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Mental Health

Interview with Dr. Allen Frances on the DSM 5

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Approximately a week ago, I wrote an article asking Will Clinical Social Workers Embrace the New DSM 5 in light of the National Institute of Mental Health withdrawing its support for the publication. Then, Dr. Allen Francis wrote an article making a case for social workers not to embrace the DSM 5.

Responses by social workers on different social media outlets varied, but one unifying question remained….Why now? Historically, social workers have not been included in the developmental process of the DSM by the American Psychiatric Association (M.D.’s) despite being the largest provider of mental health services. I decided to email Dr. Frances and asked if he was available to answer some follow-up questions about his article on social workers.

He responded, “Sure…Let’s have a telephone call today. The week is very busy”.  Dr. Frances spoke with me for almost a hour in order to help me relay the likely long term implications of the DSM V and why social workers being the largest stakeholders should be concerned too. This article is packed with resources because I independently verified every statement made by Dr. Frances in order for you to make your own assessment.

Before I dive into the interview with Dr. Frances, I would like to bring you up to speed with some background information on this not so new controversy.

What makes Dr. Allen Frances an authority on the DSM?

Dr. Allen Frances was chair for the DSM IV task force and the Department of Psychiatry at the Duke University School of Medicine, and he is currently a professor emeritus at Duke University. In late 2010, Dr. Frances did an in depth interview with Wired Magazine who had unlimited access to him as he reflected on almost two decades in the past when he authored the DSM IV. Here is an excerpt from Wired Magazine:

In its first official response to Frances, the APA diagnosed him with “pride of authorship” and pointed out that his royalty payments would end once the new edition was published—a fact that “should be considered when evaluating his critique and its timing.”

Frances, who claims he doesn’t care about the royalties (which amount, he says, to just 10 grand a year), also claims not to mind if the APA cites his faults. He just wishes they’d go after the right ones—the serious errors in the DSM-IV. “We made mistakes that had terrible consequences,” he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.  Read Full Article

The article in Wired Magazine was indeed an eye opener. It discusses how an influential advocate for diagnosing children with bipolar disorder failed to disclose money received from the makers of the bipolar drug Resperdal. When viewed with a wider lens, it not really all that surprising considering the recent revelations on Attention Deficit Disorder as discussed in the New York Times.

History of Social Work Involvement with DSM

Back to the interview with Dr. Allen Frances, the first order of business was to gain some insight on the sudden outreach to the social work profession, and I didn’t anticipate learning something new. However, this was not the case.

Dr. Frances went on to tell me about Social Worker Janet B. Williams who was the text editor on the DSM III. Additionally, he also notes that she has been the only social worker ever to be included in the DSM development process. Currently, Janet Williams is the Vice President of Global Science at MedAvante. As stated in a 2011 PRNewswire Press Release, “MedAvante solutions help sponsors achieve enhanced assay sensitivity for increased drug effect and reduced trial failure rates, enabling them to bring better drugs to market faster.”

Dr. Frances acknowledged that social workers have not been represented in the development process despite being the largest provider of mental health services. However, he did state, “Social Workers have a huge stake in improving care for the really sick and should not be distracted by the expansions of the DSM V.”

DSM 5 Impact on Consumers 

Dr. Frances expressed concerns for military service men and women being overly diagnosed with PTSD in lieu of allowing time for transitional services. Dr. Frances gives another example of how unemployment causes depression which is the result of environmental factors and not a mental illness.

Once someone regains employment and the situational stressors have abated, should this individual retain the label of a psychiatric disorder for seeking counseling as a coping mechanism? Do practitioners really want to label someone as a major depressive because they are unemployed or have been diagnosed with Cancer? Here is a video where Dr. Frances goes more in depth on the potential problems this will cause:

Unintended Consequences of DSM V

Dr. Frances stated one of the major issues with the DSM series is that its primary authors are research academics who are making suggestions and recommendations based on controlled research studies conducted in University clinics which are not helpful in everyday practice. By expanding the DSM 5 to cover challenges of everyday living, it will mislabel medical illness as a psychiatric disorder.

Dr. Frances also stated it will continue to foster an environment that diverts attention and resources away from the severely mentally ill and uninsured. As an example, Dr. Frances referenced the 1 million inmates in prison as a result of an undiagnosed and untreated mental health disorders due to poor resources and health care. Apparently, the Bureau of Justice Statistics agrees with him, and you can view their report here.

Dr. Frances quotes President Obama when he stated, “It’s easier to get a gun than an outpatient appointment.” Although gun control was not apart of our discussion, it should be noted that the National Rifle Association (NRA) is using its powerful lobbying efforts to change mental health thresholds and reporting laws in all 50 states.

Couple this type of legislation with over diagnosis by mental health professionals, the outcomes for children and families could be devastating. The New York Times does a great job of summarizing the presenting issues with current NRA proposals in an article entitled, The Focus on Mental Health Laws to Curb Violence is Unfair, Some Say. You can also view this video of Dr. Allen Frances speaking on the over diagnosis of mental illness:

Common Misconceptions About the DSM V

The interview with Dr. Allen Frances gave me an opportunity to ask him for clarification on some of the concerns expressed by social workers and their reasons for embracing the anticipated DSM 5. I made of a list of the main key points that he wanted Social Workers to know:

  • The DSM is a copyrighted manual by the APA with no official authority with public or private health insurers.
  • The ICD Codes are the only required codes necessary for billing mental health services. He states these codes are free of charge from the government with accompany resources and guides available. Here is the link found on CMS.Gov.
  • The APA is motivated by earnings for publishing a new manual to cover budgetary shortfalls.
  • Unless your institution demands use of the DSM V, Don’t buy it, don’t use it, and don’t teach it.

“The ICD is the global standard in diagnostic classification for health reporting and clinical applications for all medical diagnoses, including mental health and behavioral disorders. The United States will be one of the last industrialized countries to adopt the ICD-10, even though it was published in 1990.

Every member state of the World Health Assembly is expected to report morbidity and mortality statistics to the World Health Organization (WHO) using the ICD codes, but countries are allowed to modify the ICD for use within their own country.” ~Practice Central

https://twitter.com/AllenFrancesMD/status/335927445326802944

Dr. Frances provided his twitter feed where he disseminates information on his current projects. He also stated to tweet your questions, comments, and concerns to @AllenFrancesMD as seen above.

Recommendations

Dr. Frances states that he believes there should be a government arm similar to the FDA to help regulate, provide guidance for mental health providers, and make recommendations for public policy. He believes it should be comprised of an interdisciplinary team of psychiatry, social workers, and public health in order to create a holistic approach to treatment and diagnoses. Dr. Frances stated the APA should no longer have a monopoly on mental health especially with increasing influence from drug companies manifesting in their policies.

Also View:
Dr. Francis Op-ED in the New York Post
Don’t Buy it, Don’t Use it~Mother Jones
Find Him on Huffington Post

Deona Hooper, MSW is the Founder and Editor-in-Chief of Social Work Helper, and she has experience in nonprofit communications, tech development and social media consulting. Deona has a Masters in Social Work with a concentration in Management and Community Practice as well as a Certificate in Nonprofit Management both from the University of North Carolina at Chapel Hill.

15 Comments
Keith Owens says:

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Rachel West says:

RT @AllenFrancesMD: My advice to social workers on how to avoid the risks of #DSM5 http://t.co/ugkNchKmDw @swhelpercom @poliSW

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RT @AllenFrancesMD: My advice to social workers on how to avoid the risks of #DSM5 http://t.co/ugkNchKmDw @swhelpercom @poliSW

RT @AllenFrancesMD: My advice to social workers on how to avoid the risks of #DSM5 http://t.co/ugkNchKmDw @swhelpercom @poliSW

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RT @AllenFrancesMD: My advice to social workers on how to avoid the risks of #DSM5 http://t.co/ugkNchKmDw @swhelpercom @poliSW

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Rachel West says:

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RT @swhelpercom: Interview with Dr. Allen Frances Department Chair of Duke … – http://t.co/HW3XKGmlv7 #SWUnited #socialwork http://t.co/prYkxzb6SU

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RT @swhelpercom: Interview with Dr. Allen Frances Department Chair of Duke … – http://t.co/HW3XKGmlv7 #SWUnited #socialwork http://t.co/prYkxzb6SU

Human Services

Is Counseling For You

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Have you been in counseling or therapy? If not, have you ever hesitated in seeing a counselor, or wondered why you felt so wary? Studies show about 20-35% of Americans having attended some form of counseling and psychotherapy compared to approximately 80% of mental health professionals.

Believing that counseling and psychotherapy could be helpful for anyone in alleviating problems, improving relationships, and developing a more positive outlook toward life, a Journal for Human Services research study explores why some people attend counseling or therapy while others do not.

Researchers, Ed Neukrug, Mike Kalkbrenner, and Sandy Griffith wondered why it was that some people seemed readily to attend counseling while others hesitate or who don’t attend often to their own detriment. Their research on attendance in counseling of helping professionals and their upcoming research on attendance in counseling of the public in general offers a thoughtful analysis which will hopefully shed some light on this important concern.

After an exhaustive review of the literature, researchers independently looked at over 60 potential barriers to attendance in counseling and eventually reduced this number down to 32 specific items. Their research found three broad areas or reasons likely to affect individuals who tend to avoid counseling and therapy. They identified these areas as “Fit,” “Stigma,” and “Value” to reflect the areas they represent.

Factor 1: Fit

Fit has to do with one’s sense of comfort with being in counseling and whether one has the ability to trust the process of counseling will be beneficial. Some typical fit questions were related to whether a potential client believed a counselor would feel comfortable with the potential client’s sexuality, disability, or other aspects of the client’s identity. Other questions in this area assessed whether a potential client believed a counselor could understand him or her, was competent enough to deal with the client’s problem and could keep the client’s concerns confidential. In addition, other “fit” questions queried whether potential clients had a bad experience with a counselor in the past and if they thought they could find a counselor near to where they lived

Factor 2: Stigma

Stigma is the feeling of shame or embarrassment some people experience when they consider entering a counseling relationship. Some of the stigma questions highlighted whether a potential client believed their friends, family, peers, colleagues, or supervisors might view them negatively if they knew the individual was in counseling. Other questions focused on how some potential clients might consider themselves weak, embarrassed, or unstable if they were in counseling. Often, those with high scores on stigma believed others would judge them, and thus, they would feel badly if they were to enter counseling.

Factor 3: Value

Value is the perceived benefit or worth one believes he or she is receiving from attendance in counseling. Potential clients who would score high in this area often believed the financial cost of counseling was not worth its benefits. Participants in this category simply could not afford counseling or they didn’t have time for it. Many participants in this category believed counseling wasn’t necessary because problems usually resolve on their own, or that counseling was simply not an effective use of their time. These individuals simply did not embrace the counseling process because the financial costs in their mind are hard to justify over meeting basic needs and/or having to take time off from work.

Although some individuals cannot find a counselor to their liking, participants worried whether counseling would be worthwhile, or they were ashamed or embarrassed about going to counseling. Most people believe that when faced with difficult life problems, counseling could be helpful.

It is hoped through research like this, people can better understand why they might be hesitant to seek a counselor and  maybe overcome some of their fears. Additionally, this research can help national organizations, in the helping fields, find ways to help clients overcome these barriers.

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Global

Turnkey: A Co-Housing Experience in an Italian Public Service for Addiction

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Turnkey is a term used in the economic field, but it also fits well in a social rehab project. The idea comes from the need to give some answers to the problem of those patients that experienced a long term therapy in an addiction rehab center for 3 or 4 years.

In the Italian welfare system, the outpatient service team -work (doctor, psychologist, educator, nurse and social worker), operating in the addiction recovery can schedule long term treatment in the residential rehab centers. In some cases, this long time permanence is something obliged, because of the serious addiction and also for the lack of different life perspectives after the recovery.

These kinds of patients need more therapeutic help in order to return to civil society in order to find  meaningful social membership. Usually, these clients have no meaningful familiar connections, no job, and no significant friendship.

In the last years, our social services system has become more careful about the use of public money. They noticed social workers more equipped to provide therapeutic interventions using a holistic approach in order to spare economic resources. Social workers are more capable to assist patients in reaching a better life condition by using their abilities toward social integration.

The Project

Five years ago, the program’s director asked for the professional team to think about a solution for the rehabilitation of the” long term patients”.

I started wondering about the meaning of poverty which is not only economics but it also the satisfaction of primary needs. It’s the lack of healthy relational bonds which weakness a lot the patients coming out of the drug addiction recovery programs.

I also noticed that this relational deficiency is a modern human condition; in the weakest social situations the loneliness is something that “destroys the mind “.

So I got an idea: I proposed to my director to start thinking about a possible apartment for a temporary co-housing for at least two patients.

He liked the project and submitted the plan to the municipalities which have the competence in the social side of rehabilitation. The municipalities agreed to the project and financed it.

For the patients in long term recovery, the rent was paid through the financing with the municipalities (an average of 6.000 Euro a year for 4 years, renewable), whereas the utilities and the others cost of the house has been in charge to the occupants.

The management of activities like the admission of the patients, the guaranteed respect of the therapeutic contract, the check of daily life and the help in the money administration, are some of my specific competences as a social worker.

In my job role, I had a significant part into find fitting persons for the project who were able to live together. I also contributed to choosing the people eligible to live in that specific therapeutic situation.

I helped the patients to organize their new life and to establish minimum rules of mutual life in the apartment. The project is strictly tied to the learning of the skills required to come back to live a regular life.

For example:

– living together is an opportunity for the patients to learn mutual respect

-cleaning the home and paying the utilities is a way to come back to daily responsibility and autonomy.

– having a good neighborhood relationship is a way to learn again to have good relationships without drug addiction to interfered an apartment, next to the main social and sanitary services of the town.

The results

Since 2011, we housed 11 clients in the apartment with an average of one year placement. We should consider that one year in a residential rehab center cost 30.000 euro each person.

Eight of them returned was able to manage a regular social life, their addiction, a job, maintain social relationships which helped them to achieve a dignified lifestyle.

Two persons are still in the co-housing situation, one of them has a regular job, and he is searching for an own house. Only one person abandoned the treatment.

This intervention is a daily challenge for our team; it gave us good results in the recovery outcomes like independence, citizenship, struggle against the stigma and improvement of personal resources.

We also have spared a significant amount of public money while offering to our clients a higher quality of life.

The creativity and the professional skills mixed together with the help of other colleagues in the multidisciplinary teamwork made this project an effective strategy to help patients overcome their circumstances.

So, I can call myself a responsible social worker, because I help to improve the personal resources in my client’s life. I was mostly inspired from the basic professional principle “start from where the client is”.

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Mental Health

Will Veteran Suicide and Mental Illness Rate Improve?

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Even in Afghanistan, I will seek pet therapy! – Rick Rogers (pictured above)

It was about 9 years ago.  I decided to put down the rifle and pick up the DSM. You see, I was an infantryman since I was age 17.  That means, since I was a child, I was literally trained to kill people.  Looking back at it, that sounds like a profound concept.

I am proud of my time in the military.  I am proud of my brothers and sisters who have ever answered the call.  But…  I am also worried.

As I said, 9 years ago, I decided to change my path.  I didn’t realize where that path would lead.  I seen multiple traumas and death happen to my fellow comrades.  I went through some trauma myself, but I still worried about others more than myself.  So, I decided to become a Mental Health Specialist in the military.

It’s been a long road going from Infantryman to Social Worker. There are a lot of learned attitudes and behaviors I had to change. Can you believe it? I literally had to learn empathy.  And that took a long time.

Just about anyone in the military knows that drinking alcohol is a part of the lifestyle. Everyone I looked up to drank and considered me a p**sy if I didn’t.  So… when I was sent to Germany back in the early 2000’s as a 19 year old kid, you better believe I drank. It was legal!

Looking back at my adventures between then and now, I don’t regret a thing. Yes, there were many embarrassing moments, and I have lost many friends along the way.  I also met some great people.  My alcohol use made my path rockier than anything else.

Many others have had this experience as well.  Between 1998 and 2008, binge drinking went from 35% to 47% of veterans, and 27% of that 47% experienced combat. 

Between 2002 and 2008, misuse of opiate prescriptions went from 2 percent to 11 percent in the military.  These prescriptions were mostly due to injuries sustained in combat, as well as the strain of carrying heavy equipment.

This concerns me. When I was young, I had a good time. Looking back, maybe it wasn’t.This might not be every veteran’s experience, but the culture encouraged substance use and discouraged getting help. There are others that would agree with me.

This could explain why 20 veterans a day on average commit suicide. This is actually down from 22 a day before the 2014 study from the VA.  However, it is a 32% increase since 2001. In 2014, veteran suicides accounted for 8.5% of U.S.’s adult suicides, and the rates were especially high among 19-29 year old compared to the older generation.

Let’s not forget about the infamy of PTSD. Up to twenty percent of veterans have suffered from this. Of course, those who suffer are more likely to admit their distress to a computer program than a battle buddy or their superior.  This, again, goes with the constant culture that causes our military to fear judgment.

These wars have been a constant the last two decades, and have cost all U.S. citizens a pretty penny. According to one report, the VA spends $59 billion a year on health care.  This number is 3 times as much as it was since before 2002.

And let’s not forget the cost this country has incurred for being in war for this long.  Well, we don’t really know an exact number.  The cost is estimated by many to be in the billions or even trillions.  This isn’t including the interest from borrowed money.

So, after looking at all these figures, I am overwhelmed.  How can I even make a dent in helping our nation’s veterans? The current administration is planning on increasing our presence in war zones.  I am expecting the rate of PTSD and suicide to increase once again.  Also, our country will continue to spend.  It seems to me that we are all participating in a death and mental illness factory.   The thing is, I didn’t even get to the physical injuries many of our combatants have suffered from.

I love our nation’s military.  I want every one of them to know that I am here to support them.  But most of all, we all need to be here to support each other.

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Mental Health

First Responders: Behind The Festive Season

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I’m a social worker. I’m a first responder spouse. With my partner, I advocate for improved mental health for first responders, including educating helping professionals to understand the culture, lifestyle, and demands of the job on both responders and their families.

I hear stories from police, paramedics, firefighters and frontline rescue responders and their family members every day. Tales of trauma, grief, and horror – and on the flip side incredible strength, resilience, courage and sacrifice.  It’s December and social media is full of excited conversations about planned gatherings and festivities for Christmas and the New Year. Those posts inspire this reminder.

In Australia, there will be barbeques and beer in sweltering heat by the pool or at the beach, a stark contrast to some of our global friends whose Christmas will be white, accompanied by outdoor play with snowmen and gift giving inside by the warmth of a log fire.

Despite the contrast in temperatures across the globe, there are those who work tirelessly behind the scenes of Christmas beer and New Year cheer. Police, paramedics, firefighters, and rescue personnel are unlikely to experience the festive season in the way most people do. They are on call to ensure the public’s continued safety, health and wellbeing. And so their festive season, regardless of location, is far more likely to include these scenarios:

  • Burglary, elderly occupant assaulted and taken to hospital
  • Multiple occasions of drug overdose at a teenage party, several individuals taken to hospital in serious condition
  • Alcohol fuelled violence, multiple serious injuries
  • Bush fire endangering properties, implement evacuation procedures
  • Car accident, children seriously injured
  • House fire, no injuries but the house is beyond repair and a family is left homeless
  • Notification of the sudden death of someone’s loved one

This is a typical “festive season” for first responders. Their families are at home – not with their loved ones as is traditional, but quietly accepting that their loved one is needed out in the community to keep others safe. Some days will simply be a bit lonely, other days will be filled with concern for their safety.

For many first responders, the festive season brings back memories of trauma past. That makes the lead in time to end December a difficult one, rather than one of anticipatory excitement. And then, of course, we have those who can no longer turn out because of physical or psychological injury. Their lives forever changed by the job. Perhaps this year they do get to sit with their families and share a meal, but at a huge emotional and financial cost inflicted by their injuries.

Finally, a harsh reality in first responder world: the first responder family members who tragically have to face this “festive” season alone. This time not by choice. Their first responder’s life either taken away by an incident on the job or by a sense of hopelessness all too common in those with psychological injuries.

The festive season of giving is a timely reminder that we as a global community are exceptionally fortunate to have first responders looking after us. Whether you’re in Australia, India, Alaska or England, these people give up their precious family time to keep us safe. Many are volunteers. They are human, just like us. Witnessing human suffering is hard at any time – but this time of year adds extra burdens.  Please drive carefully, celebrate carefully. And while we all sit in the protected bubbles of our own private Christmas and New Year celebrations- please spare a thought for all frontline responders and their families

In the spirit of the season, please acknowledge their sacrifice with a note, a smile, a thank you – so that in the midst of whatever trauma they’re dealing with, they will be reminded of the true intention of these times: goodwill, human connection, and hope.

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Mental Health

Having Difficulty Creating Worksheets and Activities for Your Clients?

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Nicole Batiste, Hub for Helper Founder – third from left

Tailoring worksheets and activities specifically for your client needs can be challenging for the best of therapists and counselors. For others, maybe you are a natural born artist moonlighting as a mental health professional dazzling clients with your creativity which helps them move one step closer to becoming their best selves.

According to the National Institute of Health, there is a direct correlation between the creative arts and health outcomes when used in a therapeutic setting. The study reports: “Use of the arts in healing does not contradict the medical view in bringing emotional, somatic, artistic, and spiritual dimensions to learning. Rather, it complements the biomedical view by focusing on not only sickness and symptoms themselves but the holistic nature of the person.”

What are my options with limited artistic abilities?

For those of us who are artistically challenged, it is imperative to identify resources and begin creating a therapeutic toolbox for practice. There is one resource that I would like to share which helps both the artistically challenged as well as the artistically gifted mental health professional.

According to its website, Hub for Helpers is an “online library for all licensed therapeutic professionals to access high-quality, interactive, low-cost materials for diverse client populations”.  Hub for Helpers also states that it hopes to lessen the burden of developing materials by providing low cost options to help mental health professionals find materials to best server the need of their clients.

Hub for Helpers was founded by Nicole Batiste, a school social worker in a Texas middle school, when she saw an overwhelming deficit in affordable, accessible, and ready to use materials for therapy. Nicole sometimes found herself spending more time planning meaningful things to do in therapy than providing direct practice.

Inspired by the response to her activities from her diverse client base, she decided to create a hub for therapeutic professionals to access numerous interactive materials conveniently. Nicole states the mission for Hub for helpers is to continuously provide top notch, affordable activities to ensure that we are indeed, “helping you help!”

How does Hub for Helpers Work?

Hub for Helpers provides a quick and easy way to access and save materials in your “My Hub” account. If you are wondering how it all works, here are the tips provided on their website:

  • We strongly recommend you sign up with us to create your personal Hub. It’s quick, easy and free!
  • Begin to browse our materials by searching by the many domains provided
  • All of our resources are multi-paged packets that guide you through each activity, if you so need it
  • Once you’ve chosen an activity, check out is easy, fast and secure.
  • You will then be able to download your resource, all of our resources are in PDF format.
  • Your resource will remain in your Hub to be used repeatedly at no cost.
  • Should you choose to become a subscriber, a $40.00 credit will be issued to you each month
  • If you are a corporate subscriber a $200.00 credit will be issued to you each month to use amongst your employees.

Hub for Helpers has provided three free activities for you to download here.

What else does Hub for Helpers do?

In addition to being an online marketplace to buy low-cost worksheets and activities, for the artistically gifted, you can also sell your creations in the Hub for Helper’s marketplace. For more information, visit https://www.hubforhelpers.com/become_a_seller/.

Sponsored Content by Hub for Helpers

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Mental Health

What is Trauma-Informed Care

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“What’s wrong with you” is typically our response to what we consider problematic behavior.  But what if we shifted our mindset in such a way that would enable us to ask a question such as “What happened to you”?

Trauma-Informed Care makes that possible.

The trauma-informed perspective is a new way of evaluating consumers’ experiences and shifts from the traditional approach of care that focuses on eliminating problematic behavior to a trauma-informed approach that focuses on getting to the root of the issues so that individuals may experience recovery in an empowering manner.

Research data reveal that trauma can – and indeed, does – happen to anyone.  As a precautionary rule, then, the trauma-informed approach requires that all administrators, clinicians and other relevant staff and volunteers interact with all consumers as though they have experienced some form of trauma throughout their lives.

Trauma occurs when an external threat overwhelms a person’s coping resources. It can result in specific signs of psychological or emotional distress, or it can affect many aspects of the person’s life over a period of time. Trauma is unique to each individual—the most violent events are not always the events that have the deepest impact.  Everyone perceives trauma differently…what may be considered traumatic to one person may not be perceived the same way to another.

Acknowledging what happened to a person will help providers generate a more accurate interpretation of a consumer’s experiences as opposed to thinking there is something wrong with them.  As such, the approach to care becomes one in which there is recognition of the multiple ways traumatic experiences impact individuals’ well-being.

It also permits the provider to focus on developing, implementing and monitoring policies, procedures and practices that promote healing and recovery. According to Steven Wiland, “Human service systems become trauma-informed by thoroughly incorporating, in all aspects of service delivery, an understanding of the prevalence and impact of trauma and the complex pathways to healing and recovery.”

The trauma-informed approach is a framework that can be adapted to meet the diverse needs of various organizational, systemic, and individual structures.  All trauma-informed systems operate under the realization of the widespread impact of trauma; there is a recognition of traumatic symptoms in people part of our organizations and systems; and a trauma-informed response that yields changes in policies, practices and procedures in order to avoid the re-traumatization of people we encounter in our organizations.

 

Traditional Approach Trauma-Informed Approach
Lack of understanding about the prevalence of trauma and its impact Recognition of the prevalence of trauma and its impact
Elimination of symptoms/problematic behavior Recovery as a primary goal
Providing solutions from an expert position Collaborating with the consumer to agree upon solutions
Providing help to the helpless – providing no choices Consumers provided with choices and have autonomy
Reactive to behavioral cues – crisis driven Proactive – prevention of retraumatization – avoiding crises

In recognition of the pervasiveness of the experience of trauma, the trauma-informed approach involves the practice of prioritizing safety, trust, empowerment, collaboration, peer support, and culture through the adoption of policies and procedures embedded with these principles.

To get you started on imagining what Trauma-Informed Care might look like for your organization, take a look at examples of the traditional approach to care versus the trauma-informed approach to care as shown below.  Then ask yourself, how do we measure up?

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