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Incorporating Harm Reduction and Trauma Informed Care into Community Residential Care


I'm looking to connect with other champions of change working in the realm of adult mental health/substance abuse residential care.

In June, I became the program director of a dual diagnosis (mental health and substance abuse) community residence (New York state, overseen by Office of Mental Health, Congregate Care Level II). Since then I have been working to shift policy, procedure and best practices using a harm reduction model and trauma informed approaches. Although I am absolutely thrilled to have the opportunity to pilot a program like this, I am feeling overwhelmed and could use support.

Here are a few examples of things that I am currently working on or pondering while I should be sleeping at night...

  • Revamping Resident Rights and Responsibilities
    • hot topic here is not discharging if a resident relapses, which is the way it has always been done. MUCH conversation and debate about this one!
  • House Expectations (formally House Rules)
    • the shift from making things like chores, meetings, dinner, etc to "expected" instead of "mandatory" has been difficult. We are working to normalize the experience and remove staff from authoritarian positions, but getting away from using consequences to promote change has been tough! It feels like common sense but successful implementation has been difficult.
  • Designing the intake process to include trauma-informed assessments and questions, including resident information packets on ACEs science and harm reduction principles.
  • Service Planning
    • soooo much work to be done!
  • Staff trainings
    • the majority of my staff are open to the new language and practices but will benefit from increased training on toxic stress, regulation, and resilience building, particularly those who were trained within the medical/brain disease/12 step recovery models.

I'm eager to hear from and learn from others on this same journey. If you have tools, resources, examples, thoughts, etc on any of what I've stated above, please reach out. There is little out there it seems directly related to adult residential care, any support will help!



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Hi Dawn, I ran a number of residential programs for women (and their children) who were diagnosed with substance use disorder, mental illness, trauma, and health problems.  I understand the difficulties in shifting practices, but here are a few examples that I was able to implement: (1)  If a resident relapsed, we discussed this with the resident and shared that we thought she needed a revision in her treatment plan (no discharge); then we implemented additional supports in the plan after discussing with her; (2) our intake process always included a trauma screening (you can always use ACEs) and then further assessments.  Then going over these with the resident and collaborating with her to design the treatment plan; (3) we always implemented multi-leveled trauma trainings (including receptionists, maintenance staff and cooking staff, etc)and the trainings included toxic stress and ACEs, the difference between trauma-specific interventions and trauma-informed care, integrating trauma into substance use and mental health, etc.  If you have any questions about any of the above, please let me know.    Vivian Brown 




Hi, Dawn. 

I'm an attachment-informed Somatic  Experiencing practitioner. I have worked in addictions treatment for years. I'm a big fan of harm reduction and was thoroughly victimized by treatment centers as a younger addict and abuse survivor. I briefly worked as a program director for a treatment facility where I instituted my own curricula in body-informed trauma resolution and witnessed good trauma-informed addiction treatment at Sierra Tucson, practices that needn't be relegated to luxury treatment. 

There's a lot of ground to cover, but I like for explaining ACEs to clients and Beth Dennison makes a series of graphic spiral-bound books that explain nervous system regulation and interpersonal regulation/ threat. If you'd like to talk more, let me know. 

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