized or totally ignored the painminimized or totally ignored the pain

““Multiple wound phenomenonMultiple wound phenomenon””
The response of those working on development orThe response of those working on development or
community projects all over Nicaragua was…community projects all over Nicaragua was…
““So what do you want us to do, putSo what do you want us to do, put
a psychologist in every project?”a psychologist in every project?”
Enormous lack of knowledgeEnormous lack of knowledge
about the manifestations andabout the manifestations and
consequences of loss, violenceconsequences of loss, violence
and accumulated painand accumulated pain

Trauma and pain afflict not only individuals.Trauma and pain afflict not only individuals.
When they become widespread andWhen they become widespread and
ongoing, they affect entire communities andongoing, they affect entire communities and
even the country as a whole.even the country as a whole.
The implications are serious for people’sThe implications are serious for people’s
health, the resilience of the country’s socialhealth, the resilience of the country’s social
fabric, the success of developmentfabric, the success of development
schemes, and the hope ofschemes, and the hope of
future generations.future generations.
Nicaraguan psychologist, Martha Cabrera.
http://www.envio.org.ni/articulo/1629

Trauma-sensitive development and humanitarian aidTrauma-sensitive development and humanitarian aid
by Carolyn Yoder,by Carolyn Yoder, MA, LMFT, LPC, NCC and
founding STAR directorounding STAR director
 A way to address these limitations is forA way to address these limitations is for
organizations to become “trauma-informed”organizations to become “trauma-informed”
so that a trauma-sensitive framework can beso that a trauma-sensitive framework can be
integrated into any project: economic, health,integrated into any project: economic, health,
governance, etc.governance, etc.
 This means more than putting a psychologistThis means more than putting a psychologist
on every project. Awareness of theon every project. Awareness of the
repercussions of trauma needs to extendrepercussions of trauma needs to extend
across the organization to headquarters andacross the organization to headquarters and
field staff alike.field staff alike.

II. The impact of trauma on theII. The impact of trauma on the
 BodyBody
 BrainBrain
 BehaviorBehavior

FlightFlight
Trauma and the Body
Fight
FreezeFreeze

Peter LevinePeter Levine
•Waking the TigerWaking the Tiger
•In an Unspoken Voice:In an Unspoken Voice: How theHow the
Body Releases Trauma and RestoresBody Releases Trauma and Restores
GoodnessGoodness
Wild animals discharge theWild animals discharge the
compressed energy, completing acompressed energy, completing a
natural physiological process.natural physiological process.

When the body shifts into high gear…
. . .the brain shifts into low.

Trauma and the BrainTrauma and the Brain
Instinctual Brain
Brain Stem
Thinking/ Rational
Brain Cerebral Cortex
Emotional Brain
Limbic system
First Alert!!
Past
Present
Future

Some ways to release the traumaSome ways to release the trauma
energy and “connect the brain”energy and “connect the brain”
 Deep breathingDeep breathing
 Connection to loved onesConnection to loved ones
 Rituals, worship, prayer,Rituals, worship, prayer,
meditationmeditation
 Music, singing, dancing,Music, singing, dancing,
drumming,drumming,
 Sports ...all kinds of exerciseSports ...all kinds of exercise
 Massage, touchMassage, touch
 LaughterLaughter
 Being in natureBeing in nature
 Playing, having fun, sexPlaying, having fun, sex
 Mind/body toolsMind/body tools

Acting In
Against Self
Acting Out
Against Others
Trauma and Behavior

Pain that is not transformed is transferredPain that is not transformed is transferred
Fr. Richard RohrFr. Richard Rohr
Acting OutActing Out
•Visible depression (blaming,
(aggressiveness, irritability)
•Getting in trouble with the law
•Inability to be flexible or tolerant
•Inability to show empathy to others
•High risk behaviors such as substance
abuse or inappropriate sexual activity
•Bullying
•Repetitive conflicts
•Murder
Acting InActing In
•Alcohol & drug abuseAlcohol & drug abuse
•Increased focus on workIncreased focus on work
•Eating disordersEating disorders
•Depression (sadness, withdrawal)Depression (sadness, withdrawal)
•Feelings of numbness, anxiety,Feelings of numbness, anxiety,
self blame, shameself blame, shame
•Physical symptoms (pain,Physical symptoms (pain,
headaches, digestive problems)headaches, digestive problems)
•Self-injuring behaviorsSelf-injuring behaviors
•SuicideSuicide

Cycles of Violence
Aggressor Cycle (Acting Out) Victim Cycle (Acting In)

III. Tools and Processes forIII. Tools and Processes for
Addressing TraumaAddressing Trauma

Fingerholds (Capacitar)Fingerholds (Capacitar)

Meaning-making/ListeningMeaning-making/Listening
(Cabrera)(Cabrera)

Strategies for Trauma Awareness &Strategies for Trauma Awareness &
Resilience (STAR)Resilience (STAR)

FromFrom Capacitar for Kids,Capacitar for Kids, www.capacitar.orgwww.capacitar.org
Finger HoldsFinger Holds

““When people begin to talk about theirWhen people begin to talk about their
story, assume it, and reflect on it, [they]story, assume it, and reflect on it, [they]
find meaning and significance in what theyfind meaning and significance in what they
have lived through. . . .have lived through. . . .
This is what allows us toThis is what allows us to
go forward in life.”go forward in life.”
Martha Cabrera, Nicaraguan psychologistMartha Cabrera, Nicaraguan psychologist
“Living and Surviving in a Multiply-wounded Society”“Living and Surviving in a Multiply-wounded Society”
http://www.envio.org.ni/articulo/1629http://www.envio.org.ni/articulo/1629
Acknowledgement
Storytelling - Meaning Making

Breaking Cycles of Violence • Building ResilienceBreaking Cycles of Violence • Building Resilience

Increased resilience
““The information on the links betweenThe information on the links between
resilience and addressing trauma isresilience and addressing trauma is
very helpful to me in understandingvery helpful to me in understanding
how to stay healthy in the midst of ahow to stay healthy in the midst of a
stressful work environment.”stressful work environment.”
Humanitarian aid organization worker in Syria

South Sudan, CRS
A curriculum adaptable to different contexts
Mexico, USAID
Myanmar, Hope Int’lHaiti, Wozo

•Village STARVillage STAR
(Spanish, Urdu, Haitian Creole, Somali)(Spanish, Urdu, Haitian Creole, Somali)
•Youth STARYouth STAR
(New Orleans, Hurricane Katrina)(New Orleans, Hurricane Katrina)
• Coming to the TableComing to the Table
(Healing Historical Harms)(Healing Historical Harms)
• Journey Home from WarJourney Home from War
• Family STARFamily STAR
(Gender-based, Pakistan)(Gender-based, Pakistan)
• Custom-designed educational packagesCustom-designed educational packages for organizations wantingfor organizations wanting
trauma-informed staff to do trauma-sensitive programmingtrauma-informed staff to do trauma-sensitive programming
STAR for specific audiences

 What was one new thing you learnedWhat was one new thing you learned
about trauma?about trauma?
 What new insights did it provide on:What new insights did it provide on:

your work with trauma-affectedyour work with trauma-affected
populations?populations?

trauma-informed community healthtrauma-informed community health
workers in your organization?workers in your organization?
Questions to Consider

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