Presented by Helping Professionals Wellness Center Laurie Ellett LICSW, LCSW, CADCII, CDP and Forrest Sippey MSW, NCACII, CADCII, CDP
Forrest reports “Everyone is doing the best they CAN” was the greatest lesson he ever learned! Laurie shared her beginnings in the field were confrontational – if someone refused to move forward they were asked to walk around the treatment facility taking two steps forward and one step back until they got it. And the more a client was made to cry the more the treatment facility felt they made the greatest impact. Scott Sims of Columbia Treatment Services once shared that when he went to treatment he was made to wear a toilet seat around his neck and a sign that read “I’m a piece of …”
Laurie shared how she recalls it didn’t feel right. So today there is a new type of treatment occurring – one that uses words like collaborative instead of compliance. Where patients have a choice and they can trust you. Where we can say I’m working for you. And we ask “what can I do for you? Or Is there anything about me that leads you to question my trust. I don’t expect you to trust me. I plan to earn your trust.
Forrest shares he doesn’t know if empathy can be taught. Where you can look someone in the eye and say I get it without telling our story. A strength based approach where we acknowledge that it takes a lot of strength to survive the darkness. Trauma informed service is a place where everyone in a treatment facility is on the same page; from the maintenance person to the CEO of the treatment facility. Where the value of the people is still what it was before all the poop happened.
Trauma informed care is a place where pre-contemplation is celebrated as much as action. If I don’t value myself I see no value in changing. The brain and the psychological changes that occur were reviewed. That we do not have a shut off valve like a gazelle that is threatened by a lion and is eaten by it or grazing in the grass not recalling that it almost lost its life. Our stress continues. Strength based approach that leaves a client feeling like maybe this time they will experience recovery.
Acknowledgement that we ourselves and/or our coworkers have trauma and it’s affecting everyone.
I absolutely loved that Forrest stated “Not addressing nicotine seems wrong.”
Behaviors that impede growth
Predicting outcomes, gallows humor, observations with judging, negative chart notes, focus on productivity, critical of counselor, codependent, labeling, highly directive, territorial, being told by management your good enoughs aren’t good enough, split in team, lack of empathy, no voice, cultural thing varies by agencies, parallel process from the top down it trickles down, every single client is lying, (so what if they are lying) recognize that with a person a masters and you have an associate how do we supervise up?
We have to have compassion for the people who break the law – even sex offenders.
We need to treat our clients like customers. When a client is in denial or pre-contemplation stage of change they are doing their job – not being resistant. Let’s do our job and find their strengths when they don’t see them.
Trauma Informed Service
Referral and Screening
Welcoming: “So glad you’re here… How can we help?”
Client voice: Ask “What would you like to see happen?”
Ask: “Help me to understand…”
Provide Safety, warmth and privacy – ensure confidentiality
“Who referred you to our services?”
Listen to all of their needs…validate their experience.
Celebrate whatever stage they are in.
Recognize success, build on strengths.
Answering phone on first ring…be responsive…let them hear your smile through your voice.
Realize we are being interviewed too…(they are checking us out)
Active listening: Insurance, clarity about payment for client to know what to expect – transparency…
Give a sense of “they belong” we are her to provide excellent care.
Acknowledge their courage to make that first call.
Summarize their plan at end to improve communication.
Intake and Assessment
Welcoming – acknowledge arrival
Thoroughly review rights and responsibilities
Monitor comfort – needs – hospitality
Acknowledge difficulty of task – personal nature
Going over what’s going to happen/expectations
Not being rushed allow for processing speed
Explain roles – intake is not treatment or therapy
Address anxiety if observed
Body language and tone
Express optimism – hope – success
Acknowledge steps to success
What’s working? What’s not working?
Appropriate self disclosure
Treatment Planning and Review
Client directed – what are their goals
Paying attention to our own self care
Reviewing information beforehand
Remaining flexible and adaptable
Slowing down and speeding up
Asking for permission to give advice.
Treatment Discharging Planning
Risk needs assessment tools
Short and long term goals
Focus on trauma
Intensive out patient
How do we transition them
Hand deliver them to those services
Be in touch with that person in the community
Self help group
Sober support network
Prosocial activities Church
Positive things in the community
NAMI, Wellness Programs
Find Services – food, housing employment
Housing that accepts individuals with an assault record
Look for one stop shopping places
If they have 15 or 16 things on their plate their priorities will be to feed their kids
Address family members too. When the family is hearing from the Probation Officer that you understand that healing is this way – that gives the family hope.
Comparisons were made – threats to staff leads to immediate discharge from program – instead an intervention approach with the staff on what can be done.
Dirty UA – report to their officer – go with them to report and advocate on all of the work they have done. They will still get sanctioned however credit for what they have done well may help them stay in treatment.
If a basic rule is broken – meet with the client instead of behind closed doors without the client.
If they say they didn’t know – inquiring and informing if the person really didn’t understand especially in early recovery. Provide more clarity and teach more coping skills.
Tap 21 – Competencies an excellent resource
Tip 57 – Trauma-Informed Care in Behavioral Health Services – another excellent resource was shared
Seek professional help
Progressive relaxation techniques
30 minute circuit at the gym
Larry Nim Guided Muscle Relaxation
Practice ongoing self care
Getting in a quiet space
Power nap in the car
Take a time out
Two minute visualization
Self help books
Spend Time with Grandkids
Practice Attitude of Gratitude
Get near running water
Seek out Coworkers/Mentors or Like Minded Professionals
Self Care Robin Rose
Watch a silly movie like Troll Hunter
Remember our self care changes
Transition location – when I arrive on the I 5 Bridge I leave work behind and focus on home