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Module 3 Resources: Creating Trauma-Informed Provider Organizations

Websites and Online Materials

  1. ACEs articles by category Oct 18, 2016 – Wisconsin Dept of Health Services, ACEsConnection.com – Scott Web, from the Wisconsin Department of Health Services, has provided a comprehensive list of articles about ACEs covering Adversity Impact; Brain and Biology; Bullying; Courts, Juvenile Justice, Corrections, and Probation; Post-Traumatic Stress Disorder; Resilience; Schools; Substance Use Disorder; and Trauma-Informed Care. To access this resource copy and paste the following link into your browser http://www.acesconnection.com/blog/a-month-of-aces-articles-by-category-wisconsin-dept-of-health-services.
  2. Bright Ideas: A Youth Drop-In Center Embraces Trauma-Informed Care. National Clearinghouse on Families & Youth. A Resource of the Family and Youth Services Bureau. This website provides users with information on the program “Youth on Fire”, a drop-in center for homeless and street youth that has adopted trauma-informed interventions to reduce the progression of substance use, HIV, and hepatitis infections among their population.
  3. Building Community Resilience Collaborative Learns from Dallas, MovingHealthcareUpstream.org – The Building Community Resilience (BCR) collaborative is a national initiative focused on developing strategies for communities and hospital health systems to reduce toxic stress and prevents adverse childhood experiences (ACEs) using a population-health approach. The Alliance and Children’s Health hosted the collaborative in Dallas, TX to allow participating agencies to share lessons learned. To access this resource copy and paste the following link into your browser http://www.acesconnection.com/blog/building-community-resilience-collaborative-learns-from-dallas-movinghealthcareupstream
  4. Child Welfare Systems Grapple with How to Translate Brain Science into Practice, ChronicleOfSocialChange.org – Applying the Science of Child Development in Child Welfare Systems suggests areas where those in child welfare can apply changes to better address the brain science behind toxic stress.
  5. Child Welfare Trauma Training Toolkit (2013) 2nd Edition. The toolkit is designed to teach basic knowledge, skills, and values about working with children who are in the child welfare system and who have experienced traumatic stress. It also teaches how to use this knowledge to support children's safety, permanency, and well-being through case analysis and corresponding interventions tailored for them and their biological and resource families.
  6. Community Resilience Cookbook. When people learn about the ACE Study, they have a range of reactions, from sorrow to outrage to relief at having a framework—finally—that explains their own or others’ behavior. Then they ask, “What can I do?” This cookbook aims to answer that question. Whether you are the director of a YMCA, the head of a county health department, a sheriff, a school principal, a pediatrician or a parent, it will offer you context, definitions and questions to help you think about building resilience where you live. It will describe how communities in the United States and Canada are putting the theories of ACEs and resilience into practice.
  7. Creating Trauma-Informed Services Tipsheet Series. National Center on Domestic Violence, Trauma & Mental Health. These tipsheets provide practical advice on creating trauma-informed services at domestic violence programs and working with survivors who are experiencing trauma symptoms and/or mental health conditions.
  8. Data can help tackle childhood trauma at the community level, KansasCity.com – The Kansas Hospital Association and the Missouri Hospital Association delivered community Adverse Childhood Experiences (ACE) scores at the ZIP-code level in both states. This could help hospitals and their partners improve health improvement efforts.
  9. The Dougy Center: The National Center for Grieving Children and Families. The Dougy Center provides support in a safe place where children, teens, young adults, and their families grieving a death can share their experiences. The Dougy Center provides support and training locally, nationally and internationally to individuals and organizations seeking to assist children in grief.
  10. Elementary school launches in-house therapy for at-risk students, MLive.com – Washington Elementary School in Bay City, MI is one of the first in the state to start an in-house health center to address the medical and behavioral issues for its large population of at-risk students. The original aim of the initiative was to decrease suspensions due to behavioral issues.
  11. Episode 193 - Vic Compher and Rodney Whittenberg: "Portraits of Professional Caregivers: Their Passion, Their Pain." This podcast with interviewer Susan Green, LCSW, of the School of Social Work (University of Buffalo) includes an interview about secondary trauma and resilience in the workplace with documentarians, Rodney Whittenberg and Vic Compher, who co-produced Portraits of Professional Caregivers: Their Passion, Their Pain.
  12. Esta Soler and her Futures Without Violence Elevates Child Trauma to National Policy Stage. With several prominent child-trauma initiatives afoot, Soler’s Futures Without Violence is forging a super coalition—including the American Psychological Association, National Association of School Psychologists, the National Parent-Teacher Association, YMCA of the USA and others—meant to shape public will at the national level. As Soler says the next step is to bring the message—urgency coupled with the possibility of reversing the impacts of adverse childhood experiences—into national policy.
  13. Evaluation Brief: Trauma-Informed Care Training at Two Texas State Supported Living Centers. The report found evidence of a shift in the culture of care at both centers. Not only was the training successful in reducing the use of restraints, but staff members also cited reduced stress and more positive interactions with residents as a result of the training.
  14. ‘Expansive’ Juvenile Justice Reform Bill Close to Law in DC – The Comprehensive Youth Justice Amendment Act of 2016 has been passed by the Council of the District of Columbia (DC). The bill aims to make the juvenile justice system in DC as small and successful as possible.
  15. Head Start Early Childhood Learning and Resource Center. Early childhood mental health is a child's (birth to 5 years) growing ability to experience, regulate, and express emotions. They learn to develop close, secure relationships with peers and caring adults. Children begin to explore and learn from their surroundings, pay attention, and follow directions. Early childhood mental health is the same as social-emotional development. Head Start and Early Head Start programs partner with local professionals and other programs to ensure children, families, and staff have access to prevention and intervention services. The resources provided span several topics areas including screening and assessment, trauma, and education activities.
  16. Healthy Foster Care America. In partnership with the Dave Thomas Foundation for Adoption and Jockey Being Family, the American Academy of Pediatrics has developed materials for pediatricians on how to support adoptive and foster families.
  17. How Childhood Experiences Shape Our Nation's Health. Robert Wood Johnson Foundation (RWJF). New findings strongly suggest that Americans are ready for new approaches to address early childhood trauma and stress. To do that in a big way, we need more than science—we need a movement. The article outlines steps taken by the RWJF to create and strengthen the movement.
  18. How to Help a Young Person who has Witnesses Domestic Violence. National Clearinghouse on Families & Youth. A Resource of the Family and Youth Services Bureau. In this slideshow, Chris Newlin takes the audience through the intake process for a young person who has witnessed violence at home.
  19. Integrating Trauma-Responsive Services into Programs for Youth, AECF.org – Experts have concluded that adverse experiences in childhood can have physiological effects on the body and brain. This affects the long-term decision making skills, sense of safety, and ability to regulate emotions in young people. This webinar provides effective strategies for youth programs to implement to better serve the needs of youth.
  20. National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC) – SAMHSA. NCTIC is a technical assistance center dedicated to building awareness of trauma-informed care and promoting the implementation of trauma-informed practices in programs and services. The center facilitates the adoption of trauma-informed environments in the delivery of a broad range of services including mental health, substance use, housing, vocational or employment support, domestic violence and victim assistance, and peer support. In all of these environments, NCTIC seeks to change the paradigm from one that asks, "What's wrong with you?" to one that asks, "What has happened to you?"
  21. National Child Traumatic Stress Network (NCTSN). The National Child Traumatic Stress Network was established to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events.
    1. NCTSN Learning Center for Child and Adolescent Trauma. Psychological First Aid, Continuing Education Courses, Military Families, Special Topics, Podcasts, Learning Collaborative, Materials.
  22. The National Crittenton Foundation. The National Crittenton Foundation and the 27 members of the Crittenton family of agencies uses a social justice approach to support young girls and women at the margin to thrive, build skills, break destructive cycles and become powerful agents of personal and social change. At the core of our work is the mandate to address the profound impact of root causes, such as sexism, racism, poverty and violence in the lives of girls and young women.
  23. Nationally Recognized West Virginia Program Helps Children Deal with Trauma. In 2013, the West Virginia Center for Children’s Justice launched a program called “Handle with Care”. The collaborative program is meant to help children who’ve experienced abuse, neglect or other types of trauma succeed in school. The program that started on the West Side of Charleston is now expanding across the state and in other communities across the nation.
  24. NEAR@Home Toolkit: A Guided Process to Talk about Trauma and Resilience in Home Visiting. Home visitors are interested in bringing information about ACEs to families but worry about causing harm. The NEAR@Home toolkit addresses these concerns. This training manual created by Thrive Washington provides guided processes to help you learn and practice language and strategies to safely and effectively talk about the trauma of ACEs. The toolkit emphasizes safety and reflective support for the home visitor as a critical element in this process. Using this process, home visitors will build skills in the therapeutic use of self and discover increased compassion, patience, and stamina in their work with families.
  25. New campaign promoted power of teachers to reduce stress of traumatized students, EdSource.org – The Changing Minds campaign aims to support teachers and to provide them with information that makes it easier to have “calm, compassionate, and empowering” interactions with students that have experienced trauma.
  26. Pennsylvania Recovery and Resilience – Trauma-Informed Care for Children. The website provides details and resources for Pennsylvania’s statewide trauma-informed care initiative. It details the models and treatments they implemented to provide trauma-informed care and illustrates collaboration efforts.
  27. Practical Strategies for Creating Trauma-Informed Services and Organizations. Webinar Series. National Center on Domestic Violence, Trauma & Mental Health. This webinar series builds on previous NCDVTMH webinars, which offered a framework for understanding trauma in the context of domestic violence and for responding to trauma in the lives of survivors and their children. This new series focuses on practical strategies and tools for creating accessible, culturally attuned, domestic violence- and trauma-informed services and organizations.
  28. ProQOL.org. The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma. The ProQOL has sub-scales for compassion satisfaction, burnout and compassion fatigue.
  29. Raising Resiliency: ACEs Response Toolkit. The purpose of this toolkit, developed by the Central Iowa ACEs Steering Committee, is to answer one of the most common questions asked when discussing adverse childhood experiences (ACEs) or traumatic stress: “So, what do I do about it?" The toolkit provides resources for individuals and families and professionals and resources to strengthen communities and promote systematic change.
  30. Risking Connection. Risking Connection® teaches a relational framework and skills for working with survivors of traumatic experiences. The focus is on relationship as healing, and on self-care for service providers.
  31. Safety and Well-Being Tipsheet Series. National Center on Domestic Violence, Trauma & Mental Health. These tipsheets provide information on the ways that experiencing abuse can affect how we think, feel, and respond to other people and the world around us. The series also provides tips on how to seek support for yourself and how to help if someone you know is being abused.
  32. The Sanctuary Model represents a theory-based, trauma-informed, evidence-supported, whole culture approach that has a clear and structured methodology for creating or changing an organizational culture. The objective of such a change is to more effectively provide a cohesive context within which healing from psychological and social traumatic experience can be addressed. As an organizational culture intervention, it is designed to facilitate the development of structures, processes, and behaviors on the part of staff, clients and the community-as-a-whole that can counteract the biological, affective, cognitive, social, and existential wounds suffered by the victims of traumatic experience and extended exposure to adversity.
  33. Start Strong: Building Healthy Teen Relationships (Start Strong) is the largest initiative ever funded to prevent teen dating violence and abuse by teaching 11- to- 14-year-olds about healthy relationships. This innovative approach to prevention is rallying entire communities to promote healthy relationships and prevent teen dating violence in middle schools.
  34. Therapy For Therapists Highlights Impact Of Child Abuse. This article highlights the need for therapists to engage in therapy to help combat empathy fatigue and increase self-care. This article in particular highlights how Roy Maas Youth Alternative hired several counselors to provide counseling to staff workers. Ever since the program was implemented, staff have not called out sick from work as often.
  35. TIC Efforts in VA. This video created by Trish Mullen, highlights trauma-informed care action in Virginia including the importance of self-care.
  36. Toxic Stress Gets the Spotlight at St. Louis Med Schools (STLToday.com): This article in the St. Louis Post Dispatch describes what St. Louis University Medical Students are learning about the effects of toxic stress on children: asthma, obesity, child abuse, hyperactivity and depression.
  37. Trauma and Behavior Video Series – Discussion Guide for Resource Parents. (PDF, 130KB). Family & Children’s Resource Program. UNC School of Social Work. This guide provides links to videos regarding the impact of trauma and strategies to address trauma. This guide also provides a structured format for resource parents (foster, therapeutic foster, adoptive, and kinship parents) to discuss the videos in this series.
  38. Trauma Center at Justice Resource Institute. Dr. Bessel van der Kolk and his colleagues have published a number of articles on traumatic stress. Versions of these articles are available for download from the web. In addition, they have developed several products for clinicians, trauma survivors and their family and friends to help aid in the recovery process.
  39. Trauma-Informed Care Project. This website profiles the Trauma Informed Care Project that took place from June 10-12 2014 in Des Moines, Iowa. The website highlights resources and information about the impact of trauma, what trauma-informed care is, and how to become trauma-informed.
  40. Trauma-Informed Care Tip Sheets. Safe Start Center. This website provides links to tip sheets that discuss trauma-informed approaches for specific populations and settings. Information about how to interact with include youth, immigrant families, along with strategies for child welfare workers and early childhood providers can be found on this website.
  41. Trauma Institute and Child Trauma Institute (TI & CTI). TI & CTI provides therapy, training, consultation, information, and resources for those who work with trauma-exposed children, adolescents, and adults. TI & CTI also conducts research on trauma assessment and treatment, and on its own training programs. This web site is a resource for clinicians, researchers, and parents.
  42. The Trauma Stewardship Institute. The Trauma Stewardship Institute is an organization that provides keynote talks, organizational consulting, workshops, retreats, and disaster response. This organization has three expertise areas—raising awareness of the cumulative toll on individuals, organizations, institutions, movements, communities, and society as a whole as a result of being exposed to the suffering, crisis of trauma of humans, living beings or the planet itself; facilitating conversations on sympathetic oppression and liberation theory; and responding to acute trauma, whether individual or collective.
  43. The Traumatic Stress Institute. The Traumatic Stress Institute (TSI) of Klingberg Family Centers promotes excellence in trauma-informed services both within Klingberg and to organizations nationally and internationally who treat clients with histories of psychological trauma and attachment disruptions. TSI helps organizations foster trauma-sensitive treatment cultures, increase clinical expertise, achieve positive lasting results with difficult clients, and develop a stable and well-trained work force. TSI partners with organizations at many levels, including: whole system transformations to trauma-informed care; customized training and consultation on specific topics; and evaluation and consultation regarding the treatment of individual clients.
  44. Trauma Treatment for Children. This blog discusses the theory and practice of trauma-informed and relationship-based treatment for children and adolescents, using the Restorative Approach.
  45. Understanding the Impact of Trauma in Developing Teen Pregnancy Prevention Programs for Tribal Youth, Webinar. January 29, 2013. The Family and Youth Services Bureau presented a webinar to help Tribal Adolescent Pregnancy Prevention Program grantees provide trauma-informed care. The link provides access to the webinar, the webinar transcript, and the presentation slides.
  46. Voices from the Field: Dr. Sandra Bloom on the Sanctuary Model. Dr. Sandra Bloom is one of the creators of the Sanctuary Model, an evidence-based practice that helps youth-serving programs address trauma experienced by their clients and their staff. Dr. Bloom spoke with NCFY about her program's origins and the importance of trauma-informed practice.
  47. VAWnet – National Online Resource Center on Violence Against Women. The resource library is home to thousands of materials on violence against women and related issues, with particular attention to its intersections with various forms of oppression. Here you’ll find resources on domestic violence, sexual violence, funding, research, and international issues. You’ll also find news, announcements, and events related to the work of the movement and related fields of practice. VAWnet supports local, state, and national prevention and intervention strategies that enhance safety and well-being and address the self-identified needs and concerns of victims and survivors.
    1. Special Collection - Trauma-Informed Domestic Violence Services
      1. Part 1 – Understanding the Framework and Approach
      2. Part 2 – Building Program Capacity
      3. Part 3 – Developing Collaborations and Increasing Access
  48. Webinar: Bringing Trauma-Informed Care into the Classroom. This webinar presented by Grafton Integrated Health Network and Ukeru Systems covered bringing trauma informed care into classroom settings – both from a legal and practical standpoint.
  49. What Mindfulness Does for Urban Kids, CityLab.com – With the help of the Holistic Life Foundation in Baltimore City, participating schools have seen a decrease in suspensions through the use of mindfulness instruction for disruptive students. Youth develop positive coping skills to deal with toxic stress.
  50. When PTSD Is Contagious. Therapists and other people who help victims of trauma can become traumatized themselves. Exposed each day to the distress of others, second-line responders to tragedy—humanitarian workers, therapists, social workers, lawyers, and journalists—can develop traumatic stress disorders that mimic the PTSD of their clients, patients, and sources, down to the images of violence that can haunt a traumatized mind. Thirty to 40 percent of mental-health clients in the U.S. show symptoms of post-traumatic stress.
  51. Why school climate matters with a President Trump, PsychologyToday.com – Students who experience high levels of in-school victimization are likely to have lower educational aspirations, higher rates of school discipline, and higher rates of missed school.
  52. Youth Mental Health First Aid. Youth Mental Health First Aid is a curriculum focused on helping youth (ages 12-18) who may be experiencing a mental health challenge or in a crisis. It is a public education program which introduces participants to the unique risk factors and warning signs of mental health problems in adolescents, builds understanding of the importance of early intervention, and most importantly – teaches individuals how to help a youth in crisis or experiencing a mental health or substance use challenge. Mental Health First Aid uses role-playing and simulations to demonstrate how to assess a mental health crisis; select interventions and provide initial help; and connect young people to professional, peer, social, and self-help care. Mental Health First Aid USA worked with experts at the National Technical Assistance Center for Children’s Mental Health at the Georgetown University Center for Child and Human Development to adapt the Australian youth manual for US audiences.

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Downloadable Documents

  1. Advancing Trauma-Informed Practices: Bringing trauma-informed, resilience-focused care to children, adolescents, families, schools and communities. (PDF, 1MB). William Steele and Caelan Kuban. This white paper discusses how to bring trauma-informed practices into child-serving agencies and systems. This paper has three purposes—to define the primary experience of trauma in order to support trauma-informed care grounded in evidence based research, neuroscience, and the essential components of trauma-informed practices; to view trauma not only as a diagnostic category’ and to explain the importance of understanding the child’s experience within a trauma-informed context.
  2. Alaska & Boston: Recovery-Oriented and Trauma-Informed Care in Health Care Settings, Including Medical/Health Home Settings. (PDF, 3.7MB). The slides provided at the webinar organized by SAMHSA in January 7, 2016 show how the recovery-oriented and trauma-informed care works in health care settings, including medical and health home settings in Alaska and Boston.
  3. Becoming Trauma-Informed: What Does this Mean for Non-Clinical Staff? (PDF, 2MB). In this webinar, the Director of Trauma-Informed Services at National Council for Behavioral Health, Karen Johnson, discusses how addressing trauma is now the expectation, not the exception, in behavioral health and community organizations. Furthermore, there is an urgency to spread the understanding of trauma far beyond the scope of the clinical and peer workforce to ensure everyone in an organization is becoming trauma-informed.
  4. Concept of Trauma and Guidance for a Trauma-Informed Approach. This document from SAMHSA introduces a concept of trauma and offers a framework for how an organization, system, service sector can become trauma-informed. Includes a definition of trauma (the three "E's"), a definition of a trauma-informed approach (the four "R's"), 6 key principles, and 10 implementation domains.
  5. Consumers and Carers perspectives on poor practice and the use of seclusion and restraint in mental health settings: results from Australian focus groups. (PDF, 972KB). Seclusion and restraint are interventions currently permitted for use in mental health services to control or manage a person’s behavior. In Australia, serious concerns about the use of such seclusion and restraint have been raised at least since 1993. Consumers and their supporters have also expressed strong views about the harm of these practices. This paper presents the results of ten focus group discussions with people with lived experience of mental health issues and also carers, family members and support persons in relation to the use of seclusion and restraint.
  6. Conversations about Historical Trauma: Part One, NCTSN.org. The impact of historical trauma in tribal communities in the United States runs deep. Health care providers must understand the complexity of multigenerational trauma in order to properly serve these different populations to improve health outcomes. Decisions about possible solutions must include the tribes and incorporate their practices for processing trauma.
  7. Conversations about Historical Trauma: Part Two, NCTSN.org. Response to trauma on an individual level is fairly universal, but the addition of historical trauma can lead to different responses to trauma. The concept of Post Traumatic Slave Syndrome applies the effect of historical trauma directly to the descendants of enslaved Africans. Health care providers must consider the lens through which patients are seeing the world in order to serve them most effectively.
  8. Conversations about Historical Trauma: Part Three, NCTSN.org. Consideration of the historical trauma present in later generations of Jewish, Japanese, Hawaiian, and Pacific Island people is important for understanding the way that they may cope with trauma in the present. Events that happen in the present, like response to the September 11 attacks may reawaken past wrongs done to the ancestors of these communities. It is essential that people understand what trauma is so that they can seek out resources to better cope with it.
  9. Creating Cultures of Trauma-Informed Care (CCTIC): A Self-Assessment and Planning Protocol. (PDF, 200KB). Fallot RD, Harris M. July 2009. Community Connections. The CCTIC Self-Assessment and Planning Protocol is a system change model to transform an organization into one that is trauma-informed. This model is unique in that it uses client input to transform an organization’s services.
  10. Creating Sanctuary for Trauma-Informed Care. (PDF, 255KB). Pennsylvania Child and Adolescent Service System Program (PA CASSP). March 2009, Volume 18, Number 1. This newsletter highlight how the Sanctuary model can transform agencies and organizations. Aspects of the Sanctuary model and its benefits to children, adolescents, and their families are discussed.
  11. CW360˚: Secondary Trauma and the Child Welfare Workforce. (PDF, 2MB). Center for Advanced Studies in Child Welfare. School of Social Work, University of Minnesota. Spring 2012. This edition of CW360 focuses on secondary trauma. First-hand accounts and information on how secondary trauma impacts workers and how it can be prevented is provided throughout the newsletter.
  12. CW360˚: Trauma-Informed Child Welfare Practice. (PDF, 1MB). Center for Advanced Studies in Child Welfare. School of Social Work, University of Minnesota. Winter 2013. This issue of CW360 focuses on trauma-informed practice for children and families involved in the child welfare system. This issue is divided into three sections—an overview of trauma and trauma-informed child welfare systems, practices and models for implementing trauma-informed principles in the child welfare system, and perspectives from the field.
  13. Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. (PDF, 721KB). From the American Academy of Pediatrics Policy Statement. Pediatrics, 2012;129(1):e224-e231. The authors discuss how pediatricians can play a role in addressing childhood adversity, including screening children and families and educating families about the dangers of long-term toxic stress.
  14. Facts on Traumatic Stress and Children with Developmental Disabilities. (PDF, 130KB). National Child Traumatic Stress Network (NCTSN). Adapted Trauma Treatment Standards Work Group. 2004. This document highlights facts on traumatic stress in children with developmental disabilities, including incidence of trauma, special characteristics of the population that influence trauma, possible reasons of higher incidence of mental illness, suggestions for modifying evaluation and therapy for this population, special diagnostic considerations, and suggestions for therapy.
  15. Guide to Completing the Agency Self-Assessment for Trauma-Informed Care. (PDF, 102KB). The Agency Self-Assessment for Trauma-Informed Care is intended to be a tool to help organizations assess readiness to implement a trauma-informed approach. Honest and candid staff responses can benefit agencies by helping to identify opportunities for program and environmental change, assist in professional development planning, and can be used to inform organizational policy change.
  16. Helping Children and Youth Who Have Experienced Traumatic Events. (PDF, 163KB). SAMHSA. May 3, 2011. This short report discusses the prevalence of exposure to traumatic events among children and youth participating in two SAMHSA initiatives, the problems that trauma can cause, and available treatments that can help children and youth recover.
  17. Helping foster and adoptive families cope with trauma: a guide for pediatricians. (PDF, 4MB). American Academy of Pediatrics. 2013. The purpose of this guide is to support adoptive and foster families by strengthening the abilities of pediatricians to: 1) identify traumatized children, 2) educate families about toxic stress and the possible biological, behavioral, and social manifestations of early childhood trauma, and 3) empower families to respond to their child’s behavior in a manner that acknowledges past trauma but promotes the learning of new, more adaptive reactions to stress.
  18. How to Manage Trauma – Infographic. (PDF, 3MB). National Council for Community Behavioral Healthcare. This infographic defines trauma, highlights the prevalence of trauma, provides a checklist for trauma symptoms, and a list of helpful coping strategies.
  19. It’s just good medicine: trauma-informed primary care. (PDF, 2MB). SAMHSA-HRSA Webinar, August 6, 2013. In this webinar, the presenters discuss the prevalence of adverse life experiences (ACEs) and their effect on a person’s physical and behavioral health, how ACEs affect’s an individual’s engagement and use of primary care services, how to integrate a trauma-informed care perspective using practical skills, and how to access and use trauma-informed tools designed for primary care settings.
  20. Moving from Evidence to Action. Domestic Violence Agencies and Shelters. (PDF, 2MB). The Safe Start Center Series on Children Expose to Violence. Issue Brief #5. This issue brief translates emerging research and program practices into action steps for providers to design and implement programs in domestic violence shelters and agencies. The goal is to build the capacity of domestic violence shelters and agencies to offer sensitive, timely, and appropriate interventions that enhance children’s safety, promote their resilience, and ensure their well-being.
  21. The NCTSN Resource List By Title (232KB) is an alphabetical listing of all products developed by the National Child Traumatic Stress Network. Each of the products listed is linked to provide easy access to all materials. The resource list was updated, and includes all NCTSN products developed through January 2015.
  22. Parenting after trauma: understanding your child’s needs. A guide for foster and adoptive parents. (PDF, 2MB). American Academy of Pediatrics. 2013. This guide for foster and adoptive parents provides an overview of trauma - what it is, how it impacts children, their perceptions, and their relationships, and what parents can do.
  23. Professional Quality of Life Scale (ProQOL) version 5, 2009. (PDF, 62KB). This link provides access to the ProQOL scale, the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma.
  24. Promoting Resilience and Reducing Secondary Trauma Among Child Welfare Staff – Participant Handbook. (PDF, 965KB). The Resilience Alliance. September 2011. The Resilience Alliance is a project undertaken by the Administration for Children’s Services-New York University Children’s Trauma Institute (ACS-NYU CTI) to mitigate the impact of secondary traumatic stress among child protective staff, and thereby increase staff resilience, optimism, self-care, social support and job satisfaction, and decrease stress reactivity, burnout and attrition. This is not a one-directional training provided to staff, but rather an intervention that is done in partnership with child welfare staff at all levels, from the front line to the senior leadership of the agency. The handbook provides handouts and exercise to help staff better manage the stress of child welfare work.
  25. Promoting Resilience and Reducing Secondary Trauma Among Child Welfare Staff – Training Manual. (PDF, 1MB). The Resilience Alliance. September 2011. This manual describes a project undertaken by the Administration for Children’s Services-New York University Children’s Trauma Institute (ACS-NYU CTI) to mitigate the impact of secondary traumatic stress among child protective staff in New York City. This manual provides the reader with information about the content of the intervention and the process in creating buy-in and support for this work. In addition to providing information about how this intervention was delivered in New York City, it provides suggestions about how it could be structured to meet the needs of child welfare systems that are smaller and/or structured differently. It also provides information about the tools used to collect data from staff, which helped make adjustments to the intervention and identify where and how the work was most effective.
  26. Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse. (PDF, 97KB). Risking Connection is a theoretically sophisticated, accessible treatment and response framework guided by a manual. It helps providers develop optimally helpful resources to trauma survivors through a comprehensive contextual foundation for trauma informed services. The focus of the program on the impact of the work on the helping professional, and from teaching providers to understand and use their own reactions productively, supports decreased levels of stress and burnout for providers.
  27. The Sanctuary Model: A Restorative Approach for Human Services Organizations. (PDF, 71KB). Mirksy, L. (2010) March. EForum. International Institute for Restorative Practice. This document provides insights into the Sanctuary Model, a non-hierarchical, highly participatory, “trauma-informed and evidence-supported” operating system for human services organizations, which helps them function in a humane, democratic and socially responsible manner and thereby provide effective treatment for clients in a clinical setting.
  28. The Sanctuary Model of Organizational Change for Children’s Residential Treatment. (PDF, 109KB). Bloom SL (2005). Therapeutic Community: The International Journal for Therapeutic and Supportive Organizations 26(1): 65-81. This paper describes the Sanctuary Model® of organizational change as applied to children’s residential treatment, a trauma-informed method for creating or changing an organizational culture in order to more effectively provide a cohesive context within which healing from psychological and social traumatic experience can be addressed. The theoretical underpinnings of the model are addressed, with an emphasis on the parallel process nature of chronic stress as seen in the behavior of children and of staff, as well as the organization as a whole. A description of the process involved in creating a healthier therapeutic community is described.
  29. Secondary Traumatic Stress. A Fact Sheet for Child-Serving Professionals. (PDF, 724KB). NCTSN. 2011. This fact sheet provides an overview of secondary traumatic stress, including what it is, who is at risk what the symptoms are, how to identify secondary traumatic stress, how to prevent it, and how to intervene.
  30. The System of Care Trauma-Informed Agency Assessment (TIAA) (1MB) is an in-depth, validated data-collection tool designed by dedicated family, youth and agency staff to identify areas of strength and pinpoint areas for improving trauma-informed service. It is designed to meet agencies and communities where they are at, and to build on established successes. TIAA data guides change according to each organization’s unique strengths and needs. The assessment can be adapted for single or multi-agency use and its language modified to suit agency norms. Programs can be added to it that reflect a full service array, e.g., multi‐systemic therapy, substance abuse, co‐occurring, or day treatment services. Where data already exists on an environment’s physical and emotional safety, youth and family empowerment, trustworthiness, trauma competence or cultural competence, components of the TIAA can be used to enhance existing data collection.
  31. Tips for College Students: After a Disaster or Other Trauma. (PDF, 1MB). This publication helps college students cope with the mental health effects in the aftermath of trauma; it explains normal reactions, emphasizes the importance of talking about feelings, and offers tips for coping.
  32. Tips for College Students: After a Disaster or Other Trauma: R U a Survivor of a Disaster or Other Trauma? How R U Doing? (PDF, 637KB). TThis publication uses text-message shorthand to offer college students tips for coping after a disaster or other traumas; it describes ways students can cope with anxiety, fear, and sadness after a disaster or traumatic event, and includes resources for more information.
  33. Tips for Survivors of a Disaster or Other Traumatic Event: Managing Stress (PDF, 1MB). Substance Abuse and Mental Health Services Administration (SAMHSA) in this guide recognizes that witnessing a disaster such as hurricane, flood, or even terrorism may be as stressful as being involved in the disaster personally. It is common to show signs of stress after exposure to a disaster or other traumatic event, and it is important to monitor your physical and emotional health. This guide helps to identify early warning signs of stress.
  34. Tips for Survivors of a Disaster or Traumatic Event: What to Expect in Your Personal, Family, Work, and Financial Life (PDF, 2MB). Many people experience trauma due to natural disasters such as floods, hurricanes, and other storms and human caused events like mass violence and terrorism. For some survivors, disasters can remind them of earlier trauma and make it harder to recover. But with good social support and coping skills, most survivors have the ability to recover and are quite resilient. For those who continue to suffer Substance Abuse and Mental Health Services Administration (SAMHSA) offers these self-help tips for coping with the aftermath of trauma. This publication also discusses the long-term impact of trauma, including personal uncertainties, family relationship changes, work disruptions, and financial concerns.
  35. Tips for Talking With and Helping Children and Youth Cope After a Disaster or Traumatic Event: A Guide for Parents, Caregivers, and Teachers (PDF, 312KB). This publication helps parents and teachers recognize common reactions of children of different age groups (preschool and early childhood to adolescence) after a disaster or traumatic event; it offers tips for how to respond in a helpful way and when to seek support.
  36. Toxic Stress and Trauma-Informed Pediatric Care. (PDF, 378KB). Gottlieb, E. Massachusetts Child Psychiatry Access Project (MCPAP). 2012. This document provides an overview of childhood toxic stress and trauma, how to provide trauma-informed pediatric care, and effective treatments for childhood adversity. The document also highlights the Massachusetts Child Trauma Project established by the Department of Children and Families. Its mission is to transform the child welfare system in Massachusetts by integrating trauma-informed and trauma-focused practices into child protective service delivery.
  37. Trauma & Resilience: An Adolescent Provider Toolkit. (PDF, 20MB). Adolescent Health Working Group. The five-module curriculum is designed for providers. Each module addresses a complexity of issues through accessible, user-friendly resources including screening and assessment tools, evidence-based best practices and promising approaches, and health education handouts for youth/young adults and parents/caregivers.
  38. Trauma-Informed Care - Top Ten: A Checklist for Behavioral Health Organizations. (PDF, 1MB). National Council for Behavioral Health. This checklist helps organizations determine how committed they truly are to trauma-informed care.
  39. Trauma-Informed Organizational Toolkit for Homeless Services. (PDF, 2MB). Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. (2009). Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation. The Trauma-Informed Organizational Toolkit provides programs with a roadmap for becoming trauma-informed. The Toolkit offers homeless service providers with concrete guidelines for how to modify their practices and policies to ensure that they are responding appropriately to the needs of families who have experienced traumatic stress. It includes a trauma-informed organizational self-assessment, a user’s guide, and a manual with concrete steps for organizations to become trauma-informed.

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Additional References

  1. Helping Traumatized Families. The new edition offers clinicians a unified, evidence-based theory of the systemic impact of traumatic stress and details a comprehensive approach for helping families by promoting their natural healing resources.
  2. Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care. S.L. Bloom, & B. Farragher. Oxford University Press, 2013. This is the third in a trilogy of books that chronicle the revolutionary changes in our mental health and human service delivery systems that have conspired to disempower staff and hinder client recovery. Creating Sanctuary documented the evolution of The Sanctuary Model therapeutic approach as an antidote to the personal and social trauma that clients bring to child welfare agencies, psychiatric hospitals, and residential facilities. Destroying Sanctuary details the destructive role of organizational trauma in the nation's systems of care. Restoring Sanctuary is a user-friendly manual for organizational change that addresses the deep roots of toxic stress and illustrates how to transform a dysfunctional human service system into a safe, secure, trauma-informed environment.
  3. Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse. K.W. Saakvitne, S. Gamble, L. A. Pearlman, & B.T. Lev. The Sidran Institute, a nonprofit organization devoted to educating professionals about traumatic stress conditions, is pleased to announce the publication of Risking Connection®: A Training Curriculum for Working with Survivors of Childhood Abuse, a basic trauma training curriculum specially designed for staff in public mental health settings. The curriculum was developed by trauma specialists at the Trauma Research, Education, and Training Institute, Inc. (TREATI) of South Windsor, CT with the support of the Departments of Mental Health in the states of Maine and New York. This affordable curriculum is now available to all interested agencies and individuals. It was prepared with editorial and clinical input from helping professionals and trauma survivors with extensive experience in state mental health systems, clinical treatments of traumatic stress conditions, curriculum design, and the law.
  4. The Road Back to Wellness: Stress, Burnout & Trauma in Corrections. (PDF, 44KB). Fisher, P.T. July 2000. This is a workbook designed to provide practical help in addressing the effects of workplace stress, burnout and trauma as they occur in the corrections field. It is divided into three sections that provide background, self-assessment tools and strategies to develop your own wellness plan.
  5. Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Lipsky L.V.D., & Burk, C. 2009. A longtime trauma worker, Laura van Dernoot Lipsky offers a deep and empathetic survey of the often-unrecognized toll on those working to make the world a better place. We may feel tired, cynical, numb, or like we can never do enough. These, and other symptoms, affect us individually and collectively, sapping the energy and effectiveness we so desperately need if we are to benefit humankind, other animals, and the planet itself. Through Trauma Stewardship, we are called to meet these challenges in an intentional way--not by becoming overwhelmed but by developing a quality of mindful presence. Joining the wisdom of ancient cultural traditions with modern psychological research, Lipsky offers a variety of simple and profound practices that will allow us to remake ourselves--and ultimately the world.
  6. Using Trauma Theory to Design Service Systems: New Directions for Mental Health Services, Number 89. M. Harris, & R.D. Fallot. Jossey-Bass, 2001. Mental health practitioners are becoming increasingly aware that they are encountering a very large number of men and women who are survivors of sexual and physical abuse. This volume identifies the essential elements necessary for a system to begin to integrate an understanding about trauma into its core service programs. The fundamental elements of a trauma-informed system are identified and the necessary supports for bringing about system change are highlighted. The basic philosophy of trauma-informed practice is then examined across several specific service components: assessment and screening, inpatient treatment, residential services, addictions programming, and case management. Modifications necessary to transform a current system into a trauma-informed system are discussed in great detail as well as the changing roles of consumers and providers. This is the 89th issue of the quarterly journal New Directions for Mental Health Services.

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Self-Care Resources

Exercises and Practical Techniques

Exercise can help individuals feel better and reduce the symptoms of toxic stress. The list below provides examples of exercise models and other practical techniques that may be used by those who have experienced trauma or those working with traumatized individuals. It is important to note that these strategies to not replace treatment.

  1. Brain Gym. Brain Gym exercises to help clients use movement of comfort to help with hypo and hyper arousal. Trish Mullen shares feedback from a mom: “At first I felt silly doing brain gym and then it felt good to have fun and be silly with my daughter. We never do that anymore. I was completely amazed of how good 2 minutes of doing that stuff was for me and her…. I’m going to see if we can get our entire family doing this together. I loved the Travolta. She immediately calmed down and let herself be silly. I loved seeing that.” Trish also shares feedback from an adolescent boy: “I don’t like sitting when I get real anxious; I wish my teachers let me do brain gym. Detention school does.” He calls it his “spontaneous yoga” and will now say, “Trish, I need to do spontaneous yoga.”
  2. Brain Gym – Educational Kinesiology. Educational Kinesiology or Brain Gym, is an approach to learning directed toward specific neurological effects, to the clarification and implementation of life goals. The word kinesiology means “the science of movement”, and so Brain Gym is based on the principle that we can educate the whole person through movement. This document provides background on Brain Gym as well as examples of Brain Gym exercises.
  3. 10 Free Brain Gym Exercises. This document shows 10 free brain gym exercises as well as other guidance and resources for integrating physical activity into the complete school day.
  4. Tension and Trauma Releasing Exercises (TRE™) developed by trauma specialist Dr. David Berceli to reduce the impact of traumatic experiences on the body. TRE™ was designed to be taught to large populations for whom trauma and PTSD are pervasive (such as military personnel, and natural disaster survivors), but also benefits anyone who may be holding stress and tension in their body. Benefits and reduction of stress related symptoms are usually reported within the first few sessions, and consistently include a reduction in anxiety and chronic pain, and improvements in sleep quality.
  5. 90:10 The Single Most Important Think You Can do For Your Stress. DocMikeEvans follows up his viral health video "23 and 1/2 Hours" with this informative and practical video on managing stress. Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital.

Mobile Applications

Many free or low-cost mobile applications (apps) are now available that provide self-help, education, and support for those who have experienced trauma and for those who work with traumatized individuals. The list of available apps is lengthy and many new apps are launched daily. The list below provides example of available apps that help users reduce the symptoms of toxic stress.

  1. Binaural Beats. Binaural Beats is a free app that stimulates the brain by sending special auditory artifacts directly into headphones to produce subtle changes in behavior though entrainment of brainwaves frequency. This app can help induce relaxation, creativity and many other desirable mental states.
  2. Breathe2Relax. Breathe2Relax is a portable stress management tool which provides detailed information on the effects of stress on the body and instructions and practice exercises to help users learn the stress management skill called diaphragmatic breathing. Breathing exercises have been documented to decrease the body’s ‘fight-or-flight’ (stress) response, and help with mood stabilization, anger control, and anxiety management. Breathe2Relax can be used as a stand-alone stress reduction tool, or can be used in tandem with clinical care directed by a healthcare worker.
  3. Conscious. Conscious is a free app to help users increase mindfulness and awareness by taking simple and effective daily challenges alongside other like-minded people.
  4. eCBT Calm. CBT Calm helps people who are feeling stressed and want to learn relaxation skills. It assesses your stress level, provides relaxation skills, and also includes links to online resources for stress and anxiety. Electronic CBT (eCBT©) is not replacement for psychotherapy or for medications used to treat anxiety. Instead, eCBT Calm helps people to assess their stress symptoms and learn skills to feel more relaxed in their daily lives.
  5. eCBT Trauma. CBT Trauma is an app that helps people who have experienced a traumatic event. It uses the scientific principles of cognitive behavioral therapy (CBT) to help relieve the symptoms of Post-Traumatic Stress Disorder (PTSD) and can be used in conjunction with psychotherapy or as a standalone self-help intervention. Electronic CBT (eCBT©) is not replacement for traditional psychotherapy, or for medications used to treat symptoms of PTSD. Instead, eCBT aims to help people learn how to assess their symptoms after experiencing a trauma, learn relaxation and grounding skills to help cope with those symptoms, and how to successfully complete exposure exercises, which have been shown to dramatically reduce the symptoms of PTSD.
  6. GPS for the Soul. GPS for the Soul a free app launched by HuffPost allows users to measure their stress levels and follow interactive meditation and breathing guides. These personalized tools aim to encourage harmony and balance, as well as awareness of when our stress starts to go off the charts.
  7. Headspace. Headspace is meditation made simple. Learn online, when you want, wherever you are, in just 10 minutes a day on your computer, tablet or smartphone. The Headspace app can be used on Apple iOS or Android devices and can be downloaded from the Apple iTunes App or Google Play Store respectively. For tablets, the app can be used on any iPad with iOS 6 onwards or any Android tablet with Android 3+ (including Kindle Fire tablets).
  8. iStress. iStress is a self-help app that provides different types of stress reduction, such as positive thinking, humor and encouragement of positive attitudes.
  9. Lightning Bug. Lightning Bug is an ambience and white noise mixer for Android powered devices. Lightning Bug features a library of almost 200 sound loops and samples ranging from the natural peace of rain storms and ocean waves, to pure white noise, city trains, meditation bells, acoustic and electronic instruments, and down-tempo break beats. The app also includes many soothing backgrounds and sound visualizations.
  10. Meditation Helper. This free app is meditation timer which allows you to set a target for the length of time you want to meditate each day. It includes a widget that displays the number of consecutive days you have hit the target. It is thus useful not only as a timer, but also as a tool to help motivate you to meditate regularly.
  11. Mind Health. Rooted in Buddhist Psychology this app will serve you as a reminder of the key concepts that can help you reduce your stress, calm your mind, and sow the seeds of happiness through your meditation practice. Come back to this app frequently and reread the basic concepts, and try to apply them in your daily life. Please note that this is intended for people already familiar with meditation.
  12. Provider Resilience. This app created by the National Center for Telehealth & Technology provides health care providers with tools to guard against burnout and compassion fatigue as they help victims of trauma.
  13. PTSD Coach. Together with professional medical treatment, PTSD Coach provides users with education about PTSD, information about professional care, a self-assessment for PTSD, opportunities to find support, and tools that can help users manage the stresses of daily life with PTSD.
  14. Relax and Sleep. Relax and Sleep Well is a high quality hypnosis recording by best selling self-help audio author Glenn Harrold. This free recording will help alleviate stress and anxiety and sleep well at night. Please note the full version of this app has daytime and night-time versions. The free version includes the daytime version only but this is still a full 27-minute hypnosis session.
  15. Relax Completely. A hypnosis session for deep relaxation by one of the UKs leading hypnotherapists and trainers. Includes animated backgrounds, video interviews, relaxation tips and weblinks.
  16. Support by EBT. Emotional Brain Training (www.ebtgroups.com) focuses stress in the emotional brain. EBT provides tangible ways to create balance in your emotional brain so that your brain's emotional set point begins to improve. Begin by learning the basic tools to change your emotional brain so that you naturally process stress in a highly effective way. Once you have improved the way you process the daily stresses of life, then the 7 EBT Kits will guide you to creating lasting change. This app will help you current your current level of stress, discover what part of your brain is now dominant and then use a brain based tool to reduce our stress level and feel better.
  17. T2 Mood Tracker. T2 Mood Tracker is a free app that allows users to monitor and track emotional health. Originally developed as a tool for service members to easily record and review their behavior changes, particularly after combat deployments, it has now become very popular with many civilian users around the world. The app records a range of emotions for anxiety, depression, head injury, stress, posttraumatic stress and a user’s general well-being. Users can also create items to track their progress in unique areas. The saved results are displayed in an easy-understand graph. The data is saved in a graphical or spreadsheet file which can be transferred by e-mail or other wireless connection.

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