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Trauma-Informed Care in the context of Housing First Practice Mental Health Commission of Canada Pathways to Housing National Presented by: Brian Dean.

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Presentation on theme: "Trauma-Informed Care in the context of Housing First Practice Mental Health Commission of Canada Pathways to Housing National Presented by: Brian Dean."— Presentation transcript:

1 Trauma-Informed Care in the context of Housing First Practice Mental Health Commission of Canada Pathways to Housing National Presented by: Brian Dean Williams

2 / 2 Acknowledgments Land Teachings / traditions Participants

3 / 3 How can we speak about Trauma today in ways that… -Are honouring of the people who we are assisting? -Don’t harm those of us who are here in the room? -Are respectful of the various backgrounds and approaches that we have? -Affirm and strengthen what we’re already doing to be more effective as care providers?

4 / 4 Rethinking negative behaviors in a Housing First Context Anger Substance Use Demanding / Manipulation

5 / 5 Trauma – a working definition A socially constructed experience that overwhelms our physical, mental, social, and emotional ability to cope with and integrate it into our lives Photo credit:

6 / 6 Prevalence 76% of Canadian adults report trauma exposure in their lifetimes, with 9.2% meeting the criteria for PTSD (Van Ameringen et. al, 2008) In BC, 51% of homeless people from three communities reported childhood sexual abuse; 55% physical; 60% neglect; 58% emotional abuse; 57% meet criteria for PTSD (Torchalla et. al, 2012)

7 / 7 At Home / Chez Soi findings on Trauma 46% of At Home / Chez Soi participants had adverse childhood experiences 62 per cent emotional abuse 55 per cent physical abuse 38 per cent sexual abuse On average, participants reported between four and five of these adverse childhood experiences. At Home / Chez Soi Final Report (2014, p. 16)

8 / 8 The importance of Context -Historical -Political -Social -Economic Failing to do so risks blaming / pathologizing individuals for trauma

9 / 9 Effects of Trauma Brainstem / Survival-based responses: Fight (“Doug”) / Flight (“Charles”) / Freeze (“Veronica”) Difficulty integrating present moment with autobiographical material (hippocampus) – flashbacks and triggering process Disassociation / Hypervigilance Difficulty feeling sensations in the body, Dysregulation of Sexuality Nightmares, depression, anger PTSD: intrusive recollections, avoidant/numbing patterns, hyper- arousal symptoms Image by Kiran Foster via Flickr

10 / 10 Healthy Responses to Trauma -Post-traumatic growth -Resilience -Altruism born of suffering -Vicarious resilience (helping professional) (Hernandez, Engstrom, and Gangsei, 2010)

11 / 11 Connections with Substance Use Not a personal failing or evidence of flawed moral character Reasonable / adaptive response to trauma, initially? Over time, often leads to other health and behavioral complications Stages of change, recovery, and harm reduction

12 / 12 Making sense of Trauma Psychodynamic Behavioral Family systems Attachment Post-structural Neurobiological

13 / 13 A neurobiological perspective Capacity of the person’s social and nervous systems to adapt effectively is exceeded. Attachment struggles: lack of feeling seen, soothed, secure If the body’s normal responses to stress are not released due to the severity of the event or repeated incidents, the implicit memories can become “stuck” (impaired integration) as chronic states of vigilance in anticipation of a perceived threat, chronic states of withdrawal, or both Diminished function of neural fibres linking different regions of the brain (prefrontal cortex, hippocampus, corpus collosum) adapted from Siegel (2012), Pocket Guide to Interpersonal Neurobiology

14 / 14 Difference between Trauma-Informed Practice and Trauma Counselling All program staff should work in trauma-informed manner in all interactions, and develop therapeutic relationships with participants Not all program staff may have the training, skills, or interest to do specific trauma “work” or counselling

15 / 15 Primacy of the Therapeutic Alliance Asay and Lambert (1999) studied the common factors of major counselling techniques and what creates client change: 40% extratherapeutic factors 30% therapeutic alliance 15% expectancy / placebo 15% specific theories / techniques employed Listening for client’s recovery goals fosters therapeutic alliance

16 / 16

17 / 17 How Can we Respond? Trauma-informed Practice Guide. Victoria: BC Provincial Mental Health and Substance Use Planning Council: 1. Trauma Awareness -Staff aware of prevalence of trauma and relationship between trauma and physical, mental health, and substance use patterns -Awareness of context vs. victim-blaming -Sharing with clients the impact of trauma, where/when appropriate to do so

18 / 18 2. Emphasis on Safety and Trustworthiness Most of our clients have experienced abuse of power and have good reason to distrust us initially – defensive reactions not personal, requires patience and compassion (story of “TJ”) Collaborative crisis plans Consistency / predictability Apologizing when we mis-step

19 / 19 3. Opportunity for Choice, Collaboration, and Connection Asking for permission Emphasis on autonomy and personal control (story of Jackson’s guitar) Choice-points offered in terms of where to meet, what to discuss, which recovery goals to have and work on Leveling power relationships whenever possible, being transparent about areas where we can’t Collaborative Approach to recovery plan, counselling, housing choices, crisis plan

20 / 20 4. Strengths-Based and Skill-building Collaboratively identifying and leveraging person’s strengths and using these as a source of resiliency (i.e. TJ’s social skills) Modeling this with other service providers in community (e.g. Veronica at “case planning” meeting) Staff have a high degree of emotional intelligence

21 / 21 Narrative Practice Living through story Trauma encodes a certain kind of personal narrative This narrative is not necessarily “true” It can be deconstructed Preferred identities can be brought forward “Books 6” by Brenda Starr:

22 / 22 Narrative Therapy, Narrative Community Work A collaborative approach to homelessness, mental illness, and substance misuse Not based in psychology, but in literary theory, anthropology, sociology, queer studies, gender studies Centres person as expert in their own lives (respectful) Focus on relationship between person and problem, person and preferred strengths / direction / outcomes Paying attention to social-political context in which problems thrive Externalization, letter-writing, co-authoring, etc.

23 / 23 Victim vs. Survivor Exercise Who gets to decide which identity our clients take on? What effects do such names / stories have on their lives?

24 / 24 Re-storying Trauma Zimmerman / Beaudoin and re-writing memory when stories retold Emphasis on ways person resisted abuse and/or protected their dignity Unique outcomes (Hernandez, Engstrom, and Gangsei, 2010): -Post-traumatic growth -Resilience -Altruism born of suffering -Vicarious resilience (helping professional)

25 / 25 “We Care” vs. Self Care Risk of “trauma transmission” (Figley, 2002) in forms of vicarious trauma and compassion fatigue Collective responsibility for maintaining and thriving in this work, vs. another individual responsibility / task Mindfulness practice

26 / 26 Discussion / Questions

27 / 27 References Images acquired via Creative Commons license, via Hernandez, P., Engstrom, D., Gangsei, D. (2010). Exploring the impact of trauma on therapists: Vicarious resilience and related concepts in training. Journal of Systemic Therapies. 29(1), pp. 67-83. Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., Nelson, G., MacNaughton, E., Streiner, D., & Aubry, T. (2014). National At Home/Chez Soi Final Report. Mental Health Commission of Canada. National Cross-Site Final Report. Calgary: Mental Health Commission of Canada. Available online: Siegel, D. (2012). Pocket Guide to Interpersonal Neurobiology. New York: W.W. Norton. Urquhart, C. & Jasuira, F. (2013) et. al. (2013). Trauma-informed Practice Guide. Victoria: BC Provincial Mental Health and Substance Use Planning Council. Williams, B., & Baumgartner, B. (2014). Standing on the shoulders of giants: Narrative practices in support of frontline community work with homelessness, mental health, and substance use. International Journal of Child, Youth and Family Studies. 5(2), 240–257.

28 / 28 Thank you Contact us: Visit: Follow us: The views represented herein solely represent the views of the Mental Health Commission of Canada. Production of this document is made possible through a financial contribution from Health Canada. Les opinions exprimées aux présentes sont celles de la Commission de la santé mentale du Canada. La production de ce document a été rendue possible grâce à la contribution financière de Santé Canada.

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