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PRO.A / Trauma Informed Recovery Clearinghouse

Trauma Informed Recovery Clearinghouse

According to SAMHSA窶冱 concept of a trauma-informed approach, 窶廣 program, organization, or system that is trauma-informed:
  • Realizesツthe widespread impact of trauma and understands potential paths for recovery;
  • Recognizesツthe signs and symptoms of trauma in clients, families, staff, and others involved with the system;
  • Respondsツby fully integrating knowledge about trauma into policies, procedures, and practices; and
  • Seeks to actively resistツre-traumatization.窶

A trauma-informed approach can be implemented in any type of service setting or organization and is distinct from trauma-specific interventions or treatments that are designed specifically to address the consequences of trauma and to facilitate healing.

SAMHSA窶冱ツNational Center for Trauma-Informed Care: Changing Communities, Changing LivesツReport

Trauma-informed care is as much about social justice as it is about healing.ツSuddenly, it seems that everyone is talking about trauma. In Kansas City and Philadelphia, Head Start and daycare providers are learning how trauma affects the behavior of young children. In Florida and Connecticut, juvenile justice facilities are asking youth about their trauma histories and revamping their programs to address it. In Hawaii, the women窶冱 prison teaches inmates and staff about trauma and declares itself to be a 窶徘lace of healing and forgiveness.窶 In Joplin, Missouri, the principles of trauma-informed care are being used to rebuild the town after it was destroyed by a tornado. Prominent journalists are writing columns about trauma, and courses on trauma-informed services are appearing on college campuses. Consumer/survivor/ ex-patient communities have made trauma part of their social justice platform. Trauma is no longer a concept of interest only to health and behavioral health professionals; it is a reality to people from all walks of life. In fact, trauma-informed care is beginning to look a lot like a social movement. View the fullツbrochureツHEREツ.

SAMHSA窶冱 Concept of Trauma and Guidance for a Trauma-Informed Approach

Trauma is a widespread, harmful and costly public health problem. It occurs as a result of violence, abuse, neglect, loss, disaster, war and other emotionally harmful experiences. Trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography or sexual orientation. It is an almost universal experience of people with mental and substance use disorders. The need to address trauma is increasingly viewed as an important component of effective behavioral health service delivery. Additionally, it has become evident that addressing trauma requires a multi-pronged, multi-agency public health approach inclusive of public education and awareness, prevention and early identification, and effective trauma-specific assessment and treatment. In order to maximize the impact of these efforts, they need to be provided in an organizational or community context that is trauma-informed, that is, based on the knowledge and understanding of trauma and its far-reaching implications. Read more HERE.

SAMHSA’s Access to Recovery: Implementing Trauma-Informed Approaches in Access to Recovery Programs

Introduction: Treatment providers know that trauma is the norm, notツthe exception, in people with addictions. Experience andツevidence show that an understanding of the prevalenceツand impact of trauma built in at all points of the treatmentツsystem helps strengthen clients窶 recovery, decrease retraumatization,ツand build clients窶 trust in and use of servicesツand supports.
Treatment and recovery support service providers areツmoving toward making more trauma-informed careツavailable, and entire service systemsツare changing to respond to consumers窶
lived experiences of trauma. TheツSubstance Abuse and Mental HealthツServices Administration (SAMHSA)ツis leading the field with a strategicツinitiative in trauma and justice,ツand providing information to assistツAccess to Recovery (ATR) granteesツand providers in integrating trauma-informedツapproaches within clinicalツand recovery support services and atツadministrative and policy levels. Read the full publication HERE.

SAMHSA’S A Treatment Improvement ProtocolツTrauma-Informed Care inツBehavioral Health Services (TIP 57)

This Treatment Improvement Protocol (TIP) is divided into three parts:

窶「 Part 1: A Practical Guide for the Provision of Behavioral Health Services
窶「 Part 2: An Implementation Guide for Behavioral Health Program Administrators
窶「 Part 3: A Review of the Literature

Part 1 is for behavioral health service providers and consists of six chapters. Recurring themesツinclude the variety of ways that substance abuse, mental health, and trauma interact; the importanceツof context and culture in a person窶冱 response to trauma; trauma-informed screening andツassessment tools, techniques, strategies, and approaches that help behavioral health professionalsツassist clients in recovery from mental and substance use disorders who have also been affected byツacute or chronic traumas; and the significance of adhering to a strengths-based perspective thatツacknowledges the resilience within individual clients, providers, and communities.

  • Chapter 1 lays the groundwork and rationale for the implementation and provision of trauma-informedツservices. It provides an overview of specific trauma-informed intervention and treatmentツprinciples that guide clinicians, other behavioral health workers, and administrators inツbecoming trauma informed and in creating a trauma-informed organization and workforce.
  • Chapter 2 provides an overview of traumatic experiences. It covers types of trauma; distinguishesツamong traumas that affect individuals, groups, and communities; describes trauma characteristics;ツand addresses the socioecological and cultural factors that influence the impact of trauma.
  • Chapterツ3 broadly focuses on understanding the impact of trauma, trauma-related stress reactions andツassociated symptoms, and common mental health and substance use disorders associated withツtrauma.
  • Chapter 4 provides an introduction to screening and assessment as they relate to traumaツand is devoted to screening and assessment processes and tools that are useful in evaluating trauma exposure, its effects, and client intervention and treatment needs.
  • Chapter 5 covers clinicalツissues that counselors and other behavioral health professionals may need to know and addressツwhen treating clients who have histories of trauma.
  • Chapter 6 presents information onツspecific treatment models for trauma, distinguishing integrated models (which address substanceツuse disorders, mental disorders, and trauma simultaneously) from those that treat trauma alone.ツRead the full publication HERE.
Peer Support and Trauma Recovery:

Peer support is becoming an important strategy to help survivors of war-related violence recoverツfrom psychological trauma. After a short training in counseling techniques, peer-support workers seekツout trauma survivors in the community and help them reintegrate into society, find work, engage inツsports and come to terms with their traumatic memories. Peer-support programs incur costs relatedツto transportation and communication, but support groups may recover some costs through income generatingツprojects. Read the full article HERE.

Peer Support Provider窶埜alking the Tightrope BetweenツHelping Others & Maintaining Your Own Wellness

While the work of helping others in distress is meaningful and can be personally rewarding in many ways,ツthere are inherent challenges to continuously interacting with people who are experiencing significantツstressors in their lives. Peer support providers, like other caregivers, need to be aware of stressorsツcommonly associated with the work of a helping role and to take steps to maintain their own wellness in theツface of frequently encountered stressors associated with their work. Read the full document HERE.

Workshops for the Helping Professions: Transforming Compassion Fatigue into CompassionツSatisfaction: Top 12 Self-Care Tips for Helpers

Dr Charles Figley, world renowned trauma expert and pioneer researcher in the field ofツhelper burnout has called compassion fatigue a 窶彭isorder that affects those who do theirツwork well窶 (1995) It is characterized by deep emotional and physical exhaustion,ツsymptoms resembling depression and PTSD and by a shift in the helper窶冱 sense ofツhope and optimism about the future and the value of their work. The level ofツcompassion fatigue a helper experiences can ebb and flow from one day to the next,ツand even very healthy helpers with optimal life/work balance and self care strategies
can experience a higher than normal level of compassion fatigue when they areツoverloaded, are working with a lot of traumatic content, or find their case load suddenlyツheavy with clients who are all chronically in crisis.

Compassion fatigue can strike the most caring and dedicated nurses, social workers,ツphysicians and personal support workers alike. These changes can affect both theirツpersonal and professional lives with symptoms such as difficulty concentrating, intrusiveツimagery, loss of hope, exhaustion and irritability. It can also lead to profound shifts inツthe way helpers view the world and their loved ones. Additionally, helpers may becomeツdispirited and increasingly cynical at work, they may make clinical errors, violate clientツboundaries, lose a respectful stance towards their clients and contribute to a toxic workツenvironment.ツIt has been shown that, when we are suffering from compassion fatigue, we work moreツrather than less. What suffers is our health, our relationship with others, our personalツlives and eventually our clients. Read the full article HERE.

Professional Burnout, Vicarious Trauma, Secondary Traumatic Stress, and Compassion Fatigue: A Review of Theoretical Terms, Risk Factors, and Preventive Methods for Clinicians and Researchers

The emotional and psychological risks associated with providing direct social work services to vulnerable populations have been largely overlooked in social work educational curriculum and agency training (Cunningham, 2004; Courtois, 2002; Shackelford, 2006). These risks should be conceptualized as occurring in two separate forms: trauma-related stress and professional burnout. Vicarious trauma, secondary traumatic stress, and compassion fatigue are conditions related specifically to work with trauma populations, while professional burnout is considered a more general phenomenon which may occur within any social service setting. The forms of trauma-related stress conditions and professional burnout are often erroneously discussed either interchangeably or grouped together as one condition in the literature. It is best to conceptualize each of these conditions separately in order to have a comprehensive understanding of these complex phenomena. It is important that direct practitioners and educators understand the risk factors and symptoms associated with these phenomena in order to identify, prevent, and/or minimize their effects. As a best-practice initiative, it is appropriate that information on these conditions be infused into social work curricula as a first-line preventive measure for the training of inexperienced social workers who may be more vulnerable to the effects of these conditions (Lerias & Byrne, 2003). Information on these topics should also be included as part of agency training for practitioners already working in the field. This article provides a brief review of professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue, including the risk factors and symptoms associated with these conditions. Particular attention is paid to the inclusion of this material and the practice of self-care in both macro and micro social work education, as well as agency-training curriculum. View the full article HERE.

Developing a self-care plan

A self-care plan can help you enhance your health and wellbeing, manage your stress, and maintain professionalism as a worker with young people. Learn to identify activities and practices that support your wellbeing as a professional and help you to sustain positive self-care in the long-term. This will help you to:

  • Understand your self-care assessment
  • Develop your self-care plan.
  • Put your self-care plan into action.
  • It is useful to complete the self-care assessment before reading this article.

View more HERE.

Recovery to Practice 窶 recovery workbook:ツ

Purpose:ツThe purpose of the Recovery to Practice Next Steps training is to bring together peer support providers from a variety of places (geography, philosophy, training, lived experiences, educational backgrounds, and perspectives) to share the richness of their lived experiences as peer providers, learn with and from each other, and come to a common understanding of how to support people in recovery ツthrough some of the current best practices in peer support.

Background:ツTheツtrainingツwas developed under the Substance Abuse and Mental Health Services Administration (SAMHSA) Recovery to Practice project as a continuing education opportunity for working providers of peer support services.ツThe training was originally developed for peer support providers in the mental health system. However, skills and recovery principles practiced in this training also apply when supporting someone who is dealing with the effects of trauma, substance use, poor physical health, or multiple conditions. Access the modules of the workbook HERE.

Trauma and Addiction: 7 Reasons Your Habit Makes Perfect Sense:

Let窶冱 imagine that you can float up above the timeline of your life, turn and face the past as it stretches out behind you, and gently drift back to when your addiction first started. Now, let窶冱 drift back a little farther to before that moment. What was happening back in those days, weeks, months or years prior to when your addiction began? Did you experience an event that was less than nurturing? Did you survive a moment that overwhelmed your ability to cope? Did you live through an ordeal that changed how you perceive your place in the world? If so, then you窶况e experienced trauma.

The reason it窶冱 significant to identify and acknowledge this is because research proves that trauma can activate survival oriented behaviors that lead to addiction. Read the full article HERE.

A resource publication on Engaging Women in Trauma-Informed Peer Support: A Guidebook

This guide was created for a very specific purpose: to help make trauma-informed peer support available to women who are trauma survivors and who receive or have received mental health and/or substance abuse services. It is designed as a resource for peer supporters in these or other settings who want to learn how to integrate trauma-informed principles into their relationships with the women they support or into the peer support groups they are members of. The goal is to provide peer supporters窶巴oth male and female窶 with the understanding, tools, and resources needed to engage in culturally responsive, trauma-informed peer support relationships with women trauma survivors. Read the full guide HERE.

Gendering: The National Framework Trauma-informed Approaches in Addictions Treatment:

In 2009 a national, virtual community of practice (VCoP) provided theツopportunity for a 窶忻irtual discussion窶 of issues, research and programmingツrelated to girls窶 and women窶冱 substance use in Canada. The goal of theツVCoP was to serve as a mechanism for 窶徃endering窶 the National Frameworkツfor Action to Reduce the Harms Associated with Alcohol and other Drugs andツSubstances in Canada. Participants included planners/decision-makers, directツservice providers, educators, NGO leaders, policy analysts, researchers andツinterested women. The project was sponsored by the British Columbia Centreツof Excellence for Women窶冱 Health (BCCEWH) in partnership with the CanadianツCentre on Substance Abuse (CCSA) and the Universities of Saskatchewan andツSouth Australia.ツThis discussion guide highlights one of the topics explored in the VCoP. Itsツpurpose is to stimulate further conversation on addressing coexisting trauma,
mental health and substance use problems experienced by girls and womenツthrough trauma-informed and trauma-specific approaches. Read the full publication HERE.

Resilience to meet the challenge of addiction: Psychobiology and clinical considerations

Abstract:ツAcute and chronic stress-related mechanisms play an important role in the development of addiction and its chronic, relapsing nature. Multisystem adaptations in brain, body, behavioral, and social function may contribute to a dysregulated physiological state that is maintained beyond the homeostatic range. In addition, chronic abuse of substances leads to an altered set point across multiple systems. Resilience can be defined as the absence of psychopathology despite exposure to high stress and reflects a person’s ability to cope successfully in the face of adversity, demonstrating adaptive psychological and physiological stress responses. The study of resilience can be approached by examining interindividual stress responsibility at multiple phenotypic levels, ranging from psychological differences in the way people cope with stress to differences in neurochemical or neural circuitry function. The ultimate goal of such research is the development of strategies and interventions to enhance resilience and coping in the face of stress and prevent the onset of addiction problems or relapse.ツRead the full publicationツHERE.

A conceptual framework for the neurobiological study of resilience.

Abstract:ツThe well-replicated observation that many people maintain mental health despite exposure to severe psychological or physical adversity has ignited interest in the mechanisms that protect against stress-related mental illness. Focusing on resilience rather than pathophysiology in many ways represents a paradigm shift in clinical-psychological and psychiatric research that has great potential for the development of new prevention and treatment strategies. More recently, research into resilience also arrived in the neurobiological community, posing nontrivial questions about ecological validity and translatability. Drawing on concepts and findings from transdiagnostic psychiatry, emotion research, and behavioral and cognitive neuroscience, we propose a unified theoretical framework for the neuroscientific study of general resilience mechanisms. The framework is applicable to both animal and human research and supports the design and interpretation of translational studies. The theory emphasizes the causal role of stimulus appraisal (evaluation) processes in the generation of emotional responses, including responses to potential stressors. On this basis, it posits that a positive (non-negative) appraisal style is the key mechanism that protects against the detrimental effects of stress and mediates the effects of other known resilience factors. Appraisal style is shaped by three classes of cognitive processes–positive situation classification, reappraisal, and interference inhibition–that can be investigated at the neural level. Prospects for the future development of resilience research are discussed. Read the full publication HERE.

Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population

Abstract:ツObjective: Exposure to traumatic experiences, especially those occurring in childhood, has been linked to substance use disorders (SUDs), including abuse and dependence. SUDs are also highly comorbid with Posttraumatic Stress Disorder (PTSD) and other mood-related psychopathology. Most studies examining the relationship between PTSD and SUDs have examined veteran populations or patients in substance treatment programs. The present study further examines this relationship between childhood trauma, substance use, and PTSD in a sample of urban primary care patients. Method: There were 587 participants included in this study, all recruited from medical and OB/GYN clinic waiting rooms at Grady Memorial Hospital in Atlanta, GA. Data were collected through both screening interviews as well as follow-up interviews. Results: In this highly traumatized population, high rates of lifetime dependence on various substances were found (39% alcohol, 34.1% cocaine, 6.2% heroin/opiates, and 44.8% marijuana). The level of substance use, particularly cocaine, strongly correlated with levels of childhood physical, sexual, and emotional abuse as well as current PTSD symptoms. In particular, there was a significant additive effect of number of types of childhood trauma experienced with history of cocaine dependence in predicting current PTSD symptoms, and this effect was independent of exposure to adult trauma. Conclusions: These data show strong links between childhood traumatization and SUDs, and their joint associations with PTSD outcome. They suggest that enhanced awareness of PTSD and substance abuse comorbidity in high-risk, impoverished populations is critical to understanding the mechanisms of substance addiction as well as in improving prevention and treatment. Depression and Anxiety, 2010. ツゥ 2010 Wiley-Liss, Inc.ツRead the full publication HERE.

Women and addiction: a trauma-informed approach.

Abstract:ツHistorically, substance abuse treatment has developed as a single-focused intervention based on the needs of addicted men. Counselors focused only on the addiction and assumed that other issues would either resolve themselves through recovery or would be dealt with by another helping professional at a later time. However, treatment for women’s addictions is apt to be ineffective unless it acknowledges the realities of women’s lives, which include the high prevalence of violence and other types of abuse. A history of being abused increases the likelihood that a woman will abuse alcohol and other drugs. This article presents the definition of and principles for gender-responsive services and the Women’s Integrated Treatment (WIT) model. This model is based on three foundational theories: relational-cultural theory, addiction theory, and trauma theory. It also recommends gender-responsive, trauma-informed curricula to use for women’s and girls’ treatment services. Read the full publicationツHERE.

Implementing Trauma-Informed Approachesツin Access to Recovery Programs

Introduction:ツTreatment providers know that trauma is the norm, notツthe exception, in people with addictions. Experience andツevidence show that an understanding of the prevalenceツand impact of trauma built in at all points of the treatmentツsystem helps strengthen clients窶 recovery, decrease retraumatization,ツand build clients窶 trust in and use of servicesツand supports.ツTreatment and recovery support service providers areツmoving toward making more trauma-informed careツavailable, and entire service systemsツare changing to respond to consumers窶卍lived experiences of trauma. TheツSubstance Abuse and Mental HealthツServices Administration (SAMHSA)ツis leading the field with a strategicツinitiative in trauma and justice,
and providing information to assistツAccess to Recovery (ATR) granteesツand providers in integrating trauma-informedツapproaches within clinicalツand recovery support services and at
administrative and policy levels. Read the full publicationツHERE.

Trauma-informed: The Trauma Toolkit

A resource for service organizations and providers to deliver services that are trauma-informed.ツThis toolkit aims to provide knowledge to service providersツworking with adults who have experienced or been affectedツby trauma. It will also help service providers and organizationsツto work from a trauma-informed perspective and developツtrauma-informed relationships that cultivate safety, trust andツcompassion. Read the full publicationツHERE.

Six Principles of Trauma Informed Care

Exploring how we support others who have had traumatic experiences is critical in promoting resiliency and recovery. The simple shift from asking 窶What is wrong with you?窶 to 窶弩hat happened to you?窶敖can have significant benefits in promoting a trauma-informed treatment milieu.

The following six principles of Grafton窶冱 trauma-informed care model were presented at a recent poster session of the 57thツannual American Association of Children窶冱 Residential Centers (AACRC) conference: evaluate the function and intent of behaviors, promote a culture of comfort, recognize practices that are re-traumatizing, reinforce training for all employees,ツツtransform the language used, recognize the role of the caregiver as an opportunity to heal. Read the full postツHERE.