Fact Sheet

Harm Reduction and Place: The Social & Physical Environment

Types of Trauma

What is Vicarious Trauma?

Vicarious trauma is the emotional residue of exposure that counselors and providers have from working with people as they are hearing their trauma stories and become witnesses to pain, fear, and terror that trauma survivors have endured.

Provider Reactions to Vicarious Trauma



  • Frequent job tardiness
  • Anger / Irritability
  • Exhaustion
  • Talking to oneself
  • Rejecting physical/emotional closeness
  • Overwork
  • Absenteeism
  • Dropping out of community affairs


  • Staff conflict
  • Blaming others
  • Lack of collaboration
  • Poor relationships
  • Impatience
  • Poor communication
  • Avoidance of working with participants with trauma histories
  • Withdrawal and isolation from colleagues


  • Lack of appreciation
  • Disatisfaction
  • Negative perception
  • Loss of interest
  • Apathy
  • Detachment
  • Hopelessness
  • Low self image
  • Worried about not doing enough


  • Low motivation
  • Increased errors
  • Decreased quality of work
  • Avoidance of job responsibilities
  • Over-involved in details/perfectionism

Strategies to Manage Vicarious Trauma

  • Boundaries: Establish and maintain loving but protective boundaries around personal free time and self care.
  • Advocate: Request organizational support regarding Peer Supervision or Clinical Supervision.
  • End of Work Day Ritual: Create a ritual that signals your brain that your work day has ended and your free time has started that is meaningful for you.
  • Keep an ongoing to-do list: Keep a running list of work-related ideas so you don’t have to worry that you will forget.
  • Give yourself permission: Fully experience emotional reactions and don’t keep emotions “bottled up.”

Vicarious Trauma x Service Provision

  • Emotional: Shock, fear, grief, emotional swings, nightmares, flashbacks, increased need to control everyday experiences, isolation, anger, difficulty trusting people, shame, hyper-vigilance
  • Physical: Aches, pains, easily startled, changes in sleep patterns, appetite, getting sick, substance use

Many times these emotional or physical expressions of trauma can affect someone’s likelihood of seeking services or their ability to actually engage in services. The Substance Abuse and Mental Health Agency acknowledges this, that public institutions and service systems that are intended to provide services and supports to individuals are often themselves trauma-inducing.

These experiences of trauma people carry with them can cause consumers to be kicked out of services due to violation of policies or dissuade someone from entering a building. What can we do about this?

How can you apply harm reduction to your space?

Health & Dignity:

  • Affirming messages within space
  • Bathrooms accessible to both participants and staff members.

Participant Autonomy:

  • Having supplies and resources in spaces that are accessible without having to ask staff
  • Allowing for participants to come/leave freely

Participant Centered Services:

  • Offering what participants say is most important (e.g. access to chargers, phones, computers)

Sociocultural Factors:

  • Multilingual resources
  • Posters that explicitly state that all people are welcome
  • Variety of images in the space

Participant Involvement:

  • Creating message boards for participants to contribute feedback or share resources with others
  • Elections for services and space changes

Pragmatism and Realism:

  • Consider posting community agreements in public
  • Creating alternative spaces for people who need to move/be alone/pace

Engaging with People

  • Physical Space
  • Social Space
  • Provider Experience
  • Services Structure

Connection: How are participants being connected to services?

Expectations: What might someone want to know before they receive a service or arrive?

Waiting: What are aspects of the physical or social space that could be comfortable or triggering while someone is waiting for services?

Receiving: What does the provider experience look like while someone is receiving services?

Staying Engaged: What about the services structure may promote or become a barrier to returning?

Principles of Harm Reduction

What is Harm Reduction?

  • Incorporating a spectrum of strategies including safer techniques, managed use, and abstinence to promote the dignity and wellbeing of people who use drugs
  • A framework for understanding structural inequalities like poverty, racism, homophobia, classism, etc.
  • Meeting people “where they are,” but not leaving them there

We Use People First Language:

  • A person is a person first, and a behavior is something that can change — terms like “drug addict” or “user” imply someone is “something” instead of someone
  • Stigma is a barrier to care and we want people to feel comfortable when accessing services
  • People are more than their drug use and harm reduction focuses on the whole person

Health & Dignity: Establishes quality of individual and community life and wellbeing as the criteria for successful interventions and policies.
Participant Centered Services: Calls for nonjudgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
Participant Involvement: Ensures participants and communities impacted have a real voice in the creation of programs and policies designed to serve them.

Participant Autonomy: Affirms participants as the primary agents of change, and seeks to empower participants to share information and support each other in strategies which meet their actual conditions of harm.
Sociocultural Factors: Recognizes that the realities of various social inequalities affect both people’s vulnerability to and capacity for effectively dealing with potential harm.
Pragmatism & Realism: Does not attempt to minimize or ignore the real and tragic harm and danger associated with drug use or other risk behaviors.

Harm Reduction Interventions

  • Risk Reduction: Tools and services to reduce potential harm
  • (h)arm (r)eduction: The approach and fundamentals to reduce potential harm
  • (H)arm (R)eduction: A philosophical and political movement focused on shifting power and resources to people most vulnerable to structural violence