OVERDOSE SOLUTIONS 2013

THE ROLE OF TRAUMA INFORMED CAREIN DECREASING RELAPSE AND OVERDOSE

POTENTIALAmy Buehrer, LSW

Vice 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Identity Trust Self-Sabotage Self-Abusive/Self-Harm Isolation/Withdrawal Sexually Promiscuous or Withdrawn Relationship Problems Food/Body/Weight Issues Excessive Spending Power/Control Issues  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

QUESTIONS AND DISCUSSION