Moral Injury
•
…is the damage done to one’s conscience or
moral compass when one perpetrates,
witnesses, or fails to prevent acts that
transgress one’s own moral and ethical
values/codes of conduct/understanding.
Trauma Resiliency Mo
del™
www.communityresiliencymodel.com www.traumaresourceinsEtute.com
Adapted by Elaine Miller-‐Karas
The Trauma Resource Ins5tute
A Nonprofit CorporaEon
Our Vision
To create resiliency informed and trauma informed individuals and
communiEes.
Our Mission
A commitment to bring wellness skills, based on cuNng edge
neuroscience, to our world community, one person at a Eme, one
community at a Eme.
Resilience
Resiliency
“
Is an individual’s and community’s ability to iden4fy and use
individual and collec4ve strengths in living fully in the present
moment, and to manage the ac4vi4es of daily living.”
Miller-‐Karas(2013)
6
What Are the Two Resiliency Models?
v The Trauma Resiliency
Model (TRM):
v A skills-based course
for clinicians.
v Focused on
stabilization of the
nervous system.
v Designed to reprocess
traumatic experiences.
v Community Resiliency
Model (CRM):
v A set of 6 wellness
skills that can be
taught to community
members.
v Focused on
stabilizing the nervous
system.
v A triaged system of
care.
What is the Community Resiliency Model?
v
Set of six Wellness Skills
v
Resets the natural balance of the nervous system
v
Brings awareness to a person’s ability to come
back into his or her Resilient Zone
Re
si
lie
nt
Zo
ne
Trauma4c/Stressful Event
or
Stressful/Trauma4c Triggers
Stuck in Low Zone
Edgy
Irritable
Mania
Anxiety & Panic
Angry outbursts
Pain
Depression/Sadness
Isolated
Exhaus=on/Fa=gue
Numbness
Re
si
lie
nt
Zo
ne
Graphic adapted from an original graphic of Peter Levine/Heller, original slide design by Genie EvereW 8
Re
si
lie
nt
Zo
ne
Re
si
lie
nt
Zo
ne
Some have a deep Resilient Zone where there is a higher tolerance for a wide
range of stressors.
Some have a very shallow Resilient Zone where even small stressors bump you
out of the Zone.
Who can TRM Treat?
TRM can be used:
v
To treat any person who has survived a
traumatic event where they perceived
threat of death or injury to themselves or
others.
v
With immediate as well as past trauma.
v
To treat complex trauma as well as single
event trauma.
v
For practitioner self care to reduce
burnout resulting from secondary
traumatization.
v
Across cultures.
CRM Key Concepts
“It is about biology -‐ not human weakness.”
Primary Focus of TRM:
Biology vs. Mental Weakness
v
Responses to trauma and stress can have a major
effect on the mind, body and spirit.
v
TRM practitioners use observation and knowledge
of patterns within the nervous system.
v
TRM helps individuals track sensations connected
An Elegant Design:
The Capacity to Heal
The human body - mind
has the inner capacity to
heal and restore itself and
has a wisdom that words
cannot speak.
There is hope:
the brain is plastic…it is
changeable…
14
Skills of the
What are the 9 Skills of TRM?*
* TRM includes some of the skills of Somatic Experiencing
15 Trauma Resource Ins5tute
GROUNDING
Being fully present in the moment
TITRATION*
Working with small increments of arousal
TRACKING
Refers to the practitioner’s and client’s monitoring of sensations
PENDULATION*
Alternating between traumatic and
resource sensations
COMPLETION OF
SURVIVAL RESPONSES*
SHIFT AND STAY
Shifting to a resource and staying in the
resource state
RESOURCING & RESOURCE
INTENSIFICATION
Using positive or neutral factors to create
non-traumatic sensations
HELP NOW!
Strategies to get back to the R-Zone
GESTURING/SPONTANEOUS
MOVEMENT
Bringing awareness to spontaneous
gestures/movements that are self-soothing
Community Resiliency Model Skills
Trauma Resource Ins5tute
GROUNDING
Being fully present in the moment
TRACKING
Paying attention to sensations
GESTURES & MOVEMENTS
Bringing calming & protecEve movements
to awareness
SHIFT AND STAY
Shi[ing to a resource and staying in
the resource state
RESOURCING & RESOURCE
INTENSIFICATION
Using posiEve or neutral life experiences
to create pleasant or neutral sensaEons
HELP NOW!!
Community Resiliency Model Skills
THE BASIC THREE
Trauma Resource Ins5tute
GROUNDING
Being fully present in the moment
TRACKING
Paying attention to sensations
RESOURCING &
RESOURCE INTENSIFICATION
Using posiEve or neutral life experiences to create
pleasant or neutral sensaEons
Developing the Evidence Base
Completed Research
Katrina Study—Journal of Social Work
v The treatment group showed statistically significant gains in resiliency indicators and
decreases in posttraumatic stress disorder symptoms. China Study-International Journal of Emergency Mental Health
v 97% believe that biologically-oriented TRM training will be very to moderately relevant
or useful for their work with the Chinese earthquake survivors Research Underway
v Preliminary unpublished data showing decrease in depression scores after 3 three 20
minute CRM interventions, delivered over a period of 7 days. Haiti-HelpAge Population (Citron, Dust & Karas)
v Loma Linda University, Department of Social Work, Ivory Coast Study
v County of San Bernardino, TRM-Community Resiliency Model-Innovations and VEP
projects, State of California (Miller-Karas, Citron & Leitch)
v Family Medicine Primary Care Study. Mary Lynn Barrett, MPH, Family Practice
Residency Program. Asheville, NC
v El Paso/Juarez Mexico Study, University of Northern Colorado
Mental Health Services Act-Innovation Project-2013
v
From a wide community:
v
African-American, Latino, Asian Pacific Islanders,
LGBTQ, Native American and High Risk Youth,
Veterans & ranged in age from 22-75 years.
v
Statistically significant decreases in:
v
The average number of depression, hostility, anxiety,
and somatic symptoms.
v
Statistically significant increases in the average number
of symptoms related to:
v
Relaxed, contented, somatic well-being, and friendly
3-6 Month Follow-up
v
3-6 month follow-up data received from 57 trainees across the
underserved groups indicated that over 90% either completely or
somewhat agree that the CRM skills were useful in:
v
Managing stress (95%)
v
Having better self control (96%)
v
Helping get through hard times (92%)
v
All used the skills frequently, with 93% reporting they were using the
CRM skills daily, and 7% indicating a few times a week.
0.0%$ 10.0%$ 20.0%$ 30.0%$ 40.0%$ 50.0%$ 60.0%$ 70.0%$ 80.0%$ 90.0%$ Do#you#use#the#
TRM#techniques?# At#work?# Outside#of#work?#
83.3%# 76.5%# 61.0%# 16.7%# 23.5%# 39.0%# Yes# No# 20.1%& 42.4%& 23.0%& 3.6%& 10.8%& Do&you&find&TRM&effec8ve?& All&the&8me& Most&of&the&8me& Some8mes& Rarely& N/A& 0.0%$ 10.0%$ 20.0%$ 30.0%$ 40.0%$ 50.0%$ 60.0%$ 70.0%$ 80.0%$ 90.0%$ 100.0%$ Do#you#find#TRM#useful?# 91.0%# 9.0%# Yes# No#
Trauma Resiliency Model (TRM)
Survey Results 8/20/12
v
Collected from the staff of the Department of Behavioral Health, (DBH) San
Bernardino County:
v
Serves the underserved population with mental health challenges within the
largest county in the U.S.
v
Over 500 of their staff (case managers, social workers, counselors, psychologists,
psychiatrists) have been trained by in-house TRM Trainers.
v
The survey was conducted by the training center of DBH to determine the staff
’
s
perceptions of the usefulness and effectiveness of the Trauma Resiliency Model. (242
Respondents)
In The Zone
How o[en have you been in your Resilient Zone today?
Never Occasionally SomeEmes Frequently All the Time
Slides by Miller-Karas&Leitch 2011(c)
