“Through a Different Lens" Trauma-informed strategies for Substance Use Prevention/Treatment WE’RE ALL IN SUMMIT Trauma informed strategies related to substance use prevention and treatment Presented by Kim Dellinger, M.Ed. Executive Director, Bacon Street Youth and Family Services

Objectives That each participant will have at least three different ideas/strategies that they can use when working with a client or family who has/have co- occurring mental health and substance use disorders. That each participant will have at least two resources that they can refer back to when working with clients or families with ACEs and/or co-occurring mental health and substance use disorders. That you will be able to walk away from this presentation feeling like you learned something, you shared something, and that your time was well spent!

Keep in Mind… I’m NOT a clinician, but I HAVE been working in the prevention and treatment fields for over 14 years. The experts are sitting in this room. Understanding ACEs and trauma informed care and designing a trauma informed culture for your agency is something we can all do. It’s about people and their stories. And being patient. And as we say at Bacon Street, being “free of judgment, and full of compassion.”

It’s pretty much here. At LEAST 75% of the youth and their families being seen at our agency have a co-occurring mental health disorder. Trauma is often the presenting concern that causes mental health disorders and substance use disorders. Working with clients and their families AND using a trauma informed approach is something that can be addressed by everyone at an agency, from administration, to program staff, to interns, to clinical staff, to volunteers, and your support folks! And they should!

Crossing the Line Activity

ACEs (Adverse Childhood Experience) It is estimated that 1 in 4 youth will have experienced some form of substantive trauma during their “formative years” (Black, Woodworth, Tremblay, and Carpenter, 2012) The CDC-Kaiser ACE study is one of the largest data studies done related to ACEs. Reflects incidents that occurred during the first 18 years of a clients life.

Defining ACES Taken liberally from the CDC-Kaiser Study Over 17,000 participants in the study The more ACEs in a person’s life, the more likely they will struggle with risky behaviors

Abuse Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt. Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured. Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you.

Household Challenges Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother’s boyfriend. Household substance abuse: A household member was a problem drinker or alcoholic or a household member used street drugs. Mental illness in household: A household member was depressed or mentally ill or a household member attempted suicide. Parental separation or divorce: Your parents were ever separated or divorced. Criminal household member: A household member went to prison.

Neglect Emotional neglect: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support. Physical neglect: There was someone to take care of you, protect you, and take you to the doctor if you needed it, you didn’t have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.

What they Found… Multiple ACEs put people at risk for a higher number of health problems. Among children ages birth to 17 in the United States, 54% have 0 ACEs, 35% have 1 or 2, and 11% have 3 or more. Economic hardship is the most common ACE in the United States for children ages birth to 17. Parental divorce or separation is the second most common ACE in the United States for children ages birth to 17. Among Texas children ages birth through 17, the most common ACE is economic hardship, followed in divorce, alcohol problems, and mental illness, respectively. For more information and research about the ACE Study, go to http://www.cdc.gov/ace/index.htm.

How does this apply to Substance Use Disorders? Those with more ACEs are more likely to participate in risky behaviors You might be familiar with the terms “risk and protective factors.” In the substance abuse prevention and treatment field, we are all about reducing risk factors and increasing protective factors. Because of the nature of ACEs in a child’s life, they can impact how neuro-typical a child’s cognitive development is going to be. This impacts their decision making, their coping strategies, and their long term resiliency.

A Case Study John came to your agency when he was 13, because he was “busted” for smoking marijuana on school grounds. Referral from the middle school. During the assessment process you hear about John’s relationship with his stepfather. John’s parents divorced when he was 8 years old, and his father doesn’t have a strong connection with the family. Father’s family has a history of alcoholism. Mom is worried because he doesn’t seem to want to talk to anyone. How do we address this? Where do we start?

Strategies for success! Everyone has a story. Listen and learn about theirs. Have a client draw a picture, or write a poem, let them express themselves in a non-verbal way if that’s helpful. Let them “drive the bus” when it comes to their therapeutic goals. (Motivational Interviewing anyone??) Ask them to bring in a piece of music that reflects how they are feeling, and then discuss it with them afterwards. Stories aren’t done. There might be new chapters that come up during the therapeutic process. Pay attention to their non-verbal cues. What we’re doing isn’t about shame and blame. How we talk about the work we’re doing matters too… Think about who you are speaking to, and tailor your approach based on who they are, and where they are coming from. Smile!!! This is one of the hardest times in the life of a teen and their family. “If you’re going through hell, keep going.” Winston Churchill Use reflective language. (What I hear you saying is…) Your time is going to make a difference. Don’t shortchange the relationship. Schedule another session before the client leaves. Let them know that they matter. Call them during the week to remind them about the appointment, but also let them know you were thinking about them. Bring them something during a follow up session to spark their interest. Encourage them to bring something next time (this encourages buy-in)!

And for the staff and volunteers… Trauma happens to staff and volunteers too. There is such a thing as a trauma-organized culture for an agency. Support mental health days for staff and volunteers. Provide professional development opportunities. Have a “Walk and Talk” meeting, or get outside! Take time to laugh. Eat lunch together. As often as possible. Build in processing time for your team so that they are able to address it too…

Checking for Learning Step 1: Download the Kahoot app (here’s the link: https://kahoot.com/mobile-app/) Step 2: Find two new friends, we’re doing this in teams! Step 3: Get excited, because here we go!!!

What Questions do you have?

Do you have any questions or would you like to learn more Do you have any questions or would you like to learn more? Email: Kim Dellinger @kdellinger@baconstreet.org or call at 757.253.0111 Other important resources: SAMHSA’s model for Trauma Informed Care in Behavioral Health Services https://store.samhsa.gov/shin/content//SMA14-4816/SMA14-4816.pdf CDC-Kaiser ACEs Study https://www.cdc.gov/violenceprevention/acestudy/about.html The Sanctuary Model and S.E.L.F Tool http://www.sanctuaryweb.com/TheSanctuaryModel.aspx