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OPEN DOORSAn Inclusive Service Model

Participant Handouts and Worksheets

Table of Content

Foundational Principles Poster 1

Trauma-informed practice sheets 2

Trauma-informed self care guide 3

Article: Collective ethics as a path to resisting burnout – Dr. Vikki Reynolds 7

Practical Tools for Women with Varying Levels of Mental Wellness 9

Suicide Safety Plan 17

Power and Control Wheels for Substance Use 18

Overdose Awareness Posters: Alcohol, Opioids and Stimulant 19

Harm Reduction and Pregnancy Information for Service Providers 22

Sample Intake form 23

Sample informed consent form 25

Sample Consent to Release form 27

Sample Letter to Advise on Substance Use Policy 28

Power and Control Wheel within the Domestic Violence Shelter 29

Worksheet: Revisiting Current Policies and Practices 30

Worksheet: Review Our Work 31

Video and Audio Clips Reference List 32


Harm Reduction ResponsiveRelational

FOU

ND

ATIO

NAL

Holistic & Integrated

Anti-Oppressive

Woman-Centred

Adapted from Reducing Barriers to Support for Women Fleeing Violence: A Toolkit for Supporting Women with Varying Levels of Mental Wellness and Substance Use (BC Society of Transition Houses, 2011)


Traum-informed practice

Reflective questions (could be used in supervision):

1. What are my underlying assumptions about the experience of those with trauma and how people recover? How might this belief influence my work with others?

2. What practicular responses or behaviours of those I am assisting might trigger me? How do I know when this is happening? How will I respond?

3. How do my fultural background and personal experiences of diversity influence my interactions with others? What am I bringing to the relationship?

4. There may be some experiences in my life that could influence my ability to provide trauma-informed care. How am I managing? What am I noticing in my body? Are there areas in my life that I need to pay more attention to? Who can I turn to for support?


Source:BC Provincial Mental Health & Substance Use Planning Council. (2013). Trauma-Informed Practice Guide.


Practical Tools for Women

Post-Traumatic Stress Symptoms

Mental Health First Aid KitThe First Aid Kit is a tool for self-soothing when you are having a bad mental health day. It can be personalized and adapted however you like. Keep this kit close by so you can access it whenever you need it. Some of the basic items in there can include:

A affirmative message (i.e. I am a strong woman, I am a good person) A piece of strong flavored gum or candy – draw focus away from thoughts A picture of something you like (try to avoid photos of people) An object with texture and/or weight (i.e. a piece of rock, a heavy ring) A sample of favorite perfume or essential oil

Image AlbumHave a collection of images that are soothing and calming in a folder on your smartphone or pocket book. The images can also be affirmative and positive messages. There are lots of examples on the internet. Scroll through the pictures to help remind you of positive thoughts.

5-4-3-2-1This exercise engages all of your senses and can help bring you back to the present if you are beginning to feel dissociative.

1. Ask her to name 5 objects she can see right now2. Ask her to name 4 things she can feel right now3. Ask her to name 3 things she can hear right now4. Ask her to name 2 things she can smell right now5. Ask her to name 1 thing she can taste right now

Keep a JournalA journal or a diary can be helpful in several ways. It can help you be more in touch with how you are feeling and keep track of your mental wellness. It can also help you identify triggers and remember ways you have been successful in dealing with them. Finally, it can also highlight strengths and resilience.

Breathing ExerciseControlling breathing can help you calm your automated nervous system and decrease the “fight or flight” response. Breathe out more than you breathe in, by breathing out slowly and deliberately (like a big sigh) or by counting in a cycle of: inhale – hold breath – exhale - hold breath.

Physical ExerciseAerobic activities such as walking, running, swimming and biking can help your body use the adrenaline produced and encourage secretion of endorphins (helps to decrease stress).


Film ExerciseThis exercise can be helpful for dealing with flashbacks or intrusive memories. Pretend those memories are part of a film and you have the ability to fast forward, go back, stop and play the memory. You can visualize skipping over different parts or give it a different ending.

Affirmative Self TalkHave a script or a list of statements that you find useful. Read the statement, either out loud or in your head, whenever you feel unsafe or having a bad mental wellness day. Some examples of statements are:

I know this feeling and I know it will pass. My name is ___________, today I am ______ years old. I am here at __________ and it is

safe here. I am a strong person.

Full Body RelaxationRelax every part of your body starting at the toes and working up toward the head. Focus on one part of the body at a time and visualize each muscle relaxing. If it is difficult to focus, gently touching the body part with your fingers and “smooth out” the muscles.

YogaYoga practices can look and feel very different depending on the instructors. Most yoga practices incorporate mindfulness, meditation and physical movements to increase awareness of the mind-body connections, which is very helpful for people who may feel disconnected due to trauma.

Describe in DetailsFocus on a small area (i.e. a patch of carpet, one plank of floor board) or an object (i.e. your shoe) and describe it in detail – colour, shape, texture, etc.

My Safe PlaceThink about a place where you feel happy, safe, secure, and relaxed. Try to visualize it with as much detail as possible. What does it look like? What does it smell like? How does it feel to be there? Is there anyone else there with you?

Other Ideas:



Depressive Symptoms:

Keep a mood journey/diaryKeeping track of your daily mood can give you insight about potential triggers and help you cope. It can also help to remind you that you can have good days on days that are more difficult.

Physical ExerciseYour body produces endorphins during aerobic activities such as walking, running, swimming and biking. Endorphins is the neurotransmitter responsible for “runner’s high” and can help lift mood.

Divide up the dayDivide up the day into smaller sections and only focus on one section at a time. Give yourself permissions to skip sections if you are just not feeling up for it.

Create routinesHaving a routine can help us feel more in control. Incorporate regular exercise, rest, meal time and relaxation. Set a bed time to help with getting a proper night of sleep.

Set realistic goals & ask for helpTake a look at your tasks and commitments and ask yourself if they are realistic. If you are taking on too much, think of a way to let go of some of the responsibilities or ask others to help you.

Being in natureWalking and being in nature can be spiritually rejuvenating. Being outdoor and in sunlight will also help increase vitamin D, which has been shown to improve mood.

Identify thinking patterns that are not helpfulBe familiar with the common “Thinking Traps” and check to see if you are falling into those traps. If you are, come up with some alternative ways of thinking and write them down.

Other Ideas:


Practical Tools for WomenAnxiety Symptoms:

Rate and confront triggersBe aware of situations, people, location and things that may be a trigger for you. Rate your anxiety level for each of them can help give you a sense of perspective and a better handle on it. For example: going to the grocery store will give you low level of anxiety whereas going to the bus stop at night will give you a high level of anxiety. Develop a plan to slowing confront the triggers starting with the ones that cause the least anxiety.

Be familiar with “thinking traps”When you have a negative thought or a worry, check it against the “thinking traps” and see if that is the case. Challenge some of the worries with facts. Are there anything that supports the worry? Practice identifying thinking traps and getting out of them.

Practice relaxationThere are many ways to do that, including listening to soothing music, stretching, slow breathing. Create a list of different relaxation techniques that works for you and keep it somewhere that you can access easily.

Coping statementsWrite down statements that remind you how you can cope with a situation. Some examples are:

I just need to do my best People cannot tell when I am feeling anxious This has happened before and I know how to handle it I know this feeling will pass

Balanced statementsWrite down the negative thought or worry and come up with a more balanced thought. For example in the situation of a job interview tomorrow:

There is a chance that I might not do well in tomorrow’s interview, but not performing perfectly on a job interview doesn’t mean I won’t get the job. Even if I don’t get this job, it doesn’t mean I will never get a job. I have always been able to find work.

Other Ideas:



Psychotic Symptoms:

Identify triggersTriggers may come with or without warnings. Be aware of some of the situations that may increase risks such as not getting enough sleep, stress, and substance use. Identifying the triggers can help you better prevent a psychosis episode.

Be aware of early warning signsKnow the early warning signs and come up with plans to deal with them. These signs may be normal response to stress that can trigger psychosis. Be as specific as possible – i.e. sleeping for only 4 hours each night for 3 days instead of not sleeping well.

Build a support teamIdentify people that you can trust. It can be family, friends, doctor, social worker, etc. Let the support team know your symptoms are and ask them to help you when they see you are experiencing them. When you are unsure about your thoughts or feelings, ask them to do a reality check with you.

Create a safety planThink about ways you have been able to deal with your symptoms successfully and write them down. Make a list of phone numbers that are useful, such as the local mental health services, your support team and the crisis line. Keep the plan somewhere you can easily access.

Keep trackMark a calendar every day you keep symptoms in control and look back at your own improvement. If you choose to use medication to help control the symptoms, also note down the dosage you are using and if you notice any side effects. These can be very helpful for your doctor in the next meeting.

Other Ideas:


Practical Tools for WomenSuicide:

Develop a safety planWrite down a plan to deal with suicidal thoughts. It can include distractions, self-soothing activities, reasons to live, etc. It should also include a list of phone numbers that you can call anytime such as the crisis line, support people, and the hospital.

Reminders for reasons to liveWrite down some reasons you have for living. For example, loved ones, pets they love, religion, goals and dreams, or responsibilities. Take out the list when you are experiencing suicidal thoughts.

6 out of 10Create a list of 10 activities that you enjoy. Make sure that at least 5 of those activities will take at least an hour. When the thoughts of suicide come up, do at least 6 of the activities on the list. If you still feel suicidal after doing them, call someone you trust for support.

Personal AchievementsWrite down a list of personal achievements. Bring up the memory and try to re-live the moment. Visualize it with as many details as possible. Remember how you feel about yourself at that moment, and remind yourself that you are the same person.

Connect with othersTalk to a support person can be very helpful. Have a list of phone numbers you can call anytime to talk to someone when you are experience suicidal thoughts. The person can be someone you know or it can be an anonymous person on the crisis line.

Other Ideas:


Practical Tools for WomenSelf Harm:

Visual alternativeUse a red felt tip pen to mark where you might usually cut. Imagine the sensation of the cut on your skin where you marked with the pen.

Let it outVent anger and frustration in other ways or on other objects. For example:

Hit pillows or cushions have a good scream into a pillow or cushion Rip up a stack of paper Knead and punch at some clay or dough

Practice other coping skillsThink of other ways of dealing with the emotional pain. Make a list of all the other coping ideas that can work for you and try them out one at a time.

Pain alternativeUse a safer way to experience pain. For example:

Rub ice across your skin where you might usually cut, or hold an ice-cube in the crook of your arm or leg

Put elastic bands on wrists, arms or legs and flick them instead of cutting or hitting Have a cold bath or shower

Category GameThink of a category (i.e. colour, food, places, sports) and try to name as many things in that category as you can without repeating.

Other Ideas:


List of Distractions: Work on hobbies and handcrafts Go for a walk Watch a movie Talk to and pet animals Clean (for yourself, not for others) Talk with someone supportive Listen to music Take a warm shower or bath Prayer or meditation Exercise Nurture yourself even if you don't feel like it Be creative (crafts, music, clothing, etc.) Look back on awards and achievements Keep a scrapbook or photo album handy to review proud moments Make a checklist of accomplishments Learn something new Set short term goals one day at a time Review your strengths Call the domestic violence hotline Cook up a storm Pop bubble wraps


BASIC CONTACT INFORMATION FOR INTAKE PURPOSES (GENERIC)

Name: _________________________ Date: ________________Address: _______________________________________________________Preferred Language: ______________________________________________Interpreter needed: ____Yes ____NoIf we need to contact you, is it safe for you if we phone? ____Yes ___ NoTelephone: _____________________day ___________________ evening

To insure your privacy, agency staff will not initiate conversations or contact with you outside of the agency. We leave that to your discretion.

Children (Transition Houses)Child’s name Date of Birth CareCard No. Health Concerns__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Name of child/ren not with you at the Transition House ________________________________Are you and your partner share guardianship of your child/ren ? ___Yes ___NoWhat if any, agreements or court orders do you have relating to your child/ren?____________________________________________________________________________________________________________________________________________________________

Can you provide copies of any agreements or court orders regarding your child/ren? ___Yes ___No

Medical Alert (Transition Houses)Medical or special needs:___ access issues___ allergies___ dietary concerns___ medications___ otherDr.’s Name: __________________ Tel.___________________

Emergency contact:Name______________ Relationship__________________Tel._______________ Address______________________


Special Needs

Are legal proceedings underway or expected? ___ Yes ____NoCan you provide any copies of any court orders or agreements? ____ Yes ____ No

Do you have any special needs that you feel it would be helpful for us to know about so that we can be of most support to you?____________________________________________________________________________________________________________________________________________________________

Possible Services and Referrals Checklist

Shelter ____Support _____Safety Planning _____Legal Information _____Educational Information _____Medical _______Counseling _____Employment _____Transportation ____Other ________________________________________________________________


SAMPLE INFORMED CONSENT FORM

I consent to receive the following service(s) I have listed below which are provided by______________ (Name of Program).

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I understand that this application does not guarantee I will receive all the services I have indicated.

I also consent to having staff from the _________________ (Name of Program) to collect personal information for the purpose of delivering those services.

I understand that the personal information I provide is confidential. The release of any information regarding my involvement with the ______________ (Name of Program) may occur only with my written and signed consent subject to certain legal exceptions.

These legal exceptions are:

If Program staff have reason to believe that a child needs protectionunder section 13 of the Child, Family and Community Service Act theyare obligated (as are the general public) to inform the Ministry ofChildren and Family Development.

If Program staff have reason to believe that I am likely to cause seriousphysical harm to myself or another, they are obligated to inform theappropriate authorities.

If Program staff are required by court order to disclose specific records orto attend court and testify.


I understand that my records will be kept for _________________ (Insert Program retention period) and that they will be destroyed after that time.

I understand that Information about [Name of Program]’s privacy and confidentiality policy can be obtained by contacting _______________ (Insert Program Contact) at _________________(Insert Program Contact phone number).

Date___________________

This agreement is good until __________________ (Insert end date).

____________________________________Client name_____________________________________Client Signature

_____________________________________Agency Staff Name_____________________________________Agency Staff signature


SAMPLE AUTHORIZATION TO RELEASE INFORMATION

We ____________________________________ (Name of program) will not release any personal information about you without your permission unless a legal exception exists as explained on the Program’s informed consent form.

If you sign an authorization to release personal information, you can revoke this authorization at a later date.

I ________________________________ (Printed name of program participant), authorize this program to release the following personal information:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

To: ___________________________________________ (Name of organization and person)_________________________________________________ (Address, phone, fax, email)

For the following purposes: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I understand that I can revoke my authorization to release personal information at any time. This authorization is good until _______________________________ (Expiration date).

______________________________ ___________________________Participant Signature Date

______________________________ ___________________________Staff Signature Date

Revocation of Authorization

Authorization Release revoked on this date: _______________________________________

______________________________ __________________________________Participant Signature Staff Signature


Adapted from Sample Drugs Policy For Use By Domestic Violence Services.Copyright: The Stella Project 2006

SAMPLE LETTER TO ADVISE ON SUBSTANCE USE POLICY

DATE:

Dear ___________,

When you moved into the Transition Housing program you would have been advised that wehave a substance policy. We have this policy because we believe all people have the right to livefree from violence, including women who use substances.

Therefore we would like to remind you of a few key points from the policy:• We cannot hold onto your prescribed medication. It is illegal for you to give, share or supply any illegal drugs or prescribed medication.

Doing so could mean you are issued with a warning or eventually re-housed.• Do not use any prescribed or illegal drugs in communal areas.• Please store any prescribed or illegal drugs in the locked cupboard in your room. It is unacceptable to discriminate against other people who may use substances e.g.

name calling or exclusion.

Please follow these simply guidelines, as our goal is to run a safe, legal and secure Transition

Housing program.

If you have any questions or would like a copy of the drugs policy, please feel free to ask a member of staff.

Yours sincerely,

The Friendly Management


Revisiting Current Policies and Practices

Topic: ___________________________________________What are we doing well? What may we want to change?

How may the changes improve the way we serve women?

What may the challenges be?


Review Our Work

Topic: ____________________________

What do we ask? How does this question help us serve her better?Is the information necessary for us to provide services to her?

How might we ask this question differently? Reflect Foundational Principles …

E.g.Question we ask to determine eligibility: Have you experienced domestic violence?

We need to know if she fits within our service mandate.

Our transition house is a program for women who have experience violence in their relationships. Does that sound like what you are going through?

Woman-centred, Anti-oppression


Video and Audio Clips Reference List

For Her Own GoodOntario Association of Interval & Transition HousesLength: 29 minutes 24 secondsThe film For Her Own Good: Emotional Resiliency after Abuse shares the stories of six women who have experienced violence and oppression in their lives and have as a result grappled with the emotional effects of those experiences. The women describe their struggles in being heard and supported by a number of community supports and institutions and tell us how they were able to cope with the distress of these experiences.

Honouring Women’s Resistance to Violence and OppressionKeynote speech by Dr. Vikki Reynolds at Positive Women’s Network Hoopla: A Women’s Health CarnivalLength: 19 minutes 16 secondshttps://www.youtube.com/watch?v=YnzbsBBGKP8Vikki will address the ever present nature of women’s resistance to sexual assault and other violence. What gets read as resisting in our society is based on men’s ways of being and access to patriarchal power, but women always fight back. Wherever there is no consent there is resistance. Women fight back prudently and intelligently with all the wisdom and resources they have, but it is often not seen as resistance by the courts and by society, where women are blamed for not resisting enough in a society that teaches don’t get raped, not don’t rape. Vikki will contest some of the taken for granted ideas that pass for truth in counselling talk about the mental illness and pathology of women who are victimized by men’s violence, and offer some feminist-informed inversions of language that are more honouring of women’s ever present and intelligent resistance.

TEDxTalks: Beyond the CliffLaura van Dernoot LipskyLength: 19 minutes 22 secondshttps://www.youtube.com/watch?v=uOzDGrcvmusIn this talk, Laura offers us a window into the cumulative toll that can occur when we are exposed to the suffering, hardship, crisis or trauma of humans, other living beings, or the planet itself. Held within a larger context of systematic oppression


and liberation theory, we’ll dive into what gets hard and how to work toward reconciling it both individually and collectively.

Resisting Burnout in Feminist ActivismThe F Word radio interview with Dr. Vikki ReynoldsLength: 32 minutes 30 secondshttp://rabble.ca/podcasts/shows/f-word/2011/08/resisting-burnout-feminist-activismHave you ever been told, as a feminist or an activist, that you're sure to face burnout at some point? Have you ever been disappointed by this idea of inevitable forced retirement from social change work? Ariana Barer interviews Vikki Reynolds, an activist for over 30 years who has lived and agitated all over the world and currently resides in Vancouver where she is involved with consulting, training and clinical supervision with refugees and survivors of torture, mental health and substance abuse counsellors, rape crisis counsellors, frontline and housing workers and transgendered and queer communities. Her ideas of solidarity and community responses to oppression put the responsibility for worn out activists back where it belongs. She says we're not burning out, we're resisting being blown up.

The Myth of “Normal”Dr. Gabor MateLength: 4 minutes 8 secondshttps://www.youtube.com/watch?v=6i146j5SA9oDr. Gabor Maté speaks on the Myth of “Normal” in Psychological Disorders. He explains how mental distress and pathology exists in a continuum and are largely a result of a materialist culture that rigidly “idealize individuality and ignores emotional needs,” prioritizing objects over people and well being.

Addiction and the Rat Park ExperimentMinuteVideosLength: 3 minutes 30 secondshttps://www.youtube.com/watch?v=sbQFNe3pkssIn this video we present a summary of the Rat Park experiments that took place in the 1970's and the cause of addiction.

https://www.youtube.com/watch?v=uOzDGrcvmus

https://www.youtube.com/watch?v=YnzbsBBGKP8


Safe For AllOntario Association of Interval & Transition HousesLength: 32 minutes 16 secondsThis film explores the concept of Harm Reduction and examines some of the ways this model can be adopted for VAW organizations wishing to create inclusive safe space for women who are using substances.

https://www.youtube.com/watch?v=sbQFNe3pkss

https://www.youtube.com/watch?v=6i146j5SA9o

http://rabble.ca/podcasts/shows/f-word/2011/08/resisting-burnout-feminist-activism

http://rabble.ca/podcasts/shows/f-word/2011/08/resisting-burnout-feminist-activism

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