overdose solutions 2013 the role of trauma informed care in decreasing relapse and overdose...
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OVERDOSE SOLUTIONS 2013
THE ROLE OF TRAUMA INFORMED CARE
IN DECREASING RELAPSE AND OVERDOSE POTENTIAL
Amy Buehrer, LSWVice President of Clinical Services and Chief Compliance Officer,
Pyramid Healthcare, Inc.
Individuals with a mental health disorder or a substance dependency are stereotyped by the general population
Individuals with co occurring disorders are even more vulnerable
STIGMA
• Over 100 people die from drug overdose every day in the United States (CDC)
• In 2005, relapse rates after some form of treatment rated from 50%-90% • 75% of women and men in substance abuse treatment report abuse and trauma histories (SAMHSA/CSAT, 2000).
Statistics and Trends
DSM-IV defines a “traumatic event” as one in which a person experiences, witnesses, or is confronted with actual or threatened death or serious injury, or threat to the physical integrity of oneself or others.
◦Includes what is real and what is perceived ◦Include a sense of helplessness + fear, horror or disgust◦Is greatly grounded in personal perception
Understanding Trauma
Emotional/Developmental age or “stuckness”
Defense mechanisms/inappropriate behaviors
Understanding Trauma
Disruptive behaviors Poor frustration tolerance Depression/withdrawal Apathy/loss of interest in goals Anxiety/worry Poor concentration or focus Fighting Truancy Substance abuse/dependency
Potentially Trauma-related symptoms & behaviors
Abandonment Self-Esteem/Self-Concept Identity Trust Self-Sabotage Self-Abusive/Self-Harm Isolation/Withdrawal Sexually Promiscuous or Withdrawn Relationship Problems Food/Body/Weight Issues Excessive Spending Power/Control Issues
Other Issues commonly based in Trauma
Every time something painful happens, we push it behind “The Wall”◦ “Sore spot” (nerve endings, buttons)
Sore spot will be triggered when in current situation similar to 1st event
Memory keeps its power indefinitely – until digested/processed
The memories are not content to stay there (start to leak out)
Influences emotional feelings, physical feelings, negative core beliefs
What happens with trauma…
I am unsafe
I am unlovable
I am no good
I can’t trust people
The world is bad
I am a terrible person
It is all my fault
Negative Core Beliefs
Purpose: ◦ Create SAFE environment◦ Teach discipline & external structure until
internalized
Program Structure◦ Schedule◦ Rules◦ Expectations re: Behavior & Interactions◦ Accountability
Sanctions/Consequences
Traditional Behavior Management
Is based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization.
Recognizes that most inappropriate behaviors are the learned behavior of past experiences
http://mentalhealth.samhsa.gov/nctic/trauma.asp
Trauma Informed Care
◦Most who present for MH/CD treatment have experienced one or more traumas
◦Trauma-sensitive treatment significantly increases an individual’s engagement and success in treatment
◦Shift in viewpoint that SA, MH issues and Trauma are intertwined and that abuse of chemicals and MH symptoms are manifestations of untreated trauma.
◦ Source: http://www.wafca.org/trauma_sensitive_care.htm
Trauma-informed Care assumptions:
Developed by Ricky Greenwald◦ EMDR Within a Phase Model of Trauma-Informed Treatment, The Haworth Press, 2007
The Fairy Tale Model
Assumption that all clients have history of trauma Every incident/behavior is viewed as
opportunity for learning/processing vs. negativity/resistance
Staff asks: “What happened?” “What is going on?”
Expectations and interventions ◦ Are stage-specific and individualized◦ Treatment progress is often erratic◦ Balance Empathy and Accountability
“Compassionate Skepticism” Staff maintains “groundedness” & stability in face
of chaos & conflict – avoids personalization & reactivity
Trauma-Informed Treatment
Respect the client as an individual Recognize his/her rights, needs and
opinions Understand & accept his/her behavior
as a learned response to trauma/loss/stress.
Works to help strengthen the client’s self concept and belief system
Addresses negative core beliefs and introduces positive
Acknowledges small accomplishments
Looking at Trauma-Informed Care
Safety◦ Introduce rules/expectations◦ Conditions of confidentiality
Structure◦ In the parameters of identifying trauma
Sensitivity◦ Continual monitoring of how client doing
Success◦ Help Ct build track record of success through
achievement of small goals
Trauma-informed Treatment Basic Principles
Practical Tools
The Grocery List Float Back, MeditationResource Installation Positive Core BeliefsPerceived Threat/RelaxationSkill Development
PROGRAM/STAFF Level Understanding of Trauma & Trauma-Sensitive Care Decreasing Unrealistic expectations re: outcomes Consistency in enforcement of program structure & rules Eliminating Black & White/Either-Or thinking &
decision-making◦ “The LINE”
Staff self-awareness re: own issues◦ Act out & pass on to clients
Trauma-Informed Programming