Archive for category Trauma Exposure Reaction

10 item checklist about the intersection of domestic violence, substance abuse and mental health issues

by David Mandel, MA, LPC

Domestic violence frequently co-occurs with mental health and substance abuse issues.   A batterer may be diagnosed correctly or inappropriately with mental health issues.  A domestic violence survivor may also have a substance abuse problem.  A child who has been exposed to batterer’s behaviors may have mental or behavioral health issues. Frequently our response to these issues are “siloed,” meaning we prioritize one over the other or even completely ignore one issue to focus on another.  For instance substance abuse and mental health counselors may not screen for domestic violence or if domestic violence perpetration  is identified as an issue it may seen as a symptom of the substance abuse.  A survivor’s recovery plan may be developed without consideration of how the perpetrator might try to sabotage her recovery.   Or a child’s behavioral health issues are not evaluated in the context of historic and current domestic violence.

The following is a 1o item checklist to help begin the conversation about the intersection of domestic violence, substance abuse and mental health issues.  I share this list with the idea that raising our awareness by asking questions about the connection between different issues can be huge step forward in our ability to help families.

  1. What is the relationship between domestic violence, substance abuse, mental health issues?
  2. How have the batterer’s behavior created or exacerbated mental health/behavioral health and/or substance abuse issues for the adult survivor and/or child?
  3. What is the relationship between the batterer’s abusive behavior and any of his mental health and/or substance abuse issues?
  4. How is the batterer interfering with/supporting the treatment and recovery of family members?
  5. How are family members more vulnerable to the batterer because of their mental health and/or substance abuse issues?
  6. How is child welfare and others assessing for domestic violence when the presenting issue is adult or child behavioral/mental health/ substance abuse?
  7. What are important case or treatment plan steps when domestic violence is co-occurring with substance abuse and/or mental health issues?
  8. What are skill level/policy/practices of substance abuse and mental service providers regarding assessing for domestic violence, safety planning and the integration of co-occurring issues into their treatment plan?
  9. What information do mental health and substance treatment providers have access to regarding the domestic violence?
  10. What is the training and skill level of mental health or substance abuse evaluators/assessors regarding domestic violence in general and more specifically regarding the co-occurrence of domestic violence with substance abuse and/or mental health issues?

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David Mandel guest blogs for Hartford Courant Overcoming Battered Lives Series

Tomorrow, September 2, I will be a guest blogger for the Hartford Courant Series Overcoming Battered Lives.  The focus of the blog post will be men and domestic violence.  I will be responding to comments on the blog all day.

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Overcoming Battered Lives

The Hartford Courant recently started an on-going series of articles on domestic violence. Their in-depth look at  domestic violence in CT can be accessed here.  As part of this series, Kristen Selleck,  one of the DCF domestic violence consultants trained in the Safe and Together model and a trainer for David Mandel & Associates LLC, is a guest blogger.  Check her blog entries and the other blog postings that are part of this series here.

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Assessing for domestic violence is important for worker safety

by David Mandel

Assaults against child welfare workers are generally rare but I recently came in contact with a case where the worker was assaulted by client during a visit.  For agencies  where workers are going into the home for any reason—child welfare, parent aide, in-home family support or other services—there is an unnecessary increase in the danger for case workers when we do not universally screen for domestic violence or fail to integrate existing information about coercive control, threats or acts of violence into our safety assessment.   Even when information about coercive control and violence is available, we may be blind to connecting the dots regarding coercive control and violence because it is a “mental health” or a “physical abuse” case.

The “take away” message: Universal, thorough screening for coercive control and actions taken to harm the children can help identify safety issues for workers going into homes.

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Short and long term PTSD symptoms documented in child welfare workers

by David Mandel

The March/April 2009 Child Welfare League of America publication Children’s Voices cited a recent study conducted by the New York Administration for Children Services in conjunction with the Mount Sinai School of Medicine which found significant evidence of short and long post traumatic stress symptoms in child welfare workers in New York City. The study which asked workers workers to identify their most distressing work related event found that one week later 60% reported “clinically significant post traumatic stress disorder symptoms.” The study also found that half of that group “continued to experience clinically significant PTSD symptoms an average of 2.15 years later.”

This number doesn’t surprise me. I’ve seen the impact of trauma in close colleagues and friends working in child protection and I know the effect first hand.  I’ve been part of many conversations about sleepless nights, weekends lost to fear and anxiety about cases and nightmares filled with violence.  I’ve seen individual workers and entire systems traumatized by the death of  a child.   Child welfare workers have shared with me how their work has intruded into their most private thoughts and relationships.

Given these numbers and experiences, we need to be thinking about how we can shift the child welfare culture to be more responsive to the needs of workers.  The CWLA newsletter described two models of how to respond to trauma exposure reaction and worker stress in a child welfare agency. The Administration for Children Services in New York developed the Resilience Alliance Project which provides 12 sessions of prevention intervention focused on building skills associated with optimism, mastery over negative emotion and in the area of self-care, and collaboration. Importantly the effort has targeted supervisors as well as workers, including a component to help supervisors integrate these skills into their supervisory practice.

Closer to home, Dr. Michael Schultz, a colleague of mine at Connecticut’s Department of Children and Families has been coordinating a series of efforts to support workers with , what he refers to as, worker related stress. Mike, along with others, recognizes that any effective effort to address the impact of the work needs to be broached in a sensitive manner. Workers are often resistant to discussing worker related stress or trauma exposure reaction for fear of being perceived as weak and unable to accomplish their work.  These attitudes are often embedded in the child welfare culture and internalized by workers. (Laura van Dernoot Lipsky directly addresses this issue in her book Trauma Stewardship—see April 14 blog entry) The Department’s efforts to sensitively address this issue have included peer led Worker Support Teams, which reach out to workers who are involved in critical incidents, and day long training for workers in worker related stress. The Department’s commitment to child safety, organizational development and worker well-being come together in staff debriefings after critical incidents. These debriefings blend attentiveness to the impact of the traumatic event on staff,  mutual support, organizational dynamics and the importance of learning lessons that may prevent future critical incidents.

If you want to read entire Children’s Voices article click here.

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This work changes us (and we should be talking about it)

by David Mandel

I  want to recommend a book that I just finished reading.  It’s  “Trauma Stewardship: An everyday guide to caring for self while caring for others” by Laura van Dernoot Lipsky with Connie Burk.     The book, which is about the impact of working with trauma, should be mandatory reading for anyone in the domestic violence and child welfare fields. I felt so strongly about this that I ordered a number of copies and gave them to the Domestic Violence Consultants who work in Connecticut’s Department of Children and Families.   When I gave them the books I told them, “We make sure you have computers and other things to do your job. This book is just as important a tool for you as those things.” (I’ve been also “seeding” this book among key colleagues hoping to promote more dialog.)

Why am I so enthused about this book? Because I found it profoundly useful for me as a person who has worked on issues of violence and abuse for over twenty years, as supervisor who is committed to attending to the health and well-being of the people who work for him, and as consultant who is committed to improving the response to domestic violence.  On a personal level, I found my own experience reflected back to me in Laura’s words.  I was supported by her identification that the ” conversation stopping”  nature of my work (telling people you work with domestic violence doesn’t usually lead to lots of follow up questions) is related to our society’s aversion to dealing with trauma.  I heard my own words to my staff reflected in her insistence that acknowledging our limitations is healthy and doesn’t mean we are abandoning our clients or not committed to our work.  Reading this book helped me reflect on the ways this work has changed me (a narrow focus on work, a loss of creativity in and out of work, exhaustion and withdrawal), and reminded me that I have the capacity to make positive changes in how I care for myself.

As supervisor I found support in her writings for intensifying my commitment to discussing with my staff and others their trauma exposure reaction. (Laura uses the term “trauma exposure reaction” instead of “vicarious trauma” or “secondary trauma.”)   Her naming of how we resist discussing our reactions to trauma in the lives of our clients because of our own fears of feeling weak or being labeled as weak by others (this can be very powerful dynamic within child welfare agencies) helped me raise the subject with my staff.

And as consultant interested in improving the response of our systems to children exposed to batterer’s behavior, I’ve become clearer that we need to create more space in our agencies and institutions to talk about how our trauma exposure is impacting us.   I don’t think we can make our agencies more trauma informed, or help clients heal from their traumas when we don’t have the language and skills to deal with our own reactions.   I don’t think child welfare supervisors can mentor new workers without being able to talk about how the exposure to traumatic material is effecting them. (Could there be  a connection between the high turnover rate in child welfare and the lack of institutional capacity to address new worker’s trauma exposure reaction? ) By looking at our own trauma exposure reactions, we help ourselves, go home healthier to our families, create healthier work environments and develop the compassion and skills we need to help families who have experienced trauma in many forms.

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