Transcript Slide 1

WOMEN, TRAUMA, AND
SUBSTANCE USE
Trauma-informed Practices In
Substance Use Services For Women
Addictions & Mental Health Annual Conference
May 27, 2013
Nancy Bradley, Jean Tweed Centre
Janine Gates, Gates Consulting Inc.
Session Objectives: he Webinar
The critical role of trauma-informed
practices in services for substance-involved
women
2. The core principles and central concepts of
trauma-informed practices
3. The guidelines for trauma-informed
practices that have been developed
through a federal (Drug Treatment Funding
Program)
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“Trauma is a public health risk of major
proportions… Moreover, it often compounds
medical and psychological conditions and injuries.
This information too often goes unrecognized or
under-recognized by medical and mental health
practitioners.
We have a major education, prevention and
intervention issue.”
Christine Courtois,
Trauma Talks Conference. Toronto, 2012
Why is trauma an important issue?
Experiences of trauma are common among
substance-involved women
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In three Canadian studies, over 80% reported histories of
trauma
Numerous U.S. studies have found a high prevalence of
trauma
Research has demonstrated connections between trauma
and an array of health issues
Interconnections with substance use – both as a
precipitator and as a risk factor
“trauma is the rule, rather than the exception”
Why is trauma an important issue?
Trauma affects the whole women - the impacts are broad
and diverse:
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Health risk behaviours, coping mechanisms
Psychological and cognitive adaptations
Myriad health problems
Trauma responses are individual and variable
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an interweaving of physical impacts and emotional
adaptations
can be acute, chronic and/or delayed
are not determined by the event(s), but by a woman’s
experience of the event(s)
Why trauma-informed practices?
Without knowledge of trauma – its prevalence, its
impacts, and its interconnections with substance
use - service providers are at risk of:
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Misinterpreting behaviour
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Inadvertently using practices that trigger or
retraumatize women
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Providing ineffective services or interventions
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Limiting engagement, higher drop-out, or
unnecessary discharge
Why trauma-informed practices?
Women who have lived experience told us about
many gaps and barriers they encountered in
Ontario substance use services.
A few examples:
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“The assessment agency didn’t ask about trauma.”
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“I felt like there was a big elephant in the room and
no one was naming it.”
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“In a case conference they said they suspected I was
abused as a child...no one asked me if I was abused
and if it was OK to talk about it. I felt revictimized.”
Why trauma-informed practices?
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“There were times when I was having flashbacks
…I was told to just focus on my addiction.”
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“Being in co-ed facilities retraumatized me. I
suffered a lot of abuse and it was too difficult
hearing the stories from men - a lot who were
abusers.”
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“There needs to be a program to include children
and to re-affirm to children that they are okay.
To be able to get tools with a trauma focus and
to help the kids through it as well.”
Defining Trauma
Trauma can be precipitated by a wide range of
experiences and events, and occur at both individual
level and collective levels.
Traumatic events are more than merely stressful – they
are also shocking, terrifying, and devastating to the
victim, resulting in profoundly upsetting feelings of
terror, shame, helplessness, and powerlessness.”
(Courtois, 1999)
Traumatic experiences are unique and individual.
Experience may be influenced by an array of factors.
Defining Trauma
“ The actual experience (of trauma)… and the
assault that experience poses to sense of self,
safety, belonging, and connection ,
are intertwined.”
Kammerer & Mazelis, 2006
“Trauma is the sum of the event, the experience,
and the effect.”
SAMHSA , 2012
Trauma-informed practices
Trauma informed care is:
“a strength based framework that is grounded in
an understanding of and responsiveness to the
impact of trauma, that emphasizes physical,
psychological and emotional safety for both
providers and survivors, and that creates
opportunities for survivors to rebuild a sense of
control and empowerment.”
Coalescing on Women and Substance Use
Trauma-informed practices
How are trauma-informed practices different
from trauma-specific services?
Programs and services that are trauma-specific:
 Can include a range of service and interventions
that focus directly on the impact of trauma, and
on trauma recovery;
 Are often delivered using evidence-based models
or approaches (e.g. Seeking Safety);
 Are delivered by practitioners who have extensive
knowledge and skills in trauma treatment.
Trauma-informed practices
Organizations - and their staff:
REALIZE the prevalence of trauma
RECOGNIZE how trauma affects everyone
involved with the organization (including its
own workforce)
RESPOND by putting that knowledge into
practice
Trauma-informed practices
A change of perspective…
from:
What is wrong with this woman?
to:
What has happened to this woman?
“It wasn’t until I got here that I
realized that substances helped
me to hide my trauma.”
(focus group participant, Ontario, 2012)
Trauma-informed practices
Should be universal
 They should be used with every women, whether
or not experiences of trauma have been
disclosed
Should be integral
 They should be integrated into the organization’s
culture, and braided with current practices, so
that every interaction (verbal and non-verbal) is
trauma-informed
Trauma-informed practices
Should be used throughout an organization, to
inform its:
Values and priorities,
 Planning and strategies
 Programs and services,
 Policies and practices,
 Human resources, training, and supervision
 Infrastructure and site development
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Trauma-informed practices
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Should seek and use the input of women who
have lived experience
Should recognize the full spectrum of women’s
experience, and go ‘hand in hand’ with:
 Gender-appropriate services for women
 Anti-oppression approaches
 Culturally competent organizations and
staff
 Other system tools that reflect best
practices
Trauma-informed practices
Six key principles:
 Acknowledgement
 Safety
 Trustworthiness
 Choice and control
 Relational and collaborative approaches
 Strengths-based empowerment
modalities
Trauma-informed practices
Examples
Acknowledgement
 Show an understanding of the relationship of
trauma and substance use in written materials.
 Implement universal screening.
Safety
 Minimize triggers and reduce retraumatization
 Identify safety issues and work with women to
make safely plans
Trauma-informed practices
Examples
Trustworthiness
 Make sure that information is clear and that
all of a woman’s questions are answered;
explore her comfort level with the process.
Choice and control
 Review options and ask women’s opinions;
support a woman’s role as an expert and an
active agent in her own recovery
Trauma-informed practices
Examples
Relational and collaborative approaches
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Work collaboratively with a woman, and think
‘outside the box’ of ‘treatment as usual’ when
helpful
Strengths based and empowerment
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Focus on a woman’s resilience; reframe
trauma-related behaviors and mechanisms;
identify and celebrate changes and victories
Universal Screening for Trauma
Can help to communicate validation and hope;
Can invite a woman to acknowledge trauma, and it’s
potential impacts;
Can improve quality of services by:
 Setting the stage for treatment planning and referrals
 Flagging current safety concerns
Screening for trauma requires skill, sensitivity, and
flexibility:
 Can trigger spontaneous disclosure, or emergence of
trauma-related symptoms
 Should not be intrusive, and should be paced
Who should implement
trauma-informed practices?
All organizations where women receive substance
use services :
 In both women-only and mixed gender
environments
 In all service types – ranging from early
engagement, assessment, and withdrawal
management to residential and community
treatment
 In services for women who have concurrent
mental health issues
Pathways to Trauma-Informed Practices
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Shift in organizational culture
Formal organizational commitment
Leadership to support change
Training for all staff
Assessment of programs, services, and
organizational practices through a ‘traumainformed lens’
Clinical supervision and consultation
Monitoring, evaluation, and ongoing positive
change
Vicarious Trauma
Impacts on staff who are indirectly
exposed to trauma
 Reducing risks of vicarious trauma
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practices that recognize risks
and provide support and resources
 Staff practices that incorporate awareness
and self-care
Guidelines for Trauma-Informed
Practices in Women’s Substance Use
Services
Guidelines for the system
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Federal (DTFP) grant to develop provincial guidelines
for trauma-informed practices
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The document – Trauma Matters :
 Has been developed by a project team, managed
by the Jean Tweed Centre
 Was guided by an Advisory Committee comprised
of service providers, funders and policy makers,
and knowledge exchange specialists
 Informed by the input of women who have lived
experience
Guidelines for the system
Trauma Matters will provide:
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Information about the prevalence and impacts
of trauma among substance-involved women
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Guidelines and practical strategies for traumainformed clinical and organizational practices
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An overview of trauma-specific services
Information about resources for further
learning
Guidelines for the system
How the Guidelines were developed:
 Advisory Committee and Terms of Reference
 Request for proposals
 Selection process
 Project team hired to research and develop the
guidelines, and write the document
Guidelines for the system
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Evidence collected from:
◦ Academic and research literature,
◦ The grey literature – government reports, policy
documents,
◦ Subject area experts - specialist knowledge of
women’s substance use and trauma,
◦ Women who have lived experience of problematic
substance use and trauma.
Draft guidelines developed - appropriate to the Ontario
substance use service system.
Extensive review of multiple drafts by Advisory
Committee and other subject area experts.
Guidelines for the system
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Intended for use in Ontario substance use services
Must be braided with existing programs and with
expertise of specialized services (e.g. for youth,
Aboriginal and Native people, immigrant and refugee
services, etc.)
May also be of help to:
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Other services that work with substance involved women
(mental health, primary health care, child welfare, VAW,
justice system, etc.)
Policy makers, service and system planners, and funders
Should be used as the beginning of a learning process
about trauma and trauma-informed practices
Guidelines for the system
Trauma Matters is available on-line, as of
March 31, 2013 at:
www.jeantweed.com
www.ofcmhap.on.ca
eenet.ca
• And now posed on many other
websites
When we use trauma-informed care,
we respond to the need to heal from trauma
and help to facilitate recovery.
Coalescing on Women and Substance Use
What women have told us about
their experiences in
trauma-informed services…
“Staff recognized it first...
I was having flashbacks…”
“When I got triggered [and had a trauma reaction]
it was helpful to be able to reflect on what was
happening with me….
not getting into all the details and staying in the
present moment during sessions was really
helpful.”
(focus group participant, Ontario, 2012)
“I learned skills in how to help yourself when you
can’t really pin point what you are feeling and
going through.
I find that empowering and very helpful because
they are skills I can take with me.”
(focus group participant, Ontario, 2012)
“They always had blankets, that was really helpful, I
feel like I need to cover up or something, I don’t
want anyone looking at me, because of the
trauma of it, I just need something there, even if
it’s just my coat. I remember my counsellor’s
office, there was a couch and a pillow and a
blanket, and I always took the blanket because I
didn’t want anyone to see my face while I was
talking. It really, really helped.”
(focus group participant, Ontario, 2012)
“Eventually I learned to nurture myself and
to have a safe little spot in my home
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when I’m feeling vulnerable… I am able to
nurture myself.”
(focus group participant, Ontario, 2012)
“The most important thing is validation.
Validation. Validation. Validation.
And the acknowledgment of the things we
have been through and why we have
done the things we have done. Just
how it is all linked.”
(focus group participant, Ontario, 2012)
Presenter Contact Information
Project Manager:
Nancy Bradley, Executive Director,
The Jean Tweed Centre
416-255-7359
Email: [email protected]
Project Team Lead:
Janine Gates, Gates Consulting Inc.
613-547-8478
Email: [email protected]
Advisory Committee Members
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Debbie Bang - Womankind Addiction Service
Nancy Bradley - Jean Tweed Centre
Gloria Chaim - Child, Youth and Family Program, CAMH
Robin Cuff - Toronto Drug Treatment Court Program, CAMH
Lucy Hume - Jean Tweed Centre
Kathryn Irwin-Seguin - Iris Addiction Recovery for Women
Paul McGary - Pinewood Centre, Lakeridge Health
Pam McIntosh - House of Friendship
Carol Wu - Amethyst Women’s Addiction Centre
Heather Bullock - Evidence Exchange Network, CAMH
Stephanie Gloyn - Evidence Exchange Network, CAMH
Julia Greenbaum - Knowledge and Innovation Support, CAMH
Kathy Kilburn - Kilburn Consulting, Health Systems
Danielle Layman-Pleet - Ministry of Health and Long Term Care
Jessica Penner - DTFP Project Coordinator, CAMH
Project Team
Gates Consulting Inc.
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Janine Gates
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Wendy Reynolds (AWARE )
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Lucy Van Wyk (Therapist in Private Practice)
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Jennifer Amos (Researcher and Editor)
Questions?
Comments?