by SD Ferencik — Victims of domestic violence, both adults and children, are survivors of traumatic This document, Trauma-Informed Care Protocols and Best Practices, has.
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Funding for this manual was made possible in whole by cooperative agreement grant number 5U79SM057460-04 from SAMHSA. The views expressed in written materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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TABLE OF CONTENTS Introduction, Acknowledgemen ts and a Note on Language . X Understanding Trauma .. 1 Domestic Violence and Trauma . 2 Brain Processes During Trauma 12 Fight, Flight and Freeze Reactions . 14 Trauma Triggers . 16 Trauma and Memories 17 Disassociation .. 19 Hyperarousal, Intrusion, and Constriction .. 21 Emotional and Psychological Reactions to Trauma 29 Behavioral and Physical Reactions to Trauma . 32 Impact of Trauma on Belief Systems .. 34 Cultural Experiences of Trauma 36 Responding to Trauma Survivors General Principles when Working With Trauma Survivors .. 38 Assisting Survivors with Coping 39 Do™s and Don™ts of Trauma Recovery .. 42 Become a Trauma Champion 43 Supporting Battered Women as Trauma Survivors .. 45 Survivor Reactions and Advocate Interventions . 47 Tools for Coping with Traumatic Stress . 49 Trauma Bibligraphy . 51 Trauma-Informed Care Best Practices 53 Trauma-Informed Care Protocols Hotline Calls . 76 Intakes .. 83 Support Groups .. 90 Exit Interviews 98 Safety Planning . 102 Trauma and Parenting . 112 Caring for the Caregiver: Understanding Vicarious Trauma 119 Appendices .. Trauma-Informed Care Checklist (Appendix A) . 127 Trauma-Informed Care Best Practices (Appendix B) .. 132 Suggested Best Practices for Child Victi ms of Domestic Violence (App. C) 134 Trauma-Informed Care and Strengths Based Approach (Appendix D) 137 Resources (Appendix E) . 139 Case Study: Deborah, Antoine, Je remiah and Alicia (Appendix F) . 141
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Introduction Victims of domestic violence, both adults and children, are survivors of traumatic experiences. Being hurt by someone you love and is a part of your family can have serious consequences on how survivors of do mestic violence think, act and feel. In a 2010 survey of Ohio™s domestic violence programs, over 90% of respondents responded that most or all adults and children who experience domestic violence have a traumatic experience that impacts their thoughts, feelings or behaviors. Therefore, helping professionals working in domestic violence services and programs need a basic understanding of how traumatic experiences impacts individuals. Understanding trauma and trauma reactions will inform and guide domestic violence staff in their intera ctions and decision-making process with adults and children who seek services . In the 2010 survey about trauma, only 14% of respondents from Ohio™s domestic violence programs stated that they felt that all staff and volunteers in their organizations had a working understanding of trauma reactions and regularly incorporate that knowledge into their service provision. Due to the generous support of the Ohio Department of Mental Heal th, ODVN developed this manual to assist Ohio programs in improving their respon se to survivors who have experienced trauma. This document, Trauma-Informed Care Protocols and Best Practices, has been developed to assist domestic violence programs become more trauma-informed when providing services to su rvivors of domestic violence. In the past decade much has been writte n and researched in both areas regarding trauma and domestic violence. We now ha ve validated reasons to incorporate this knowledge into our work with both child victims and adult victims. If we, as domestic violence workers, fail to incorp orate this new information and internalize trauma-informed responses, then we become guilty of causing secondary victimization to the children, woman and men that we serve. This idea, design and creation process of this manual, Trauma-Informed Care Best Practices and Protocols has been one which has involved numerous individuals from around the state of Ohio who have dedica ted their time and expertise to ensuring that the voices of women, children and men who are victimized by the traumatic experiences of domestic violence are a central part of this document. The time for trauma-informed care is now! It is the right, ethica l and just approach to utilize in domestic violence programs, trainings and services because we serve people with histories of violence, repeated harm and trauma.
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This project would not have been possible without the generous support of the Ohio Department of Mental Health, who partne red with us and supported us in every way possible. Without their support, this manual never would have been developed. Special thanks goes to Leslie Brower and Carrol Hernandez at the Ohio Department of Mental Health for their thoughtful feedback and dedication to transforming systems for trauma survivors. We also thank the Ohio Domestic Violence Network for their focus on trauma and the materials and resources developed by ODVN on trauma. Much of the trauma information in this manual was taken from ODVN publicatio ns and manuals on trauma. Please join us in further improving and enhancing the services we provide and the care we offer by becoming a trauma-informed advocate. Peace, The Trauma-Informed Care Advisory Committee Aisha Brothers, MSW, LSW, Victim Advocate, Artemis Center, Dayton Kristine Buffington, MSW, LISW-S, Vice-President of Mental Health Services, Renewed Minds, Toledo Annelle Edwards, MSW, LISW-S, Co-Executive Director, Eve, Inc., Marietta Sonia Ferencik, MSSA, LISW, Child Trauma Services Coordinator, The Domestic Violence Center of Greater Cleveland, Cleveland Shayna Jackson, MSSA, LISW-S, Executive Director, WomenSafe, Inc., Chardon Teresa Lopez, Outreach Case Manager, YWCA Battered Women™s Program, Toledo Julie Lampe, RASS, Coordinator, Safer Futures, Kent Krystal Martin , MSSA, LISW, Outreach Coordina tor, Ohio Domestic Violence Network, Columbus Melissa Pearce, Executive Director/CEO, Domestic Violence Project, Inc., Canton Rebecca Born , MSW, LISW-S, Executive Director, Connections, A Safe Place, Cincinnati Rachel Ramirez, MSW, LISW , Training Coordinator, Ohio Domestic Violence Network, Columbus
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Note on Language We acknowledge that perpetrators and surviv ors of domestic violence come from all backgrounds. They may be of any age, ra ce, ethnicity, socio-ec onomic status, or sexual orientation. We also know that wo men are at a much greater risk of being victimized and that sexism promotes vi olence against women in our society. In 2005 women accounted for 84% of spouse victims and 86% of victims of violence at the hands of a boyfriend or girlfriend. ( Family Violence Statistics: Including Statistics on Strangers and Acquaintances. 2005. U.S. Department of Justice, Bureau of Justice Statistics) . In addition, the vast majority of individuals who access domestic violence services are women, and women and their children make up nearly all of the individuals housed by domestic violence shelters. For these re asons, we describe victims/survivors as females and perpetrators of domestic violence as males throughout this manual. This is not intended to deny or minimize other abusive situations but rather to reflect the majority of domestic violence cases. All survivors of domestic violence, including women, men and children, deserve our support and advocacy. Throughout this manual, the term fisurvivorfl and fivictimfl will be used to describe the person who has experienced domestic violence at the hands of his or her partner. We use the term fivictimfl to remi nd us of the violence and control that victims in abusive relationships face, while fisurvivorfl reminds us of the ways in which individuals who experience domestic violence are surviving every day and working hard to stay safe. The term advocate, helpers, staff will be used interchangeably throughout this manual. It serves to represent the domestic violence worker in various roles and titles.
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2 WHAT IS TRAUMA? When working with survivors of domestic violence, an advocate™s first concern is often that of physical safety and cri sis intervention. Both of these goals are appropriate and effective when working with survivors, and both should be informed by a thorough understanding of trauma. Although it is obvious that experiencing abuse at the hands of an in timate partner is traumatic, it can be difficult to view domestic violence through the lens of trauma during daily advocacy activities. Certainly, advocates will be more effective and responsive to the needs of survivors if they under stand domestic violence in the context of trauma. The following section of the manual will discuss traumatic A hallmark of traumatic experience is that it typically overwhelms an individual mentally, emotionally, and physically.
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3 responses survivors of domestic viol ence experience, as well as helpful advocacy interventions. So–What is Trauma? According to Judith Herman™s book, Trauma and Recovery , psychological trauma is characterized by feelings of: intense fear helplessness loss of control threat of annihilation Survivors of domestic violence certainly experience these feelings as they encounter violence at the hands of their intimate partners. In addition, trauma typically involves threats to harm a person or an encounter with violence. Again, this certainly applies to the situations of domestic violence survivors. A hallmark of traumatic experience is that it typically overwhelms an individual mentally, emotionally, and physically. These feelings of being overwhelmed are what is typical for a person who is traumatized. Judith Herman also reports that fitraumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory.fl The following sections of this chapter explain some of these changes that may occur for survivors as well as how trau matic responses may manifest in our interactions with the women we serve. Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory.
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4 Traumatic reactions are NORMAL responses to ABNORMAL situations. So–What is it about the event that makes it traumatic? Peter A. LeVine, Ph.D, describes in his book, Healing Trauma, that the determination or source of the trauma is based in the individual™s perception of the event and does not have to come from a huge catastrophic event. A person can become traumatized when his/her ability to respond to a perceived threat is in some way overwhelmed. A traumatic experience can impact a person in obvious and subtle ways. Trau ma is fiin the eye of the beholder;fl what one person may consider traumatic may not be traumatic to another person. So–Who gets traumatized? Although generalities of traumatic responses will be presented in the following pages, it is important th at advocates understand that no two survivors will respond to the traumatic experience of domestic violence in the
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5 exact same way. Even when family experiences the same traumatic event, individual members of one family might have very different responses. There is another equally important concept for advocates to understand about traumatic responses: traumatic reactions are NORMAL reactions to ABNORMAL events. Traumatic reactions are not a sign of emotional or psychological weakness, but are typical reactions to the traumatic experience of intimate partner violence. Judith Herman also indicates that, fiThe most powerful determinant of psychological harm is the character of the traumatic event itself. Individual personality characteristics count for littl e in the face of overwhelming events. There is a simple, direct relationship between the severity of the trauma and its psychological impact.fl In other words, anyone could experience some of the symptoms discussed on the following pages if they experience a traumatic event. A trauma-informed approach is based on the recognition that many behaviors and responses expressed by survivors are directly related to traumatic experiences. The Center for Mental Health Services National Center for Trauma-Informed Care
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