Trauma Talks
Please check back for program updates.

8:00am

Registration

8:45 to 9:00am

Welcome & Opening Remarks

9:00 - 10:00am

Keynote Address:
Advocacy for Trauma-informed Care: Moving from Construct to Reality

Dr. Janice LeBel will be presenting: Advocating for Trauma-informed Care: Moving from Construct to Reality in which shewill offer pragmatic recommendations and strategies for trauma-informed system change.  Dr. LeBel has direct experience of advancing a trauma-informed agenda with multiple health and social service systems and concretizing trauma-sensitive practice into practice standards, program operations and funding streams. Her presentation will review beginning and more advanced steps in these processes.  Specific strategies to move from theory to practice include: foundational content knowledge, focused leadership skills, key data elements, full inclusion of persons-served and more.  Finally, she will also offer typical pitfalls and challenges, and suggestions for mitigating ‘false steps’ along the way of system transformation.


Dr. Janice LeBel, PhD, ABPP

10:00 - 10:15am

Q&A Session

10:15 - 10:45am

Refreshment Break & Networking

10:45 - 12:00pm

Concurrent Session #1
 

Workshop A
Room NF007

Recognizing Trauma in Mental Health: Trauma-Informed Responses with Youth and People with Psychosis

Recognizing Trauma in Mental Health: Trauma-Informed Responses with Youth and People with Psychosis
Presenters:  Debbie Ernest, MSW,RSW  Advanced Practice Clinician – Complex Mental Illness Program, CAMH,  Robert Bancroft, MSW, RSW Advanced Practice Clinician –Child Youth and Family Service, CAMH and Sandra Cushing, MSW, RSW Advanced Practice Clinician – Complex Mental Illness Program, CAMH
Presentation Format: Workshop
Skill Level:  All
Abstract:  This workshop will assist clinicians develop knowledge and skills in applying a trauma-informed lens to  assessment and treatment of complex clinical presentations with a focus on two vulnerable populations:  children/youth and people with psychosis. A better understanding of trauma, its associated behaviours and effective treatment planning will be highlighted through the use of didactive and interactive modalities, emphasizing the opporutnitiy for applied learning. Three clinician-facilitators will present information on PTSD symptoms, trauma impacts and stage-oriented trauma-informed care that can be applied across clinical populations . Videotaped vignettes will demonstrate the application of trauma-informed care theory to clinical practice with a youth and with an adult with psychosis. Participants will participate in reflective debriefing and discussion of the vignettes and will be encouraged to share experiences from their own practice and work contexts.
 Learning Objectives:

  1. Recognize the features of PTSD and Complex PTSD
  2. Describe potentially traumatic events
  3. Delineate the symptoms of trauma and how they are reflected in behaviour with youth and with people with psychosis
  4. Describe a stage-oriented approach to trauma-informed care
  5. Apply the principles and strategies of trauma-informed care to their own practice

Debbie Ernest, MSW, RSW, Robert Bancroft, MSW, RSW and Sandra Cushing, MSW, RSW

Workshop B
Room NF008

ANTI-OPPRESSION PSYCHOTHERAPY™: “The Intersectional (Diverse) Client”

ANTI-OPPRESSION PSYCHOTHERAPY™:  “The Intersectional (Diverse)  Client”
Presenters: 
Roberta K. Timothy, PhD. and Mercedes Umana, PhD. Candidate,  Continuing Healing Consultants
Presentation  Format: Workshop
Skill Level: All
Abstract:  This introductory training workshop will examine how Anti-Oppression Psychotherapy™ (AOP), a trauma-informed modeli, can be used as a tool of advocacy with diverse clients. Firstly, the historical and contemporary context in relation to the impact of racismii and other determinants of health will be briefly explored. Secondly, the importance of theoretical and methodological concepts and practices of AOP iii will be discussed and essential definitions of AOP will be described. Thirdly, some of the principles of AOP will be explained in the context of issues relating to anti-oppression, trauma, and psychotherapy looking at how its implementation impacts diverse communities in Canada, America, Caribbean, Latin America and transnationally. Fourthly, the “diverse client” will be explored indicating the importance of addressing intersectional factors of identity such as race, indigeneity, class/SES, gender/gender identity, sexual orientation, age, (dis)ability, and spirituality in psychotherapy praxis. Fifthly, the experiences of intersectional trauma in clients’ lives will be looked at. Finally, the importance of the use of resistance and resiliency as empowering therapeutic tools for clients, practitioners, and communities will be examined. This presentation will utilize several case studies to indicate how AOP can be used with diverse clients as a model of trauma-informed social justice praxis.
Learning objectives:

  1. To demonstrate the importance of intersectionality in psychotherapy/psychology practice. 
  2. To list some skills working with "diverse clients" from an anti-oppression trauma informed model.
  3. To describe the basic principles of AOP (Anti-Oppression Psychotherapy).
  4. To show the usefulness of AOP praxis for advocacy and support.

i See Timothy, R., (2012). “Anti-Oppression Psychotherapy as trauma-informed practice,” in “Moving the Addiction and Mental
Health System Towards Being more Trauma-Informed” edited by Nancy Poole and Lorraine Greaves of the British Columbia Centre of Excellence for Women’s Health.
iiSee Timothy, R., (2007). ”Third World Women, of Color and Other Racialized Terms: Black Women Speak” in Centering Black Feminist Thought in the Canadian Feminist Landscape, Inanna, Publications, Canadian Women’s Studies’. Toronto. Wane, N., Massaquoi, N (Eds.).
iii See Timothy, R. (2007). “Resistance Education: African/Black Women Shelter Workers’ perspectives.” Doctoral Dissertation. University of Toronto.

Roberta K. Timothy, Ph.D., and Mercedes Umana, Ph.D. Candidate

Workshop C
Room VC101

Trauma-Informed Case Conceptualization

Trauma-Informed Case Conceptualization
Presenters: Dr. Rosemary Barnes Independent Practice and Dr. Nina Josefowitz Independent Practice
Presentation Format: Workshop
Skill Level: All
Abstract: This workshop will describe how to develop a trauma-informed case conceptualization using a lifespan framework based on attachment, developmental psychopathology, trauma, and risk and resilience research.  The workshop will focus on mental health assessment of adults and will discuss (1) locating an individual’s past traumatic experiences in relation to developmental stages and (2) identifying negative cascades of events, attachment style, and complex posttraumatic reactions.  Evidence concerning the cumulative effects of trauma on physical and mental health will be reviewed.  Childhood or adolescent exposure to extensive adversity or trauma is well-known to increase risk for later difficulties with mental disorders, behaviour, relationships, physical health, intellectual function, school achievement, and occupational function.  A lifespan developmental framework can provide a trauma-informed understanding of how risk and resilience factors have affected an individual over an extended period and can guide clinical intervention decisions.
Learning Objectives:

  1. Describe the basis for a trauma-informed case conceptualization, including theory related to attachment style, psychological development, risk, resilience, and developmental trajectory.
  2. List three risk and three resilience factors that affect an individual’s likelihood of experiencing mental and physical health problems subsequent to trauma exposure.
  3. List three ways in which a trauma-informed case conceptualization can be used in providing clinical care.

Dr. Rosemary Barnes and Dr. Nina Josefowitz

Paper Session A
Room NF006

Integrating Trauma-informed Care into Healthcare Settings

Paper Session A.1: Healing Milestones: Insights from a Trauma-Survivor Chiropractor

Healing Milestones: Insights from a Trauma-Survivor Chiropractor
Presenter: Dr. Patrick Milroy, BA, MA, DC - Chiropractor
Presentation Format: Single Paper
Skill Level: All
Abstract: A presentation by Chiropractor, Dr. Patrick Milroy, that couples his personal trauma-survival with clinical insights for the touch professional. The touch professional is in a unique position to either facilitate healing the healing journey of the survivor, or disrupt healing, or worse yet, retraumatize, because of the nature of the practitioner-client relationship. Dr. Milroy’s presentation reviews the importance of history taking, and relationship building, when consulting with the trauma survivor. The importance of story-telling by the trauma survivor is shared with and emphasis on what Dr. Milroy refers to as “Healing Milestones” and subtopics such as trauma’s “ripple effect,” reframing, spirituality and trauma, gratitude and forgiveness. Dr. Milroy’s personal trauma was that of sexual violence which he hopes will now serve as a lightening rod to educate and sensitize practitioners on trauma-informed care.

Learning Objectives

  1. Demonstrate knowledge of Trauma-Informed Care as related to the touch professions.
  2. Describe the importance of “Healing Milestones,” the “ripple effect,” and “reframing” for the trauma survivor.
  3. List resources and recommendations that the touch professional can offer the trauma-survivor.

Dr. Patrick Milroy, BA, MA, DC

Paper Session A.2: Massage Therapy: A Resource for Establishing Safe Touch in Clients with Trauma Histories

Massage Therapy: A Resource for Establishing Safe Touch in Clients with Trauma Histories
Presenter:  Erin Whyte, R.M.T.
Presentation Format: Single Paper
Skill Level: All
Abstract:  Massage therapists are in a unique position to provide treatment to survivors of childhood sexual abuse, victims of partner violence, people with PTSD, or anyone with negative touch histories.   A trauma-informed care perspective coupled with a strong therapeutic relationship by a massage therapist can facilitate client outcomes in a safe, boundaried, and empowering way.  Massage therapy can be a resource for trauma clients that are stable enough in their emotional process to safely receive touch without being triggered into implicit memories. It can be a helpful adjunct to traditional therapy when clients are ready to reintroduce safe touch into their lives and reinforce a mindful connection to their body.  Trauma clients that exhibit high degrees of muscular tension, depression or anxiety can also benefit from a trauma-informed care approach . Evidence is emerging that bodywork is a relevant, valid, and evena necessary piece to the trauma healing process.
Learning Objectives:

  1. Describe the parameters of trauma-informed approach to massage therapy.
  2. Explain the benefits of employing massage therapy as an adjunctive form of treatment for clients living with trauma.
  3. Identify when a massage therapy referral is appropriate and when it is contraindicated.

Erin Whyte, R.M.T.

Paper Session A.3: Trauma-Informed Care for Paramedics Through Prevention

Trauma-informed Care for Paramedics Through Prevention
Presenters:  Polly Ford-Jones PCP, MA Faculty, Humber College Paramedic Program, PhD Student Health Policy and Equity York University, Craig MacCalman ACP, MSc, BScN, Faculty Humber College Paramedic Program and Richard Alvarez ACP, MSc Faculty, Humber College Paramedic Program
Presentation Format: Single Paper
Skill Level: All
Abstract: Paramedics respond daily to emergency situations and individuals in crisis. This repeated exposure to trauma has led to a heightened risk of occupational stress injury and PTSD diagnosis amongst paramedics (Sterud et al., 2006; Fjeldheim et al., 2014). Current intervention strategies for managing paramedic occupational stress include time out periods, peer support teams, voluntary and mandatory debriefings and access to mental health services (Paramedic Chiefs of Canada, 2014). These strategies are deployed after exposure to a traumatic event and encompass an approach known as critical incident stress management (CISM) (Paramedic Chiefs of Canada, 2014). While the CISM approach has benefit, it does not prepare the paramedic for predictable exposures to traumatic events. Exposure to trauma evokes individual behavioural and psychological changes that can either be transformational or maladaptive (Fernando, 2010). An individual’s response to trauma depends on their level of resilience prior to the critical incident (Agaibi and Wilson, 2005) and evidence suggests improvements to stress management in paramedics can be made through preventative strategies. In order for care for paramedics to be ‘trauma-informed,’ it is necessary to acknowledge the significant exposure to trauma in this work and employ preventative strategies, as well as comprehensive care following traumatic events. The need for trauma-informed care for paramedics is explored through discussion of implementation of individualized prevention and intervention strategies.
Learning Objectives:

  1. Differentiate current reactive practices in mental health for Ontario paramedic services.
  2. Discuss the relationship between resiliency and coping as it applies to paramedics' responses to trauma.
  3. Discuss the benefits and challenges to the implementation of preventative strategies in the management of paramedic occupational stress injury within the context of trauma-informed care.

Polly Ford-Jones PCP, MA, Craig MacCalman ACP, MSc, BScN and Richard Alvarez ACP, MSc

Paper Session B
Room VC115

Advocacy for Special Populations

Paper Session B.1 - Challenging Bill C-31: Advocating for Refugee Claimants at the Supreme Court of Canada

Challenging Bill C-31: Advocating for Refugee Claimants at the Supreme Court of Canada
Presenter: Pat Durish, MSW, RSW, Ph.D.
Presentation Format: Case Study
Skill Level: All
Abstract: This presentation is a case study in advocacy at the level of the Supreme Court of Canada. In 2013, three refugee claimants, (a gay man from Serbia, a gay couple from Romania and a gay, Roma man from Romania), after receiving negative decisions from the Refugee Board, applied to have these decisions judicially reviewed. The application proposed to challenge the constitutionality of the Conservative Government’s Designated Country of Origin, (DCO), designation established in 2012. The Canadian Association of Refugee Lawyers, (CARL), was given intervenor status for the proceedings. In an unprecedented move, CARL sought expert testimony not only from legal scholars and social scientists, but also representatives of advocacy groups and clinicians. As a social worker who regularly provides trauma assessments for refugee claimants, I was approached to submit an affidavit to support CARL’s challenge. This presentation describes the process, outcome and implications of my involvement. The discussion is specific to this particular case but also holds implications for advocacy in a broader sense. Refugees are by definition trauma survivors. It is imperative that we continue to do the work of educating policy and decision makers about the effects of trauma so that the refugee process can become more effective at granting protection to this vulnerable population.
Learning objectives:

  1. To become more informed regarding the recent changes to the refugee process and their impact on refugees claimants, particularly racialised populations, LGBTQ folks and individuals who have experienced gender based violence.
  2. To understand the possibilities for advocacy at various levels of the claimant process.
  3. To investigate the potential of collaborating across disciplines in support of advocacy efforts. 

Pat Durish, MSW, RSW, Ph.D.

Paper Session B.2 - Trauma-Informed Youth Justice in Canada

Trauma-Informed Youth Justice in Canada
Presenter: Judah Oudshoorn, Professor of Community & Criminal Justice, Conestoga College
Presentation Format: Single Paper
Skill Level: All
Abstract:  Childhood, psychological trauma is an influential factor why young people end up in trouble with the law. Research indicates that between 70 -90% of young offenders have histories of childhood trauma: many are survivors of individual traumas, such as family violence, sexual abuse, and/or neglect, and many are survivors of collective traumas, such as white supremacy (i.e., colonization of Indigenous peoples), patriarchy (i.e., male violence), and/or greed (i.e., overrepresentation of people living in poverty who are incarcerated). Yet, criminal justice professionals are often ill equipped to deal with the effects of trauma, instead reinforcing a system that further traumatizes. By taking a trauma-informed perspective, the criminal justice system can foster the creation of safe communities through
principles of resilience, restorative justice, decolonization, and healing, rather than risk assessment, prison, and punishment.
Learning Objectives:

  1. To demonstrate connections between psychological trauma and conflict with the law.
  2. To describe ways current criminal justice system responses exacerbate individual and collective traumas.
  3. To advocate for trauma-informed care to be a guiding framework for youth justice in Canada.

Judah Oudshoorn, Professor of Community & Criminal Justice

Paper Session B.3 - Hidden in Plain Sight: The Need for Trauma-Informed, Disability-Affirmative Care for Women with Physical Disabilities

Hidden in Plain Sight: The Need for Trauma-Informed, Disability-Affirmative Care for Women with Physical Disabilities
Presenter: Kaley Roosen, M.A. Affiliation: Clinical Psychology Doctoral Student, York University
Presentation Format: Single Paper
Skill Level: All
Abstract:  The disturbingly high rates of abuse and trauma within the population of Canadian women with physical disabilities (60% or up to 2.1 times that of women without disabilities) have been largely unaddressed in the psychological and medical support communities. Disability scholars have used the phrase Hidden in Plain Sight to capture the seemingly limited attention in trauma literature towards caregiver abuse and medical trauma, which are rampant in the disability community. Despite being a particularly high-risk group, research has further demonstrated that women with physical disabilities face unique challenges in receiving treatment and support for trauma and abuse, including the unfortunate re-traumatization by medical health professionals who have little-to-no training in disability. This talk will explore the various physiological, psychological and sociocultural factors that place women with disabilities at such high risk for trauma and abuse. Next, I will explore the potential viability for introducing a trauma-informed, disability-affirmative model of care to specifically address the service needs and research gaps for this at-risk group of women. Participants will be provided with specific recommendations for adopting this practice within their established therapies and support services.
Learning Objectives:

  1. Identify women with physical disabilities as an under-represented, high-risk group for mental health distress, complex trauma and abuse; with particular attention on the impact medical trauma and caregiver abuse.
  2. Demonstrate how previous supports and therapies have further marginalized and re-traumatized this at-risk population.
  3. Describe how therapists and other healthcare providers can utilize a trauma-informed, disability-affirmative therapy/care for clients with disabilities.

Kaley Roosen, M.A., Clinical Psychology Doctoral Student

Paper Session C
Room NF004

Building Trauma-informed Organizations and Programs

Paper Session C.1: Your Experiences Matter: Creating an Organizational Culture of Trauma Informed Care

Your Experiences Matter: Creating an Organizational Culture of Trauma Informed Care
Presenter: Holly Murphy MN, RN BScN, CPMHN(c)
Presentation Format: Single Paper
Skill Level: All
Abstract: The IWK Health Centre is a pediatric and obstetric hospital that provides care to women, children, youth and their families from Nova Scotia, New Brunswick and Prince Edward Island.  We are currently in the process of becoming a trauma-informed organization and examining our trauma-specific services to better serve those who have experienced trauma.  Since 2014, we have created a Trauma Informed Care Team (Advisory Group, Project Team and Working Groups) composed of over 150 individuals from internal teams and community system partners.  We have just formally launched this initiative by providing trauma awareness and education sessions to staff and community partners.  At this launch we presented our organization-wide education, evaluation, and research plans, as well as our new province-wide trauma informed care logo ‘Your Experiences Matter’ and website.
Learning Objectives:

  1. To describe the IWK Health Centre’s process to become a trauma-informed organization.  
  2. To describe the IWK Health Centre’s education, evaluation and research plan to become a trauma-informed organization.
  3. To describe the trauma informed care partnerships built with services across all sectors to build a trauma informed care province.

Holly Murphy MN, RN BScN, CPMHN(c)

Paper Session C.2: A Trauma-Informed Approach to Supportive Housing for Women

A Trauma-Informed Approach to Supportive Housing for Women
Presenters: Chelsea Kirby, MPH, The Jean Tweed Centre and Kaela McCarney, MSW, RSW, The Jean Tweed Centre
Presentation Format: Case Study
Skill Level: All
Abstract: This case-study presentation will describe two trauma-informed supportive housing programs for women (and women with children) with substance use and/or mental health issues.  The women involved in this housing experience complex substance use and/or mental health issues, are homeless or under-housed prior to entry into the program, are high users of the health care system (e.g. emergency department, withdrawal management services), and may have involvement with the criminal justice system and/or child welfare.  These two supportive housing programs are unique in that they offer housing to women with children in their care, or transitioning back into their care, which is a gap in the system .The development of these housing programs will be presented, including; advocacy and collaborative strategies within the system and partnerships to promote trauma-informed, women-centered care, the design of unique housing models and programming to best meet the needs of women, and the use of feedback from women in the program to improve quality of services.  This presentation will also offer a list of resources to participants who want to further their understanding of supportive housing and in particular, a trauma-informed approach.
Learning Objectives:

  1. Describe a trauma-informed, women-centered housing model.
  2. Demonstrate strategies for advocating for and building partnerships for trauma-informed housing.
  3. Describe innovative strategies for supporting women with children in supportive housing (which has not traditionally been inclusive of families).

Chelsea Kirby, MPH and Kaela McCarney, MSW, RSW

Paper Session C.3: Child & Youth Advocacy Centres: A Multidisciplinary Team Response to Child Abuse

Child & Youth Advocacy Centres: A Multidisciplinary Team Response to Child Abuse
Presenter: Pearl Rimer,  Director of Operations, Boost Child & Youth Advocacy Centre
Presentation Format: Single Paper
Skill Level: All
Abstract: In 2013, Boost Child & Youth Advocacy Centre (CYAC), together with community partners, opened Toronto’s first CYAC for child/youth victims of sexual and physical abuse, neglect, and human trafficking. The objective of the CYAC is to improve the current system of investigation, protection, treatment, advocacy and prosecution of child abuse with a collaborative approach resulting in a coordinated, multidisciplinary, trauma-informed response to victims in a child-focused environment. Research was conducted to evaluate the implementation of best practice standards and evidence-based/evidence-informed multidisciplinary practices, programs and services in a CYAC setting.
Method: The evaluation was a mixed-method, multi-site, multi-agency, multidisciplinary staff 18-month project that included both CYAC and comparison samples.
Results:

  • Better communication resulting in improved partner relationships and collaboration, a greater adherence to protocol, a more unified investigative process, and more efficient system overall
  • Importance of the Advocate
  • Prompt medical and mental health responses, and referrals for children/youth and families
  • Better risk management for clients
  • A more thorough and engaging way to work with families in crisis

Conclusions: Based on the results, this research underscores that the CYAC model is an improved, efficient and effective approach to managing and servicing high-risk child maltreatment cases.
Learning Objectives:

  • Describe the components of a Child & Youth Advocacy Centre, and indicate how the model differentiates from traditional child abuse investigations and responses.
  • List the strengths, limitations and outcomes that can be achieved under this model, supported by an 18-month evaluation.

Pearl Rimer, Director of Operations, Boost Child & Youth Advocacy Centre

Symposium A
Auditorium

Integrating Trauma - and Violence-Informed Care in Health Care Responses to Health Inequities and Family Violence

Integrating Trauma - and Violence-Informed Care in Health Care Responses to Health Inequities and Family Violence
Presenters: Victoria Smye RN PhD, Associate Professor of Nursing, Faculty of Health Sciences, University of Ontario Institute of Technology, Marilyn Ford-Gilboe, PhD, RN, FAAN, Professor and Women’s Health Research Chair in Rural Health, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, and C. Nadine Wathen, Associate Professor & Faculty Scholar, Faculty of Information & Media Studies, and Research Scholar, Centre for Research & Education on Violence Against Women & Children, Western University
Presentation Format: Symposium
Skill level: All
Abstract: In this symposium, we present an overview of the concept of Trauma- and Violence-Informed Care (TVIC)and illustrate its application using examples from research testing an organizational intervention to enhance equity-oriented primary health care (EQUIP) and a national initiative focussed on developing educational guidance and tools in family violence (VEGA)


Paper 1:  “Integrating the “V” in Trauma- and Violence-Informed Care (TVIC): The Traumatic Effects of Violent People, Systems and Structures”
Presenting author: Victoria Smye RN PhD, Associate Professor of Nursing, Faculty of Health Sciences, University of Ontario Institute of Technology
Other authors (in this order):
Colleen Varcoe, RN, PhD, Professor, University of British Columbia School of Nursing
Annette J. Browne, PhD, RN, Professor, University of British Columbia School of Nursing
Marilyn Ford-Gilboe, PhD, RN, FAAN, Professor and Women’s Health Research Chair in Rural Health, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University
C. Nadine Wathen, Associate Professor & Faculty Scholar, Faculty of Information & Media Studies, and Research Scholar, Centre for Research & Education on Violence Against Women & Children, Western University


When systems and providers who serve victims of violence lack an understanding of its complex and lasting traumatic impacts, they risk causing further harm. Trauma-informed Care (TIC) seeks to create a safe environment for clients based on an understanding of the effects of trauma, and its close links to health and behaviour. Unlike trauma-specific care, it is not about eliciting or treating people’s trauma histories. Trauma- and violence-informed care (TVIC) expands the concept of TIC to account for the intersecting impacts of systemic and interpersonal violence and structural inequities on a person’s life (Elliott et al., 2005). This shift is important as it brings into focus both historical and ongoing interpersonal violence and their traumatic impacts and helps to emphasize a person’s experiences of past and ongoing structural violence so that problems are not seen as residing only in their psychological state (Williams & Paul, 2008);  rather, they also reside in social spaces. Importantly, because TVIC strives to make practices and policies safe, it fosters opportunities for service providers to prevent harm. In this presentation, we discuss the principles of TVIC and explore the added benefits of adopting this perspectives as a foundation for shifting practices and policies. 


Paper 2: “Fostering TVIC in Primary Health Care: Emerging Lessons and Findings from an Organizational Level Intervention”
Presenting author: Marilyn Ford-Gilboe, PhD, RN, FAAN, Professor and Women’s Health Research Chair in Rural Health, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University
Other authors (in this order):
Annette J. Browne, PhD, RN, Professor, University of British Columbia School of Nursing
Colleen Varcoe, RN, PhD, Professor, University of British Columbia School of Nursing
C. Nadine Wathen, Associate Professor & Faculty Scholar, Faculty of Information & Media Studies, and Research Scholar, Centre for Research & Education on Violence Against Women & Children, Western University
Victoria Smye RN PhD, Associate Professor of Nursing, Faculty of Health Sciences, University of Ontario Institute of Technology

 
EQUIP is a complex intervention designed to enhance the capacity of primary health care (PHC) organizations to address the health consequences of discrimination and structural and interpersonal violence by shifting practices and organizational policies and processes. Facilitated by a practice consultant, EQUIP integrates education on equity-oriented care, trauma- and violence-informed care, and cultural safety, along with ‘Organizational Integration and Tailoring’, in which clinics select, implement and evaluate local changes to enhance care (Browne et al., 2015).  In a multiple-case study, we are testing EQUIP in four PHC clinics serving patients living in marginalizing conditions. To evaluate process and impacts, we are drawing on different types of data collected before, during and after the intervention at various intervals including: surveys of staff knowledge, attitudes and practices; in-depth qualitative interviews with staff and key stakeholders, and detailed practice consultant reports to track the process of change and factors shaping it; and structured interviews with a cohort of 567 patients to assess their experiences of health care and selected health outcomes. We will describe the EQUIP intervention in relation to TVIC to address what was implemented, emerging findings about impacts and implications for fostering TVIC in “real world” clinical settings. 

 
Paper 3: “The VEGA (Violence, Evidence, Guidance, Action) Project: A Public Health Response to Family Violence”
Presenting author: C. Nadine Wathen, Associate Professor & Faculty Scholar, Faculty of Information & Media Studies, and Research Scholar, Centre for Research & Education on Violence Against Women & Children, Western University
Other authors (in this order):
Harriet MacMillan, MD, MSc, FRCPC, Professor, Departments of Psychiatry and Behavioural Neurosciences, and of Pediatrics, Offord Centre for Child Studies, McMaster University
Marilyn Ford-Gilboe, PhD, RN, FAAN, Professor and Women’s Health Research Chair in Rural Health, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University
Colleen Varcoe, RN, PhD, Professor, University of British Columbia School of Nursing


Family violence is a major public health problem with devastating effects on individuals, families, and society.  The VEGA project is developing national, evidence-based public health guidance and education to enable health and social service professionals to provide safe, compassionate and integrated care for those exposed to family violence. Funded by the Public Health Agency of Canada, one of VEGA’s key deliverables is to develop educational tools based on principles of trauma- and violence-informed care (TVIC), integrating issues of equity with respect to race, ethnicity, culture, ability and gender and appropriate for adaptation and implementation by different provider groups and in various settings. Using an integrated knowledge translation model, a National Guidance and Implementation Committee (NGIC) representing22 Canadian health and social service professional organizations provides overall guidance and assists with testing of educational strategies and development of metrics and dissemination approaches. This presentation will introduce VEGA, provide an overview of activities to date, and set the stage for discussion of how TVIC principles are being used to develop family violence guidance that leads to care encounters that area positive and safe, including through specific engagement strategies to ensure participation from NGIC members from initial stages and through project completion.

Learning Objectives:

  1. To describe the theoretically grounded concept of trauma- and violence-informed care (TVIC), distinguish it from trauma-informed care, and explain what this concept adds to current thinking and practice.
  2. To describe how the EQUIP Intervention engaged primary health care organizations in adopting TVIC as part of a focus on equity-oriented care, and highlight research findings about the impacts of this intervention at staff and organizational levels.  
  3. To introduce the VEGA (Violence, Evidence, Guidance, Action) Project and discuss how the principles of TVIC are being used to inform the development and uptake of national guidance and educational tools in the area of family violence for health and social services providers. 

Vicki Smye, Marilyn Ford Gilboe and Nadine Wathen

12:00 - 1:15pm

Lunch (provided) & Poster Session
VC Foyer

1:15 - 2:15

Keynote Address:
Treating the Complexities of Complex Trauma: Integrated and Evidence-Based Treatment Approaches

Treating the Complexities of Complex Trauma: Integrated and Evidence-Based Treatment Approaches
Presenter: Christine A. Courtois, PhD, ABPP
Presentation Format: Workshop
Skill Level: All
Abstract:
Complex trauma is the result of repetitive and layered forms of attachment trauma and childhood abuse, along with other forms of prolonged and repetitive trauma. The aftereffects are themselves complex and span neurobiological, psychological, interpersonal, and spiritual domains. They can have lifelong impact or can appear periodically in rather disguised form. This presentation will provide an overview of aftereffects and their associated diagnoses, with emphasis on their neurobiological and dissociative aspects. A sequenced treatment that extends beyond the treatment of posttraumatic symptoms has received consensus support but is being questioned by some who instead recommend the early application of evidence based trauma-focused treatment. This presentation will focus on the need for integrated care and collaboration between therapist and client. The treatment is founded on a solid and trustworthy relationship between client and therapist to provide a catalyst and a container for therapeutic issues to be addressed.
Learning Objectives:

  1. Attendees will be able to describe dimensions of complex trauma.
  2. Attendees will be able to describe several aftereffects of complex trauma.
  3. Attendees will be able to outline the sequence of treatment for complex trauma and identify components of integrated care.
  4. Attendees will be able to identify several types of evidence-based trauma-focused treatments.

Christine A. Courtois, Ph.D., ABPP

2:15 - 2:30pm

Q&A Session

2:30 - 2:45pm

Refreshment Break

2:45 - 4:00pm

Concurrent Session #2
 

Networking Session
Room VC115

Advocating for Trauma Care: We know we need it but how do we get it?

Title: Advocating for Trauma Care: We know we need it but how do we get it?
Presenter: Jennifer Chambers
Presentation Format: Networking Session
Skill Level: All

Abstract: The importance of trauma care is in competition with other models and types of mental health care. This workshop will be about how to advocate effectively for trauma services. Community development - coming together and finding a voice - is an essential first step. Next are the strategies for influencing decision makers. It will also be an opportunity for trauma champions (or those who aspire to be) to network for mutual support. Participants are invited to bring the particulars of the arena they seek to influence for discussion and brainstorming.

Learning Objectives:

  1. Participants will know how to organize for change.
  2. Participants will have a myriad of strategies for influencing decision makers.
  3. A network for supporting trauma service development will be created.

Jennifer Chambers

Workshop A
Room NF007

Viewing DSM-5 Through a Trauma Lens

Viewing DSM-5 Through a Trauma Lens
Presenters:  Cassandra L Bransford, PhD, LCSW and Ruth A. Blizard, PhD
Presentation Format: Workshop
Skill Level: All
Abstract: Decades of research have documented the salient role of trauma in the etiology of many forms of psychopathology. Despite this, little is said about the role of trauma in most of the diagnostic categories in the DSM-5 (APA, 2013), beyond the updated and expanded section on Trauma and Stress Related Disorders. Graduate programs have been slow to make content on trauma a centerpiece of professional education (Courtois & Gold, 2009), and many practitioners have not received post-graduate training in trauma assessment and interventions (Cook & Newman, 2014). Given the shortage of mental health professionals trained in trauma-informed care, it is imperative that both students and practitioners become competent in trauma-based assessments and interventions with clients from a wide range of psychiatric diagnoses. This presentation will illustrate how trauma can impact functioning and produce symptoms similar to a range of DSM-5 diagnoses that do not currently specify trauma as a risk factor, including borderline personality, substance abuse, and panic disorder. Research and clinical vignettes will be used to illustrate how to conduct a trauma-informed assessment and arrive at a differential diagnosis between post-traumatic syndromes and disorders that are assumed to have a biological basis, such as ADHD, major depression and schizophrenia.
Learning Objectives:

  1. Participants will be able to demonstrate key components of a trauma assessment.
  2. Participants will be able to list trauma-based symptoms.
  3. Participants will be able to describe traumatic etiology that may lead to specific symptom-constellations.

Cassandra L Bransford, Ph.D., LCSW and Ruth A. Blizard, Ph.D.

Workshop B
Room VC101

Yoga and the Treatment of Trauma

Yoga and the Treatment of Trauma
Presenters: April  Stirling RSW 200RYT 100hr Warrior and Bob Chuckman MSW (Candidate)
Presentation Format: Workshop
Skill Level: All
Abstract:  This interactive workshop provides an opportunity to understand the neurobiological impact of early and repeated trauma.  It is a hands on experience of trauma informed yoga, which will be demonstrated within the experience provided. The format of the co-led workshop itself, includes the five principles of Trauma Informed Care.  Thus, participants will gain strategies, along with an actual experience of a short yoga practice that is designed to benefit trauma survivors. In her psychotherapy practice, April Stirling specializes in the treatment of trauma.  Trauma informed yoga has proved of great benefit to her many clients.  If we are going to heal trauma, as opposed to mask symptoms, we must expand our understanding of what the symptoms mean. Robert Chuckman is a social worker in clinical practice in addictions and mental health in the Toronto area with extensive trainings and practice in gender responsive trauma treatment for men. We understand the symptoms of trauma as, in part, the body’s way of telling the story.  From this standpoint, options for treatment and healing expand beyond traditional approaches.  Our workshop is based on the works of Peter Levine, Bessel van der Kolk, Stephen Porges, and David Emerson. *Participants are encouraged to dress in easy to move clothing and bring a towel if possible.
Learning Objectives:

  1. Participants will be able to describe the neurobiological impact of trauma.
  1. Participants will experience the healing benefits of yoga.
  2. Participants will be able to apply the practice of yoga to help treat trauma.

April Stirling RSW 200RYT 100hr Warrior and Bob Chuckman MSW (Candidate)

Workshop C
Room NF006

Advocating For Trauma-Informed Circles of Care in Working with Youth Survivors of Torture and War

Advocating For Trauma-Informed Circles of Care in Working with Youth Survivors of Torture and War
Presenter:
Amy Soberano, MSW, RSW, Child and Youth Counselor and Nadia Umadat, MSW, RSW, Child and Youth Settlement/Trauma Counselor
Presentation Format: Workshop
Skill Level: All
Abstract: Youth survivors of torture and war who seek asylum in Canada have not only endured extreme pre-migration trauma, but also often experience interpersonal and systemic violence in their processes of fleeing abuse and seeking safety in a new country (Drachman, 1992; Bartolomei, Eckert & Pittaway, 2014; Birman et al., 2005). The impacts of such pervasive marginalization are complex, and intersect in a myriad of ways with other markers of identity once in Canada such as race, immigration status, age, language, socioeconomic status, and sexuality to produce multilayered barriers to navigating the settlement process. Adopting a trauma-informed lens is not only critical to ensuring access to meaningful service provision, but integral to resisting structures of violence which further disempower marginalized communities who are already dispoprtionately more likely to experience trauma (Blanch, 2008).  As Counselors at the CCVT we are routinely forced to advocate alongside the youth we work with for a trauma-informed approach to social service delivery across a range of institutional structures.
Learning Objectives:

  1. Understanding the impact of pre-migration and migration trauma, including torture and war, on youth settlement and rehabilitation.
  2. Identifying post-migration challenges, related to navigating social services as a newcomer youth.
  3. Identifying best practices in advocacy work with newcomer youth, using anti-oppressive and collaborative frameworks.

Amy Soberano, MSW, RSW, Child & Youth Counselor and Nadia Umadat, MSW, RSW, Child & Youth Settlement/Trauma Counselor

Paper Session A
Auditorium

Making the Invisible Visible

Paper Session A.1 - Stepping Outside the Treatment Box: Using Autoethnographyas Therapy for Trauma

Stepping Outside the Treatment Box: Using Autoethnography as Therapy for Trauma 
Presenters: Dr. Colleen McMillan, Renison University College, University of Waterloo and  Dr. Helen Ramirez, Women and Gender Studies, Wilfrid Laurier University 
Presentation Format: Single Paper
Skill Level: All
Abstract: Our paper challenges the Western clinical treatment modality to address trauma resulting from an automobile accident as the preferred method of healing.  Framed by feminist theory that research can also be a therapeutic process (Park-Fuller, 2000) the authors used a feminist informed auto-ethnographic approach to identify and deconstruct oppressive practices embedded in the evidence-based medical approach to trauma.
Methods: A feminist framed auto-ethnographic (Ellis &Bochner, 2000) approach was used during the 24 month period in which the combined therapy/ research took place.
Findings: Writing from the standpoint of the therapist and the patient, the authors come to the finding that the act of healing cannot be private, for risk of perpetuating current discourses of shame associated with trauma. Only through intentional transparency can oppressive genderized and structural systems that are ignored by medical approaches be made visible(Reed-Danahay, 1997).  As such, the authors advocate for actual names, locations and events to be used.
Conclusions: Approaching trauma from a traditional clinical modality represents a false boundary by severing off the social/cultural/political contexts that inform how an individual interprets their experience. Framing treatment with auto-ethnographic methodology can allow for a deeper, more meaningful and holistic exploration of a traumatic event.
Learning Objectives:

  1. To demonstrate how the research method of autoethnography holds potential to be an effective healing approach for trauma. 
  2. To model how the client/therapist relationship can collaboratively confront larger systemic oppressive processes toward a deeper form of healing.

Dr. Colleen McMillan and Dr. Helen Ramirez

Paper Session A.2 - My Body, My Choice: Speaking the Unspoken by Writing in the Flesh

My Body, My Choice: Speaking the Unspoken by Writing in the Flesh
Presenters: Deborah Davidson, Associate Professor and Mandi Gray, PhD, Candidate, York University, Department of Sociology
Presentation Format: Single Paper
Skill Level: All
Abstract: Fraught by silence and misrepresentation, for the traumatized, “the greatest confrontation with reality may also occur as an absolute numbing to it (Caruth, 1995, p. 6)”. Tattoos serve as a way to embody experiences and emotions which may be so intense as to defy spoken language. Like trauma, tattoos are wounds, albeit wounds controlled by choice, rendering the wound into something restorative and, unlike self-harm, socially acceptable. Tattoos, in their use of the body as of a surface for text (MacCormack, 2006), as a form of public storytelling (Crossley, 2006), as graffiti for the soul (Sullivan, 2009), are used to articulate trauma, reclaim and reframe experience. Our purpose is to inform trauma care, to describe, illustrate, and reflect on trauma as an embodied experience, and on the commemorative tattoo as an empowering artifact of trauma. We do so by presenting an overview of the literature along with illustrations through visuals and accompanying narratives. Further, we reflect on the capacity to remake meaning, and on tattoos as one means to integrate trauma into one’s life in a way that demonstrates “the choice of what happens to [one’s] body (Inckle, 2016, citing Jeffreys 2000, p. 423).”
Learning objectives:

  1. To develop an understanding of trauma as an embodied experience.
  2. To analyze the place of commemorative tattoos as visual representations of trauma and resilience.
  3. To reflect on one’s own practice with persons who have experienced trauma in relation to ‘choice.’

Deborah Davidson, Associate Professor and Mandi Gray, Ph.D. Candidate

Paper Session A.3 - Addressing Domestic Sex Trafficking Through a Trauma Informed Lens

Addressing Domestic Sex Trafficking  Through a Trauma Informed Lens
Presenter: Carly Kalish, MSW, RSW – East Metro Youth Services
Presentation Format: Single Paper
Abstract: Domestic Sex Trafficking occurs when individuals are recruited, or, coerced into working in the sex-trade by means of exploitation through threat of their physical, psychological, and emotional being.  It is an issue that has become a growing concern within Canada affecting young women and girls entering adolescence who are both emotionally and financially marginalized. This presentation will explore the issue of domestic sex trafficking. It will detail the comprehensive system of psychological manipulation used by traffickers to lure their victims into the sex trade and to keep them in it.  It will explore the various individual and systemic risk factors that contribute to making the population of young women most vulnerable to becoming trafficked. It will describe the ways in which traumatic experiences effect psychological, emotional, and neurological development and how this affects an individual’s vulnerability to becoming trafficked into the sex trade.  Lastly, the presentation will explore trauma based interventions specific to the population.
Learning Objectives:

  1. List specific strategies and interventions to engage and treat domestic human trafficking from a trauma based perspective.
  2. Demonstrate the relationship between trauma and emotional vulnerabilities connected to human trafficking.
  3. Develop competencies in recognizing victims of domestic sex trafficking and in addressing their needs for practitioners across.

Carly Kalish, MSW, RSW

Paper Session B
Room NF004

Addressing the Needs of Vulnerable Families

Paper Session B.1 - Looking Back- Looking Forward: An Intergenerational Trauma-Informed Maternal-Infant Therapy Group

Looking Back- Looking forward: An Intergenerational Trauma-informed Maternal-Infant Therapy Group
Presenters: Diane de Camps Meschino MD
Presentation Format: Single Paper
Skill Level: All
Abstract:  Purpose: Mothers with experience of childhood interpersonal trauma often their struggle with interactions with their infants, mood, anxiety, and affect regulation. Interactions may perpetuate intergenerational trauma, impairing infant attachment, maternal mood and parenting.
Methods: Two hour groups with 6 mothers-infant pairs for 12 weeks include:1. Individual interviews determine the impact of childhood interpersonal trauma and a formulation is given to each participant. 2. Trauma informed therapy techniques to improve affect regulation, depression, and anxiety are taught and practiced. 3.Emotional and cognitive insights are gained via group reflections on parenting style and attachment style (simultaneously looking at family of origin and infant interactions). Watch Wait and Wonder(infant play therapy) further reveals projections onto infant. Group therapy processes insights and emotional reactions. 4. Mentalizing-based parenting knowledge and skills are taught and practiced as alternatives to repetition of unwanted parenting experiences. Outcomes were assessed via questionnaires, semi-structured interviews, and pre- and post-treatment measures, Results: The feasibility and acceptability were excellent. Depression symptoms scores decreased (sig);Anxiety scores decreased; and total Parenting Stress Index decreased. Surveys and interviews revealed enhanced insight, parenting capacity, affect regulation, and positive maternal-infant interactions. It is possible to reduce intergenerational trauma during an infant’s first year.
Learning Objectives: 

  1. Describe the potential impact of mothers’ Adverse Childhood Experiences (trauma), depression, and anxiety on mother-infant interactions and infant outcomes.
  2. List the interventions used in a novel maternal infant group intervention
  3. Describe the benefit of combining family of origin and mother-infant reflection interventions with parenting skills to strengthen maternal insight, mentalizing capacity and parenting behaviours.

Diane de Camps Meschino MD

Paper Session B.2 - Mothering While Homelessness: Intersecting Sites of Exclusion, Trauma, and Resistance

Mothering While Homelessness: Intersecting Sites of Exclusion, Trauma, and Resistance
Presenter: Sarah Benbow RN PhD, Professor, School of Nursing, Faculty of Health Sciences, Human Services and Nursing, Fanshawe College, London ON
Presentation Format: Single Paper
Skill Level: All
Abstract: Mothers experiencing homelessness experience multiple and compounding trauma(s). The purpose of this study was to critically examine the socio-political context, health needs, exclusionary and inclusionary forces, and strategies of resistance demonstrated by mothers experiencing homelessness. This critical narrative study was informed by the theoretical perspective of intersectionality. Data were collected at various homeless shelters and programs that provide services for women and mothers who are homeless in Southern Ontario. Based on research findings, participants troubled the notion of receiving adequate “care” within a system that inherently excludes them. That is, participants noted the systemic discrimination and stigma they experienced across and within multiple health and social sectors. Further, participants made note of the never-ending and compounding trauma(s) they experienced throughout their lives and while homeless, even once acute crises were overcome.  Findings suggest that services, including trauma-informed services ,are limited in comprehensively addressing the needs of mothers experiencing homelessness. Rather, a paradigmatic shift to support systemic trauma-informed policies, practice, and overall philosophy of care is needed. Within such a shift, attention must be paid to the incredible acts of resistance enacted in response to trauma(s), as well as the exclusionary practices preventing necessary access to services.
Learning Objectives:

  1. To describe the intersecting sites of exclusion and trauma in the lives of mothers experiencing homelessness.
  2. To identify how resistance can be understood as a strength in providing care to those who experience social exclusion and trauma.
  3. To examine systemic barriers and facilitators to enacting trauma-informed care to all populations.

Sarah Benbow RN Ph.D.

Paper Session B.3 - Capacity Building and Therapeutic Consultation for Children and Families with Histories of Complex Trauma in Rural, Remote, and Underserviced Canadian Communities through Tele Mental Health Services

Capacity Building and Therapeutic Consultation for Children and Families with Histories of Complex Trauma in Rural, Remote, and Underserviced Canadian Communities through Tele Mental Health Services
Presenters: Susan Dundas, MD, FRCPC, Psychiatrist with the TeleLink Mental Health Program at The Hospital for Sick Children, Janine Lawford, MSW, RSW, Social Worker with the TeleLink Mental Health Program at The Hospital for Sick Children, David Willis, PBMD, MBA, Program Manager with the TeleLink Mental Health Program at The Hospital for Sick Children,  and Jaclyn Kerr, HBSc, Research Coordinator with the TeleLink Mental Health Program at The Hospital for Sick Children
Presentation Format: Single Paper
Skill Level: Intermediate
Abstract: Purpose: The TLMHP has provided psychiatric assessment to underserviced communities in Ontario for 15 years and recently in Nunavut.  Initially, a consultative model of service was created to meet clinical needs. However, it became apparent that this model was not adequate to service children presenting with complex trauma histories and a new multidisciplinary therapeutic consultation model and team were developed to address these emerging needs. Method: Children with presenting histories of acute traumatic incidences or ambient developmental trauma are triaged to this team. Subsequent consultations involve an expert psychiatrist and social worker who provide therapeutic trauma-focused consultation and recommendations for intervention. Clinical capacity building needs are also identified and relevant members of the child’s systems may participate in a variety of capacity building experiences. After each consultation, diagnostic/epidemiological information is collected.
Findings:347 consultations (initial and follow up) have occurred between 2010 and 2014 and have been examined and analyzed for epidemiological patterns. Conclusions: In enhancing the knowledge base of service providers and families with histories of trauma, as well as developing culturally sensitive practices and knowledge for working with remote communities and ongoing comprehensive qualitative research, this team works towards a bilateral knowledge transfer that is viable and self-sustaining. 
Learning Objectives:

  1. To illustrate the development of the Complex Developmental Trauma multidisciplinary model of therapeutic consultation, capacity building, teaching, and knowledge transfer.
  2. To demonstrate the epidemiological pattern that has emerged in children and youth with Complex Developmental Trauma within rural, remote, and underserviced communities in Ontario. 
  3. To develop culturally sensitive practices, increase bilateral transfer of knowledge, and discuss implications regarding professional competencies and training requirements of practitioners consulting to rural and remote communities which service children with Complex Developmental Trauma.

Susan Dundas, MD, FRCPC, Janine Lawford, MSW, RSW, David Willis, PBMD, MBA, and Jaclyn Kerr, HBSc,

Panel A
Room NF008

Becoming Trauma-Informed Social Work Educators

Becoming Trauma-Informed Social Work Educators
Presenters: Janice Carello, LMSW, PhD Candidate, University at Buffalo, Molly R. Wolf, LMSW, PhD, Assistant Professor, Edinboro University of Pennsylvania, and  Elaine S. Rinfrette, RN, MSW, PhD, LCSW-R, LSW, Assistant Professor/MSW Program Director, Edinboro University of Pennsylvania
Presentation Format: Panel Discussion
Skill Level: All
Abstract: Despite movement toward a trauma-informed approach to healthcare, human services, and K-12 education, this shift has been slow to occur in higher education, including programs that train professionals for clinical practice. As social work professionals, we understand the need to work from a trauma-informed perspective. As educators, we experienced this need and use it as an educational model as well. By utilizing a ‘what happened to you’ perspective over a ‘what’s wrong with you’ perspective, we have been able to work with our students and fellow educators in a different way than before. During this panel, we will a) present our rationales for becoming trauma-informed educators, b) describe the processes by which we are becoming more trauma-informed in our approaches to teaching, and c) explore the methods we have been using to advocate for trauma-informed educational practices. 
Learning Objectives:

  1. Identify reasons to adopt a trauma-informed approach to teaching.
  2. Describe processes for developing trauma-informed educational policies and practices.
  3. Describe methods for advocating for trauma-informed educational policies and practices.

Janice Carello, LMSW, Ph.D, Candidate, Molly R. Wolf, LMSW, PhD and Elaine S. Rinfrette, RN, MSW, Ph.D., LCSW-R, LSW

4:00pm

Closing Remarks
*Please note agenda subject to change
 

Location

University of Toronto
Northrop Frye Hall
73 Queen's Park Crescent East
Toronto ON
Canada
M5S1K7

Women's College Hospital