Moving Towards Healing Places
This trauma-informed, harm reduction curricula can improve the efficacy of providers to engage people who are both experiencing homelessness and using drugs.
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
The Stages of Change
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
Research: Housing x Harm Reduction
National Harm Reduction Coalition spent six months doing formative research, conducting focus groups, one-on-one interviews and phone calls with providers and consumers of services across San Francisco.
Through these conversations, one of the key themes that emerged was that consumers expressed feeling judged by staff — especially when they have trans lived experience, visible mental health symptoms and/or drug use.
Consumers also said housing programs often felt punitive and triggered previous trauma; similarly, providers experience vicarious trauma from supporting people who are chronically unhoused and navigating a system with limited resources.
Providers with direct lived experience of trauma likewise are overlooked and want more concrete support to gain insight into their responses and reactions.
Lastly, it was determined that providers felt a need to be rigid around rules because housing options are so limited, although consumers state that high barrier regulations are often a reason they choose not to access housing, when available.
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
BEHAVIOR
- Frequent job tardiness
- Anger / Irritability
- Exhaustion
- Talking to oneself
- Rejecting physical/emotional closeness
- Overwork
- Absenteeism
- Dropping out of community affairs
INTERPERSONAL
- 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
VALUES/BELIEFS
- Lack of appreciation
- Disatisfaction
- Negative perception
- Loss of interest
- Apathy
- Detachment
- Hopelessness
- Low self image
- Worried about not doing enough
JOB PERFORMANCE
- 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
If you’re in a management position:
- Actively involve people with lived experience of homelessness in the creation of policies
- Perform an audit of all program policies and question reasons for different policies (funding, safety, regulation) and be open to identifying policies that can change
- Change policies to recognize that people use drugs for a variety of reasons — do not require abstinence to get services
- Invite open conversation regarding policies and procedures with all levels of staff and participants
- Review language in program materials and therapeutic interventions to ensure gender inclusivity and person-first, non-stigmatizing language
- Provide every staff member, regardless of licensure status, with weekly clinical supervision
- Provide harm reduction and trauma-informed training to every level of staff from security guards to leadership
If you’re in a direct service position:
- Offer to meet people outside or in a location of their choosing where they feel the most comfortable
- Allow people to choose the chair they sit in in your office
- Acknowledge and validate all coping skills, even ones that appear to cause harm (e.g. substance use, self-harming behaviors, volatile relationships)