LETS PEER COUNSELING TRAINING FIVE
DOCUMENTATION.
PROGRESS NOTES • •
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Progress notes are written documentation that describes an individual’s progress toward achieving objectives that are identified with the Peer Counselor. In addition to documenting progress towards completing the goals and objectives, progress notes provide essential information sharing between coproviders. As such, it is very important to record all of the required documentation in a timely manner. The process of writing the notes may help provide clarity as to how best serve the person.
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If the peer is responsible for writing their own progress notes, the process may help in providing a mechanism for evaluating self-progress.
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The perspective may offer a chance to think of changes or a different approach that may be useful.
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Do not go back and alter information.
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Records are to be kept confidential and should be accessible to co-providers and supervisors on a need to know basis. For example, by working as a LETS Peer Counselor, Community Health Managers may have access to all of the records for the agency.
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However, the only records that the professional should read are the records of individuals the professional is involved in serving.
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You should not be sharing among Peer Counselors.
“IF IT ISN’T DOCUMENTED, IT DIDN’T HAPPEN.”
SELF-IMAGE A FEW YEARS AGO, THE MENTAL HEALTH EMPOWERMENT PROJECT IN NEW YORK LED 30 EMPOWERMENT WORKSHOPS AROUND THE STATE. ABOUT 600 CONSUMERS PARTICIPATED. ONE OF THE QUESTIONS THEY ANSWERED WAS, "WHAT'S DISEMPOWERING ABOUT BEING DIAGNOSED WITH A MENTAL ILLNESS?” IN OTHER WORDS, HOW DOES GETTING DIAGNOSED WITH A MENTAL ILLNESS IMPACT SELF-IMAGE? THE PARTICIPANTS CAME UP WITH SIX MAJOR REASONS, PARAPHRASED HERE, FROM THE CONSUMERS' POINT OF VIEW:
DATA ASSESSMENT PLAN
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Data: This refers to solid information about progress toward the peer’s goal. Data is information that can be seen, be felt, be touched or heard – information received through the senses rather than by thinking. For instance, a note may state, “Jane was trembling when I took her to the watercolor workshop on Saturday, May 10. She stopped trembling and watched the demonstration, then spoke to a woman standing next to her about how interesting the demonstration was and what she learned.” Notice that no interpretation as to why Jane was trembling was included in the note.
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Data is not based on personal or professional judgment or assessment, but is based only on that which is what is gained through the senses.
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A method for including data is to use quotes from the individual in the Data section of the note.
DATA ASSESSMENT PLAN •
Assessment: This is the interpretation applied by the writer to the data that has been recorded. The only conclusions or interpretations that should made are ones that will make sense to any reader. Conclusions and interpretations should be approached as tentative judgments rather than certain facts. For instance, the note may state:
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“Jane seems to be trying to meet her goal of making friends. She was, perhaps, nervous, but in speaking with the woman at the workshop, she was successful. Maybe Jane will continue with this goal and begin to feel less nervous about speaking with others, so that she can eventually form friendships.”
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Qualifiers, such as “perhaps” or “maybe” can be useful for describing potential outcomes that may eventually equal success. Success cannot be assumed and must be shared by the individual and or the family in order for the goal to truly be met.
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Avoid judgments or farfetched assessments. To state that Jane is now forming friendships, just because she spoke with one person, would likely be inaccurate. It would not make sense, either, to state that she now has good relationship skills. It would be farfetched to say these things. It would be equally inaccurate to state that Jane is not trying, or that she cannot learn to form friendships, or that she failed because she did not actually form a friendship with the woman at the workshop.
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In addition to being inaccurate, these conclusions are judgments. It might actually be a great accomplishment that Jane agreed to go at all! Passing judgment on someone else in the context of a progress note is unprofessional. It’s easy for personal biases to slip into the workplace at times but it’s especially important to monitor for this in the progress notes. Because the progress notes become part of the permanent clinical record, it is more difficult to correct mistakes or to change such judgments later.
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The use of the phrase “as evidenced by” in a sentence allows you and the reader to see what prompted a particular part of the assessment. For example,
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“Jane appears to be making progress in her goal of making new friends as evidenced by the observations of this writer, who has seen Jane reaching out to numerous parties at the group home and at the clubhouse.”
DATA ASSESSMENT PLAN
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Plan: The plan consists of the short, intermediary steps to meeting the goal that are a result of the data and assessment. For instance, Jane may agree that next time at a workshop she will talk with two people. The Plan would then be written;
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“Jane says she will talk with 2 people at the next workshop.” If Jane indicates a willingness to expand her goal to include talking with three people, then ask one for coffee afterwards or she might agree to take a sample of her own artwork to share with someone, this can be written as;
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“Plan: 1. Jane says she will talk with two people at the next workshop. 2. Jane will talk with three people at the third workshop she attends. 3. Jane will take a sample of her artwork and discuss it with a person at the workshop or she will ask a person there to have coffee when the workshop is done.”
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The following DAP note is an example of how a DAP progress note might look. Please note that agencies may differ in terms of their progress note requirements. You can still use the basic principles of DAP, however.
DATA ASSESSMENT PLAN
YOU DO NOT HAVE TO USE DAP’S BUT THEY ARE AN INCREDIBLY USEFUL TOOL IN NOTE TAKING!
CULTURAL AWARENESS.
MULTICULTURAL AWARENESS IS AN EXTENSIVE SUBJECT THAT COULD TAKE SEVERAL YEARS OF ADVANCED STUDY TO BEGIN TO MASTER. IN THIS TRAINING WE FOCUS ON A FEW KEY CONCEPTS RELATED TO PEER SUPPORT PRACTICES. THE FIRST STEP IS TO DEFINE CULTURE.
CULTURE IS •
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Culture refers to the values of a group of people and it influences dress, language, religion, customs, food, laws, codes of conduct, manners, behavioral standards or patterns, and beliefs. Culture and its components play an important role in how people of different backgrounds express themselves, seek help, cope with stress, and develop social supports.
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Learned: The process of learning one’s culture is called “enculturation.”
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Shared: The members of a society share the culture; there is no “culture of one.”
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Patterned: People in a society live and think in ways that form definite patterns.
Culture affects every aspect of an individual’s life, including how the person experiences, understands, expresses, and addresses emotional and mental distress.
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Mutually constructed: and reinforced through a constant process of social interaction.
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Arbitrary: Not based on “natural laws” external to humans, but created by humans according to the “whims” of the society. Example: standards of beauty.
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Internalized: Habitual, taken-for-granted, perceived as “natural.”
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What all this really means is that: Culture is a shared understanding of reality. Even simpler, culture is common ground.
“Cultural Identity” refers to the group one identifies with and where one looks for standards of behavior. In short, culture is the way in which a person sees and identifies oneself. As most of us know, culture and recovery are intricately interwoven. Culture permeates all aspects of life and influences everyone’s perceptions of recovery.
CULTURAL COMPETENCE •
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Cultural competence is the ability to relate effectively to individuals from various groups and backgrounds. Culturally competent services respond to the unique needs of members of minority populations and are also sensitive to the ways in which people with disabilities experience the world. Within the behavioral health system (which addresses both mental illnesses and substance abuse), cultural competence must be a guiding principle, so that services are culturally sensitive and provide culturally appropriate prevention, outreach, assessment and intervention. Cultural competence recognizes the broad scope of the dimensions that influence an individual’s personal identity. Mental health professionals and service providers should be familiar with how these areas interact within, between and among individuals. These dimensions include:
DIMENSIONS OF CULTURE: •
Culture is the shared beliefs, ideals, and values of a group of people regardless of race and ethnicity.
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Race is a biological categorization (color of skin, eyes, hair…)
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Ethnicity is a group of racially similar people of similar origin.
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Subculture is a segment of a culture with different customs, norms, or values from the main culture to which they belong.
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Components of culture include age, gender, sexual identity, religion, and other characteristics that contribute to a person’s cultural identity.
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Language, disability, class/socioeconomic status, education, etc.
CULTURAL COMPETENCE •
The term Asian American includes people from a variety of nations, such as Afghanistan, China, India, Syria and Japan. It includes both immigrants and those whose families have lived in the United States for generations.
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The term African American implies that 33.9 million people share certain characteristics because of their ties with some of the 797 million people in Africa, who live in 54 different countries and speak some two thousand different languages.
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The term Native American includes people who may be of unmixed ancestry or whose Native American lineage is only a fraction of their backgrounds, who may trace their roots to any of more than 500 different tribes, and who may or may not identify with tribal culture.
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According to 2006 Census Bureau estimates, some 44.3 million Americans were identified as Hispanic.
FOR MORE INFORMATION ON DISPARITIES, CHECK OUT OUR ‘LEARN’ SECTION OF THE WEBSITE.
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Within this “group,” 64 percent were of Mexican background, 9 percent were of Puerto Rican background, 3.5 percent Cuban, 3 percent Salvadoran and 2.7 percent Dominican. The remainder are of some other Central American, South American, or other Hispanic or Latino origin.
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For decades, studies have shown that African Americans are more likely to be misdiagnosed with schizophrenia than any other ethnic group. Reasons for this remain unclear.
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A protein that metabolizes several antidepressant medications is less active in East Asians. This increases the risk of higher blood levels of medication and more side effects within members of this population, indicating that everyone doesn’t respond to and metabolize medication in the same way and at the same rate.
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Research on Native Americans and Alaskan Natives is limited, but existing studies suggest that members of these populations experience a disproportionate percentage of mental health problems and disorders. For example, the suicide rate among Native Americans and Alaskan Natives is 50 percent higher than the national rate.
WITH THE INCREASING DIVERSITY OF THE U.S. POPULATION, MENTAL HEALTH SERVICE PROVIDERS MUST BE AWARE OF THE INFLUENCES THAT CULTURE HAS ON PSYCHOLOGICAL PROCESSES, MENTAL ILLNESSES, AND THE WAYS THAT PEOPLE SEEK HELP. THEY MUST ALSO BE AWARE OF THE VARIETY WITHIN GROUPS.
DIVERSITY + DISPARITY
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Diversity is anything that is “different from the majority.” For instance, women are a minority in the military. There is diversity when women join and participate in typical military activities with men.
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Disparity is an inequality or a large difference; or both. For instance, the number of women who become officers in the military is small compared to the total number of officers in the military. There is a disparity in military officers who are women vs. those who are men.
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Racial and ethnic minorities: Are less likely to have access to available mental health services; Are less likely to receive necessary mental health care; Often receive a poorer quality of treatment; Are significantly underrepresented in mental health research
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Members of racial minority groups, including African Americans and Latinos, underuse mental health services and are more likely to delay seeking treatment. Consequently, in most cases, when such individuals seek mental health services they are at an acute stage of illness. This delay can result in a worsening of untreated illness and an increase in involuntary services.
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Members of minority populations are more likely to experience other factors – such as racism, discrimination, violence and poverty – that may exacerbate mental illness.
BARRIERS •
Cultural barriers that prevent members of minority populations from receiving appropriate care include:
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Mistrust and fear of treatment;
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Language barriers and ineffective communication;
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Access barriers, such as inadequate insurance coverage; and
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A lack of diversity in the mental health workforce
Alternative ideas about what constitutes illness and health;
CAN YOU THINK OF ANYTHING ELSE?
ETHNOCENTRISM •
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Ethnocentrism is judging another culture solely by the values and standards of one’s own culture. At the heart of ethnocentrism is the belief: “My way is the ‘right’ way.” Ethnocentrism leads us to make false assumptions about others. We are ethnocentric when we use our cultural norms to make generalizations about other people’s cultures and customs. Such stereotypes and generalizations, often made without conscious awareness that we've used our culture as a universal yardstick, can be off-base and cause us to misjudge other groups of people.
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Ethnocentrism can lead to cultural misinterpretation and it often distorts or hinders communication.
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Ethnocentric thinking causes us to make false assumptions because:
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It leads us to make premature judgments.
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By evaluating "them" by what we are best at, we miss the many other aspects of life that “they” may do better than we do.
It sets up an “us” vs. “them” dynamic. "They" may not be very good at what we are best at.
CULTURAL BLINDNESS •
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Cultural blindness is the way in which people in a dominant culture view others. The underlying message seems harmless enough, “I see you the same as me,” and it might seem, from the perspective of the dominant culture, to be a genuine invitation to join with people from different cultures. However, people from a position of privilege tend to see their own perspectives as normal and other perspectives as alien or wrong. The assumption when saying, “I see you the same as me,” is that you will automatically see things my way, because anything else is wrong.
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Cultural blindness makes it difficult for those who benefit from privilege to fully understand how people who lack the same privilege experience the world, which ultimately allows prejudice, discrimination, and oppression to continue.
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Cultural blindness can happen with race, age, gender, religion, sexual orientation, disabilities, and within sub-cultures of all of these cultures.
BIASES +
STEREOTYPES.
DISCRIMINATION •
In general, discrimination refers to the hostile or negative feelings of one group of people toward another. It can cause bias in service provision and can prevent people from seeking help. Cultural competency must address the biases and stereotypes that are associated with an individual’s culture and various identities.
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Racism: prejudice or discrimination based on a person’s race, or on the belief that one race is superior to another;
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Ageism: bias toward an individual or group based on age. For example, young people may be stereotyped as immature and irresponsible; older adults may be called slow, weak, dependent and senile;
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Sexism: discrimination or prejudice based on gender;
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Heterosexism: prejudice against people who are gay, lesbian, bisexual, transgender, or intersex. It is also the assumption that all people are heterosexual and that heterosexuality is correct and normal
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Homophobia: the fear and/or dislike of homosexual people or homosexuality;
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Classism: any form of prejudice or oppression against people who are members of (or who are perceived as being similar to those who are members of) a lower social class; and
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Religious intolerance: an inability or unwillingness to tolerate another’s beliefs or practices.
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Mental health professionals and service providers must be aware of how stereotypes and stigma influence not only their clients but also their own thoughts and views of others.
STIGMA/PRIVILEGE •
Stigma occurs when you are treated differently, negatively, for beliefs or attributes you may possess.
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Privilege is the opposite of stigma. Privileges are advantages that some may have that others are not afforded due to discrimination.
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Stigma and discrimination can have a powerful effect on a person’s sense of self-esteem and self-worth, and the degree to which a person trusts others. Self-stigma is when one believes and internalizes negative messages about oneself until there seems to be no hope and no point in trying to change for the better.
BUILDING AWARENESS •
Use open-ended questions to identify each person’s unique cultural outlook.
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Re-evaluate intake and assessment documentation, as well as policies and procedures, to be more inclusive.
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Employ qualified mental health workers who are fluent in the languages of the groups being served.
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Understand the cultural biases of staff and provide training to address educational needs.
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Understand cultural biases.
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Identify resources, such as natural supports, within the community that will help an individual recover.
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Design and implement culturally sensitive treatment plans.
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Evaluate procedures and programs for cultural sensitivity and effectiveness.
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Survey clients and workers to elicit their understanding of cultural competence and culturally competent practice.
DOES CULTURE INFLUENCE RECOVERY? •
Different cultures have different traditions of healing, spirituality, and seeking and receiving help for what practitioners consider to be mental health concerns. In addition, the notion of what is “normal” or what constitutes “the good life” also differs considerably from one culture to another, just as ideas of what constitutes “illness” differ.
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For these reasons, it is essential for recovery-oriented Counselors to ask about, explore, and understand each person’s cultural identity and affiliations as core aspects of who they are as people.
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Since recovery has to do with the kind of life the person had prior to the illness, the kind of life the person desires to lead in the future, and the treatments that are effective for the illness he or she has, cultural differences become even more important in determining what a person’s recovery will look like. There are multiple pathways to recovery, and culture is one of the factors that will determine which paths are most accessible to and useful for which people.
EXAMPLE •
Depression and dementia are the most common forms of mental illness in older adults. Depression, often associated with physical illness or disability, increases health care costs and can lead to suicide.
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“Chinese elders typically don’t seek help for depression and other mental disorders,” said Sandy Chen Stokes, a nurse and geriatric specialist at El Camino Hospital’s Older Adult Transitions (OATS), an outpatient counseling service (in Mountain View, California). “…You go along with what your culture tells you: tough it out or let time heal the problem. … They don’t know depression can be treated … (Some) end up as an inpatient or in a locked facility” (Cloutman, 2001).
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Stokes began an outreach program by first disseminating information about depression in Chinese-language newspapers, radio and television programs. With a gift from an anonymous donor, Stokes purchased translation devices so that Chinese clients could be integrated into an English-speaking counseling group.
QUICK GUIDE •
Know where you are coming from- we will work on identifying our own beliefs and where they come from
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Know where they are coming from- learn about different cultures. Expose yourself to perspectives different from your own.
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Know where they are- just because the individual you are working with is from a different culture does not mean they identify strongly with it. You need to understand what is important to them now.
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Do not make assumptions- cultural awareness is not prescriptive. It is about approaching each individual with an attitude of openness to their experience and perspective.
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Ask questions- This is key! We need to do our best not to make assumptions but rather ask questions to let the individual lead us to an understanding of who they are.
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Respect- We must treat those we serve with respect and honor their uniqueness and experiences.
YOUR ROLE: •
Is aware, accepts and values cultural differences; and
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Is aware of one’s own culture and values.
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Differences in culture and values may arise from belonging to a group, large or small, or may arise from unique qualities of an individual.
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As a Peer Counselor, it is your responsibility to ensure that you deliver culturally aware services to the peers that you serve.
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A step towards cultural awareness is to be aware of your own cultural identity. This will help you to understand what shapes your own beliefs, priorities and perceptions. This self-awareness will allow you to be aware of your own cultural biases so that you can keep them from intruding on your relationships with the people you serve.
EFFECTS OF
TRAUMA ON RECOVERY
Trauma occurs when an external threat overwhelms a person’s coping resources. - Kathryn Power
TRAUMA •
According to SAMHSA’s National Center for Traumainformed Care (NCTIC), traumatic experiences can be dehumanizing, shocking or terrifying, singular or multiple compounding events over time, and often include betrayal of a trusted person or institution and a loss of safety.
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Trauma can result from experiences of violence. Trauma includes physical, sexual and institutional abuse, neglect, intergenerational trauma, and disasters that induce powerlessness, fear, recurrent hopelessness, and a constant state of alert.
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Trauma impacts one's spirituality and relationships with self, others, communities and environment, often resulting in recurring feelings of shame, guilt, rage, isolation, and disconnection. Healing is possible.
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Trauma-informed practices engage those with histories of trauma in a way that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.
IT CHANGES THE APPROACH FROM ONE THAT ASKS, "WHAT'S WRONG WITH YOU?" TO ONE THAT ASKS, "WHAT HAS HAPPENED TO YOU?"
WHAT DOES IT LOOK LIKE? •
The effects of unresolved trauma are similar to symptoms of mental illness. People who have experienced severe trauma frequently carry multiple mental health diagnoses but find the mental health system to be re-traumatizing and treatment ineffective.
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People sometimes develop disturbing symptoms years later and do not even remember the traumatic events that were the original cause.
EFFECTS OF TRAUMA •
The effects of trauma are often mistaken to be symptoms of mental illness. Most people are not aware of the influence past trauma can have on their quality of life. Some are not even aware these experiences are considered traumatic -- because for them, it was just “normal.” There was nothing else to compare it with.
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Memories of a traumatic experience may be fragmented and confusing. They may have happened when the person was pre-verbal or they may have been forgotten completely. If the person does remember, the memories may be so deeply disturbing that they cannot be put into words. It is also possible that the person fears retaliation from the abuser if the secret is revealed.
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If a person is having a hard time talking about “what happened,” creative expressions like poetry, drawing, painting, or music can be a way for the person to share what he or she cannot put into words.
PEER SUPPORT •
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Something perceived as very traumatic by one person may not bother another. Timing can be a big factor. A traumatic experience from the past can suddenly be triggered and bring distressing emotions when an anniversary date or related occasion (such as the birthday of a lost loved one) brings memories of what happened. As peer supporters, we listen and seek to understand at a deep emotional level the kinds of things that have happened in a person’s life. Many people are completely unaware that traumatic experiences from their past can be a significant factor in physical disabilities, mental health disabilities or behaviors that prevent them from moving forward in their recovery. Awareness is the first step toward change.
UNIVERSAL PRECAUTIONS: •
In general, universal precautions are aimed at preventing an illness or injury before it happens. In a hospital environment, universal precautions include washing hands and using hand sanitizer to avoid spreading germs, or wearing gloves to avoid exposure to infected blood.
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In the public sector, ‘safe sex,’ is a universal precaution to avoid spreading STDs. In mental health settings, universal precautions refer to treating everyone, including supervisors and staff, as if they have a history of trauma.
“Trauma must be seen as the expectation, not the exception in behavioral health treatment systems.” - Linda Rosenberg
PREVALENCE •
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97% of homeless women with serious mental illness (SMI) experienced severe physical and sexual abuse; 87% experienced abuse in both childhood and adulthood 90% of public mental health clients have been exposed to trauma; most had multiple experiences of trauma; 34-53% report childhood sexual or physical abuse; 43-91% report some form of victimization 81% of adults diagnosed with bipolar disorder or dissociative identity disorder (DID) were sexually or physically abused as children
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29-43% of people diagnosed with SMI have post-traumatic stress disorder (PTSD)
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66% of men and women in substance abuse treatment report childhood abuse and neglect
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77% of male veterans in substance abuse inpatient units were exposed to severe childhood trauma; 58% had a history of lifetime PTSD
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50% of women in substance abuse treatment have a history of rape or incest
Huckshorn, K., Panzer P., Arauz, E. (2012). Assessing for and Addressing Trauma in Recovery-Oriented Practice. Webinar in the Recovery to Practice (RTP) Series: Implementing Recovery-Oriented Practices.
TRAUMATIZING PRACTICES
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Current practices in mental health care that could potentially be traumatizing – or re-traumatizing include: Use of force, restraints, seclusion, making people suppress genuine feelings of fear or anger or grief, telling people to remove their clothes, treating people as if they are invisible, discrediting peoples’ experiences, blaming or shaming, maintaining power and control over people, making decisions for people rather than with people, and many more. Because so many of these traumatizing practices involve power and/or force, often experienced as oppression, let’s explore power and power dynamics.
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Oppression: Oppression is defined as the exercise of authority or power in a burdensome, cruel, or unjust manner. It can also be defined as an act or instance of oppressing, the state of being oppressed, and the feeling of being heavily burdened, mentally or physically, by troubles, adverse conditions or people, and anxiety.
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Oppression occurs between individuals, within relationships, in institutions, and through public policy. At its extreme, oppression can lead to revolution and war. Those who are in power are rarely aware of the ways in which they oppress others. Those who are oppressed often find the experience to be traumatic.
POWER DYNAMICS •
Power dynamics are a common cause of conflict (or drama). While there are many ways in which power can be used or misused, people often take on three distinct power roles:
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Victim: believes she or he cannot take care of her/himself (powerless)
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Persecutor: believes people need to be coerced or controlled (abuse of power to feel powerful)
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Rescuer: believes other people cannot take care of themselves (misuse of power to feel powerful)
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These roles are normally outside of our conscious awareness. No one ever says, “I believe other people can’t take care of themselves,” but in a given situation one may behave that way without even realizing it; responding based on past experience.
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If we happen to go into auto-pilot mode and take on one of these power roles, we often find ourselves switching to one of the other roles, and at some point the whole process tends to feel bad!
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Power by itself is a positive thing; a source of energy or strength or authority (as in “the power vested in me”). But the misuse of authority has turned power into something negative; sometimes sinister.
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Power “over” implies an imbalance of power, with the one on top being more, the one on the bottom being less powerful. Being on the bottom of the situation, we may call up power “against” some foe, hence power becomes an opposing force or opposing forces in tension with each other.
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It may also be a liberating force when power becomes the “strength to overcome.” If we join forces with others, we combine our own power with others and use it for something good.
TRAUMA-INFORMED
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Trauma-informed practices ensure comfort; are always welcoming, avoid conflict, meet needs assertively, and minimize any traumatic event that could hurt clients or staff.
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Inclusion, equality, and respect are guiding principles in this work.
Malmgreen, C. (1993). Some Thoughts on Power and Authority. The Transformer for AVP Workshop Leaders, Fall Issue. Alternatives to Violence Project, New York. Huckshorn, K., Panzer P., Arauz, E. (2012). Assessing for and Addressing Trauma in Recovery-Oriented Practice. Webinar in the Recovery to Practice (RTP) Series: Implementing Recovery-Oriented Practices.
SECONDARY TRAUMA •
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Secondary traumatic stress (STS), also known as “vicarious trauma” or “compassion fatigue,” is natural and normal potential effect of empathic engagement with a traumatized person. It can happen to anyone. The prevalence of trauma in those receiving mental health and substance use services puts peer supporters at high risk for secondary trauma. It is similar to job-related burn-out, but is specifically related to exposure to traumatic circumstances, which may trigger thoughts or feelings about personal traumatic experiences that have not been resolved.
RISK FACTORS: •
Degree of exposure (intensity or frequency, or both) cumulative
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Intensity of the work
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Personal history of trauma
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Lack of social support / isolation
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Punitive work environment
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Lack of appropriate and supportive supervision
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Exposure to acts of terrorism or violence outside of work
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If not recognized and addressed early, secondary trauma can lead to destructive thoughts and behaviors in all of the domains of wellness.
SELF-AWARENESS •
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As peer supporters, it is especially important for us to be aware of our own trauma and our tolerance for revisiting it (through telling our recovery story) while working on positive relationships with others. On one hand, it can help us to find common bonds with others who are experiencing similar circumstances. On the other hand, there may be limits to our capacity to continuously revisit those circumstances. We need to be ever watchful for warning signs of secondary trauma, which is similar to job burn-out, but in this case it is deeply rooted in our own past and connected to the experience of being repeatedly exposed to traumatic events in the lives of others that are beyond our control.
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Just as recovery from primary trauma is unique to each person, you will have your own unique way of healing from secondary trauma – if it happens to you. The most important thing to remember: healing is possible!
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How? In a word, just be “self-ish”!
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Self-aware / set limits
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Self-care / increase relaxation and reduce stress
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Self-expression / find a creative outlet for feelings
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Self-importance / put healing yourself before everyone else
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(think oxygen mask on a plane).
MINDFULNESS/ GROUNDING TECHNIQUES
WHEN YOU ARE DISRUPTED FROM THE PRESENT MOMENT BY MEMORIES OF THE PAST OR FEARS OF THE FUTURE, THERE ARE A WIDE VARIETY OF TECHNIQUES THAT CAN HELP TO BRING YOU BACK. THESE “MINDFULNESS” OR “GROUNDING” TECHNIQUES ARE INTENDED TO STOP DISTRESSING THOUGHTS OR ANXIOUS FEELINGS AND RESTORE YOUR SENSE OF BALANCE AND ABILITY TO BE EFFECTIVE IN THE PRESENT MOMENT.
STOP •
Stop what you are doing. Put everything down just for a few minutes.
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Take a breath. Breathe normally and follow your breath coming in and going out. Think “in” and “out” if that helps. Do this for a few moments.
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Observe your thoughts, feelings, and emotions. Try to name any emotions that come up. Stepping back mentally and naming your emotions can have a calming effect.
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Now notice your body position and posture, and anywhere that you’re holding tension or pain. Become aware of your whole self, not just your thoughts or feelings.
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Proceed with something that will support what you need in the moment.
BREATHE •
Breathe... 1, 2, 3, 4: Inhale, through the nose for the count of four... Hold your breath for the count of four... Exhale for the count of four... Repeat several times or as needed.
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Or, take in a slow, deep breath through your nose while counting to five. The hand on the chest should stay still, while the one over your diaphragm should raise with your breath. This is how you know the breath is deep enough.
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When you reach the count of five, let the breath out slowly (through your nose) at the same rate. Concentrating on your hands and the counting will help focus you and calm you down. Continue these breaths until you feel relaxed.
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Relax your muscles. Find a comfortable position to sit in (or lie down).
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Close your eyes and begin to focus solely on your toes. Curl them under tightly for a count of five, squeezing the muscles together as hard as you can, then relax.
NOTICING •
Low Road/High Road: Walk around slowly cataloging things you notice that are close to the ground… Make another sweep, noticing things that are higher up... Make another sweep noticing things that are even higher, and so on…
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What’s That Sense? If your internal “chemicals” are churning, try to notice precisely what they feel like. Report findings to yourself or a recovery buddy. (For example, “I have a burning sensation in my stomach...” or, “My chest feels tight and it’s hard to breathe…”) Check on specific body parts and notice...My hands feel like; my arms feel like; my neck feels like; my shoulders feel like, my feet feel like, and so on...
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5 Sensing: Pick up an object and touch it with great concentration... noticing texture, temperature, softness, etc. Tune into the sounds around you with great concentration. Notice smells... and if you don’t have any you can identify... scout out some (sniff a plant, your chapstick, etc.) Pay attention to taste… what’s going on in your own mouth right now? Do you need to scout out that old stick of peppermint gum? Look around you with great concentration and notice things you hadn’t noticed.
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Rules: Mentally run through the rules of any game you like to play with a buddy. For example, Go Fish: Everyone gets seven cards... The first person asks “Do you have any Jacks...? “ If yes, partner hands the card over. If not, partner says, “Go Fish” and person draws a card. Do the same for other childhood games, board games, sports, or other pastimes that involve rules.
THINK ABOUT SOME OTHER COPING MECHANISMS, OR ONE’S THAT YOU’VE FOUND PARTICULARLY USEFUL.