Transcript The Role of Trauma Informed Care in Decreasing Relapse and

OVERDOSE SOLUTIONS 2013
THE ROLE OF TRAUMA INFORMED CARE
IN DECREASING RELAPSE AND OVERDOSE POTENTIAL
Amy Buehrer, LSW
Vice President of Clinical Services and Chief Compliance Officer, Pyramid Healthcare, Inc.
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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
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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).
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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
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Emotional/Developmental age or
“stuckness”
Defense mechanisms/inappropriate
behaviors
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Disruptive behaviors
Poor frustration tolerance
Depression/withdrawal
Apathy/loss of interest in goals
Anxiety/worry
Poor concentration or focus
Fighting
Truancy
Substance abuse/dependency
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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Sexually Promiscuous or Withdrawn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
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Every time something painful happens, we
push it behind “The Wall”
◦ “Sore spot” (nerve endings, buttons)
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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
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I am unsafe
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I am unlovable
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I am no good
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I can’t trust people
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The world is bad
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I am a terrible person
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It is all my fault
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Purpose:
◦ Create SAFE environment
◦ Teach discipline & external structure until
internalized
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Program Structure
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Schedule
Rules
Expectations re: Behavior & Interactions
Accountability
 Sanctions/Consequences
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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 retraumatization.
Recognizes that most inappropriate behaviors are the learned
behavior of past experiences
http://mentalhealth.samhsa.gov/nctic/trauma.asp
◦ 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
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Developed by Ricky Greenwald
◦ EMDR Within a Phase Model of Trauma-Informed Treatment, The Haworth Press, 2007
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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”
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Staff maintains “groundedness” & stability in face
of chaos & conflict – avoids personalization &
reactivity
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
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Safety
◦ Introduce rules/expectations
◦ Conditions of confidentiality
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Structure
◦ In the parameters of identifying trauma
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Sensitivity
◦ Continual monitoring of how client doing
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Success
◦ Help Ct build track record of success through
achievement of small goals
 The
Grocery List
 Float Back, Meditation
 Resource Installation
 Positive Core Beliefs
 Perceived Threat/Relaxation
 Skill Development
PROGRAM/STAFF Level
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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