Tra uma -Info rme d Hig he r Ed uc a tio n: Re sp o nd ing to the Effe c ts o f Child ho o d Tra uma a nd Ad ve rse Child ho o d Exp e rie nc e s

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1 Tra uma -Info rme d Hig he r Ed uc a tio n: Re sp o nd ing to the Effe c ts o f Child ho o d Tra uma a nd Ad ve rse Child ho o d Exp e rie nc e s Ang e la Willits, MSW, LCSW Assistant Clinic al Pro fe sso r

2 Ap p re c ia tio ns Divisio n o f Dive rsity, Eq uity a nd Ed uc a tio na l Ac hie ve me nt Je nnife r Sa mp so n MSW, APSW Je nnife r A. King DSW, MSW, LISW a nd Amy Ko rsc h- Willia ms MSSA, CNM, LISW-S Ca se We ste rn Re se rve Unive rsity

3 Ag e nd a a nd Ob je c tive s Wha t is tra uma a nd the ACEs? O b je c tive : Und e rsta nd ke y c o nc e p ts re la te d to tra uma inc lud ing the ACE stud y, p re va le nc e ra te s, the tra uma re sp o nse, p o te ntia l imp a c ts, a nd c o mmo n tra uma trig g e rs Wha t is Tra uma -Info rme d Ca re? O b je c tive : Und e rsta nd the tra uma -info rme d c a re fra me wo rk a nd tra uma -info rme d Wha t Is Se c o nd a ry Tra uma? Ho w c a n we re sp o nd in hig he r e d uc a tio n to a ssist stud e nts a ffe c te d b y tra uma a nd a d ve rse c hild ho o d e xp e rie nc e s? Ob je c tive : Eng a g e in c ritic a l thinking stra te g ie s fo r imp le me nting ke y p rinc ip le s o f tra uma -info rme d c a re in o ur wo rk

4 Info rma tio n p re se nte d via slid e s a nd sp e a ke r Wha t to Exp e c t Sma ll g ro up d isc ussio ns tha t mig ht invo lve sha ring o f yo ur p ro fe ssio na l e xp e rie nc e s a nd id e a s (within yo ur c o mfo rt le ve l) Brie f vid e o s Wha t we won t do: Ta ke the ACE que stionna ire

5 Re mind e r Ta lking a b o ut tra uma is o fte n d iffic ult Ta ke c a re o f yo urse lf Re c o g nize Re sp o nd Bre a the Shift a tte ntio n Ta ke a wa lk Yo ur p re fe rre d c o ping

6 Wha t is a tra uma?

7 DSM-5 Dia g no stic Crite ria : Fo r a d ults, a d o le sc e nts, a nd c hild re n o ve r 6 Crite rio n A: Exp o sure to a c tua l o r thre a te ne d d e a th, se rio us injury, o r se xua l vio le nc e in o ne (o r mo re ) o f the fo llo wing wa ys: 1. Dire c tly e xp e rie nc ing the tra uma tic e ve nt(s) 2. Witne ssing, in p e rso n, the e ve nt(s) a s it o c c urre d to o the rs 3. Le a rning tha t the tra uma tic e ve nt(s) o c c urre d to a c lo se fa mily me mb e r o r c lo se frie nd. In c a se s o f a c tua l o r thre a te ne d d e a th o f a fa mily me mb e r o r frie nd, the e ve nt(s) must ha ve b e e n vio le nt o r a c c id e nta l. 4. Exp e rie nc ing re p e a te d o r e xtre me e xp o sure to a ve rsive d e ta ils o f the tra uma tic e ve nt(s) (e.g., first re sp o nd e rs c o lle c ting huma n re ma ins; p o lic e o ffic e rs re p e a te d ly e xp o se d to d e ta ils o f c hild a b use.) Note : Crite rio n A4 d o e s no t a p p ly to e xp o sure thro ug h e le c tro nic me d ia, te le visio n, mo vie s, o r p ic ture s, unle ss this e xp o sure is wo rk re la te d. Ang e la Willits, LCSW; Ple a se d o no t d istrib ute

8 Exa mp le s o f Tra uma tic Eve nts Ab use (se xua l, p hysic a l, e mo tio na l, ve rb a l) Ne g le c t Ca r a c c id e nts Co mmunity vio le nc e Bullying Te rro rism Do me stic vio le nc e Sc ho o l vio le nc e Tra uma tic lo ss o f a p a re nt/ c a re g ive r Me d ic a l tra uma o r se rio us illne ss Re fug e e tra uma Na tura l d isa ste rs He a ring a b o ut vio le nc e o r sud d e n d e a th o f a c lo se lo ve d o ne No t Inc lud e d But Imp o rta nt: Histo ric a l tra uma Multig e ne ra tio na l tra uma : imp a c t o f tra uma o ve r g e ne ra tio ns Ra c e -b a se d tra uma Fa r-re a c hing e ffe c ts o f p o ve rty Ho me le ssne ss (No rth, 2015)

9 56% o f the g e ne ra l p o p ula tio n re p o rte d a t le a st o ne tra uma tic e ve nt Life time p re va le nc e fo r se xua l tra uma a mo ng wo me n ra ng e s fro m 15-25% Pre va le nc e A 2008 stud y sho we d tha t 18.5% o f re turning Ve te ra ns ha d symp to ms c o nsiste nt with p o sttra uma tic stre ss d iso rd e r (PTSD) o r d e p re ssio n In the U.S., 18.9% o f me n a nd 15.2% o f wo me n re p o rte d e xp e rie nc ing a na tura l d isa ste r in the ir life time (SAMSHA, 2016) 95% o f me nta l he a lth c lie nts ha ve b e e n e xp o se d to a tra uma tic e ve nt a nd mo st ha ve multip le e xp o sure s (No rth, 2015)

Pre va le nc e in Co lle g e Stud e nts Two third s o f inc o ming fre shma n (n=3000 a t two p ub lic unive rsitie s) re p o rte d e xp o sure to a tra uma Risk fo r Se xua l Vio le nc e Mo st c o

10 Pre va le nc e in Co lle g e Stud e nts Two third s o f inc o ming fre shma n (n=3000 a t two p ub lic unive rsitie s) re p o rte d e xp o sure to a tra uma Risk fo r Se xua l Vio le nc e Mo st c o mmo n: life - thre a te ning illne ss a nd sud d e n lo ss o f a lo ve d o ne 10% fo und to me e t c rite ria fo r PTSD (Re a d, J.P., O uime tte, P., White, J., Co ld e r, C., & Fa rro w, S., 2011)

11 The Ad ve rse Child ho o d Exp e rie nc e s Stud y / utub e.c o m/ wa tc h? v=c c KFkc fxxc &t=4s ACE Que stio nna ire / jfc j.o rg / site s/ d e fa ult/ file s/ Find ing %2 0Yo ur%20ace%20sc o re.p d f

12 ACE Stud y Imp lic a tio ns Ad ve rse e xp e rie nc e s in c hild ho o d ha ve sub sta ntia l lo ng te rm imp a c t o n he a lth a nd we ll-b e ing In so me ne ig hb o rho o d s a nd c o mmunitie s, a sc o re o f fo ur o r mo re is the NO RM The se e xp e rie nc e s ha ve sig nific a nt imp a c t o n a d ult live s Se lf-re p o rte d suic id e a tte mp ts inc re a se e xp o ne ntia lly with ACE sc o re s -- g o ing fro m a sc o re o f 0 to 6 inc re a se s the like liho o d o f a tte mp te d suic id e b y 5,000% (12x mo re like ly to a tte mp t) Ind ivid ua ls with a n ACE sc o re o f 4 we re 6x mo re like ly to strug g le with d e p re ssio n, 7x mo re like ly to d e ve lo p a lc o ho lism, 10x mo re like ly to inje c t stre e t d rug s (c o mp a re d to tho se with a sc o re o f 0) With re g a rd to a d ult ra p e, wo me n with a n ACE o f 0 re p o rt a t a p re va le nc e ra te o f 5%, while wo me n with a n ACE sc o re o f 4 o r mo re re p o rt a p re va le nc e o f 33% Hig h-risk b e ha vio rs p re d ic te d b y ACE sc o re s inc lud e d smo king, o b e sity, uninte nd e d p re g na nc ie s, multiple se xua l p a rtne rs, a nd se xua lly tra nsmitte d d ise a se s (va n d e r Ko lk, 2014)

13 Disc ussio n In yo ur wo rk with stud e nts, wha t ha ve yo u e nc o unte re d re g a rd ing the ir e xp o sure to tra uma? Wha t imp a c ts o f tra uma ha ve yo u o b se rve d in stud e nts mo o d, b e ha vio rs a nd func tio ning?

This is Yo ur Bra in o n Tra uma http s:/ / www.yo utub e.

14 This is Yo ur Bra in o n Tra uma http s:/ / utub e.c o m/ wa tc h? v=xh5t-dqdta8 Dr. Ja mie Ma ric h; 2:45-3:52

The Tra uma Re sp o nse The Fig ht, Flig ht o r Fre e ze Re sp o nse Onc e a thre a t is p e rc e ive d, a n a la rm syste m g o e s o ff in o ur b ra in initia ting a c ha in re a c tio n in the

15 The Tra uma Re sp o nse The Fig ht, Flig ht o r Fre e ze Re sp o nse Onc e a thre a t is p e rc e ive d, a n a la rm syste m g o e s o ff in o ur b ra in initia ting a c ha in re a c tio n in the symp a the tic ne rvo us syste m The b o d y re le a se s ve ry p o we rful stre ss ho rmo ne s (e.g., c o rtiso l a nd a d re na line ), le a d ing to a n inc re a se in he a rt ra te, b re a thing, a nd b lo o d p re ssure (va n d e r Ko lk, 2014) Atte ntio n is fo c use d o n the imme d ia te thre a t Ma y b e una b le to fe e l thing s like p a in, hung e r, fa tig ue Evo ke s a n inte nse fe e ling o f fe a r a nd a ng e r (He rma n, 1992)

16 The Fre e ze Re sp o nse Physic a lly, me nta lly a nd e mo tio na lly immo b ilize d This re sp o nse ma y b e mo re re le va nt to c hild re n a nd wo me n (Ba ke r e t a l., 1995) In c a se s o f se xua l a ssa ult, so me time s re fe rre d to a s To nic Immo b ility (TI) o r Ra p e -ind uc e d p a ra lysis 12-50% o f a ll ra p e vic tims e xp e rie nc e TI d uring a ssa ult

17 Co mmo n Re a c tio ns to Tra uma (PTSD Symp to ms) Inc re a se d Arousa l: Ma rke d a lte ra tio ns in a ro usa l a nd re a c tivity a sso c ia te d with the tra uma tic e ve nt(s), inc lud ing sta rtle, sle e p d isturb a nc e s, a ng ry o utb ursts, re c kle ss o r se lf-d e struc tive b e ha vio rs I just c a n t c o nc e ntra te. I fe e l so o n e d g e. I c a n t re la x. I b lo w up a t p e o p le. No ise s d rive me c ra zy! I c a n t c o ntro l my te mp e r. Intrusive Expe rie nc e s: d istre ssing me mo rie s; d istre ssing d re a ms; d isso c ia tive re a c tio ns (fla shb a c ks); re a c tivity whe n re mind e d o f the e ve nt b y inte rna l o r e xte rna l c ue s I c a n t c o nc e ntra te. I c a n t g e t the se tho ug hts o ut o f my he a d. I fe e l o ut o f c o ntro l. Avoida nc e : Inte rna l re minde rs: me mo rie s, ima g e s, tho ug hts, fe e ling s Exte rna l re minde rs: p e o p le, p la c e s, c o nve rsa tio ns, a c tivitie s, o b je c ts, situa tio ns I m just g o ing thro ug h the mo tio ns. I d o n t ha ve a life a nymo re. I just wa nt to b e le ft a lo ne. Ang e la Willits, LCSW; Ple a se d o no t d istrib ute

18 Co mmo n Re a c tio ns to Tra uma (PTSD Symp to ms) Ne g a tive Alte ra tions in Cog nitions a nd Mood Ne g a tive b e lie fs a b o ut se lf, o the rs, wo rld, a nd c a use o f the tra uma The wo rld is no t a sa fe p la c e. No o ne is sa fe with me. I ha ve b a d jud g me nt. I sho uld ha ve kno wn. It s my fa ult. Pe o ple c a n b e truste d. Pe rsiste nt ne g a tive e mo tio na l sta te a nd d iffic ulty e xp e rie nc ing p o sitive e mo tio ns De ta c hme nt Lo ss o f inte re st in thing s o nc e p le a sura b le Diffic ulty re me mb e ring a sp e c ts o f the tra uma

19 Tra uma s Imp a c t o n Me mo ry Und e r o rd ina ry c o nd itio ns, the ra tio na l a nd e mo tio n p a rts o f the b ra in wo rk to g e the r to p ro d uc e a n inte g ra te d re sp o nse (o r me mo ry) Tra uma tic me mo rie s a re d iffe re nt -- o ur b o d ie s p ro c e ss a nd sto re the se me mo rie s d iffe re ntly Le ss o rg a nize d a nd c o he re nt No t lo g ic a l o r line a r na rra tive s (i.e., b e g inning, mid d le, e nd ) Ma y b e fra g me nte d se nso ry e xp e rie nc e s (e.g., o ne ma y o nly re me mb e r so und s a nd sme lls, se e q uic k ima g e s, o r e xp e rie nc e p hysic a l se nsa tio ns in p a rts o f the b o d y) Mo re d iffic ult to c o mmunic a te The b ra in strug g le s to d iffe re ntia te b e twe e n the p a inful me mo ry a nd re a l d a ng e r

20 The Imp a c t o f Tra uma o n Stud e nts Whe n we und e rsta nd ho w tra uma a ffe c ts the b o d y, c e rta in b e ha vio rs g o fro m a p p e a ring ma la d a p tive to b e ing re a so na b le o r a t le a st so me wha t und e rsta nd a b le. Exa mp le s: Why a c o lle g e fre shma n with a tra uma histo ry mig ht d rink to o muc h a lc o ho l a t a fo o tb a ll g a me Why a stud e nt mig ht se e m d e fia nt, infle xib le o r c o mb a tive whe n inte ra c ting with a n a utho rity fig ure Why a stud e nt c a n g o fro m b e ing so c ia lly a c tive to sud d e nly iso la ting, missing c la ss a nd d e a d line s Why a stud e nt mig ht g ive va rying d e ta ils a b o ut a tra uma tic e ve nt

21 Tra uma Trig g e rs

22 Tra uma Trig g e rs Trig g e r -- so me thing tha t re mind s the ind ivid ua l o f the o rig ina l tra uma hig hly sub je c tive a c tiva te d thro ug h o ne o f the five se nse s Exa mp le s o f p o ssib le trig g e rs?

23 Po te ntia l Trig g e rs in Co lle g e Life Se p a ra tio n/ lo ss Limite d c o ntro l La c k o f p riva c y Be ing a lo ne Fe e ling thre a te ne d Inte ra c tio ns with a utho rity fig ure s Inte ra c tio ns with unfa milia r p e o p le Re je c tio n To uc h Lo ud no ise s La c k o f info rma tio n a nd / o r p re d ic ta b ility Tra nsitio ns/ d isrup tio n in ro utine Ce rta in sme lls Be ing o b se rve d Intrusive o r p e rso na l q ue stio ns Lo c ke d ro o ms (We b b, 2016)

24 Ho w mig ht this info rma tio n imp a c t yo ur wo rk with stud e nts?

25 Tra uma -Info rme d Ca re

26 Wha t Is Tra uma -Info rme d Ca re? Tra uma -info rme d c a re is a shift in p e rsp e c tive tha t ta ke s into a c c o unt the pre va le nc e o f tra uma Tra uma -info rme d c a re is a le ns thro ug h whic h to vie w o ur wo rk with ind ivid ua ls A mo ve me nt fro m Wha t s wro ng with yo u? to Wha t ha p p e ne d to yo u? A wa y o f b e ing, ta lking a nd o ffe ring c a re Tra uma -info rme d c a re is NOTa sp e c ific inte rve ntio n to a d d re ss a tra uma -re la te d d iso rd e r

27 SAMHSA s Trauma-Informed Care Model Realize Recognize Respond Resist Understand trauma as widespread Aware of signs & symptoms Integrate knowledge into policies & practices Actively avoid retraumatizing

28 SAMHSA s Key Principles of TI Care Safety Trustworthiness & Transparency Peer Support Collaboration & Mutuality Empowerment, Voice, & Choice Cultural, Historical, & Gender Issues

29 Trauma-Informed Student Services Safety Trustworthiness & Transparency Peer Support Collaboration & Mutuality Empowerment, Voice, & Choice Cultural, Historical, & Gender Issues

Trauma-Informed Services Safety Trustworthiness & Transparency Peer Support Tell people what you re going to do before you do it; Create a safe environment; Use of check-in/check-out; Pacing of

30 Trauma-Informed Services Safety Trustworthiness & Transparency Peer Support Tell people what you re going to do before you do it; Create a safe environment; Use of check-in/check-out; Pacing of material provided; Worker attunement. Provide clear discussion of role and process; Information on confidentiality and how information will be used; Respond promptly to communication ( ); Promote predictability in interactions. Inform students of events occurring in the school/on campus; Provide referral information to health/wellness resources; Promote students sharing resources with one another. Collaboration & Mutuality Empowerment, Voice, & Choice Cultural, Historical, & Gender Issues Understand the power differential and seek to minimize its effect; Collaborate in decision-making to share power; Involve students in creating/revising policies if possible; Give opportunities for students to offer feedback; Build in choices wherever possible: physical space, use of time; Promote self-advocacy skills; Focus on identifying strengths and good coping Ask for pronouns; Avoid microaggressions and acknowledge impact when they occur; allow time for processing of current events related to social justice, diversity, bias, oppression

31 Tra uma ro b s the vic tim o f a se nse o f p o we r a nd c o ntro l; the g uid ing p rinc ip le o f re c o ve ry is to re sto re p o we r a nd c o ntro l to the survivo r. -- Jud ith He rma n, M.D. Tra uma a nd Re c o ve ry

32 Pro mo ting Sa fe ty in the He lp ing Inte ra c tio n My g o ld e n rule : Te ll p e o p le wha t yo u a re g o ing to d o b e fo re yo u d o it Fo re sha d o w wha t will ha p p e n (p ro c e ss a nd p ro c e d ure s) Pro vid e e xp la na tio ns in multip le fo rms a nd mo re tha n o nc e (ve rb a l a nd writte n) Co nsid e r inc o rp o ra ting wha t to e xp e c t ne xt into yo ur d isc ussio ns a s a ma tte r o f ro utine

33 A Sa fe Enviro nme nt Surve y the e nviro nme nt fo r p o te ntia l trig g e rs Lig hting Art/ sig ns/ c o mic s/ q uo te s Se a ting : a rra ng e me nt o f o ffic e ; he ig ht a nd so ftne ss o f c ha irs No ise s (e sp e c ia lly lo ud, une xp e c te d so und s) Ad d we lc o ming to uc he s a nd c o mfo rt ite ms Offe r c ho ic e Pre fe rre d se a t Do o r o p e n o r c lo se d Cre a ting the b ub b le o f c a lm in yo ur p o sture, vo ic e, e ye c o nta c t a nd mo ve me nts

34 Ang e la Willits, LCSW a willits@ wisc.e du

35 Re fe re nc e s Be rg e r, R. & Quiro s, L. (2014). Sup e rvisio n fo r tra uma -info rme d p ra c tic e. Tra uma to lo g y, 20(4), Fig le y, C.R. (1995). Co mp a ssio n fa tig ue : Co p ing with se c o nda ry tra uma tic stre ss diso rde r in tho se tra uma tize d. Ne w Yo rk: Brunne r-ro ute le d g e. who tre a t the Fra nklin, L. D. (2011). Re fle c tive sup e rvisio n fo r the g re e n so c ia l wo rke r: Pra c tic a l a p p lic a tio ns fo r sup e rviso rs. The Clinic al Sup e rviso r, 30(2), Gil, S. & We inb e rg, M. Se c o nd a ry tra uma a mo ng so c ia l wo rke rs tre a ting tra uma c lie nts: The ro le o f c o p ing stra te g ie s a nd inte rna l re so urc e s. Inte rna tio na l So c ia l Wo rk, 58(4), He sse, A. R. (2002). Se c o nd a ry tra uma : Ho w wo rking with tra uma survivo rs a ffe c ts the ra p ists. Clinic al So c ial Wo rk Jo urnal, 30(3), Jo ub e rt, L., Ho c king, A., & Ha mp so n, R. (2013). So c ia l wo rk in o nc o lo g y: Ma na g ing vic a rio us tra uma The p o sitive imp a c t o f p ro fe ssio na l sup e rvisio n. So c ia l Wo rk in He a lth Ca re, 52:2, Ma sla c h, C. (1982). Burno ut: The c o st o f c a ring. Eng le wo o d Cliffs, NJ: Pre ntic e -Ha ll. Mie hls, D. (2010). Co nte mp o ra ry tre nd s in sup e rvisio n the o ry: A shift fro m p a ra lle l p ro c e ss to re la tio na l a nd tra uma the o ry. Clinic al So c ial Wo rk Jo urnal, 38, Mo uld e n, H. M., & Fire sto ne, P. (2010). The ra p ist a wa re ne ss a nd re sp o nsib ility in wo rking with se xua l o ffe nd e rs. Se xua l Ab use : A jo urna l o f re se arc h a nd tre a tme nt, 22(4), No rc ro ss, J. C., & G uy, J. D., Jr. (2007). Le a ving it a t the o ffic e : A g uide to p syc ho the ra p ist se lf-c a re. Ne w Yo rk: G uilfo rd. She e la, R. A. (2001). Se x o ffe nd e r tre a tme nt: The ra p ists e xp e rie nc e s a nd p e rc e ptio ns. Issue s in Me nta l He a lth Nursing, 22, Te a te r, M. (2011, No ve mb e r) Co mp a ssio n Fa tig ue : Re c a p ture yo ur se ne o f p urp o se ho p e a nd jo y. Wo rksho p sp o nso re d b y CMI Ed uc a tio n Institute, Inc. We b b, S. (2016). Tra uma -info rme d c a re : Emp o we ring. Eng a g ing. Effe c tive. Bro wn Ba g, UW-Ma d iso n Sc ho o l o f So c ia l Wo rk. Wilkin, L. & Hillo c k, S. (2015). Enha nc ing MSW stud e nts e ffic a c y in wo rking with tra uma, vio le nc e, a nd o p p re ssio n: An inte g ra te d fe minist-tra uma fra me wo rk fo r so c ia l wo rk e d uc a tio n. Fe minist Te a c he r, 24(3), ).

36 Re fe re nc e s Ba ke r, W.L., Bla kle y, T.L., Pe rry, B.D., Po lla rd, R.A., Vig ila nte, D. (1995). Child ho o d tra uma, the ne uro b io lo g y o f a d a p ta tio n, a nd use -d e pe nd e nt d e ve lo p me nt o f the b ra in: Ho w sta te s b e c o me tra its. Infa nt Me nta l He a lth Jo urna l, 16(4), Ca mp b e ll, R. (2012, De c e mb e r 3). The ne uro b io lo g y o f se xua l a ssa ult. An Na tio na l Institute o f Justic e Re se a rc h fo r the Re a l Wo rld se mina r. Re trie ve d fro m http :/ / nij.g o v/ multime dia / p re se nte r/ p re se nte r-c a mp b e ll/ p a g e s/ p re se nte r-c a mp b e ll-tra nsc rip t.a spx. Co llins, J. (2009, Ma rc h/ Ap ril). Ad d re ssing se c o nd a ry tra uma tic stre ss: Eme rg ing a p p ro a c he s in c hild we lfa re. Childre n s Vo ic e. 18 (2). Re trie ve d fro m http :/ / wla.o rg / a d dre ssing -se c o nd a ry-tra uma tic -stre ss/. Co mp a ssio n Fa tig ue Awa re ne ss Pro je c t (CFAP). (2016). Re c o g nizing c o mp a ssio n fa tig ue. Re trie ve d fro m http :/ / o mp a ssio nfa tig ue.o rg / p a g e s/ sympto ms.html. Fa uc i, J.E., G o o d ma n, L.A., Wilso n, J.M. (2015). Brining tra uma -info rme d p ra c tic e to d o me stic vio le nc e p ro g ra ms: A q ua lita tive a na lysis o f c urre nt a p p ro a c he s. Ame ric a n Jo urna l o f Ortho p syc hia try. 85(6), He rma n, J. (1992). Tra uma a nd Re c o ve ry: The a fte rma th o f vio le nc e fro m do me stic a b use to p o litic a l te rro r. Phila d e lp hia, PA: Ba sic Bo o ks. Sub sta nc e Ab use Me nta l He a lth Se rvic e s Ad ministra tio n Tra uma a nd Justic e Stra te g ic Initia tive. (2014). SAMHSA s Co nc e p t o f tra uma a nd g uida nc e fo r a tra uma -info rme d a p p ro a c h. Re trie ve d fro m http :/ / sto re.sa mhsa.g o v/ shin/ c o nte nt/ / SMA / SMA p d f. The Na tio na l Child Tra uma tic Stre ss Ne two rk. (2016). Se c o nda ry Tra uma tic Stre ss. Re trie ve d fro m http :/ / tsn.o rg / re so urc e s/ to p ic s/ se c o nd a ry-tra uma tic -stre ss We b b, S. (2016, Ma rc h 17). Tra uma -info rme d c a re : e mp o we ring, e ng a g ing, e ffe c tive. UW-Ma d iso n Sc ho o l o f So c ia l Wo rk Bro wn Ba g le c ture, Ma d iso n, WI. Wo o llisc ro ft, J. (2011). Ma king the ra p y sa fe. Re trie ve d fro m http :/ / tsn.o rg / re so urc e s/ to p ic s/ se c o nd a ry-tra uma tic -stre ss

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