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Trauma Complex Case Care for People Living in Housing Who Have Lived in Public Places How to Maintain Their Housing if This is Their Aim

September 16, 2015

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


Trauma-Informed Care Protocols and Best Practices…/ODVN_Trauma-InformedCareBestPractices…


Trauma-Informed Care Best Practices (Appendix B) . … Case Study: Deborah, Antoine, Jeremiah and Alicia (Appendix F) .In the past decade much has beenwritten and researched in both areas …. violence and trauma on people’s lives. ….majority of the survivors living in shelters have experienced severe abuse in.


Work Sheets for the Trauma Care Session November 7

Worksheet I  Framework

1. We discussed ways that shelter living can be difficult for everyone and talked about the particular things that would make being here work for her. _____/_____/_____

2. We discussed the ways we view this shelter as a community and what that means for both residents and staff (i.e. supportive peer environment, shared responsibility, accountability to each other, notions of physical and emotional safety, any rules we have and why we need them, processes for addressing difficulties that arise, concepts of inclusive design and mutual respect) _____/_____/_____

3. We discussed what kinds of accommodations might be needed for her to feel safe and comfortable in the shelter and developed strategies for making this happen (e.g.) a quiet room, ways to reduce sensory stimulation, relief from certain chores, identification of potential trauma triggers, respite from childcare, addressing issues of stigma, concerns about sleep patterns, lights, locked doors, medication, additional time or repetition to process information, particular kinds of things she might find upsetting, what things are most helpful when she is feeling that way (being alone, having a quiet place to go, listening to music, contact with others, physical contact, no physical contact, ways to check to see if she is really “there” and what might help her reconnect, etc.,). _____/_____/_____

4. We discussed some of the common emotional or mental health effects of domestic violence and what one can do about them. _____/_____/_____

5. We discussed the things abusers do to drive or make their partners feel “crazy”. _____/_____/_____

6. We discussed the ways abusers use mental health issues to control their partners.


7. We discussed how she feels the abuse by her partner has affected her emotional well-being and/or mental health. _____/_____/_____

8. We discussed ways she has changed as a result of the abuse. _____/_____/_____

9. I asked if she is having any kinds of feelings that concern her. _____/_____/_____

10. We talked about how many of the things she’s experiencing are common responses to abuse. _____/_____/_____

11. We talked about the links between lifetime trauma, DV, and mental health issues and whether she’d had other traumatic experiences that might be affecting her now. _____/_____/_____

12. We talked about how a survivor’s own emotional responses to abuse can affect how she responds to her children and offered strategies for noticing and addressing those concerns. _____/_____/_____

13. I assured her that if her responses to any of the abuse or trauma she’s experienced caused her suffering or get in the way of things she wants to do then we can help her access additional resources and services. _____/_____/_____

14. We talked about whether there were any mental health needs or concerns she might want to discuss (re: past interactions with mental health providers/mental health system, treatment medications hospitalizations). _____/_____/_____

15. I asked if her abusive partner interfered or has attempted to interfere with current or past mental health treatment or medication. __

16. We discussed our medication policy and asked her to let us know if she has any particular medication related needs that we could be helpful with (e.g. has run out and needs new supply, is having problems with side effects, is not sure they’re helping, she can’t afford them/insurance or Medicaid won’t cover them, etc.). _____/_____/_____

17. I provided links to information or resources to help her advocate for herself around medication issues. _____/_____/_____

18. We discussed her interest in mental health consultation and/or referral and her wishes and concerns about that. _____/_____/_____

19. While conducting support groups or house meetings at which she was present, I discussed mental health symptoms as being normal responses/adaptations to trauma and abuse. _____/_____/_____

20. I provided information, support and reassurance if/when she was uncomfortable with the mental health needs of other women in the program. _____/_____/_____

21. At her request (and with her written consent), I participated in conversations with her and her mental health provider/s about the issues she is facing and informed her mental health providers about domestic violence-specific issues they needed to be aware of, including appropriate documentation; safety and legal issues; abuser accountability and not involving her partner in treatment; the role of advocacy and any additional needed resources and supports. _____/_____/_____

22. I advocated with mental health providers/systems on her behalf if/when she requested this (and with her written consent). _____/_____/_____

23. I reflected on my own responses to and feelings about this particular person, where they come from and how they may be affecting me (i.e. vicarious trauma, transference/counter transference, evoking my own experiences of trauma) either privately or with trusted others (including supervisors, peers, family, friends, etc.) _____/_____/_____ 131 


24. I reflected on how my responses might be affecting her. _____/_____/_____

25. I noticed how difficulties among women in the shelter/agency community affect staff and how difficulties among staff or within the agency, affect women in the shelter/agency community (in general) as well as this particular woman. _____/_____/_____

26. I noticed instances when tensions among women in the shelter/agency community and staff related to this individual and found supportive ways to discuss this with her. _____/_____/_____

27. I discussed the process of healing from abuse and other trauma using empowerment-based approaches (e.g. offering a sense of hope; providing information; viewing symptoms as adaptations; thinking about what happened to you, not what’s wrong with you; offering connection but understanding the effects of experiencing betrayals of trust; discussing “feeling skills” providing information and access to peer support resources). _____/_____/_____

28. We worked together on strengthening or developing new “feeling skills” (i.e. relaxation training, grounding, affect regulation exercises). _____/_____/_____

29. We worked on incorporating safety planning into other mental health recovery planning /peer support activities and/or helped her connect with peer support groups. _____/_____/_____

30. I feel that I have the supervision and support I need to reflect on and respond effectively and empathically to the issues that arise in my work. _____yes_____no

31. I feel that my agency has created a culture that is welcoming to all survivors; supports openness and communication among both staff and shelter residents; promotes an atmosphere of mutual respect and shared responsibility; is attuned to policies and practices that may be re-traumatizing to survivors (and staff) and has thoughtful and respectful mechanisms in place to address issues as they arise. _____yes_____no

Best Practices Worksheet II

1. A commitment to non-violence is essential in a domestic violence service agency. Because advocate-survivor relationships are based on equality, an advocate will not use punitive interventions because they emphasize power differentials.

2.  Each individual seeking services has her own unique history, background, and experience of victimization. Treat each survivor as an individual.

3. Healing and recovery is personal and individual in nature. Each survivor will react differently. Programs and advocates need to be consistent yet flexible.

4. Establishing a connection based on respect and focusing on an individual’s strengths provides the survivor an environment that is supportive and less frightening. 

  5. The experience of domestic violence violates one’s physical safety and security. Programs need to provide safe physical spaces for both adults and child survivors.

6. Emotional safety is imperative so that survivors can feel more secure and comfortable. They need to live in an environment where their worth is acknowledged and where they feel protected, comforted, listened to and heard.

7. Healing and recovery cannot occur in isolation but within the context of relationships. Relationships fostered with persuasion rather than coercion, ideas rather than force, and empathy rather than rigidity will encourage trust and hope with survivors.

8. When a trauma survivor understands trauma symptoms as attempts to cope with intolerable circumstances, this understanding takes power away from abusers and an individual’s abusive experiences.

9. Despite a survivor’s experience of abuse, women and children may still feel an attachment to the person who has harmed them.

10. The administration of the agency must make a commitment to incorporate knowledge about trauma into every aspect of service delivery and to revise policies to insure trauma-sensitivity


11. Advocates need to look at the “big picture” and not just view the adult or child victim as only their “behaviors and symptoms”.

12. The manner in which a survivor experiences traumatic reactions will certainly be affected by the culture to which she belongs.

13. Collaborating with a survivor places emphasis on survivor safety, choice and control.

14. Personal boundaries and privacy are inherent human rights.

15. Assume information will need to be repeated from time to time. Survivors of trauma and loss may have difficulty retaining information and processing information.

16. Secondary traumatic stress can cause advocates to lose perspective and slip from understanding to blame.    


Worksheet  III Children Affected by Trauma

All children who are exposed to trauma are affected by it in some way or another.

A child sees it, hears it and walks into the aftermath of the harm.

™ Children who live in a shared custody arrangement may be impacted by the battering adult’s behavior while on visits. ™

Children living with trauma have complicated feelings about their parents.

™ Children often worry that they are responsible for the violence in their homes. ™

Children need validation for their experiences and feelings, not judgments regarding how they should behave or feel about their parent, parents, or caregivers.

For example, a helper should never tell a child to not be mad at his mom or dad.

Below are some of the ways in which advocates can support young people exposed to trauma: ™

  • Recognize the potential effects of trauma on youth seeking domestic violence services in such areas as attendance, attention, sleeping, and behaviors.  ™


  • Maximize the infant’s, toddler’s, youth’s, or teen’s sense of safety by responding to the needs of traumatized youth in domestic violence shelters, programs and services.


  • ™ Evaluate and understanding the impact of policy decisions on youth programming and women’s services and how this impacts parenting.


  • ™ Recognize the importance of an advocate’s self-care and the potential impact of secondary traumatic stress in working with youth. ™


  • Be aware of your approach, tone and body language when interacting with children. There are many ways in which you could trigger trauma reactions. ™


  • Be able to observe and identify youth in need of help, due to trauma. ™


  • Understand the power dynamics in your relationship, the batterer’s tactics and impact and be aware of your use of words, choices, and body language in your work with children so as to not induce secondary traumatization. ™


  • Assist infant, youth or teen in reducing overwhelming emotions and feelings.



  • Provide interventions that help children make new meaning of their experience with domestic violence and help to reframe the trauma experience along with grief and loss issues.


  • ™ Address how experiencing trauma can impact a child’s behavior, development, and relationships.


  • ™ Advocate and coordinate with parents, staff, schools, and other agencies.


  • Inform and educate others regarding the impact of domestic violence and traumatic stress in children.


  • ™ Support and promote positive and stable relationships in the life of the child by utilizing a child-centered and strengths-based approach. 


  • Be sensitive to the impact of traumatic stress reactions on pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. ™

Incorporate for families incoming into shelter, the understanding of traumatic stress and grief and loss in the communal living environment and what that may look like in behaviors of infants, youth and teens, for example, be aware of  trauma, domestic violence and grief and loss in shelter programming.

For example, recognize how the following can impact children: ƒ

  • New, different bedrooms, ƒ Living with others, sleeping with others in bedroom, ƒ
  • Not having their pillows, blankets, and toothbrushes,
  • ƒ Missing their toys, friends, and pets,
  • ƒ Eating different foods, not culturally theirs,
  • ƒ Styles and mannerisms of different staff and volunteers


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. Trauma is “in the eye of the beholder;” what one person may consider traumatic may not be traumatic to another person.


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, “The most powerful determinant of psychological harm is the character of the traumatic event itself. Individual personality characteristics count for little in the face of overwhelming events.

There is a simple, direct relationship between the severity of the trauma and its psychological impact.” In other words, anyone could experience some of the symptoms discussed on the following pages if they experience a traumatic event.


Trauma-informed services: • Focus on understanding the whole individual and context of his or her life experience

• Infused with knowledge about the roles that violence and victimization play in the lives of women

• Designed to minimize the possibilities of victimization and re-victimization

• Hospitable and engaging for survivors

• Facilitates recovery

• Facilitates growth, resilience and healing

• Respect a woman’s choices and control over her recovery

• Form a relationship based in partnership with the survivor, minimizing the power imbalance between advocate and survivor

• Emphasize women’s strengths

• Focus on trust and safety

• Collaborate with non-traditional and expanded community supports (such as faith communities, friends and families, etc.) • Provide culturally competent and sensitive services

Experiencing “triggers” that can reawaken traumatic responses.

• Avoidance or isolation produced by traumatic experience is exaggerated.

• All actions have potentially serious consequences so survivors know that thorough plans must be made before taking action.


When the experience of trauma is chronic, the brain continually responds as if under stress by preparing the body for “flight, fight, or freeze” even though the actual traumatic event has ended.


Ordinary perceptions may be altered – for example, a person’s sense of time may slow down • Non-essential body processes will be disrupted –

for example, a person may be able to disregard the need for food or sleep

• These changes described above are normal, adaptive reactions.

They mobilize the threatened person for reaction to the traumatic event –

the reaction of flight, fight or freeze


  • Fight The person decides to “fight back” in the face of traumatic events. Fighting back may take the form of physical or verbal resistance. A good example of this is the fight response of soldiers in combat.


  • Flight In the face of trauma, the person’s reaction is to flee the situation. The body mobilizes to leave the traumatic experience. Nature provides many examples of animals fleeing dangerous situations.


  • Freeze This traumatic response involves a shutting down of physical reactions to the violence that is occurring. Survivors may have feelings of being unable to move and/or may instinctually “freeze” to endure the trauma.

Women may be more likely to have this type of reaction as they are socialized by both culture and religion to yield in the face of powerful events. It’s important to recognize that survivors usually do not consciously “choose” their particular fight, flight, or freeze response.

In addition, survivors may feel a significant amount of shock or shame about how they reacted in the moments of traumatization.

Finally, this point in time is not a good time for trying to teach or provide new information. The person is only focused on immediate needs.


Trauma Triggers

The idea of there being certain “triggers” for survivors that will make them feel emotionally distressed is fairly well accepted by most domestic violence advocates. For example, advocates know not to yell at survivors or touch them without permission. We understand that controlling behavior on the part of the advocate may trigger the survivor to respond to us as though we are her partner. It is critically important for all advocates to understand trauma triggers.


What is a trigger?

Triggers are those events or situations which in some way resemble or symbolize a past trauma to individual survivors. These triggers cause the body to return to the “fight, flight, or freeze” reaction common to traumatic situations. When triggered, survivors do not necessarily return to a fullblown traumatic response, but may experience discomfort or emotional or physical distress.

This distress ranges from mild discomfort to acute distress. Events or situations that might otherwise be insignificant become associated with the trauma in a survivor’s mind and body and become “triggers” that indicate danger to a survivor. Common Triggers to Trauma Responses:

• Sounds

• Smells

• Colors

• Movements

• Objects

• Anniversaries

• Significant life events •

Any event or situation that resembles or symbolizes the trauma


advocates may hear from survivors. Rather than “playing detective” to get at the “truth” of what happened, it is important that advocates view memories of abuse through the lens of trauma to gain a fuller understanding of survivors’ experiences. Repetitive traumas often result in memory disturbance, and woman-defined advocacy requires us to start where the survivor is, which may not be with a fully detailed verbal account of abuse.


There are three clusters of “symptoms” often associated with traumatic experiences. These three responses are most associated with the diagnosis of Post-Traumatic Stress Disorder (PTSD); however, these reactions may occur whether or not a diagnosis of PTSD is appropriate. Each category will be discussed more in depth in the following pages of this manual. The three categories of traumatic responses are not individual and discrete, however. They overlap and intertwine and may occur in an oscillating pattern for survivors of violence.

1. Hyperarousal This refers to the physiological changes that occur in the brains of trauma survivors which prepare them for “fight, flight, or freeze” on a continuing basis. Being in a state of hyperarousal leads the survivor to startle easily, be constantly on the alert for danger, and be very sensitive to the reactions of others.

2. Intrusion or re-experiencing events These symptoms refer to the experience of the trauma “intruding” upon a survivor’s life after the trauma is over. Intrusion may include nightmares, flashbacks, or intrusive images. There is a sense of reexperiencing the traumatic event that is out of the control of the survivor.

3. Constriction or avoidance This refers to the narrowing down of consciousness or “numbing” of feelings and thoughts associated with the traumatic situation. In constriction, the survivor avoids all circumstances associated with the trauma and may withdraw from others in an attempt for emotional safety.


There are a number of emotional and mental responses indicating physiological hyperarousal. There are two major reactions that are indicative of hyperarousal:

1. Hypervigilance – Survivors may be constantly on the lookout for danger.

2. Exaggerated startle reflex – Survivors may be easily startled or unable to get used to sudden sounds or movements.

the most adaptive effect of hyperarousal is the ability of survivors to read the moods of those around them. That way they can adapt to the needs of their surroundings in an effort to keep themselves safe. This can often be misconstrued as manipulation but is, in effect, a very good safety planning mechanism.


Intrusive thoughts involve the ways in which survivors find themselves spending a lot of time thinking about the traumatic event, regardless of whether they want to or not. They might be doing something else and all a sudden, have a flood of images or emotions related to the trauma that seems beyond their control.

Some survivors may become preoccupied with the Intrusion includes a cluster of reactions that involve survivors reliving the traumatic events as though they are reoccurring in the present.  trauma and feel unable to be distracted from the traumatic thoughts, or they might feel like they don’t have the power to stop thinking or talking about the trauma.

Another aspect of intrusive symptoms is their exacerbation at times of anniversaries or by things that remind the survivor of the original trauma. For example, survivors may start to experience nightmares or intrusive thoughts at the same time each year. This typically corresponds with the anniversary of a significant aspect of the traumatic experience.

Also, intrusive symptoms may be exacerbated around court dates, counseling sessions, or in other situations when the survivor will have to discuss the trauma or interact with the abuser. There is an important distinction to make in terms of intrusive symptoms. Some intrusive symptoms are clearly thoughts or memories, and the survivor knows that they are simply recollections. However, flashbacks do not appear to be memories or thoughts to survivors.

The survivor feels as if the trauma is actually occurring in the present. Nightmares and Flashbacks The intrusive symptoms of nightmares and flashbacks are both a function of how traumatic memories are stored and accessed differently than typical memories.

Judith Herman describes that, “The traumatic moment becomes encoded in an abnormal form of memory, which breaks spontaneously into consciousness, both as flashbacks during waking states and as traumatic nightmares during sleep.”


Flashbacks may be described as the survivor’s acting or feeling as if the traumatic event is actually recurring in the present. Memories of trauma that have been encoded as intense emotional or physical sensations may erupt into the consciousness in the form of flashbacks and physical pain or panic. Flashbacks may be triggered by small, seemingly insignificant smells, sights, sounds, or other reminders; but the experience of having a flashback is intense, vivid, and typically quite scary for the survivor


Constriction refers to the cluster of traumatic reactions that involve the narrowing down of consciousness or numbing of feelings and thoughts associated with the traumatic situation.

This numbing of feelings works to protect a survivor from experiencing the overwhelming emotions associated with the trauma, such as terror, helplessness, distress, anger, etc. This numbing reaction may encompass the numbing of both emotions and bodily sensations.

Traumatic events may be remembered, but they may be distorted by lack of feeling or apparent indifference or emotional detachment. This numbing is very adaptive and protective.

It can be viewed as the mind’s way of protecting the survivor against unendurable information or feelings. In addition, survivors may restrict their lives significantly to create a sense of safety for themselves. They may avoid people, situations, and/or conversations related to the trauma.

This can be difficult and frustrating for an advocate who needs information related to the experience of abuse to provide advocacy services, but it should be understood in the context of self-protection and coping. Advocates should understand that survivors do not do this intentionally and may not even be consciously aware that they are experiencing this.

Effects of Constriction Constriction is a very adaptive response to traumatic experience; however, there are certainly costs to this reaction as well. Although coping is used for self-protection, constriction can result in withdrawing from others who could give support and assist in healing. It can also lead to avoiding anything associated with the trauma which can effectively limit positive, healing activities such as support group participation.

Although painful feelings are numbed through constriction, positive feelings are numbed as well. A survivor doesn’t have the ability to pick and choose what feelings to repress – all feelings are numbed.

This numbness can lead advocates to underestimate the severity of the trauma or a survivor’s emotional reaction to the abuse. Finally, the experience of numbness, or absence of feeling, can also be troubling to survivors.

Some survivors may create high-risk or painful situations to counteract these feelings of numbness (i.e. self-mutilating behaviors). Conversely, when people are not able to detach or dissociate spontaneously, they may turn to other activities such as alcohol or other drugs to produce a numbing effect.


Below is a list of ways in which survivors react to trauma emotionally. Historically, many helping professionals have viewed these reactions negatively, or have viewed these as evidence that something is wrong with the trauma survivor. A trauma-informed approach understands these reactions as normal responses to an abnormal event, and does not view them as evidence of a survivor’s problems, bad decisions, personal shortcoming, or weaknesses.

9 Shock and disbelief

9 Fear and/or anxiety

9 Grief 9 Guilt or shame

9 Denial or minimization

9 Depression or sadness

9 Anger or irritability

9 Panic

9 Apprehension

9 Despair

9 Hopelessness

9 Emotional detachment

9 Feeling lost or abandoned

9 Increased need for control

9 Emotional numbing

9 Difficulty trusting

9 Mood swings

9 Feeling isolated

9 Intensified or inappropriate emotions

9 Emotional outbursts

9 Feeling overwhelmed

9 Diminished interest in activities

9 Hyper-alertness or hypervigilance

9 Re-experiencing of the trauma

9 Desire to withdraw

9 Spontaneous crying

9 Exaggerated startle response

9 Feelings of powerlessness


Trauma also impacts how people think and the ways in which they process and understand information. When working with survivors, taking the following trauma reactions into account is critically important to effective advocacy with survivors. Below are some of the ways in which trauma impacts how people think:

9 Difficulty concentrating

9 Slowed thinking

9 Difficulty making decisions

9 Confusion

9 Difficulty with figures

9 Blaming self or others

9 Poor attention span

9 Mental rigidity

9 Disorientation

9 Uncertainty

9 Memory difficulties

9 Difficulty with problem solving

9 Nightmares

9 Flashbacks

9 Intrusive thoughts

9 Distressing dreams

9 Suspiciousness


There are number of behavioral or physical reactions to traumatic experiences in addition to the emotional reactions discussed previously. Traumatic experience has a strong physiological component which affects both the psychological and physical body. These effects can manifest in both physical symptoms and as behaviors for survivors of abuse. Behavioral or Physical Reactions

9 Sleep disturbance

9 Appetite disturbance

9 Fatigue

9 Inability to rest

9 Angry outbursts

9 Change in interaction with others

9 Withdrawal or isolation

9 Rapid heartbeat

9 Nausea or upset stomach

9 Aches and pains

9 Increased susceptibility to illness

9 Decrease of humor

9 Fainting

9 Dizziness

9 Weakness

9 Grinding of teeth


Often these reactions look like a person’s personality has changed or mirror signs of chronic depression. Sometimes this results in others missing the significance of the trauma and misdiagnosing these conditions. Because bodies express what cannot be verbalized, traumatic memories are often transformed into physical outcomes including**:

9 Chronic pain

9 Gynecological difficulties

9 Gastrointestinal problems

9 Asthma

9 Heart palpitations

9 Headaches

9 Musculoskeletal difficulties Chronic danger and anticipation of violence stresses the immune and other bodily systems, leading to increased susceptibility to illness. Other Difficulties Associated with Traumatic Experiences**:

9 Eating problems

9 Substance abuse

9 Problems in relationships

9 Physical problems that doctors can’t diagnose

9 Self-harmful behavior, self-mutilation

9 Sexual difficulties: promiscuity, dangerous sexual practices, or denial of sexuality


A trauma champion thinks about his or her own behavior as to whether it is hurtful or insensitive to the needs of the trauma survivor. 

As a champion you will shine the spotlight on trauma issues with respect to your job role as well.

 In meetings, in advocacy and in day-to-day routines, you are the one As a trauma champion, you think “trauma first!” When trying to understand a person’s behavior, you will ask, “Is this related to violence and abuse?”  reminding all other staff and volunteers about the significant role trauma and traumatic stress plays in the lives of survivors. 

A champion is the staff person who consistently is asking questions about trauma and suggesting ways to support victims of domestic violence in a trauma-informed manner. 

A trauma champion influences others to consider the impact of trauma in everyday interactions and observations. 

A trauma champion models appropriate respect, honesty, empathy and affords individuals their dignity in every interaction with women, children, and co-workers.


Trauma Resources


ODVN used the following resources to develop chapter one and chapter two of this manual. Many of the resources can be accessed via the internet or are available at the ODVN clearinghouse.

Domestic Violence and Mental Health Policy Initiative. Herman, Judith. Trauma and Recovery. Basic Books: New York, NY (1997).

Mason, Patience HC. PTSD: What It Is and How to Recover. The PostTraumatic Gazette. High Springs, FL: May-June 1995. Ochberg, Frank. PTSD: Understanding a Victim’s Response. Networks. National Center for Victims of Crime: Fall2003/Winter 2004.

Ochberg, Frank. Posttraumatic Therapy. Psychotherapy, Volume 28, No. 1. Spring, 1991. Rothschild, Babette. (1999). Making Trauma Therapy Safe: The Body as Resource for Braking Traumatic Acceleration. Self and Society, May, 1999. Sidran Foundation. What are Traumatic Memories? 1994 52 The International Critical Incident Stress Foundation, Inc. (ICISF) Signs and Symptoms. Van Der Kolk, Bessel A. The Compulsion to Repeat the Trauma: Reenactment, Revictimization, and Masochism. Psychiatric Clinics of North America. Volume 12, No. 2. June 1989.

Vermilyea, Elizabeth G. Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress. The Sidran Press: Baltimore, MD (2000).

Werk, Kay. Common Signs and Symptoms of a Stress Reaction. Netcare Corporation. Women, Co-Occurring Disorders and Violence Study. SAMHSA. Creating Trauma Services for Women with Co-Occurring Disorders. August 2003.




Trauma-Informed Care Protocols and Best Practices…/ODVN_Trauma-InformedCareBestPractices…


Trauma-Informed Care Best Practices (Appendix B) . … Case Study: Deborah, Antoine, Jeremiah and Alicia (Appendix F) .In the past decade much has beenwritten and researched in both areas …. violence and trauma on people’s lives. ….majority of the survivors living in shelters have experienced severe abuse in.


  •  Trauma-Informed Care Risking Connection: A Training Curriculum for Working With Survivors of Childhood Abuse. (Jan. 2000) by Karen W. Saakvitne, Sarah Gamble, Laurie Anne Pearlman, and Beth Tabor Lev Sanctuary in a Domestic Violence Shelter: A Team Approach to Healing, Madsen, LIbbe H., Blitz, Lisa V., McCorkle, David and Panzer, Paula G. MD. (Pages 155-171) Psychiatric Quarterly, Vol. 74, No.2, Summer 2003.
  • The Long Journey Home: Guide for Creating Trauma-Informed Services for Mothers and Children Experiencing Homelessness. The National Center on Family Homelessness, Prescott, Laura, Soares, Phoebe, Konnath, Kristina and Bassuk, Ellen Using Trauma Theory to Design Service Systems (Harris, M. and Fallot, R.D. (Eds.). (2001)


  • Trauma Trauma and Recovery: The Aftermath of Violence. Herman, Judith, MD. Basic Books. (1992)


  • Women Speak Out video (Community Connections, 1999) is a powerful video that can be used to sensitive staff on the effects of trauma in the lives women. Trauma through A Child’s Eyes: Awakening the Ordinary Miracle of Healing. By Peter Levine with Maggi Kline. North Altantic Books. (2007)
  • 140 Domestic Violence Safety Planning with Battered Women; Complex Lives/Difficult Choices by Jill Davies, Sage Publishing (1998)
  • Advocacy Beyond Leaving: Helping Battered Women in Contact with their Partners by Jill Davies (2009).


  • Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others By Laura van Dernoot Lipsky with Connie Burke. Berrett-Koehler Publishers, Inc. (2009)
LINKS AND WEBSITES Ohio Domestic Violence Network @
On-line Trauma Focused Care @
The National Child Traumatic Stress Institute @
The National Center on Domestic Violence, Trauma and Mental Health @
The National Institute of Trauma and Loss in Children @
Witness Justice @
The Life Experience of Deborah, Antoine, Jeremiah & Alicia Objective:  
To enhance advocates skills in identifying the difference between a trauma­informed approach and a traditional service approach in working with individuals impacted by domestic violence and victimization.
Background: Deborah arrived at the shelter at 4:15 p.m. on Wednesday, the night before she was taken by ambulance to the emergency room at the local hospital following an incident of threats, menacing and violence perpetuated by her ex-husband.
The ex-husband fled the scene before the police arrived. The police called 911 due to her head injury and bloody nose. The officer transported her three children to the hospital, as there was no family near, and so their children sat alone in a waiting room, all night long, while their mother was being seen.
She was treated for a concussion due to a head injury. She also was strangled and kicked in her ribs and legs. Deborah described that the children’s father threatened to hunt her down to kidnap his children and to kill their family dog, Jake.
The hospital social worker called the domestic violence hotline and referred Deborah for shelter. Deborah spoke directly to the hotline volunteer and was accepted based upon the safety concern and threats. However, she was told she would have to wait to arrive until after 1 p.m.
She was instructed to call the regional district police department and to tell them that she and her three children had been accepted to the shelter.
She had to arrange an escort to the shelter with the police. The hospital social worker gave her bus tickets to go and stay the day at the community center since it was 6:30 in the morning.
The children were going to miss school and daycare.
Arriving at the Shelter: Deborah and her three children, Antoine (age 13), Jeremiah (age 6) and Alicia (age 4) have been staying at the community center since 7 a.m. that morning.
They arrived at the confidential shelter after waiting for a police escort for more than 5 hours. (Police escorts are a mandated standard safety policy of the agency.)
The family had only eaten a peanut butter sandwich, juice and chips at the center around noon. Also, none of them had slept much during the night, because they spent all night at the hospital.
They carried in only a tote bag of items with them.  The family arrived at the shelter during shift change, when the day shift is leaving and the night shift is arriving.
The office door typically remains closed, due to the confidential nature of the information being shared by staff working the hotline and daily shelter activities.
Deborah was given her room assignment and some personal care items by the advocate who greeted her at the door. The advocate was friendly and apologized for leaving her upon her arrival, but said she must get back to the office and go over resident plans and results before 5 pm.
Case Management Meeting:
The next day the shelter staff held their case management meeting to go over the residents progress, any house concerns and how people (residents) are doing on their chores and meeting their goals and objectives.
¾ Maya, an advocate, reported during the meeting that Deborah was seen pacing in the hallway and repeatedly looking out the dining room window. She makes the other women uncomfortable because she walks around humming and constantly checking on her children, insisting that they stay next to her in the room.
If Deborah goes to the bathroom, she makes the children sit outside the bathroom in the hallway.
¾ Angelina, another advocate, said that Deborah was not very open to talking to her and that she just wanted to find a place to stay. Angelina said Deborah should be more respectful and thankful for her bed because the shelter has a wait list and there are others who need the space more than she does.
¾ Angelina thinks that perhaps maybe Deborah is going through withdrawal because she was using substances, and that is why she is so paranoid and withdrawn and keeping information from the advocates.
¾ Mary, who works on the night shift, indicated that she believes Deborah needs a mental health assessment because she is rocking, listless, and nonresponsive to staff.
Mary says that Deborah is super paranoid and hums all of the time. There is some tension between staff at this meeting due to the alternative views of this woman’s behavior.
There is obvious disagreement about what is going on with Deborah and how to respond.
¾ Jessica, another advocate, asked if anyone had sat in a quiet space and talked with Deborah yet. She wants to ask Deborah is she feels unsafe, frightened or what she might need to help her.
¾ Mary and Angelina disagree with Jessica’s approach, thinking that only mental health professionals should talk to Deborah about her feelings and fear.
¾ Maya is more concerned about how the other residents are feeling with this  new family’s arrival.
Case study
1— Who is thinking in a trauma-informed approach? • What makes their thought process trauma-informed? • What is the potential impact of this type of approach for Deborah and her children? How will interacting with Deborah in this way most likely make her feel?
2— Which advocates are approaching Deborah in a traditional approach? • What makes this approach more traditional? • What is the potential impact of this traditional approach for Deborah and her children? That is, how will interacting with Deborah in this continued manner most likely impact her experience and make her feel?
3- What are some explanations for Deborah’s reactions since she has stayed at the shelter? • What effect did her “journey” to the shelter have on her? • What may be the reason for her keeping her children close to her side? • How would the threats and intimation of the batterer impact her in a communal living environment? • What rules of the shelter may impede her needs at this time? • What would be the best approach in speaking with her about her behaviors? • Are the “chores” the most critical issue that the shelter advocates need to address?
4- How can advocates be mindful of be new residents’ perspective?
5- What are some of the children’s and Deborah’s potential trauma triggers from their abusive experience? • What are ways you as an advocate can be a trauma champion for the individuals in this shelter?

Trauma-Informed Care Protocols and Best Practices…/ODVN_Trauma-InformedCareBestPractices…


Trauma-Informed Care Best Practices (Appendix B) . … Case Study: Deborah, Antoine, Jeremiah and Alicia (Appendix F) .In the past decade much has beenwritten and researched in both areas …. violence and trauma on people’s lives. ….majority of the survivors living in shelters have experienced severe abuse in.

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