Incorporating Harm Reduction and Trauma Informed Care into Community Residential Care

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I'm looking to connect with other champions of change working in the realm of adult mental health/substance abuse residential care.

In June, I became the program director of a dual diagnosis (mental health and substance abuse) community residence (New York state, overseen by Office of Mental Health, Congregate Care Level II). Since then I have been working to shift policy, procedure and best practices using a harm reduction model and trauma informed approaches. Although I am absolutely thrilled to have the opportunity to pilot a program like this, I am feeling overwhelmed and could use support.

Here are a few examples of things that I am currently working on or pondering while I should be sleeping at night...

  • Revamping Resident Rights and Responsibilities
    • hot topic here is not discharging if a resident relapses, which is the way it has always been done. MUCH conversation and debate about this one!
  • House Expectations (formally House Rules)
    • the shift from making things like chores, meetings, dinner, etc to "expected" instead of "mandatory" has been difficult. We are working to normalize the experience and remove staff from authoritarian positions, but getting away from using consequences to promote change has been tough! It feels like common sense but successful implementation has been difficult.
  • Designing the intake process to include trauma-informed assessments and questions, including resident information packets on ACEs science and harm reduction principles.
  • Service Planning
    • soooo much work to be done!
  • Staff trainings
    • the majority of my staff are open to the new language and practices but will benefit from increased training on toxic stress, regulation, and resilience building, particularly those who were trained within the medical/brain disease/12 step recovery models.

I'm eager to hear from and learn from others on this same journey. If you have tools, resources, examples, thoughts, etc on any of what I've stated above, please reach out. There is little out there it seems directly related to adult residential care, any support will help!

Kindly,

~Dawn

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Original Post

Hi Dawn, I can certainly understand the overwhelmed feeling. 

I'm not sure if you ever dipped into the topic of the needs of human trafficking victims or not but their mental health and service providers need to be trauma-informed and ACE aware as well. They are subjected to ongoing trauma. You may very well have encountered a victim of HT in your work and don't even know it because many trauma victims have, in fact, been trafficked but they don't even realize it themselves, especially if trafficked as a minor. 

I'm a member of the Michigan Human Trafficking Health Advisory Board (MHTHAB) and I'm a survivor of human trafficking (HT). Our board is trying to push the awareness of HT, the ACEs and the need for oversight of "safe" houses for victims. We have found that many shelters claim to be a safe place for victims of HT when, in fact, they are the most dangerous places to live. 

I am also a co-author of an online HT training program for healthcare and law enforcement. My program teaches empathy towards victims of HT and my co-author and I have done a lot of research regarding trauma-informed care and services for HT victims. We haven't found any HT service providers that are ACE aware or that are using the ACE assessment either. 

The resource that comes to mind is the Office of Victims of Crimes training. I have not taken the training and I feel overwhelmed just trying to navigate through it all. They talk about being trauma-informed but they don't mention ACEs. 

https://www.ovcttac.gov/taskfo...a-informed-approach/

https://www.ovcttac.gov/views/...Online_VATOnline.cfm

I'm going to follow you and the responses you get because I want to learn about this myself. Thank you for posting

If I can be of any assistance going forward, feel free to reach out. 

Warmly 

Ruth Rondon

As a frontline practitioner in criminal Justice, I remember the times, not too long ago that Trauma Informed care and trauma informed practices didn't feature strongly in strategy documents, interventions based models or within professional standards and guidance training. Trauma informed practices and ACE awareness is gathering momentum. This summer in Dublin, Ireland, a joint Justice Agencies conference took place, the theme, "Toward a Trauma-Responsive Criminal Justice System: Why, How and What Next?". ACE's spearheaded this game changing event. In more recent months I have transferred into our Human trafficking law enforcement area. I continue to be an active voice on ACE & communicate its importance in every facet of the work

Dawn:
I hope you get more support and responses from the wider community. I don't mean to minimize your overwhelm or what a big task you are undertaking. I have to say though how much hope it gives me that someone like you is heading this program because of how much you know (and GET) about ACEs. I'm so impressed with how deep and wide you are taking your learning and experiences to make changes. I know you've found too little that works with adults with ACEs, and acknowledges, incorporates trauma-informed policy into the work. So often, it's used to educate and prevent ACEs as though it's too late for those with lots of ACEs as though we'll just skip that part and have only ACE free people in the future. 

Please keep asking your questions, bringing the challenges, insights and also wins and sharing them here. You have a valuable and unique perspective as a parent, survivor, advocate and professional. Please keep sharing!
Cis

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