Trauma-Informed Peer Support

1. Trauma-Informed Peer Support Darby Penney National Center on Trauma-Informed Care RSVP Conference Keynote September 26, 2012

3. Purpose of the Guide To help make trauma-informed peer support available to women who have experienced trauma and violence.

4. Goals of the Guide • Facilitate a process of self-exploration • Provide peer supporters with knowledge to be advocates and skills to support others • Provide mental health professionals and administrators with an understanding of the role of peer support within trauma- informed systems

5. Contents I. Fundamentals Introduction to Trauma and Trauma-Informed Practices Am I a Survivor? Applying These Concepts to Self and Others Peer Support Fundamentals Gender Politics, Criminalization of Women, and Trauma III. Moving Into Action Trauma and Peer Support Relationships Self-Awareness and Self-Care Organizational Context: Working in Systems Trauma-Informed Storytelling and Other Healing Practices Self Inflicted Violence Reclaiming Power Through Social Action II. Cultural Considerations • Culture and Trauma • Religion, Spirituality, and trauma • Trauma-Informed Peer Support Across the Lifespan

6. Format of the Guide Information and statistics describing the specific topic Stories from survivors illustrating specific points “How-to” discussions about specific techniques Exercises for self-examination and for working with trauma survivors in mutual relationships Additional resources: web and print

7. Today we’ll touch on… Trauma & its impact Trauma-informed practices Peer support basics Bringing trauma-informed approaches to peer support

8. TRAUMA AND ITS IMPACT

9. What is “trauma?” Trauma occurs when an external threat overwhelms a person’s coping resources.

10. Some Potential Sources of Trauma • Community and school violence, bullying • Cultural dislocation or sudden loss • Historical/generational targeted violence • Chronic stressors like racism, poverty • Natural disasters • Invasive medical procedures • Any misuse of power by one person over another • Childhood sexual, physical, emotional abuse • Neglect, abandonment • Rape, sexual assault, trafficking • Domestic violence • Experiencing/ witnessing violent crime • Catastrophic injury or illness, death, loss, grief • Institutional abuse and neglect • War/terrorism 10

11. Institutional Trauma Overt Coercion • Court-ordered hospitalization • Restraint and seclusion • Forced medication • Forced ECT • Outpatient commitment • Involuntary treatment of any kind Subtle Coercion People may agree to services they don’t want because they fear: • losing housing • losing employment • losing child custody • Losing access to services they DO want

12. The ACE Study • Decade long, 17,000 + people involved • CDC and Kaiser Permanente collaboration • Largest epidemiological study ever done on trauma • Looked at effects of adverse childhood experiences over the lifespan

13. ACE study found • Direct linkages between trauma and a wide range of physical, emotional, social problems • Rates of chronic physical illness, substance abuse, mental health diagnoses, homelessness, rise exponentially when people experienced multiple adverse childhood events

14. Rates of Trauma Studies show: at least 85% of people with serious psychiatric diagnoses are trauma survivors Similar rates for people with histories of substance abuse, foster care, homelessness, receiving public assistance, and incarceration For incarcerated women, the rate is near 100%

15. Results of Trauma Shatters trust and safety, leaving people feeling powerless Profound disconnection from self and others People are often unaware that their current challenges may relate to earlier trauma People differ in their ability to give voice those experiences

16. Healing is Possible Healing from trauma, like healing from a physical injury, is a natural human process. Richard Mollica, 2006

17. Healing from trauma requires: Regaining a sense of control over one’s life and one’s environment Cultivating a sense of safety Developing the ability to trust self & others Reconnecting with others

18. TRAUMA-INFORMED PRACTICES

19. Trauma-informed Practices Ask “What Happened To You?” rather than “What’s Wrong With You?” Assume anyone encountered may be a trauma survivor

20. Trauma-informed Practices • Focus on safety, autonomy and choice, elimination of coercion • Seeks to understand the meaning people make of their experiences

21. Trauma-informed Practices Require review of all policies and procedures to root out traumatizing practices Everyone – all staff, service users - is educated about the impact of trauma

22. PEER SUPPORT FUNDAMENTALS

23. Peer Support Fundamentals Some organizations define peer support as a “helping relationship” similar to the hierarchical roles of professionals. In this guide, it is defined as the development of mutual relationships built upon peer support principles.

24. Peer Support is NOT A “program model” Focused on diagnoses or deficits About “helping” others in a hierarchical way Being a “counselor” Pressuring people to comply with treatment Monitoring people’s behavior

25. Peer Support Fundamentals Peer Support is rooted in: A natural human response to shared adversity The desire for healing & growth Compassion for self and others Consciousness-raising Builds upon reciprocal relationships among a community of equals

26. Peer Support Principles: Voluntary Non-judgmental Respectful Reciprocal Empathetic

27. Peer Support Settings/Activities Independent peer support groups Peer-run organizations Peer support staff within mainstream programs Internet/ social media Formal support groups Informal or 1-1 peer support Educational focus Social focus Advocacy focus

28. Organizational Considerations Peer supporters working in mainstream programs can face extraordinary challenges Primary role: to bring a different type of conversation to treatment and service settings

29. BRINGING TRAUMA-INFORMED PRACTICES TO PEER SUPPORT

30. Trauma-Informed Peer Support Uses everyday “human experience” language, not “symptom speak” Relates directly to survivors’ experiences and the meaning they make of their lives, not labels of “mental illness” or addiction

31. Trauma-Informed Peer Support Sees coping strategies, not “symptoms” Helps survivors examine the totality of their life situation to make sense of how they are coping and surviving Creates a safe space to consider new coping strategies

32. Culturally Responsive Support Develop understanding of groups commonly discriminated against and targeted for violence. (e.g. people of color, LGBT, young people, elders, immigrants) Assume nothing and create space in your conversations for each person to explore and define her/his own cultural identity and connections.

33. Being with Trauma Survivors DON’T • Assume all survivors need professional help • Focus only on extreme forms of violence • Rely on DSM definitions and symptoms • Ignore the political context of violence DO • Assume resilience and create opportunities • Allow person to define what’s most traumatic • Be open to different ways of making meaning about trauma

34. Avoid “Helping” that Hurts 34 • “Helping” in a top-down manner may • reinforce feelings of helplessness • imply that one person is more “recovered” than the other • convey the message that the survivor is incapable of directing her/his own life

35. Self-Awareness Be aware of: the impact of trauma on your own life your own emotional “hotspots” Words, sights, smells, sounds, behaviors, characteristics, emotional responses how your own experiences and healing processes may influence your feelings and responses to people you support

36. Story-telling Purpose of telling one’s story is NOT to wallow in the pain of past events, but to: understand how these experiences contributed to our current beliefs and actions, and consider if and how we want to change those beliefs and actions in ways that will improve our lives.

37. Survivors Telling Their Stories Personal narratives organize our experience and help us make sense of what has taken place. Stories lay the groundwork for survivors to develop hope about the future. Stories can also be told through music, dance or movement, drumming, art, and writing.

38. Role of clinicians and administrators • Understand the unique role of trauma-informed peer support and nurture its growth • Don’t ask peer supporters to violate their principles as part of their job duties • Promote trauma-informed practices throughout the organization

39. Download the Guide at: http://www.nasmhpd.org/Publications/EngagingWomen.aspx