UNDERSTANDING AND IDENTIFYING TRAUMA

RESPONSE IN SELF AND OTHERS

DECEMBER 19, 2024

 DISCLAIMER
T h i s pr e s en ta t i o n w a s p r ep a r ed f o r N T T A C u n d er a co op er a t i v e a g r ee m en t
f r om th e S u b s ta n ce A b u s e a nd M en ta l H ea l t h S e rv i c es A d m i n i s tr a t i on
( S A MH S A ) . A l l m a te ri a l a p p ea r i n g i n th i s p r es e nt a ti on , ex c e pt t h a t ta k e n
d i r ec tl y f r o m c op yr i g h t ed s ou r c es , i s i n th e p ub l i c d o m a i n a n d m a y b e
r ep r od u ce d o r co p i ed w i t h ou t p er m i s s i o n f r o m S A M H S A or th e a u th or s .
C i t a ti o n o f t h e s ou r ce i s a pp r ec i a te d . D o no t r ep r od u ce o r d i s t r i b ut e th i s
p r es e nt a ti on f o r a f ee w i t h ou t s p ec i f i c, w ri tt en a u th o r i z a ti o n f r om th e
N T T AC . T h i s p r es en t a ti o n w i l l be r ec or d ed a n d p o s te d o n ou r w eb s i t e.

T h i s ev en t i s s u pp o r ted b y S A MH S A of th e U. S . D ep a r tm en t o f H e a l th a nd
H u m a n S er v i c es (H H S ) a s p a r t o f f i n a n ci a l a s s i s ta n ce a w a rd S M - 2 0 - 0 0 8 o ve r
f i v e ye a r s ( 2 0 2 0 - 2 0 2 5) w i t h 1 0 0 p er ce n t f un d ed b y S A MH S A / H H S . A t th e t i m e
o f t hi s p r es e n ta t i on , M i r i a m D e l p hi n - R i tt m on s er v ed a s A s s i s ta n t S e c r et a ry f o r
M e n ta l H ea l th a n d S ub s t a n c e Us e a n d A d m i n i s tr a t or of S AM H S A . T h e c on t en ts
a r e th o s e of th e a ut h or ( s ) a n d d o n ot n ec es s a r i l y r e pr e s en t th e o f f i c i a l
v i ew s o f , n or a n en d o rs em en t , by S A M H S A / H H S , or th e U. S . G ov er n m en t .
 SESSION SECURITY
In the case of any security issues that may occur, this
session will immediately end and will not resume
using the same join link. A separate email will be sent
to all participants with further instructions.
www.nttacmentalhealth.org
 OUR VISION AND SERVICES

All children, youth, and families living

with and impacted by mental health
challenges will have access to the
resources and opportunities they
need to thrive in a comprehensive
and equitable system of care.
 COMMONLY ASKED QUESTIONS

Look for the follow-up email after today’s session!

Do you provide a Certificate of Completion for this event?
A certificate will automatically be emailed to all online participants in the follow-up
email. If you joined through the phone only, please email Bridget Ukawu at
bukawu@cars-rp.org to report your participation.

Can I get a copy of the presentation that was used for this event?
A copy of the presentation was sent out in the reminder email and will be resent in
the follow-up email for today’s session within 2 business days.

Can I get a copy of the recording for this event?

The recording of this session will be sent in the follow-up email, if recorded. You may
also access this session’s recording and all other archived recordings in the
“Resources” section of our website. Check back often as new additions are always
being added. https://nttacmentalhealth.org/resources
7
 CONTINUING EDUCATION HOURS
Complete the evaluation survey,
then you’ll be redirected to the CE Hours Form.
Complete the evaluation survey and earn valuable Continuing Education (CE) hours at
no extra cost, enhancing your professional development.

Credit is being offered by the Center for Applied Research Solutions (CARS) for the
following licenses: ASW, BRN, CCS, CSD, LCSW, LEP, LMFT, LPCC, PPS, PRSS, JI-RPS, MHPS,
RSPS, PSS, Peer Instructor, & General Contact Hours.

CARS is an approved provider for: CCAPP #4N-08-923-0722, CA Board of Registered

Nurses #CEP16303, Texas Certification Board #2124-23, and CAMFT #131736.
Attendees are responsible for checking with their licensing or credentialing board to
ensure acceptance of the CE hours issued.

8
 WELCOME TO TODAY’S SESSION!
UNDERSTANDING AND IDENTIFYING TRAUMA
RESPONSE IN SELF AND OTHERS
TODAY’S PRESENTER

Dr. Denisha Carter

MedStar Georgetown University Hospital
Licensed Clinical Psychologist
Licensed Clinical Psychologist
Assistant Professor, Department of Psychiatry
Work)
Director of Clinical Training (Psychology & Social Work)
Sensitive Content
The contents of this presentation may bring up
uncomfortable feelings and may be activating to some
individuals. If you are feeling distress please prioritize
taking care of yourself which may look like:
 Doodling
 Excusing yourself from the space
 Taking deep breaths
 Allowing your mind to briefly wonder to a safe place or
positive memory
Learning Objectives
1. Introducing the concept of trauma (primary, secondary and
complex trauma)
2. Evaluating impact of Adverse Childhood Experiences (ACEs)
across the lifespan
3. Identifying trauma response through the use of observation
and screening tools
4. Increasing understanding of secondary traumatic stress and
vicarious trauma on laypersons
INSTRUCTIONS
For the next few items, we are interested in
your own genuine opinions.

Again, please do not respond how you think

the presenter might want you to respond.
Instead, provide your own honest opinions.
 On the items below, please select a response ranging from
1 (strongly disagree) to 7 (strongly agree).

1. Even minor, everyday events can be traumatic.

2. Reading a book, watching a movie, or hearing about a news story can

negatively impact one's emotional health in the long term.

3. Almost any event can be traumatic depending on who is experiencing it.

4. Although some people might be able to handle watching violent content on

the news, this could permanently damage someone vulnerable.

5. Even if people act in a well-intentioned way, they could traumatize someone

vulnerable accidentally.
Defining Trauma
 Trauma results from an event,
series of events, or set of
circumstances that is experienced
by an individual as physically or
emotionally harmful or
threatening and that has lasting
adverse effects on the individual's
functioning and physical, social,
emotional, or spiritual well-being. https://www.youtube.com/watch?v=4fwFkyvPzqw

Substance Abuse and Mental Health Services Administration [SAMHSA], Trauma and Justice Strategic Initiative, 2012, p. 2.
 Types of Trauma
● Primary (Direct): experienced personally or as a witness of the event;
likely to include physical and psychological impact
● Secondary (Indirect): may not have physically experienced or
witnessed the event, but a psychological impact may occur

● Acute: exposure to a single event that last for a limited period of time

● Chronic: experiencing multiple traumatic events over a long period of

time

● Complex: repeated and ongoing; frequent

Wish Stones
Identify 3 wishes that you have for your present life.
Barriers to Treatment

https://www.youtube.com/watch?v=MMUyIUNaR54
Adverse Childhood Experiences
 Adverse Childhood Experiences (ACEs)

Center for Disease Control. Adverse Childhood Experiences (ACES). What are Aces? https://www.cdc.gov/aces/media/images/Types-of-ACEs.png
Adverse Childhood Experiences

Growth Catalysts (growthcatalysts.org (Retrieved from https://growthcatalysts.org/2020/09/14/twitter-lesson-1-aces-adverse-childhood-

experiences/#jp-carousel-923)
 Number of ACEs

Source: Centers for Disease Control and Prevention, Kaiser Permanente. The ACE Study Survey Data [Unpublished Data}. Atlanta, Georgia: US Department of
health and Human Services, Centers for Disease control and Prevention, 2016. Retrieved from https://www.cdc.gov/violenceprevention/aces/about.html
Philadelphia ACE Survey The Philadelphia Expanded ACE questions look at
Community-Level Adversity
In 2012 & 2013, researchers surveyed 1,784
Witness Violence How often, if ever, did you see or hear
adult Philadelphian participants about the
someone being beaten up, stabbed, or shot
original ACEs and 5 additional community-
in real life?
level stressors.
Felt discrimination While you were growing up, how often did
Using a more socioeconomically and racially you feel that you were treated badly or
diverse urban population, ACEs were unfairly because of your face or ethnicity?
measured to help understand whether Adverse Did you feel safe in your neighborhood? Did
household ACEs alone can sufficiently
neighborhood you feel people in your neighborhood looked
measure adversity, particularly among
experience out for each other, stood up for each other,
various subgroups.
and could be trusted?
Bullied How often were you bullied by a peer or
classmate?
Lived in foster care Were you ever in foster care?

Source: The Philadelphia ACE Project. Retrieved from https://www.philadelphiaaces.org/philadelphia-ace-survey

Philadelphia ACE Survey The Philadelphia Expanded ACE questions look at
Community-Level Adversity
Witness Violence How often, if ever, did you see or hear
This study’s demographic makeup looks someone being beaten up, stabbed, or shot
significantly different than the original study, in real life?
to include the fact that roughly a quarter of
residents live in poverty. Felt discrimination While you were growing up, how often did
you feel that you were treated badly or
Researchers found that almost 7 in 10 adults unfairly because of your face or ethnicity?
had experienced one ACE and 2 in 5 adults Adverse Did you feel safe in your neighborhood? Did
had experienced 4 or more ACEs. neighborhood you feel people in your neighborhood looked
experience out for each other, stood up for each other,
and could be trusted?
Bullied How often were you bullied by a peer or
classmate?
Lived in foster care Were you ever in foster care?

Source: The Philadelphia ACE Project. Retrieved from https://www.philadelphiaaces.org/philadelphia-ace-survey

 Percentage of Children with No ACES

Source: Child Trends (2018) retrieved from https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity

 Percentage of Children with 1 ACE

Source: Child Trends (2018) retrieved from https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity

 Percentage of Children with 2 or More Aces

Source: Child Trends (2018) retrieved from https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity

The Relationship Between Adversity Within a Family and
Adversity Within a Community
 ACEs: A Personal View

What is
your ACEs
score?
 ACEs: A Personal View

Breakout Session (5-7 mins)

How might knowledge of your own ACE score

affect how you interact with others?

Why is it important to be aware of your own

ACEs score?
In My Backyard:
Example of
ACEs Impact in
Washington, DC
 Adverse Childhood Experiences
US-DC Comparison 2017-2021

Source: National Survey of Children's Health, US Department of Health and Human Services, Health Resources and Services Administration (HRSA),
Maternal and Child Health Bureau (MCHB)
Source: Institute for Family Studies. Nearly Half of US Children Have Suffered At Least One Adverse Childhood Experience. Retrieved from
https://ifstudies.org/blog/nearly-half-of-us-children-have-suffered-at-least-one-adverse-childhood-experience
 Adverse Child Experiences in DC
(2021 Data)—Subgroup Data

Source: National Survey of Children's Health, US Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal
and Child Health Bureau (MCHB)
Adverse Child
Experiences in DC

2021 Subgroup Data

 ACEs in DC vs ACEs Nationwide, Cont.

 45% of children in the US have experienced at least 1 ACE

 1 in 10 children have experienced 3 or more ACEs

 61% of black (non-Hispanic) children and 51% of Hispanic

children have experienced at least 1 ACE, compared with 40%
of white non-Hispanic children and only 23% of Asian non-
Hispanic children

Source: Child Trends. (2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity . Authors: Vanessa Sacks
and David Murphey. Retrieved from: https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity
Source: Wave Trust (London and Glasgow). The 70/30 Campaign: Empowering Communities to Protect Our Children. Retrieved from
https://www.wavetrust.org/Handlers/Download.ashx?IDMF=48b4b5c8-840a-4d65-b72f-c69f1e4a893b
Health Effects

Source: Community & Family Services Division at the Spokane (WA) Regional Heal th Di strict.
Retrieved from https://cdn.prod.websi te-files.com/64dba1073e5cc7805d59ecc5/6552213bc5634a37864543c8_ACES-Handouts.pdf
Neurobiological
Foundations
of ACEs
 Trauma in the Brain

Johanson Consulting. (2020). Brain function illustration. Retrieved December 18, 2024, from
https://johansonconsulting.ca/wp-content/uploads/2020/04/brain-function.jpg
Break time!
Let’s Refresh Our Brains

• Trauma:
• Shocking experience that poses a real or perceived threat to life or safety
• Complex trauma:
• Involves repeated exposure to traumatic events that are chronic and
typically begin early in childhood
• Toxic Stress/Chronic Stress:
• Exposure to excessive, chronic feelings of stress that leads to prolonged
activation of the stress-response system
• Adverse Childhood Experiences (ACEs):
• A quantifiable way to understand toxic/chronic stress
 Trauma
Screening
Trauma Screening & Ethnic Minorities

https://www.youtube.com/watch?v=EfC6zxU54jU
Scenario #1
Teresa is a 25 year old female who recently graduated from an MBA program.
She moved to a new city and started a new job a few months ago that she loves.
However, Teresa's boss often makes her feel uncomfortable. He sometimes
massages her shoulders while she's working, and often compliments her on her
clothes and body. Teresa dreads going to work, and even though it is a great job,
she is thinking of leaving.

Since she began her job Teresa has stopped going out with her work friends,
sleeps a lot on the weekends and only talks to her sister briefly once a week
thought they used to speak daily for a last an hour each night. During a recent
doctor’s appointment her physician expressed concern about rapid weight gain.
  Intense or unpredictable feelings
 Changes to thoughts and
behavior patterns
Sensitivity to environmental
Common Reactions 
factors
to Trauma  Strained interpersonal
relationships
 Stress-related physical symptoms
 BEHAVIORAL PHYSICAL

Observational Cues

HYGIENE COGNITIVE (I.E.,

MEMORY ISSUES)
Screening for Trauma ▪ Self Report

▪ Online Screening
○ https://www.ptsd.va.gov/screen/
○ https://screening.mhanational.org/scr
eening-tools/ptsd/
● Formal screening and assessment should
be completed with the support of a
qualified mental health professional
 ● Respecting individual experiences

● Maintaining healthy interpersonal

boundaries

● Supporting individuals through

Engagement minor changes

● Consistent, open and

compassionate communication

 Awareness of how an individual’s

culture affects how they perceive
trauma, safety and privacy
 A form of positive growth made
from seemingly negative and
stressful situations in life

Negative and positive

Post-Traumatic 

outcomes may occur

Growth
 Controversial

 Might secondary trauma result

in post-traumatic growth?
 Vicarious Trauma and
Secondary Traumatic Stress
Life Goals Activity
 Impact of Exposure to Vicarious Trauma

● Result of engaging with high-

risk populations over time
● Long term exposure can shift
an individual’s personal identity
as well as their view on the
world as a whole

Source: Van Dernoot Lipsky, L. (2010). Trauma stewardship: An everyday guide to caring for self while caring for others.
Who Doesn’t Love a Good Visual!

Source: Originally published by The Institute on Trauma and Trauma-Informed Care; cited in Community Health Care Association of New York State (2022). Community Care Corner: Health Center Wellness
Resources. Trauma-Informed Toolbox Strategy Session: Secondary Traumatic Stress and Vicarious Trauma. Retrieved from https://www.chcanys.org/sites/default/files/2022-
09/STS%20AND%20VT%20Slides.pdf
 Indicators of Vicarious Trauma

Look out for signs of Vicarious

Trauma.

Source: We Level Up Florida. (n.d.). Vicarious trauma: Signs, symptoms, and treatment. Retrieved December 18, 2024, from https://welevelupfl.com/behavioral-health/vicarious-trauma/
 Vicarious Trauma, Secondary Trauma, Compassion Fatigue &
Burnout
Vicarious Trauma Secondary Trauma

● Change in worldview ● Exhibiting symptoms of PTSD without

● Repeated exposure being exposed directly to trauma
● Witnessing trauma over time ● Faster onset
● Can lead to feelings of anger, misplaced
guilt, isolation, detachment, and
Compassion Fatigue intrusive thoughts

● Combination of VT, Burnout and Burnout

Secondary Trauma ● Feelings of hopelessness, fatigue and
● Develops gradually over time overwhelm
● Develops gradually over time

Source: Krause, D.J. and Green, S.A. (2015) as cited in Community Health Care Association of New York State (2022). Community Care Corner: Health Center Wellness Resources. Trauma-Informed Toolbox
Strategy Session: Secondary Traumatic Stress and Vicarious Trauma. Retrieved from https://www.chcanys.org/sites/default/files/2022-09/STS%20AND%20VT%20Slides.pdf
Who might be at risk?

● Any professional who works directly with traumatized children

● An individual who is in a position to hear the recounting of traumatic
experiences
● Potentially greater among women
● Potentially greater among individuals who are highly empathetic by nature
● Potentially great among individual who have unresolved personal trauma
● YOU!
ABCs of Vicarious Trauma
● Awareness
○ Develop skills
○ Self-Regulation strategies
○ Self-compassion
● Balance
○ Predictable routines
○ Intake of external information
○ Boundaries
○ Healthy habits
● Connection
○ Intentional with personal and professional time
○ Create space for self-reflection, humor and laughter
○ Explore meaning in professional experiences

Source: University at Buffalo School of Social Work, Institute of Trauma and Trauma-Informed Care (2022).
 Secondary Traumatic Stress Continuum

Source: Sprang, G., Whitt-Woosley, A., & Eslinger, J. (2022). Diagnostic and translational utility of the Secondary Traumatic Stress Clinical Algorithm (STS-CA). Journal of Interpersonal
Violence, 37(13-14), NP10998–NP11018. https://doi.org/10.1177/08862605211044961
 Principles of Secondary Traumatic Stress

1. Knowledge of Risk
2. Sense of wellbeing
3. Monitor personal strengths and vulnerabilities
4. Active monitoring
5. Zone of tolerance

Source: Bride BE, Sprang G, Hendricks A, Walsh CR, Mathieu F, Hangartner K, Ross LA, Fisher P, Miller BC. (2024) Principles for secondary traumatic stress-
responsive practice: An expert consensus approach. Psychological Trauma. Nov 16(8):1301-1308.. Retrieved from
https://www.stsconsortium.com/_files/ugd/72c6ae_79b78bc9b7114126be0688caf0a516e1.pdf
Break Out Time!

Scenario #2

As a counselor working with refugees, Walter builds close professional relationships with many people
who have survived war and torture. He often finds himself thinking of the horrors they describe, and
has difficulty sleeping. When he does sleep, Walter is regularly awoken by nightmares.

Partner Chat questions:

1. What is Walter experiencing? (ie. VT? Compassion fatigue?)
2. How might Walter personal address what he is experiencing?
3. What are some potential symptoms that a loved one might observe?
What Can YOU do?

● Cognitive
● Physical
● Spiritual
● Social/Recreational
● Verbal
How could you have
assisted Walter or
Teresa?
Rule of 3

1. What are 3 new things you learned during today’s workshop? Of the 3 things you learned what is one
thing you will implement after this workshop?

2. Of the 3 things what is one thing you will share with some else?

3. Of the 3 things what is one thing you will commit to learning more about?
 Please reach out to me with
any additional
Questions ? questions at
denisha@medstarwise.org

Thank you!!!
 JOIN US!

Trauma Informed Practice in Integrated Settings

January 23, 2025
10:30 am – 12:00 am PT
 THANK YOU FOR JOINING US!
Look for the follow-up email after today’s session!
Do you provide a Certificate of Completion for this event?
A certificate will automatically be emailed to all online participants in the follow-up
email. If you joined through the phone only, please email Bridget Ukawu at
bukawu@cars-rp.org to report your participation.

Can I get a copy of the presentation that was used for this event?
A copy of the presentation was sent out in the reminder email and will be resent in
the follow-up email for today’s session within 2 business days.

Can I get a copy of the recording for this event?

The recording of this event will be sent in the follow-up email for today’s session,
if recorded. You may also access this session’s recording and other archived
recordings in the “Resources” section of our website or on our YouTube Channel.
68
 YOUR FEEDBACK IS IMPORTANT TO US!

We need to hear from you to keep bringing you these FREE resources!

Your completion of the survey is a very important part of our quality control and to our
future funding for this project, as it allows us to continue to provide you with resources
and training at no-cost. In addition, it allows us continually improve our services and
provide the information and resources you are needing in the field.

If you could please take a few minutes to let us know your thoughts, it would be greatly
appreciated. You have 3 ways to access the survey. The link will be put into the chat
box, it will automatically pop up in your browser when the webinar ends, and it will also
be provided in the follow-up email sent after the session.

Please take a few minutes to complete the survey!

Your time and feedback are greatly appreciated and valued!

69
 CONTINUING EDUCATION HOURS
Complete the evaluation survey,
then you’ll be redirected to the CE Hours Form.
Complete the evaluation survey and earn valuable Continuing Education (CE) hours at no extra
cost, enhancing your professional development.

Credit is being offered by the Center for Applied Research Solutions (CARS) for the following
licenses: ASW, BRN, CCS, CSD, LCSW, LEP, LMFT, LPCC, PPS, PRSS, JI-RPS, MHPS, RSPS, PSS,
Peer Instructor, & General Contact Hours.

CARS is an approved provider for: CCAPP #4N-08-923-0722, CA Board of Registered Nurses

#CEP16303, Texas Certification Board #2124-23, and CAMFT #131736.
Attendees are responsible for checking with their licensing or credentialing board to
ensure acceptance of the CE hours issued.

70
 STAY CONNECTED!
www.nttacmentalhealth.org

ACCESS OUR WEBSITE GET SOCIAL WITH US!

Upcoming Events Facebook: @nttac.mh

Archived Recordings Instagram: @nttac.mh

Request Support Twitter: @nttac_mh

Publications & Resources LinkedIn: NTTAC

Newsletter Signup YouTube: @nttac_mh

71
Thank you.

SAMHSA’s mission is to reduce

the impact of substance abuse and
mental illness on America’s communities.

www.samhsa.gov
1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)