By Punky Pletan-Cross, Hale Kipa CEO
The field of human services has been evolving over most of my career, although that change may not be quite as rapid as it is in the technology industry where change takes place at the speed of light. However, in human services there has been a significant evolution of our understanding of the various behaviors that Hale Kipa frequently sees particularly as an adolescent serving organization, as well as the reasons for the behaviors. One of the “aha” moments for me came a number of years ago when I began to understand in a very much clearer way what trauma is and why it really matters. (Let me try to explain).
A long-term study was conducted by the US Centers for Disease Control and Prevention and Kaiser Permanente, known as the Adverse Childhood Experiences Study. ACE’s for short. The intent of the study was to assess the association between childhood trauma, stress, and maltreatment, and health and wellbeing later in life. Not surprisingly almost 2/3 of those participants reported at least one childhood experience of physical or sexual abuse, neglect or family disfunction, and 20% reported three or more such experiences.
Those early childhood traumas were found to be highly correlated with serious emotional problems, health risk behaviors, social problems, adult disease and disability, mortality, high healthcare and other costs, and in worker performance problems when these individuals became adults. That is a rather technical way to say that during the formative years of childhood, traumatic events have a major impact. In fact, we now know that it actually changes the developing brain. As an organization that has been working with adolescents and families for almost 50 years, Hale Kipa works with a population where most if not all of the youth and family that we work with have experienced either trauma directly or vicarious trauma, trauma that they have seen, observed, or have been present for. An example of vicarious trauma might be a child who sees domestic violence in the family or who has parents who are substance abuse users whose behaviors causes the youth or child to become anxious, afraid, or neglected.
Whatever the cause of trauma it clearly imprints on the individual. A saying that I like is, “Traumatic reactions are normal reactions to abnormal situations.” The normal reaction to an abnormal situation is that individuals develop a wide variety of coping skills that protect them from being re-traumatized or that give them some degree of comfort and soothing from the trauma itself. There are many different kinds of behaviors that I might use as examples. A simple example may be that someone who is a cigarette smoker may actually be smoking less for enjoyment of the cigarette or even the addiction to the nicotine than they are for the comfort they receive from that repetitive activity. There are many self-soothing behaviors that are associated with trauma and there are also a variety of other protective behaviors some of which we in the community at large often find difficult to understand.
During our first 30 years here at Hale Kipa, there was relatively little understanding of trauma and thus we were ill equipped and ill prepared to understand the underline issues that were at play. I am not immune from seeing people whose life choices mystify me. And yet, if I look at their behaviors through a trauma lens I began to realize that it is highly likely that the behavior that I am observing is related in some way to a traumatic experience, often in childhood. As a result, a number of years ago Hale Kipa made a commitment to become a trauma informed organization. In fairly simple terms that means we are now attempting to pay attention in as many ways as we can to what trauma is, and how it manifests itself in the individuals and families that we serve. In addition, we are also trying to avoid retraumatizing individuals since that is obviously counterproductive when it comes to assisting them in working through their past trauma issues.
Trauma informed care means focusing on the whole person. In attempting to understand their behaviors, there is often a disconnect between our expectations regarding those behaviors and what someone actually does. For instance, there are accounts of individuals who are victims of rape, who seem to have little or no affect. Typically, people assume that individual should be showing a lot of affect and emotion. But in reality, shutting down, or stoicism, is a self-protective measure that provides an individual a sense of control and security.
As a trauma informed organization, we have to make certain that the facilities where our youth and families come for services are welcoming, and not retraumatize. Individuals may need to have personal and private space, and such a simple thing as a handshake can be profoundly anxiety producing to an individual with a history of trauma. It is important to recognize that we acknowledge when they arrive that we understand that they have had traumatic experiences but that they are not those traumatic experiences. What has been helpful for Hale Kipa is that we are a strength-based organization. And we really do see them as the bundles of potential that they have and not their histories nor their behaviors. That has made it a bit easier for us as an organization when individuals arrive to meet them where they are, and to work to develop a safe environment as a place of refuge as it were for that individual. Refuge or safe place is a metaphor that we hold very dear, since we aspire to be a place that is safe enough to test the behaviors that our youth and families need in order to be successful in the real world. Our goal is not to replace the behaviors that are “inappropriate” according to societal definitions or those that are causing the individual harm. Our goal is instead to offer the individual alternatives so that they have the power and control to make choices to change their lives in ways that matter to them. Recognizing that a history of trauma may cause them to act in ways that are unexpected at least to us, and with the constant reminder that we are jointly working with them to assist them in addressing their trauma while they maintain control and the power over the process, has assisted us in adapting a very different way of thinking about the work that we are doing.
Trauma Informed Care is first and foremost a philosophy of providing care. We must always remember that trauma related symptoms and behaviors originate from adapting to traumatic experiences. They are a form of a coping skill. That is one of the reasons why our goal is to increase resilience by helping an individual to develop additional and new coping skills. The recovery from the trauma must also clearly be identified as a goal in the treatment. There are always a range of alternative strategies that can be taught that an individual can learn to cope with their past trauma. Our goal is to increase the tools in their toolkit. And we need as always to focus on strengths. The process of recovery from trauma is neither easy or a straight path. It requires persistence and patience, and the staff to be able to sit with significant affect and emotion. That in turn requires an ability to have legitimate empathy and understanding. We cannot impose expectations in an unreasonable way on an individual who is doing the work they need to do to recover from trauma.
In sharing this information, I am also acutely aware that one of the populations that is particularly prone to vicarious trauma are the helpers, the people at Hale Kipa that work on a day-to-day basis with the youth and families that we serve. The process of listening to the traumatic experiences of others has a profound impact on the listeners as they hear the stories. If the helper is not aware of the impact of vicarious trauma, then they will not take the necessary steps with regard to selfcare to assure that they themselves do not succumb to trauma related behaviors. One of the concepts bandied about most of my professional career has been the idea of burnout. I have begun to realize that part of what burnout really means is that we have taken on so much of the material, the sadness, the violence, the pain, and the anger of the people that we have been trying to work with, that we lose our ability to have and use the kinds of coping skills that allow us to function effectively. To be able to come back every day meeting each individual as though today is a new experience, a new opportunity, and with hope, optimism and the energy for a collaborative therapeutic process. Trauma is a powerful dynamic and our goal as a trauma informed organization is to try to ensure that we can provide the highest probability that an individual can be successful in achieving their goals for their lives.