Why trauma-informed practice?
Research has shown that the vast majority of individuals who experience problems with opioid misuse have current or past experiences of trauma and violence. The goal of trauma-informed systems is to avoid re-traumatizing individuals and support safety, choice, and control in order to promote healing.
This discussion guide is intended to stimulate further conversation on “becoming trauma-informed” and assist health care and social service providers in considering additional ways of addressing the opioid crisis in their particular context.
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Trauma awareness
Being “trauma aware” means asking “What has happened to this person?” rather than “What is wrong with this person?”
Strategies
- Recognize past and current experiences of trauma and violence as a potential risk factor for opioid misuse and that substance use can be a form of coping with the effects of trauma, sometimes differently for women, men, trans and gender-diverse people.
- Learn about local programs and services that provide trauma specific treatment for women, men, trans and gender-diverse people who may be interested in a referral. Also consider integrated, interdisciplinary, multimodal, or holistic programs that address multiple concerns related to trauma, addiction, and chronic pain.
- Offer information about the relationship between pain, trauma, and opioid use to patients. This increased understanding of how past experiences of trauma affects their physical well-being can create understanding and self-compassion.
Discussion questions
- How prevalent is trauma in the population(s) you work with? In what ways is your organization already "trauma-informed" and addressing trauma (directly or indirectly) with your patients?
- In what ways has increasing opioid use and misuse affected your work? Which populations are affected and in what ways (e.g., women using prescription opioids, accidental overdoses by seniors)? In your opinion, what are the factors contributing to these trends? Are there additional ways your organization can address these trends, e.g., changing prescribing practices, prevention by addressing adverse childhood experiences, family support?
- What kind of information about trauma and substance use is available to your clients? Is it accessible, up-to-date, and tailored to the population you work with?
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Safety and trustworthiness
People need to feel they are out of immediate danger (i.e. physically, emotionally, spiritually, and culturally) before they can engage with services.
Strategies
- Create opportunities for clients/patients and staff to provide feedback on how the program environment affects physical and emotional safety, e.g., locks and lights, layout of furniture, safety glass.
- Become aware of possible triggers in routine aspects of the care you provide, e.g., locks and lighting, security glass, intake questions, lack of privacy during procedures, chaotic environments. If possible, develop strategies, no matter how small, to minimize the possible impact of these activities.
- Learn about the signs of burnout, vicarious trauma, and compassion fatigue and be able to recognize them in yourself and other coworkers. Learn about how and where to access support and care.
Discussion questions
- What are possible triggers for re-traumatization in your particular area of work, e.g., urine testing, searching belongings, administration of medications, locks and lighting? What are some of the ways these could be minimized, e.g., explaining the reasons for these procedures, providing clients/patients with some control over how a procedure is implemented?
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Choice, collaboration, and connection
Experiences of trauma often leave individuals feeling powerless, with little choice or control over what has happened to them.
Strategies
- When meeting a patient for the first time, ask how they would like to be addressed. Check whether they would like to be called by their first name or last name or by their title (e.g., Ms. Smith, Freddy, Dr. Medley). Use pronouns that reflect a person’s gender identity (e.g., he, she, they); if unsure, respectfully ask.
- Recognize that alternate approaches to pain management need to be in place before people will be receptive to reducing their opioid use, especially if opioids are helping them to cope and manage on a daily basis.
- Review language used in policies, forms, reports, and other documentation. Identify where it is possible to move towards more supportive, recovery-oriented, strengths-based language that emphasizes choice, collaboration and control, e.g. “Patient chooses to opt out of treatment” instead of “Patient is non-compliant.”
Discussion questions
- How much choice do your patients have in the services they receive, and when, where, and by whom the service is provided, e.g., time of day or week, office vs. home vs. other locale, gender of provider? Are you able to work in more flexible ways? What groups might benefit from these types of strategies?
- What is your clinic’s philosophy towards substance use? What is the value of both harm reduction and abstinence-based services? How can each contribute to addressing the opioid crisis?
- In what ways does the language currently used at your organization support hope for healing from trauma and reduce stigma related to substance use? What else might be helpful?
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Strengths-based approach and skill building
Promoting resiliency and coping skills can help individuals manage triggers related to past experiences of trauma and support healing and self-advocacy
Strategies
- Help patients identify their strengths. Ask about people’s interests, survival strategies, practical skills, spirituality, and community connections.
- Teach and model skills for recognizing triggers, calming, centering and staying present.
- Support patients in developing new skills for managing pain and/or make referrals to other organizations or services or provide information about online or self-management resources.
Discussion questions
- What policies and practices within your organization support a focus on strengths? What about those that seem more focused on deficits? Some areas to consider include program entry requirements, intake procedures and organizational values. What are some first steps for helping to shift your organization towards being more strengths based?
- Consider the population(s) you work with. What skills might be the most helpful in promoting healing from trauma? What are some of your strengths as an organization in terms of providing practical skills training? What additional training for staff might be helpful? What other organizations could you work with in the community?
- What is the role of your organization in the community? In what ways are you connected to initiatives to support resilience at a community level? Are there other things you can be doing with regards to addressing some of the underlying conditions contributing to the opioid crisis?
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