When Veterans and Their Families Come for Help: What Service Providers Need to Know

10 04 2015

Guest author: Erica Zulawski, MS, MSW candidate

Military welcome home Jack

Through my personal and professional experience with veterans, I have come to understand the unique needs and challenges some male and female veterans experience when readjusting to civilian life. Many veterans say that the military has forever changed them, especially if deployed to areas of combat or conflict.

Soldier with flag FREE morguefile0001980652808

When PTSD is not diagnosed and treated…

My father was a Vietnam veteran. I would like to share some parts of our family’s story.

  • My father would wake up in the middle of the night screaming from awful nightmares and night terrors. I had never heard a man or anyone scream like that before. I was afraid. My siblings and I did not know what was happening to him, and there was no one to explain anything.
  • My dad drank a lot while I was growing up, and he would isolate himself from friends and family. He was there physically, but rarely emotionally available.
  • I resented him for missing a great part of my childhood because of his alcoholism. I also resented the military in many ways because it had taken away my father’s ability to be a good dad and live a meaningful and satisfying life.
  • He was always angry and irritable with overwhelming emotion, always on edge. Family members were also always on edge hoping not to upset him. My father’s illness controlled and dictated the temperament of each of us.

Vet Blog Post Man a with drink photo from FreeDigitalPhotos.net

  • Though severely “rocked” by his traumatic Vietnam experiences, my father would still proudly hang the American flag each morning. I would say that he struggled with a “love/hate relationship”, a love for his country and the military, but hatred for what he lost of himself in the war.
  • He was a very broken person, consumed with emotional and physical pain, suffering every day and drank heavily to self-treat his symptoms. He desperately needed help, but had no idea that he needed it and was deteriorating with each passing day. My mother had no idea how to get him help, so he suffered in silence until he wasn’t able to do it anymore. There was the lack of support and services available for my father and for us as a family to cope with his PTSD, depression and alcoholism. We felt helpless, scared and overwhelmed.

The only time I ever heard him talk about Vietnam was when his “war buddies” would come over to our house to talk and drink. I still don’t know what he endured in the military. When I began working with veterans, I gradually started to understand that what my father was struggling with wasn’t uncommon among that era of veterans: Post-Traumatic Stress Disorder (PTSD) and depression from his military service.

Why is it important to understand and identify the unique challenges and needs of veterans and their families?

Soldier hands behind back FREE morguefile0001566431353

I believe there is a great need for social workers  and other human service professionals within the community (both veteran and non-veteran affiliated agencies and organizations) to become educated on serving veterans and their families so that they can best meet their needs. Policies and program are needed to help veterans and families develop coping skills and find supports. Some of the reasons are listed below.

  • Many veterans fail to get the help they need because of social stigma and barriers to health care and other services. Some non-veteran affiliated organizations and agencies may provide services and treatment to veterans because they may not qualify for some or any VA benefits or health care because of their type of discharge; were never activated from a Reserve or National Guard unit; and/or have some apprehension about using the VA system. There are others who are unaware of the benefits and services available to them. Please refer to the link in the Resource section to learn more about the U.S. Department of Veterans Affairs: Health benefits and eligibility.
  • Being culturally competent and sensitive may decrease the challenges in providing effective services to veterans and their family members. Some veterans will present with chronic and acute mental, social, and physical conditions, as well as being at risk for: unemployment, poverty, homelessness, substance abuse, depression, and PTSD that may be attributed to military related trauma and experiences.
  • To alleviate the backlog of specialty appointments, particularly mental and behavioral health appointments, the VA and Congress implemented the Veterans Choice Card program in August 2014. Veterans who meet the criteria for the program will be allowed to seek health care services outside of the VA system. Please refer to the link in the Resource section to learn more about Veterans Access, Choice, and Accountability Act of 2014.
  • Veterans who live in rural areas may not have easy access to VA health care and services and are more likely be treated in non-VA affiliated agencies and organizations. Providers in these demographic areas need to be familiar with their unique needs and challenges. Please refer to the link in the Resource section for more information about Rural Assistance Center: Veterans and Returning Soldiers.
  • Both VA and non-VA affiliated providers need to understand the complexity of deployment and how multiple deployments can impact the mental, emotional and psychological well-being of a person and their ability to reintegrate and adapt back into civilian life, their community and their family. Please refer to the link in the Resource section to learn more about How Deployment Stress Affects Families.
  • Providers need to be aware of signs and symptoms to recognize if the person they are working with has been in the military. In addition, providers need to be aware of referring agencies and organizations and the services available to veterans and their families if the provider is unable to offer needed services. It’s important that the provider not be afraid to ask appropriate and sensitive questions about the person’s military experiences to gain a better understanding in an effort to treat the “whole” person.
  • VA and non-VA agencies and organizations can network to use the best assessment tools, interventions and treatments for veterans and their families.  Please refer to the link in the Resource section to learn more about the Joining Forces initiative.
  • Agencies and organizations can create an environment where veterans and their families feel safe to reach out and find the support and guidance they need. Make it as simple and convenient as possible, and remove barriers to rigid, structured and complex systems that may feel overwhelming and burdensome. Many who try to access services and treatment will either give up or not bother if it’s too confusing and/or has the potential to trigger or retraumatize.
  • Consider the veteran’s life before the military. Think about adverse childhood experiences (ACEs) that may contribute to the issues and problems that the veteran is struggling with- consider pre-military trauma. Think about how the veteran’s complex trauma, pre-military, peri-military and post-military experiences have impacted and affected their overall life within their roles and responsibilities to the family structure, the community, their jobs and school. Please refer to the Adverse Childhood Experiences Study link in the Resource section.
  • It is beneficial to ensure that services and treatment for veterans and their families are implemented in a way that provides the five principles of trauma-informed care: safety, empowerment, trustworthiness, collaboration and choice. Please refer to the link in the Resource section for more information about Trauma-Informed Care (TIC).
  • Children of service members and veterans also have unique needs and challenges, and can be at risk for emotional and mental health issues like secondary PTSD from being affected by their parents’ military related trauma. Please refer to the link in the Resource section for more information about Overall Effects on Children.

Resources

Online self-study course: Trauma-Informed Care: Working with Veterans, Service Providers and the Military Culture with Patrick Welch, PhD, Sgt. USMC (Ret)

U.S. Department of Veterans Affairs: Health benefits and eligibility

Veterans Access, Choice, and Accountability Act of 2014

Rural Assistance Center: Veterans and Returning Soldiers

How Deployment Stress Affects Families

Joining Forces initiative

The Adverse Childhood Experiences Study

Overall Effects on Children

Treatment Approaches

NASW Standards for Social Work Practice with Service Members, Veterans, & Their Families

Free online course: The National Child Traumatic Stress Network: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Cognitive Processing Therapy (CPT) Fact Sheet for Clinicians

Free online course: Cognitive Processing Therapy

Trauma-Informed Care (TIC)

U.S. Department of Veterans Affairs: PTSD: National Center for PTSD

Other Helpful Resources

‘Why Is Dad So Mad?’ Veteran writes book to explain his PTSD to his daughter.  Also available at www.amazon.com

Military Times: Rand: Civilian mental health providers don’t ‘get’ the military

The Impact of Deployment on U.S. Military Families

Understanding the Impact of Deployment on Children and Families

Using Trauma-Informed Care with Veterans – Dr. Patrick Welch

Use Veteran recovery stories to build connections

Photo Credits

Welcome Home Jack- Our Hero

Hands behind his back

Soldier with flag

Man with a drink





Improving the System for Our Loved Ones: A Mother’s View of Addiction and Services

16 07 2014

Depressed teen free Morgue file

Guest author: name withheld for confidentiality

The day before Christmas, I received a phone call from my oldest son asking me to pick him up on a downtown corner in a risky neighborhood. He gets in the car wearing sunglasses even though the day is dark and cloudy.  My inner alarm sounds and my heart starts to tear… he is high again.  Back home I watch him slowly begin to detox. How many times does this need to happen?  My rule is that he can stay at home as long as he is willing to get help. Of course he agrees as he has nowhere to go. We plan to go to a local hospital inpatient unit but you have to be in a certain physical state to get admitted, and this depends on who is doing the intake and bed availability. Sometimes he can be admitted, sometimes not- yet he is the same person each time, out of control and in need of addiction treatment. We have to wait until Christmas morning to go there.  Not exactly my plan for a family Christmas but I am prepared to do whatever it takes to save his life. 

We arrive at the inpatient unit only to have him turned away. They say he is not sick enough. Really? He is an out of control addict using heroin, asking for help and I am terrified he will die. So now what?  He can’t come back home and refuses to go to a different hospital inpatient unit to see if he can be admitted there. So he decides to stay with a ‘friend’ as he cannot stay with me if he is not in treatment- it is too risky for my family because of past incidents. I drop him off, not knowing what he will do next and the heartache I feel is overwhelming.  What kind of mother turns her son out Christmas day? I feel like I am living in a perpetual grief state as I wait for the worst to happen.  Will this be the last time I see him?

It wasn’t always like this. His childhood was blessed- large and loving family, many friends, fun activities, and strong church involvement.  He graduated near the top of his high school class and attended a private university. But drugs don’t care if you have a college degree.

 Drug use. addictionImage courtesy of Victor Habbick-FreeDigitalPhotos.net ID-10073274I was told people can have the potential to be an addict long before they touch a drug.  This is true of my son.  He is very creative with an eccentric personality that is so fun yet always intensely, sometimes obsessively, focused on the current interest. When he latched onto a new interest that was not so healthy, the consequences became deadly.  After having suffered several major psychological traumas in his late teens, his addictive personality took over to stop his thoughts and feelings.  First it was alcohol, then marijuana, then pain killers finally escalating to heroin. The lies, the deceptions, the thefts from family and friends could no longer be ignored but I was determined not to lose my child. The service system is far from perfect and whether or not your child is receptive to help makes a difference.

older woman head in hands free morgue fileI have had people telling me to cut him off, let him hit rock bottom, and move on in with my life. And a few who said never give up on your child. How can I move on in my life when my son is a big part of it and needs help?  I also walked a fine line trying to avoid being the enabler. I struggled with every decision and often doubted if my choices were right.  Rock bottom can mean death. Will this push him to suicide or will he survive the next overdose? Will he start cutting his arms again? I have cried my eyes out over this, made myself physically and emotionally sick with worry and stress, mourned his death over and over, and planned his funeral.

Twice he was kicked out of inpatient residential programs for not following the rules leaving him with no place to go. How did that help him? He also quit seeing several outpatient therapists because he was smart enough to recognize their insufficient skills or they lacked the rapport needed to keep him in treatment. I have had him arrested, requested a three-day hold in psychiatric unit, cut him off financially, visited him in jail, begged for the best treatment placements through the drug court, taken him to therapy, attended NA meetings with him- often to no avail. I watched him make gains in his recovery only to relapse and have to start over. I remember when I first admitted to friends that he was an addict, I was told that expect him to relapse.  I was stunned by this statement- not my kid, he can do this. I was so wrong as the addiction was more powerful than my amazing, talented son.

 If I could offer any advice to families walking in my path and the service system, it would be:

 

  • For families, please persevere.  Ask many questions, seek help, get therapy, cry if you need to, get mad, and be prepared to fight the battle of your life. Give them hope when they are unable to do it for themselves.
  • Always believe in the person battling an addiction and never give up on them. Be compassionate and persistent even in the face of lies and relapses.
  • The addiction service system needs to find improved ways to meet the needs of people who are up sick and desperate for treatment.
  • Please stop turning them away from treatment saying they don’t meet criteria, or there is no room and giving them no place to go when they are sick and desperate.  
  • Find better places for residential treatment homes so they are not close to ‘crack’ houses that create great temptation.
  • When they keep their cell phones in residential treatment their dealers are still calling them- another temptation that could be avoided.
  • When they are in drug court, break the rules for participation and get throw out of treatment,  why are they immediately discharged from treatment on their own  and not turned immediately back over the custody of the courts?  They do eventually get re-arrested but the time in between can be deadly.  This is a big gap in the program that needs to be fixed.
  • Trauma and addiction go together as I saw this with my son. Psychological trauma is often part of why the person is addicted and both parts of who they are need to be treated as the drugs never go away as long as the emotional pain is still there. So intertwined, yet many of the counselors I interacted with did not have the skills or knowledge to provide effective treatment. I am told this is called a dual-disorder. Agencies need to support staff in gaining advanced treatment skills.
  • Remember that the family is suffering, too. My son’s addiction traumatized all of us. Family members need support. Whether you are a friend, family member or service provider, please understand and empathize with the feelings of shame, sadness, anger, guilt, embarrassment and helplessness we feel. The effect of addiction is devastating and the impact on families and friends is horrific, widespread and so long lasting as trust is often irreparably broken.

Epilogue: As of this moment, my son is in recovery and making progress with the support of a very skilled trauma and addiction therapist. I hope and pray each day that healing and recovery continue. Yet part of me still is still scared, still holding my breath each time the phone rings…

Resources:

New York State Combat Heroin & Prescription Drug Abuse http://combatheroin.ny.gov/

National Institute on Drug Abuse www.drugabuse.gov

Narcotics Anonymous www.na.org

Alcoholics Anonymous www.aa.org

Nar-Anon Family Groups www.nar-anon.org

National Council on Alcoholism and Drug Dependence www.ncadd.org

SAMHSA evidence-based treatments for addiction http://www.nrepp.samhsa.gov/SearchResultsNew.aspx?s=b&q=addiction

SAMHSA Co-Occurring Disorders http://media.samhsa.gov/co-occurring/

National Center on Trauma and Trauma-Informed Care http://beta.samhsa.gov/nctic/trauma-interventions

Photo credits:

Woman and teen photos from www.morguefile.com

Drug photo credit- Drug and addiction use courtesy of Victor Habbick at www.freedigitalphotos.net





EMDR- rapid healing of “small t” and “big T” trauma

4 12 2013

The beginning of the end…

I recently received a new, unexpected diagnosis when I went to a skilled EMDR  therapist for help with chronic pain: Post-traumatic Stress Disorder (PTSD- DSM-IV definition and PTSD DSM-5 definition). Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for trauma developed by Francine Shapiro, PhD.  I have a less severe form of PTSD than many others who have been through horrific experiences. I have what Shapiro calls “small t” trauma. LOTS OF IT! “Big T” trauma is comprised of the things people typically think about as major causes of PTSD (see the chart below).

For me, one more thing happened this year and my resilience and coping efforts were just worn out. My already daily pain escalated. Many of us have “small t” trauma and our own unique levels of resiliency.  I grew up as a Campbell’s Condensed Soup kid (tomato was my favorite). Going into treatment I felt like a can of “Trauma Soup”- lots of trauma ingredients packed tightly into the can of mind/body/spirit!  Yet I never really considered these “small t’s” as causing my pain and other struggles. I felt as if I had these evil gremlins clinging to my mind and body, persistently resisting cognitive-behavioral efforts to make them let go of me.

It bothers me greatly that people often focus on the “big T” trauma and overlook the damaging power of “small t” trauma. Many of our clients have both types, and tragically for some, years of horrific “big T” trauma. “Small t” traumas  can also derail  quality of life and functioning. Universal trauma screening could identify many trauma survivors, change treatment plans,  and CHANGE THEIR LIVES!  Psychological trauma is a hidden epidemic. 90% of clients in public behavioral health settings have experienced trauma. – SAMHSA-HRSA Center for Integrated Health Solutions.

Below is a great chart from the TraumaAndDissociation Facebook page via www.dissociative-identity-disorder.net/wiki/Trauma  that shows some differences between “small t” and “big T” trauma. “Small t” trauma is sometimes called complex trauma and those with multiple incidents of “big T” trauma can also have complex trauma. (Link to the graphic image of this chart.) 

“Big T” Trauma

  • Major events normally seen as traumatic
  • Emotions, beliefs  & physical sensations occur in both the mind & body

Examples

-Serious accidents

-Natural disasters

-Robbery, rape and urban violence

-Major surgeries, life threatening illness

-Chronic or repetitive experiences, e.g., child abuse & neglect

-War, combat, concentration camps

*May cause PTSD in some people but not all

“Small t” Trauma

  • Overwhelming but not often seen as traumatic
  • Emotions, beliefs  & physical sensations occur in both the mind & body
  • Unprocessed traumas have a long-lasting, negative effect
  • Can cause concentration, self-esteem & emotional regulation difficulties
  • Stunts and colors later perceptions
  • Often no intrusive imagery
  • Most common in neglected/abused children
  • Become part of a negative spiral when a “Big T” trauma occurs
  • Sometimes referred to as “complex trauma”

 

What does EMDR treatment feel like?

  • I have been told that it is not possible to accurately describe what EMDR feels like to someone who has not experienced it. I agree that this is probably true- even when I give a trusted person very detailed descriptions of a session. But I wanted to try in the hope that more clinicians will consider becoming EMDR trained and  more people will seek out treatment.
  • Memory reprocessing is unique to each person. No judgments are to be made. There is structured EMDR protocol as well as strong clinical skill used. (Here are some EMDR Frequently Asked Questions.)
  • Every EMDR treatment session feels like a miracle to me. It rapidly reprocesses the gremlins of traumatic memories in my brain so that they no longer control me. And after resolving memories in an EMDR session, it is fascinating how much easier cognitive-behavioral methods now work!
  • After the basic intake information, I was asked to go back to my earliest memories and quickly give a short statement to create a log the therapist wrote of bullet points for  all of my memories. No judgments were made about what felt traumatic to me. Traumatic is a person’s perception of the experience. This list created the working plan for how we would proceed from beginning to end. Some memories are treated as individual memories, and some that have a similar theme are addressed through a cluster that enables the first, worst,  and most recent to be reprocessed and then the larger cluster is pulled together for reprocessing.
  • Before starting EMDR, I was taught to make a mental container so that I could place disruptive or unfinished memory reprocessing into the container. Using the EMDR technique, the container was “installed” so that it would stick (my word) in my brain and be there to use when needed. I practiced in session and then practiced using my container in various ways during the week so that I had mastery before I needed to use it for powerful feelings and memories.
  • To the best of my recollection, working on a single memory feels like this: I am asked to briefly describe it, notice and rate the distress level as well as the place in my body where I feel the trauma. I hold that focus and then starting using the eye moment as directed by my therapist. I can feel the memory changing in many ways during EMDR. After a brief period of doing the eye moment, we stop and I take a relaxing breath.  I share how the memory and feelings changed. No matter how crazy I feel about the way the memory is reprocessing (sometimes like watching a movie that I am writing as I sit there), there is no judgment- just attentive, compassionate focus from my therapist. We keep repeating the process- focusing on changing feelings, reassessing my distress level as we work to let my distress drop down to zero, and installing positive feelings/affirmations. Yes, there are tears but it still feels so effortless for me, so fast. I feel very relaxed and free the entire time, even when a tough memory makes me weary or takes 1 ½ sessions to complete the reprocessing. Sometimes we can do two memories in a one hour session.
  • When I arrive for the next session, my therapist always checks in to ensure that the memory work done in the last session has remained at zero distress. In one instance, more feelings bubbled up over the week and we had to work a while longer to finish resolving the memory. That is normal.
  • I am committed that I am not going to stop treatment until I get through every bit of trauma. As they say, “the way out is the way through”. I attend weekly sessions. Some people have a need or an option to go through an EMDR intensive that is usually done in a couple of days and includes multiple sessions during that time. Here are some examples of how people healed in a recent blog written by Ricky Greenwald, PsyD about the intensive EMDR treatment model.

View a client video about EMDR including the effect of PTSD on the brain (this video shows the use of EMDR equipment instead of therapist fingers for the eye movement).

Summary

Trauma is NOT about what is wrong with someone, it is about what HAPPENED to them. Needing treatment to heal and asking for it is about COURAGE, not about society’s perception that it is a weakness.

We need to remember that there two faces of trauma, “Big T” and “small t”- both deserve equal respect and a nonjudgmental approach. Evidence-based practices and a good therapeutic relationship can take you behind the human curtain and help a person heal. When trauma is not treated, people do not heal and sometimes they die. EMDR is evidence-based, fast, and life changing. We need more skilled EMDR therapists across our country, throughout the world.

I know there are people who think I should not talk about this in the way that I am in this blog…I do so because I am a social worker…I am an advocate…I am one of the many faces of PTSD…one of the many trauma warriors battling to become stronger, wiser, healthier, and happier than we ever thought possible.

Author: Lesa Fichte, LMSW, Director of Continuing Education

Photo credit: free photos at www.morguefile.com and drkathleenyoung.wordpress.com through Creative Commons Attribution

Additional Resources

EMDR & EMDR Training

EMDR International Association www.emdria.org

Trauma Institute & Child Trauma Institute (Ricky Greenwald) http://www.childtrauma.com/

EMDR Institute, Inc. (Francine Shapiro) http://www.emdr.com/francine-shapiro-phd.html

Western New York EMDR Training http://www.socialwork.buffalo.edu/conted/emdr.asp

 Trauma-Informed Care

 National Center on Trauma-Informed Care http://www.samhsa.gov/nctic/

National Child Traumatic Stress Network http://nctsnet.org/

International Society for Traumatic Stress Studies http://www.istss.org//AM/Template.cfm?Section=Home

Online Trauma-Informed Clinical Foundation Certificate Program, University at Buffalo School of Social Work Office of Continuing Education http://www.socialwork.buffalo.edu/conted/trauma-ticfc.asp

University at Buffalo School of Social Work Institute on Trauma and Trauma-Informed Care http://www.socialwork.buffalo.edu/research/ittic/

The Anna Institute www.theannainstitute.org





Dueling Disorders- the battle inside…

30 08 2013

Dueling

No, the title is not a typo. I know that Dual Disorders   and Co-occurring Disorders  are the correct terms for the combination of substance abuse and mental health disorders. I think a better term to bring home the power of this comorbid brain and body chaos is “Dueling Disorders.”  That’s what killed my brother. The mental health issues and addictions battled within him, each fueling the fight until he finally surrendered. The treatment he was given did not help him stop the battle.

I do not believe he had any hope that the behavioral health and medical system could help him. Maybe it was the lack of hope for healing that really killed him and not the Dueling Disorders? Our family will never know for certain.

In our work, I ponder if we too easily  compartmentalize people’s needs and address only their parts we are most comfortable with?  If yes, does this impair our ability to see the whole person in front of us- their strengths, their joys, their dreams, their level of confidence, their history of trauma, their façade or “curtain” that they put forth to hide behind, as well as the parts of themselves with addictions and mental health challenges? Humans hide in plain sight so what does it take to create a good therapeutic relationship so you can have a chance to  see the whole person and engage them in treatment?

Why was I inspired to write this post?

Obviously, my brother is always on my mind. But also because the title of an article in the August 2013 publication of Counselor: The Magazine for Addictions Professionals stopped my breath: Dual Diagnosis: Expectation, Not Exception.   The point being that we should expect that our clients come to us with a Dual Diagnosis and not just expect a single diagnosis.  And working at a school of social work with a trauma-informed curriculum and trauma continuing education programs, I am acutely aware of the need to see the whole person. I don’t know if any care provider ever saw the whole of my brother. I think they only saw his successful facade and the little bits he would reveal that he needed help with. 

According to SAMHSA, approximately 8.9 million adults have co-occurring disorders.  And approximately 90% of those seen in public behavioral health settings have a trauma history. I find these numbers horrifying, a sad statement about the world we live in.

Thoughts on how to begin to help people more effectively

  • Is your agency or practice current with evidence-based treatment for co-occurring disorders? Does it adhere to the principles from SAMHSA for an integrated screening and assessment process?
  • Does it offer a trauma-informed environment that follows the guiding principles of safety, trustworthiness, choice, collaboration, and empowerment? Are services person-centered? Is there universal trauma screening? How do staff effectively build  therapeutic relationships?
  • If your organization has clinicians who are highly skilled in working with those who have a co-occurring disorders, is there anything more that can be done to share their skills with less experienced clinicians?
  • If your clinicians lack sufficient skills and knowledge to best meet the needs of this population, what is one step you could take to begin to address this need?
  • Is lethality assessed and if there is risk, is it part of the treatment plan?
  • If you or your agency are in state of “overwhelm” from workloads, complex client needs, and rapidly changing regulatory expectations, what is one step you can take to best serve this population? If you woke up tomorrow, and clients were better served, what would be different?
  • if your services are not where you want them to be and you do not know what to do first, start by asking the “5 Whys” to get to the root issue.
  • Have you reviewed your strategic plan  for needed updating to better serve people’s needs?
  • Do you collect program evaluation data so you know what service  outcomes are?

Some days, we just need to stop and take a breath to celebrate how much we already do to effectively help people heal, and identify the steps to get us to enhanced skills in evidence-based and best practice so that even more people can have that chance. And remember that hope is one of the most powerful things we can give our clients in a therapeutic relationship. Resource information is listed below.

Hope and belief in the ability to heal is a lifeline.

Author: Lesa Fichte, LMSW, Director of Continuing Education

Selected References & Resources

 SAMHSA

TIP 42 Substance Abuse Treatment for Persons with Co-Occurring Disorders http://store.samhsa.gov/product/TIP-42-Substance-Abuse-Treatment-for-Persons-With-Co-Occurring-Disorders/SMA12-3992

Based on TIP 42 Substance Abuse Treatment for Persons with Co-Occurring Disorders http://www.samhsa.gov/co-occurring/topics/healthcare-integration/CODQGAdmin.PDF

Effectively serving individuals with co-occurring mental and substance use disorders requires integrated screening and assessment processes.http://www.samhsa.gov/co-occurring/topics/screening-and-assessment/index.aspx

Evidence-based Practice for Dual Disorders  http://www.samhsa.gov/co-occurring/topics/training/OP5-Practices-8-13-07.pdf

Jacobs, D. & Brewer, M. (2004).  American Psychiatric Association Practice Guideline: Provides recommendations for Assessing and Treating Patients with Suicidal Behaviors. Psychiatric Annals 34:5 (373-380). Also on line at www.stopasuicide.org/downloads/Sites/Docs/APASuicideGuidelinesReviewArticle.pdf

Trauma-Informed Care

National Center on Trauma-Informed Care  http://www.samhsa.gov/nctic/

Trauma-Informed Assessment and Screening PowerPoint http://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%2Fwww.theannainstitute.org%2FDTSA.ppt

Trauma Assessment for Adults – Self-Report Version (one tool from the above PowerPoint) http://www.istss.org/AM/Template.cfm?Section=TraumaAssessmentandDiagnosisSIG&Template=/CM/ContentDisplay.cfm&ContentID=3227

Greater Buffalo Trauma-Informed System of Care Community Plan http://www.hfwcny.org/Tools/BroadCaster/Upload/Project327/Docs/HFCWNY_Trauma_Report_Interactive___Final.pdf

Online Trauma-Informed Clinical Foundation Certificate Program, University at Buffalo School of Social Work Office of Continuing Education http://www.socialwork.buffalo.edu/conted/trauma-ticfc.asp

University at Buffalo School of Social Work Institute on Trauma and Trauma-Informed Care http://www.socialwork.buffalo.edu/research/ittic/

Treatment Outcome Evaluation

Scott D. Miller, PhD. Free Session Rating Scale and Outcome Rating Scale. http://scottdmiller.com/performance-metrics/

Therapeutic Relationship

Evidence-based Therapeutic Relationships http://www.nrepp.samhsa.gov/Norcross.aspx

Therapeutic Relationship vs. Treatment Model blog post by Ricky Greenwald, PsyD http://www.childtrauma.com/blog/therapeutic-relationship-vs-treatment-model/

Videos

Video from TedX: 11 minutes of a powerful story from a young man who tells a “stop in your tracks” story about what depression feels like. A must listen for every human service professional. http://www.upworthy.com/this-kid-thinks-we-could-save-so-many-lives-if-only-it-was-okay-to-say-4-words?c=ufb1

Video: 5 minutes from Claudia Black Ph.D. – Double Jeopardy: Addiction & Depression http://www.youtube.com/watch?v=Xean4EFGjC0

Photo Credit: Free Photos from www.morguefile.com

 








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