SHIFTING PERSPECTIVE: Understanding and Addressing Trauma Among People Receiving Behavioral Health Services Webinar

Data shows at least 800,000 people with serious mental illness are admitted annually to jails in the United States. Of this population, 72 percent meet the criteria for co-occurring disorders. Moreover, a minimum of 65 percent of adults in substance abuse treatment report childhood abuse or neglect. With these figures in mind, the impact of trauma on a person's overall health becomes evident. It also points to a conclusion that many people with trauma histories have overlapping problems with mental health, addictions, and physical health and are victims or perpetrators of crime.

Trauma and Justice is one of SAMHSA's eight strategic initiatives. The term trauma is commonly understood as an event involving abuse of any form, neglect, loss, violence, being witness to violence, discrimination, or natural disaster that produces extreme stress and overwhelms a person's ability to cope. On November 9, 2010, SAMHSA hosted a webinar called Understanding And Addressing Trauma Among People Receiving Behavioral Health Services. The webinar focused on promoting integration of trauma-informed care (TIC) into public mental health systems.

TIC has been shown to be an evidence-based, cost effective intervention that diverts persons with co-occurring disorders out of the criminal justice system.

The five core elements of TIC are:

• Safety — is everything being done to ensure physical and emotional safety (welcoming, respectful, sufficient personal space, consistency)
• Trustworthiness — are expectations and interactions for everyone clear and consistent (boundaries, respect, non-judgmental)
• Choice — is a condition being created so individuals experience a feeling of choice and control (providing options, choices, optional program supports
• Collaboration — is the approach one of sharing and collaboration in all interactions (learning from each other, seeking input, listening first)
• Empowerment — is there a fostering of the individual's strengths, experiences, and uniqueness for building upon (recovery, hope, skill building)

TIC speaks to shifting perspectives. Instead of asking what went wrong, the question becomes what happened and how do we work together.

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Resources and Links

• SAMHSA's National Center on Trauma-Informed Care

  SAMHSA's National Center for Trauma-Informed Care (NCTIC) is a technical assistance center dedicated to building awareness of trauma-informed care and promoting the implementation of trauma-informed practices in programs and services.

• Homelessness Resource Center: Trauma Topic Page

  The resources and subtopics in this section provide information about the linkages between trauma and homelessness, and strategies for providing trauma-informed care.

• Community Connections

  Community Connections is the largest not-for-profit mental health agency serving men, women and children in the nation's capital. Since its founding in 1984, Community Connections has been committed to innovative and compassionate mental health, addictions and residential services for the District of Columbia's most vulnerable citizens. Community Connections combines a commitment to quality mental health care with a passion for research and education that has led to our status as a recognized national leader in the delivery of creative and constantly evolving, evidence-based services for our consumers and our community.

• Trauma-Informed Organizational Toolkit for Homeless Services

  The Toolkit offers homeless service providers with concrete guidelines for how to modify their practices and policies to ensure that they are responding appropriately to the needs of families who have experienced traumatic stress. The Trauma-Informed Organizational Toolkit includes:

  1. Trauma-Informed Organizational Self-Assessment.
  2. User's Guide
  3. How-To Manual for Creating Organizational Change

• Seeking Safety

  Seeking Safety is a present-focused treatment for clients with a history of trauma and substance abuse. The treatment was designed for flexible use: group or individual format, male and female clients, and a variety of settings (e.g., outpatient, inpatient, residential). Seeking Safety focuses on coping skills and psychoeducation and has five key principles: (1) safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions); (2) integrated treatment (working on both posttraumatic stress disorder (PTSD) and substance abuse at the same time); (3) a focus on ideals to counteract the loss of ideals in both PTSD and substance abuse; (4) four content areas: cognitive, behavioral, interpersonal, and case management; and (5) attention to clinician processes (helping clinicians work on countertransference, self-care, and other issues).

• Trauma Affect Regulation: Guide for Education and Therapy (TARGET)

  Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is a strengths-based approach to education and therapy for survivors of physical, sexual, psychological, and emotional trauma. TARGET teaches a set of seven skills (summarized by the acronym FREEDOM--Focus, Recognize triggers, Emotion self-check, Evaluate thoughts, Define goals, Options, and Make a contribution) that can be used by trauma survivors to regulate extreme emotion states, manage intrusive trauma memories, promote self-efficacy, and achieve lasting recovery from trauma. TARGET can be adapted to assist men and women from various age groups, cultures, and ethnicities who have had a variety of traumatic experiences. This program can be offered in 10-12 individual or group counseling or psychoeducational sessions conducted by clinicians, case managers, rehabilitation specialists, or teachers.

• Trauma Recover and Empowerment Model (TREM)

  The Trauma Recovery and Empowerment Model (TREM) is a fully manualized group-based intervention designed to facilitate trauma recovery among women with histories of exposure to sexual and physical abuse. Drawing on cognitive restructuring, psychoeducational, and skills-training techniques, the gender-specific 24- to 29-session group emphasizes the development of coping skills and social support. It addresses both short-term and long-term consequences of violent victimization, including mental health symptoms, especially posttraumatic stress disorder (PTSD) and depression, and substance abuse. TREM has been successfully implemented in a wide range of service settings (mental health, substance abuse, criminal justice) and among diverse racial and ethnic populations.