Module 2 - Unit 3: Trauma-Informed
Core Principle: Trauma Informed
“Peer recovery support utilizes a strengths-based framework that emphasizes physical, psychological, and emotional safety and creates opportunities for survivors to rebuild a sense of control and empowerment” (SAMHSA, 2015).
Trauma Informed Support
What is trauma?
Trauma is an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life threatening. These events can have long-lasting negative effects on an individual’s functioning and mental, physical, social, emotional, or spiritual well-being.
Trauma Informed Support
How can I work with a client’s support system in a trauma informed manner?
Self-regulate (e.g., breathe, pause) to help you respond rather than react
Focus on the relationship
Remove judgement from the situation
Incorporate the four R’s of trauma-informed care:
- Realization – Understand how trauma can affect individual clients, their families, and communities.
- Recognize – Recognize signs of trauma such as triggers in the environment, including relationships, emotional triggers, anniversaries, or situations.
- Respond – Commit to provide a safe, supportive environment. We can’t protect all clients from all triggers, but we can do our part to help keep everyone safe.
- Resist retraumatization – Reduce stressful and toxic environments that interfere with recovery.
(SAMHSA Trauma & Justice Strategic Initiative, 2014)
Trauma Informed Language
Stigma:
- is a form of discrimination against a specific group of people
- is often a result of misinformation and negative stereotypes
- contributes to negative attitudes towards people with substance use disorders (SUD)
- limits the power for those living with SUD to obtain employment, housing, and access to healthcare
- discourages people with SUD from seeking the care and treatment they deserve
Using recovery-centered language helps avoid creating more trauma and humanizes people with SUD. This goes a long way in reducing stigma!
*Note. With any language, some may still utilize this language to describe themselves and that is okay.
Effective Communication
Learning how to effectively communicate with clients can help them to make positive changes towards recovery.
Motivational Interviewing (MI) is one tool that can be used when working with people struggling with substance use.
Key Elements of MI:
- Collaboration vs. Confrontation
- Evocation rather than imposing ideas
- Autonomy vs. Authority
- Compassion
(Motivational Interviewing Network of Trainers, 2019)
Pause & Reflect:
Think about a time when someone else tried to force you to make a change.
Now think of a time when you decided you were ready to make a change.
What about a time when motivation to change came from within? What was the difference? How did you feel? What was the outcome?
Effective Communication
The goal of motivational interviewing (MI) is to help clients identify their own reasons for change. When clients can voice their own desires, they are more bought in and more likely to stick with the changes.
Check out some popular MI skills in this short videos from Motivational Interviewing Network of Trainers, 2019
Signs of Escalation & Duress
Despite our best efforts, we know that clients may have moments of distress, crises, and escalation.
Early warning signs of an escalating person:
- Change in mood and level of anxiety
- Pacing or movement (toward you or away)
- What they are saying and how they are saying it
- Changes in baseline behaviors
- Eyes watchful, scanning, or assessing
- Concentration problems
- Disorganized behaviors
Danger signs:
- Face pale or flushed, lips tighten over teeth
- Eyebrows drop to cover/protect eyes
- Rapid and deep breathing
- Clenched fists
- Stance goes from square to bladed
- Lowering of entire body to lunge
Watch: This brief covers simple calming and de-escalation strategies.
Recognizing Signs of an Overdose
If you think someone is experiencing an opioid overdose, follow these steps:
Call 911 first!
Shake the person’s shoulders and, in a loud, clear voice, call their name and ask if they are OK.
If they do not respond, perform a sternal rub by making a fist and firmly rubbing the center of their breastbone with your knuckles. This hurts and tests for unconsciousness in patients who do not respond to sound.
Give naloxone according to the package instructions. Even if you are not 100% sure they are experiencing overdose, administer the naloxone. It will not hurt them if it’s not an overdose, and could save their life if it is!
(Liu, et a. & National Capital Poison Center, n.d.)
Overdose Prevention & Naloxone
According to the Arizona Administrative code R9-12-201:
All recovery residences are to have naloxone readily available. All staff, residents, and managers should know its location and how to administer it.
Where to obtain naloxone:
Any pharmacy across Arizona. Fees may apply. Ask your doctor for a prescription – most insurance plans, including AHCCCS will will pay for the medication.
Click here to watch Youtube Short on “>How to Use Naloxone Nasal Spray”<//a>
Resources for Training
Here are just a few resources to increase your knowledge and skills in supporting peers struggling with their mental health. These are also listed in the resources for Module 2. Organizations around Arizona provide many of these training for free!
LivingWorks Suicide Prevention Training: https://www.livingworks.net
- LivingWorks offers trainings as short as 90 minutes or as in-depth as 2 days to help lay people recognize and connect people struggling with thoughts of suicide to professional supports.
QPR (Question, Persuade, Refer) Suicide Prevention Training: https://qprinstitute.com/
- QPR is a suicidal thinking, behavior, and attempts prevention training for participants to be able to recognize the warning sides and refer people at risk
Emotional-CPR: https://emotional-cpr.org/
- Emotional-CPR (eCPR) is a program and practice developed by persons with a lived experience of recovery from trauma or mental health challenges to train community members to support others through mental health crises
CPR/First Aid: https://www.redcross.org/take-a-class/cpr
Mental Health First Aid: https://www.mentalhealthfirstaid.org/
- Mental Health First Aid is a skills-based training course that teaches participants about mental health and substance use issues
Sonoran Prevention Works: https://spwaz.org/training-and-consulting
- Overdose Prevention, Recognition & Response Training; Trauma and Drug Use: Harm Reduction and Support Strategies
Key Takeaways
- Instead of asking, “What’s wrong with this person,” we ask, “What happened to them?”
- Empathy is key.
- Respond with acceptance, resilience, and (above all) hope.
- Conflict is going to happen! Learning the signs of escalation and how to de-escalate is essential.
- Save a life by recognizing signs of overdose and what to do if an overdose occurs.
