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Trauma-Informed Care, Recovery-Oriented Care:
Correlated & Complementary Rebecca Miller, Ph.D.
Department of Psychiatry, Yale School of MedicineJune 19, 2018
Poll Questions
How much do you already know?
Where do you work?
What population?
Housekeeping Information
• Mute speakers if you are calling in to avoid echo on your end
• This webinar is being recorded, and the recording will be available on MHTTC on Friday, June 21st
• If you have questions during the webinar, please use the “Chat and Questions” box
• If you have questions after the webinar, please e-mail: [email protected]
Learning Objectives
• Review key values of Trauma-Informed Care (TIC)
• Differentiate between trauma informed care and trauma specific services
• Define recovery-oriented care (ROC)
• Identify how ROC relates to TIC
Why I do this work
The Overarching Principle: RECOVERY
A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Recovery = Cure?Recovery does not refer to an end product or result. It does not mean that one is “cured” nor does not mean that one is simply stabilized or maintained in the community. Recovery often involves a transformation of the self wherein one both accepts ones limitations and discovers a new world of possibility. This is the paradox of recovery, i.e., that in accepting what we cannot do or be, we begin to discover who we can be and what we can do.
Patricia Deegan, Ph.D.
Four Dimensions of Recovery (SAMHSA)Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way
Home: a stable and safe place to live
Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society
Community: relationships and social networks that provide support, friendship, love, and hope.
TraumaExposure to trauma in the general population:Men: 43%-92% Women: 36%-87%
• 90% exposed to at least one traumatic event
• 43% diagnosable with PTSD• Usually multiple traumatic
events, including physical and/or sexual abuse, rape, violence, emotional abuse, neglect, loss, witnessing any of these events, etc.
• Coercion in the mental health system, along with practices of seclusion and restraint, can be further traumatizing
(Mueser et al., 1998)
Breslau, N. (1998), Epidemiology of Trauma and PTSD. In Trauma, Vol. 17, ed. Yehuda, R., ch. 1.
In Public Mental Health
We all likely have experienced trauma – a side effect of having lived on this earth
We all are in recovery from “something” – heart disease, smoking, eating disorder, substance use, mental illness
Values of Trauma-Informed
Care
•Safety•Trustworthiness•Choice•Collaboration•Empowerment
“Universal Precautions”
Approach your work with the assumption that all people in the workplace (staff and people receiving services alike) have faced some trauma in their lives.
Transforms the question from “What’s wrong with a person?” to “What’s happened to a person?”
Not just services…
• TIC includes looking at policies, procedures, physical environment, staff relationships, hierarchy in the organization
• AND…• Assessing trauma in those receiving services• Addressing trauma• Providing (gender-specific) services to treat trauma
Trauma specific interventions
• These are interventions specifically addressing trauma
• Fit under the umbrella of range of services that should be offered in a recovery-oriented care system
• Some interventions include• Trauma Recovery Empowerment Model (also
M-TREM)• Seeking Safety• PE therapy• EMDR
Overlaps with Recovery Oriented Care • Both are focusing on the process and the
journey, not a label • Strengths-focused• What happened to you? (vs what’s
wrong with you)• What are your hopes and dreams? Goals
for the future? (vs what are your problems to fix)
TIC - ROC 1-2-3 You and Me• Trauma specific
services – focused on addressing trauma specifically
• Trauma informed –keeping principles in mind
• Recovery – an individual’s journey and path
• Recovery-oriented• Keeping
principles in mind• Exercise
metaphor
• Trauma can leave us upside down• Psychosis can leave us unable to trust our minds• Systems can leave us burnt out
Traditional
Stability
Compliance
Control
Focus on deficits
Low expectations
Recovery
Hope for future
Choice
Partnership
Focus on strengths
High expectations
USPRA PCP Toolkit Presentation, Miller, Guy, & Tondora, 2009
Moving towards Recovery
Traditional
Learned helplessness “victim”
Protection from failure
Stabilization is the goal
Moving Towards Recovery
Recovery
Active participation
Risk is supported
Meaningful life is the goal
From WNYCCP 2005USPRA PCP Toolkit Presentation, Miller, Guy, & Tondora, 2009
NOT… BUT…
What do people with yourdiagnosis
need?
What do allpeople need?
ANDWhat do youreally want?
Being Person-Centered…
USPRA PCP Toolkit Presentation, Miller, Guy, & Tondora, 2009
Addressing Trauma
A key element of recovery oriented systems
Moving from a medical model to a disability model, a rehabilitation model, or a strengths-based model
More and more focus on the impact of trauma, ACEs, context, on mental health disorders
Contact
Great Lakes [email protected]
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New England [email protected]
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Katie [email protected]
Upcoming Webcast
Visit www.mhttcnetwork.org/newengland or www.mhttcnetwork.org/greatlakes to register.