A presentation for Professional Counselors on implementing trauma-informed care, evaluation, and potential treatment using Strategic Trauma and Abuse Recovery (c). Specifically for Christian-integration.
5. MY JOURNEY
DENICE COLSON, PHD, LPC, MAC, CPCS, CCS
Worked in the mental health field since 1982.
Experience includes:
Residential treatment for adolescents
Inpatient treatment for children and adults
Developed and managed a co-occurring disorders inpatient program that
was specifically Christian in early 1990s in Texas.
Outpatient treatment for adults and adolescents.
Specializing in trauma recovery since 1992-3
Currently Executive Director at Eagle’s Landing Christian
Counseling Center with main office in McDonough and
satellite office in Conyers.
6. MY PURPOSE
I am a Christian, a Christ-Follower, a Born-Again believer first,
and a counselor second.
I see my life purpose as ministry using the methodology of
counseling.
I am an “Integrationist” from the beginning of my career.
I believe in the principle from Experiencing God (Henry
Blackaby), which is:
Look around, see where God is working, and go and join
Him there!
I believe that trauma, especially childhood trauma, is where
God is working in the field of counseling NOW.
7. Denice Colson, PhD, LPC, MAC, CPCS* Copyright 2014
7
TRAUMA=PAIN
“Mental pain is less dramatic than physical
pain, but it is more common and also more
hard to bear. The frequent attempt to
conceal mental pain increases the burden: it
is easier to say “My tooth is aching” than to
say “My heart is broken.”
― C.S. Lewis, The Problem of Pain
8. R. Denice Colson PhD, LPC, MAC, CPCS* Copyright 2014
8
THE OPPORTUNITY FOR CHRISTIAN
COUNSELORS…
“We can ignore even pleasure. But pain insists
upon being attended to. God whispers to us in our
pleasures, speaks in our conscience, but shouts in
our pains: it is his megaphone to rouse a deaf
world.”
(C.S. Lewis, The Problem of Pain)
9. 2 SHARE EACH OTHER’S
BURDENS, AND IN THIS
WAY OBEY THE LAW OF
CHRIST. (GALATIANS 6:2)
We have the opportunity to
meet people in their pain,
develop a comforting and
healing relationship with them,
and, by being good
ambassadors, introduce them
to the ONE who can provide
ultimate and eternal healing
for their souls.
“Comfort, comfort my
people,”
says your God.
2 “Speak tenderly to
Jerusalem.
Tell her that her sad days
are gone
and her sins are
pardoned. (Isaiah 40: 1-2)
10. www.TheAnnaInstitute.org
18 months
Anna Carolyn Jennings
God created us in His image
to be in relationship with Him
and to demonstrate His
goodness
Years later – in a mental
institution
The enemy uses TRAUMA to
rob, steal and destroy the
beauty God has given us and
thereby convince people that
He is NOT good.
13. Vincent Felitti, MD (Kaiser
Permanente)
Robert F. Anda, MD
(CDC)
Adverse Childhood Experiences
14. Largest scientific research study of it’s kind
Analyzes the relationship between multiple
categories of childhood trauma (ACEs), and
health and behavioral outcomes later in life.
15. HOW IT GOT STARTED…
Felitti, V. (2011) Adverse Childhood Experiences and The Origins of Addiction. Neuroscience of
Addiction. Presentation to the Alberta Family Wellness Center. Retrieved from
http://www.albertafamilywellness.org/resources/video/origins-addiction
16. SHE GAINED 400 LBS IN
A SHORTER TIME THAN
IT TOOK TO LOSE 400
LBS.
Felitti, V. (2011) Adverse Childhood Experiences and The Origins of Addiction.
Neuroscience of Addiction. Presentation to the Alberta Family Wellness Center. Retrieved
from http://www.albertafamilywellness.org/resources/video/origins-addiction
17. ISSUES RAISED BY PATIENT X…
Perhaps overeating and obesity were
not the core problem; each was only
the marker of the core problem.
Like smoke is the marker of a fire.
18. PERHAPS
WHAT IS
MOST
OBVIOUS
• May not be the essence of
the problem.
• It’s what’s looming
beneath the surface that
really sinks people’s lives.
19. STUDY DESIGN
Initiated in 1995 and 1997- enrollees at Kaiser
Permanente in San Diego are being tracked
17,500+ middle-class American adults
Cohort population was 80% white including
Hispanic, 10% black, and 10% Asian.
Their average age was 57 years;
74% had been to college, 44% had graduated
college; 49.5% were men.
20. 10 questions: Review handout now.
Take the assessment now for yourself and post your score anonymously to
PollEverywhere.com by using the app.
Directions: To participate, open your text app. In the “To” screen type
37607. In the message type RDA3. You will receive a response.
Once you find your score, identify the corresponding letter. When the poll
is “live” this is what you will text:
20 Denice Colson, PhD, LPC, MAC, CPCS* Copyright 2014
FINDING YOUR ACE SCORE
A—0
B—1
C—2
D—3
E—4
F—5
G—6
H—7
I—8
J—9
K--10
22. HOW STRONG IS THE STUDY?
Replicated in 20 US states and Puerto Rico as well as China,
Macedonia, Philippines, Saudi Arabia, South Africa,
Thailand, and Viet Nam
ACE surveys had been completed in Albania, Latvia,
Lithuania, and Macedonia, with further studies underway in
Montenegro, Romania, Russian Federation and Turkey
61 Publications by principles and their associations on
CDC.gov
Same results.
23. Used a simple scoring system from 0 to 10
Exposure during childhood or adolescence to
any category of ACE was scored as one point.
Multiple exposures within a category were not
scored
ACE Score Determination
28. Household Dysfunction, by Category (%)
Alcoholism or drug use in home 27%
Loss of biological parent < age 18 23%
Depression or mental illness in home 17%
Mother treated violently 13%
Imprisoned household member 5%
PREVALENCE OF ACE
29. Dose-Response Relationship
Higher ACE Score Reliably Predicts Prevalence of
Disease, Addiction, Death
Higher ACE Score
Responsegetsbigger
The size of the
“dose”—
the number of ACE
categories
Drives the
“response”—
the occurrence of
disease, addiction,
and death.
31. ACE AND NEUROLOGICAL DEVELOPMENT
http://developingchild.harvard.edu/resources/inbrief-the-impact-of-early-
adversity-on-childrens-development-video/
36. ACE SCORE AND UNINTENDED
PREGNANCY OR ELECTIVE ABORTION
0
10
20
30
40
50
60
70
80
%haveUnintendedPG,orAB
0 1 2 3 4 or more
ACE Score
Unintended Pregnancy
Elective Abortion
37. Sexual Abuse of Male Children and Their
Likelihood of Impregnating a Teenage Girl
0
5
10
15
20
25
30
35
Not 16-18yrs 11-15 yrs <=10 yrs
abused Age when first abused
1.3x 1.4x
1.8x
1.0 ref
38. IN OTHER WORDS…
Boys who were sexually abused are more
likely to impregnate a teenage girl.
The earlier the age when the boy was
sexually abused – the greater the
likelihood that he will impregnate a
teenage girl
39. Frequency of Being Pushed, Grabbed, Slapped, Shoved or
Had Something Thrown at Oneself or One’s Mother as a Girl
and the Likelihood of Ever Having a Teen Pregnancy
0
5
10
15
20
25
30
35
Never Once, Sometimes Often Very
Twice often
Pink =self
Yellow =mother
40. ACE SCORE AND INDICATORS OF
IMPAIRED WORKER PERFORMANCE
0
5
10
15
20
25
Absenteeism (>2
days/month
Serious Financial
Poblems
Serious Job
Problems
0 1 2 3 4 or more
ACE Score
PrevalenceofImpaired
Performance(%)
41. More than 75% of girls in juvenile justice system
have been sexually abused. (Calhoun et al, 1993)
Criminal Justice Problems and Unaddressed
Sexual/Physical Abuse
80% of women in prison and jails have been
sexually/physically abused. (Smith, 1998)
100% of men on death row in CA have a history of
family violence (Freedman, Hemenway, 2000)
43. SUICIDE
The likelihood of adult suicide attempts increased
30-fold, or 3,000%, with an ACE score of 7 or
more.
Childhood and adolescent suicide attempts
increased 51-fold, or 5,100% with an ACE score of
7 or more.
One study found childhood sexual abuse to be
the single strongest predictor of suicidality. (Read
et al, 2001)
44. 51 – 98% of public mental health clients with
severe mental health diagnoses have
unaddressed sexual/physical abuse
Serious Mental Health Diagnoses and
Unaddressed Sexual/Physical Abuse
93% of psychiatrically hospitalized
adolescents had histories of physical and/or
sexual and emotional trauma. Only 32% met
criteria for PTSD (Goodman et al, 1999, Mueser et al,
1998; Cusack et al, 2003)
45. • Sense of helplessness, paralysis, captivity, inadequacy,
powerlessness, danger, fear…
LASTING ALTERATIONS IN SELF-PERCEPTION
• Sense of Shame, Guilt, Self-Blame, Being Bad…
• Sense of defilement, contamination, being spoiled,
degraded, debased, despicable, evil…
• Sense of complete difference from others, deviance, utter
aloneness, isolation, non-human, specialness, unseen, unheard,
belief no other person can ever understand…
47. ACE AND ADULT ALCOHOLISM
A 500% increase in adult alcoholism is
directly related to adverse childhood
experiences.
As the number of ACE increase, the
more likely a person is to begin
drinking before 14, or between 15-17
and the less likely they are to begin
drinking at 18 or at 21 (the legal age).
49. ACE AND OBESITY
66% reported one or more
type of abuse.
Obesity risk increased with
number and severity of each
type of abuse.
International Journal of Obesity (2002) 26, 1075 – 1082. doi:10.1038=sj.ijo.0802038
50. ACE AND CURRENT
SMOKING
A child with 6 or more
categories of adverse
childhood experiences is 250%
more likely to become an adult
smoker .
51. ACE and Current Smoking
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4-5 6 or more
ACE Score
%
52. ACE AND IV DRUG USE
A male child with an ACE
score of 6 has a 4,600%
increase in the likelihood that
he will become an IV drug
user later in life
53. Adverse Childhood Experiences and
Likelihood of > 50 Sexual Partners
0
1
2
3
4
AdjustedOddsRatio
0 1 2 3 4 or more
ACE Score
Higher # of ACEs more likelihood of the adult having had 50 or more sexual
partners and being at risk for unwanted pregnancy, socially transmitted diseases,
HIV/AIDs.
57. STUDIES ON HEART DISEASE ILLUSTRATE
THAT ACES ARE RELATED TO ADULT
DISEASE BY TWO WAYS:
1)Indirectly through attempts at self-help through
use of agents like nicotine, alcohol, food, etc.
2)Directly through chronic stress
60. ACE AND SPIRITUAL DEVELOPMENT
The Impact on View of God, Self-in relationship to God, and
Attachment to God
61. SPIRITUAL IMPACT
If a person’s physical and psychological health is
impacted by adverse childhood experiences even
50 years after their occurrence (Felitti, 2004), then
their spiritual health will also be impacted.
62. SPIRITUAL IMPACT
One study found that 77% of their targeted population,
adults who were participating in therapy and had
experienced sexual abuse as a child, reported
experiencing obstacles to spiritual development,
including:
lack of worthiness,
existential questions about the meaning and purpose of life,
unresolved religious questions about the beliefs they grew up
with,
disillusionment about their faith or religious beliefs,
distrust, anger, guilt, and other miscellaneous obstacles (Ganje-
Fling, Veach, Kuang, and Hoag, 2000).
63. Same study: 68% of the comparison group, which
was also participating in therapy but had not
experienced sexual abuse as children, reported
the same obstacles.
Whether or not this group had experienced some
other type of traumatic experience was not
assessed, though the fact that they were in
psychotherapy would indicate the presence of
some type of distress.
Spiritual Impact
64. SPIRITUAL IMPACT
One’s image of God appears to grow out of one’s
paternal and maternal care-giving images (Brokaw &
Edwards, 1994; Dickie et al., 1997; Hall & Brokaw,
1995; Hall et al., 1998; Justice & Lambert, 1986;
Nelson, 1971).
Parents have the strongest influence on their
adolescent’s religiosity (Benson, Donahue, and
Erickson, 1989).
Poor attachment bonds with God are related to
difficulty finding meaning and purpose in life (Beck
and McDonald, 2004)
65. SPIRITUAL IMPACT
Reinert and Edwards found that verbal, physical,
and sexual mistreatment were all associated with
increased insecurity in attachment to God as well
as with God concepts which were less loving and
more controlling and distant (2009).
69. IN 2012, $80
BILLION WAS
PAID TO
ADDRESS
CHILDHOOD
ABUSE AND
NEGLECT
http://www.preventchildabuse.org/images/research/pcaa_cost_report_2012_gelles_perlman.pdf
72. ACE Causes serious and chronic health, behavioral
health and social problems
Impacts one’s perception of self and others.
Often unrecognized, ignored or denied.
Finally, ACE is a public health tragedy of epidemic
proportions Leading to long-term use of multi-
human service systems at an estimated annual cost
of $80 billion
Impacts brain and nervous system directly.
74. FIRST STEP…
ADMIT WE HAVE A PROBLEM
(One survivor who didn’t get a trauma-informed treatment
approach)
75.
76. TRAUMA-INFORMED CARE
(SAMHSA-NATIONAL CENTER FOR TRAUMA
INFORMED CARE)
Trauma-informed care is an approach to engaging people
with histories of trauma that recognizes the presence of
trauma symptoms and acknowledges the role that
trauma has played in their lives. …seeks to change the
paradigm from one that asks, "What's wrong with you?"
to one that asks, "What has happened to you?“
http://www.samhsa.gov/nctic/
77. 2. Change your perspective: 90% of
clients have unaddressed trauma and
may not even recognize it!
78. 3. WE CAN CHANGE OUR APPROACH TO
EVALUATION…
Rather than only
evaluating the surface…
Make an attempt to
evaluate for the root of
the problem.
79. EFFECT OF TRAUMA-ORIENTED
EVALUATIONS ON DOCTOR OFFICE
VISITS (DOVS)
Benefits of Incorporating a Trauma-oriented Approach
Biomedical evaluation: 11% reduction in DOVs
(Control group-700 patient sample) in subsequent year.
Biopsychosocial evaluation: 35% reduction in DOVs
(Trauma-oriented approach) in subsequent year.
(>120,000 patient sample)
80. PRINCIPLES TO APPLY RE: EVALUATION
AND TREATMENT
• Do a trauma evaluation as part of intake or after
first session.
• Avoid Common Errors of Trauma
Informed Care
83. HANDOUTS AND EDUCATIONAL
MATERIALS
Impact of Trauma and Abuse
Handout (available on website if you
sign up for my newsletter)
Break Every Stinking Chain! Healing
for Hidden Wounds- Available on
Amazon.com as an ebook for only
$3.99
84. Avoid Most Common Mistakes: Herman
writes…
“…the single most common therapeutic error
is avoidance of the traumatic material…”
and, “…probably the second most common error is
premature or precipitate engagement in
exploratory work, without sufficient attention to
the tasks of establishing safety and securing a
therapeutic alliance” (1997, p. 172)
85. GET TRAINED!
Strategic Trauma and Abuse Recovery August 10-
11, 2016, McDonough!
www.TraumaEducation.com
Sign up for email newsletter.
88. Provide a roadmap through trauma recovery.
Act as stepping stones strategically placed
around the pitfalls of trauma recovery.
88 Denice Colson, PhD, LPC, MAC, CPCS* Copyright 2014
THE PHASES AND STAGES …
90. “I BELIEVE THIS IS THE MOST IMPORTANT
THING THAT YOU CAN EVER DO, TO BEGIN
TO DEAL WITH THIS, WITH THIS
INTERGENERATIONAL TRANSMISSION OF
ADVERSITY THAT CAUSES SO MANY
PROBLEMS IN OUR SOCIETY.”
ROBERT F. ANDA, MD
