1 Bringing an Inclusive Service Model to your community DAY 1Open Doors Bringing an Inclusive Service Model to your community DAY 1 Acknowledgement of traditional Indigenous Territory. Before the training begins, acknowledge and honour the Indigenous traditional stewards of the location where the training is taking place. This practice is part of the reconciliation and decolonization work. It is recommended that the trainer research the name of the Indigenous territory and the First Nations people that are on the land. It may also involve acknowledgement of treaties that may have covered that area, or an acknowledgment of the fact that no such treaties exist in the area. Suggested Script “Before going further, I wish to acknowledge the ancestral and traditional (unceded) territories of the _____ (ie. Coast Salish) Peoples, and in particular, the _______________________________ (name of First Nations, ex. the Squamish, Musqueam, and Tsleil-Waututh First Nations in Metro Vancouver) on whose territory we work, live and play / on whose territory we stand.”

2 Joanne Baker Executive Director Pakka Liu Training CoordinatorBC Society of Transition Houses Pakka Liu Training Coordinator BC Society of Transition Houses Introduction of the trainer

3 Impetus for Open Doors Women who have experienced violence and who have mental health and substance use issues often face restricted access to transition houses & safe homes. As a result they are at increased risk of homelessness/further violence. Homeless shelters report many of the women using their services have experienced violence.

4 Project background Lead by the YWCA Canada Project partners:Canadian Network of Women’s Shelters and Transitional Houses (CNWSTH) BC Society of Transition Houses (BCSTH) The Canadian Women’s Foundation Aims to increase access for women fleeing violence and are coping with trauma, mental wellness and substance use to VAW shelters and transition houses.

5 Project background The goal of the project is to foster national systemic change by implementing an inclusive service model in communities and supporting broad use of the model This 3-year project is training and supporting 50 Community Service Leaders with the aim of changing the standard of service in each of their 50 communities

6 Project components The 50 Community Service Leaders will participate in one of 6 regional trainings: Hamilton, ON (Summer 2016) Calgary, AB (Fall 2016) Halifax, NS (Spring 2017) Yellowknife, NT (Fall 2017) Québec, QC (Spring 2018) Iqaluit, NU (Spring 2018) Additional supports provided to support systemic change: Regional Service Networks Website – opendoorsproject.ca Webinars & learning community

7 Inclusive service model developmentYWCA Saying Ye: Effective Practices in Sheltering Abused Women with Mental Health and Addiction Issues BCSTH Reducing Barriers to Support Women Fleeing Violence Toolkit. CNWSTH Practice Implementation Manual Gap analysis of non-VAW focused shelter serving abused women online survey. Needs assessment thought focus groups with abused women in non-VAW focused shelters.

8 Inclusive service model in a nutshellWorking in a ‘grey’ zone guided by the circumstances and needs of women and their children. Recognising that one size does not fit all. Working from strengths. Incorporating Feminist Trauma-informed practice. Using a harm reduction approach. Women who have experienced violence and who have MH and SU issues face restricted access to transition houses/shelters – as a result they are at increased risk of homelessness/further violence. How are women’s shelters and transition houses responding? Implementing a lower/reduced barriers or harm reduction approach. Working in a ‘grey’ zone guided by the circumstances and needs of women and their children rather than set rules and procedures. Recognising that one rule does not fit all. Saying ‘yes’ more than ‘no’ as often as possible. Rather than relying on predetermined rules, continually compare practice against a model of practice. Work from framework/guidelines rather than rules.

9 To sum it all up … Saying ‘yes’ more than ‘no’ as often as possible

10 Group Agreement How can we make the most out of our time together?What do we need to establish to make this space safe for everyone? To make sure that our time together is generative and safe for everyone, we need to establish a group agreement. Some of the information shared maybe sensitive and challenging. What would you like to see to make this a safe space for everyone? Ask the group to say out loud what they would like to see in the group agreement. Write it down on a flip chart. Tear out the page and stick it somewhere visible on the wall. Points we would generally want covered: confidentiality, limit distractions (phone), respectful behaviours – disagree with the idea not the person, self care.

11 Dreams and nightmares What does the group hope to get out of this workshop? What are some of our shared fears? Hopes and Fears activity Provide sticky notes to the participants. Ask them to write down their hopes for the training in one colour and their fears for the training in another colour. Ask the participants to stick them onto the board with hopes on one side and fears on the other side. Summarise some of the fears first and then the hopes. Acknowledge the honesty for sharing the fears and the commonality in the room. The idea is to acknowledge the mix of hopes and worries that we bring to a new training. It is useful to share these with the trainers and other participants in a safe way so that we can try to realise their hopes and avoid or overcome some of the things that they are fearful of. Both hopes and fears are important. Hope nourishes us and gives us motivation. Although fears can make us feel vulnerable, they can be an important check on our behaviour and provide a prompt to reflect and review for ourselves and others. At the end of the training, revisit the hopes and fears board. Ask participants to leave their notes with hopes that were realised through the training and to take away the fears that have not come to pass or have been overcome through the training. Through this review, we get a sense of how well the training met their hopes and took care of their fears.

12 Agenda Introduction Adult learning principles Trainer’s toolkitDay 1 Introduction Adult learning principles Trainer’s toolkit Experiential learning cycle Connecting the dots Foundational principles Day 2 Feminist trauma-informed practice Mental wellness Medical model Substance use Harm reduction approach Supporting mothers Day 3 Revisit house rules and intake Record keeping Supporting each other Planning for training CNWSTH Practice exchange and practice implementation

13 Blue vs. White Trainer’s slides Participant’s slidesThe blue slides contain information for those of you who are being trained to pass on this content to others. The white slides are slides with content that you can use when you are passing on this training to others.

14 Being challenged is often a really useful – although sometimes scary - part of the learning experience.

15 Why are you here? Take a moment and think individually about :What are some of the values and principles you hold that brought you to this work? Where do they come from? How do these values and principles guide you in your work? Share back with the group ONE of the values or principles that you hold the closest to your heart. Activity direction: Write “Our values and principles” on a flip chart paper and hand out sticky notes to the participants Ask the participants to think individually about the values and principles they hold, where do they come from and how do they guide them in their work. Ask the participants to write down each value and/or principle on a separate sticky notes. When they are done, ask them to stick the sticky notes on the flip chart paper. Ask them to stick similar ones in clusters (note: facilitator may need to help organize). Ask participant to share ONE value or principle that is important to them. Direct the participants to look at the clusters of values and principles on the flipchart and note that those are the collective values in the room. This is what the group can come back to when working through challenging topics. This activity could also be conducted as a think-pair-share.

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17 Adult learning principlesMalcolm Shepherd Knowles (1913 – 1997) was an American educator well known for the use of the term Andragogy as synonymous to the adult education. According Malcolm Knowles, andragogy is the art and science of adult learning, thus andragogy refers to any form of adult learning. (Kearsley, 2010).

18 Adult learning principlesKnowles’ 5 Assumptions of Adult Learners Self-directed Adult learner experience Readiness to learn Immediacy of application and problem centeredness Internal motivation to learn Malcolm Shepherd Knowles (1913 – 1997) was an American educator well known for the use of the term Andragogy as synonymous to the adult education. According Malcolm Knowles, andragogy is the art and science of adult learning. Thus andragogy refers to any form of adult learning. Self-directed As we mature, our self concept moves from one of being dependent toward being self-directed. Adult Learner Experience As we mature, we accumulate experience that increasingly becomes a resource for learning. Readiness to Learn As we mature, our readiness to learn becomes oriented increasingly to developmental tasks associated with our social roles. Orientation to Learning As we mature, our perspective of time changes from one of postponed application of knowledge to immediacy of application. Our learning orientation becomes more focused on problem-solving. Motivation to Learn As we mature, the motivation to learn is increasingly internal. A social analysis of learning is also important. The economics of learning and training. The amount of unpaid time devoted to this. Unequal access to training and education opportunities.

19 Getting and keeping their attentionThere are many ways to keep audience engaged and a trainer can decide which one to use based on topic, personal style, size of the audience and energy in the room. Examples: Touch Each Page Gallery Walk Think-Pair-Share Think-Pair-Share activities are embedded throughout the slides. It is a strategy designed to enable participants to relate to a topic and formulate individual ideas by allowing them to share their ideas with other participants. Rather than using a basic recitation method in which a trainer poses a question and one participant offers a response, Think-Pair-Share encourages a high degree of participant response and can help keep participants on task. Using a timer may help keep this activity brief and maintain structure. Refer participants to page 9 of the Facilitator’s Guide for a list of reasons why Think-Pair-Share activities are useful. Have participants read silently or as a group. Consider using the following Think-Pair-Share activity to demonstrate. THINK about an example of when a previous experience with an interactive professional development activity increased your understanding of presented content. Pause for 15–20 seconds. PAIR with your neighbor. SHARE your experience with your neighbor. Debrief to reinforce components of the Think-Pair-Share activity.

20 Energize! When the energy in the room is low or after a very heavy topic, energizers can help refresh the participants Examples: Belly-writing Leading a stretch Count down to 15 Belly Writing: This is a silly activity that only takes a few minutes and have some movements involve. The facilitator will ask everyone to stand up and give the instruction to the activity. Pretend there is a pen sticking out of your belly button. At the count of three, everyone will write their name in the air with the imaginary pen by moving their torso around. Leading a stretch: This is a low-movement activity. The facilitator will ask everyone to think of a stretch movement that can be easily done based on the abilities in the room. The facilitator will lead the first stretch and ask each participants to lead one stretch. Count Down to 15: Divide the group into two smaller groups. The facilitator will give the following instruction: The goal of the activity is to count to 15 before the other group. Each person will call out a number sequentially while walking around in a random pattern. You cannot communicate who is going to call out a number next – no signals, eye contacts or gestures. If two people call out the same number at the same time, the group must restart the process again. When one group is able to count to 15, the activity is over.

21 Experiential learning cycleFrom: Experiential Learning is the process of consciously learning from experience in order to improve future practice. The learning cycle developed by Kolb (1984) and successfully used in many adult learning processes gives the base for bringing together the three dimensions of social learning and change (individual, organizational and societal/institutional) in a full spiral of action and reflection. Learning according to this theory involves a four-stage cyclical process. An individual or group must engage in each stage of the cycle in order to effectively learn from their experience. The cycle starts with individual or group experiences of events (or things). But these experiences alone do not lead to learning. First it is necessary to reflect on this experience. This means exploring what happened, noting observations, paying attention to the feelings of yourself and others. It means building up a multidimensional picture of the experience. Questions to ask: What happened? What has succeeded or failed? What significant things happened? Describe the events: Who was involved, what did they do? What picture emerges? How did I/we feel? The second stage of the cycle involves analysing all this information to arrive at theories, models or concepts that explain the experience in terms of why things happened the way they did. This theorising or conceptualising about experience is very important to learning. It is where solutions to problems, innovative ideas and lateral thinking come from. Drawing on existing theories is a crucial part of this stage. Questions to ask: Why did it happen? Why have we had successes or failure? Why did it happen, what caused it? What helped, what hindered? What did we expect? What assumptions did we make? What really struck us? Do we know of any other experiences or thinking that might help us look at this experience differently? With this understanding of past experience, the next stage involves deciding what is most important and generating ideas about how to improve future actions. It is working out how to put what has been learned into practice. Questions to ask: So what? So what are the implications for the process? What would we have done differently? What did we learn, what new insights? What was confirmed? What new questions have emerged? What other theories help us to deepen these learnings? Finally, in the fourth stage, putting these new ideas or solutions into practice by taking action will result in a new experience. And so the cycle continues. Now what? What action will we now take to make improvements? Questions to ask: Now what does this mean for practice? What do we want? What do we want to do, to happen? How? What are we going to do differently? How will we not repeat the same mistake? What do we have to let go of or stop doing? What steps will we use to build these new insights into our practice?

22 Lunch time!

23 Making the ConnectionsMental wellness, substance use & violence against women Making the Connections

24 Gender-based Violence1 Social Context Gender-based Violence Mental Wellness Substance Use “A women’s experiences with violence often precede her mental wellness and/or substance use concerns” (Gatz et al., 2005; Humphreys et al., 2005; Humphreys, 2007) Open discussion (or think-pair-share): What do you think this diagram illustrates? Each influences the other – but research shows that often it is experiences of violence that come before concerns around mental health and substance use. Not just ‘predisposition’ to mental wellness issues – violence can cause the wellness issue outright (trauma, anxiety and depressive conditions). Mental health – now seen as normal response to violence (such as trauma, PTSD, anxiety, depression). Substance use – may help numb physical and emotional pain – may be forced on her by her abuser as a means of controlling her – may help her cope with the mental health responses to violence – may dull her senses so her ability to assess risk in a situation is compromised. We use these insights to bring others ‘on board’ to a more inclusive service model. Points we might make: Without a more inclusive approach, those who have experienced the most harm may receive the least support. It is very rare for women to have just one, distinct support need (such as violence). The issue of insurance and liability for adverse events can be used as a rationale for a less inclusive model of service. It can be argued that an inclusive approach that encourages disclosure about substance use and mental wellness and facilitates strategizing about how this will be managed is a more robust way to manage risk. Social Location

25 Many “symptoms” that women exhibit represent their attempts to cope with and adapt to traumatic stress … [yet we often] focus on what is ‘wrong’ with this person, rather than on what horrible things have happened to this person. Lori Haskell is assistant professor in psychiatry at the University of Toronto and is an academic research associate with the Centre for Research on Violence Against Women and Children. Her research is on the subject of victimization and its effects, violence prevention, and trauma and psychological development. One of the main findings from her research is that many so called “mental illness symptoms” are actually coping strategies. This shift in thinking about symptoms can help us acknowledges the different ways people cope, whether good or bad, and coming from a place of compassion. The various responses are seen as their best efforts to cope with external events. The external events (abuse and violence) are the problem, not the women’s traumatic responses to it. Every adaptation helped an abused person survive in the past and to some degree in the present. - Lori Haskell, Bridging Response: A front-line worker’s guide to supporting women who have post-traumatic stress

26 Video: For Her Own Good Things to keep in mind as you watch the video:What are the key messages the women want us to hear? What did the women find useful in their healing journey? What are the links between violence, mental wellness and substance use? Video is produced by the Ontario Association of Interval & Transition Houses. Video length: 30 minutes The film For Her Own Good: Emotional Resiliency after Abuse shares the stories of six women who have experienced violence and oppression in their lives and have as a result grappled with the emotional effects of those experiences. The women describe their struggles in being heard and supported by a number of community supports and institutions and tell us how they were able to cope with the distress of these experiences. Video is produced by the Ontario Association of Interval & Transition Houses

27 Remember – no one expects you to be a drug and alcohol expert – you just need to be able and willing to have conversations with women about their substance use and relate these conversations to the risks women are exposed to, their safety and ongoing physical, mental, emotional and spiritual needs. Freedom from Violence: Tools for Working with Trauma, Mental Health and Substance Use EVA BC - Tessa Parkes, Freedom From Violence Toolkit

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29 Foundational PrinciplesValues that guide our work Foundational Principles

30 Foundational Principles for supporting womenWoman-Centred Anti-Oppression Holistic & Integrated Harm Reduction Relational The bedrock of our polices and practices. Although what we do and how we do our work may be different across agencies, time and context, we can always come back to these concepts to guide us when we need to make a decision or change. Each of these principles can contribute to the shelter/transition house being a safe place for women and their children. It may be useful to use the metaphor of these foundational principles being the ‘bedrock’ through the training. The principles can operate as the solid ground, or foundation, beneath our feet. Responsive Adapted from Reducing Barriers to Support for Women Fleeing Violence: A Toolkit for Supporting Women with Varying Levels of Mental Wellness and Substance Use (BC Society of Transition Houses, 2011)

31 Woman-centred Take into account the various social factors and contexts that shape women’s lives. Intersectionality = various inequities/forms of oppression are interconnected and impact different women differently. Each woman’s experience is unique. They are the experts of their own lives. Discussion questions/prompts for the group: In what ways are your services currently women-centred? Where is there room for change to build on your current policies, procedures and practices? One source of conflict – we may say that we believe women. But do we all believe her to the same level? How much truth is taken for granted? To open up discussion about woman-centred practice, it can be useful to share examples of how women’s experience has not been centrally considered in many areas of life. For example, early research into heart disease only looked at the experience of men; bathrooms in public buildings often do not cater for the number of women using them (add your own examples!)

32 Woman-centred Focus on women’s strength and resistance (strength-based and response-based approach) Provide non-judgemental information about all options available to women, and respect and support their decisions Recognizing women are competent at making decisions that are best for them. Women-centred Principles: Treat women as experts of their own lives and take the lead from the women they are supporting Focus on women’s strength and accomplishments (strength-based approach) Provide non-judgemental information about the various options available to women, and respect and support their decisions Acknowledge the social realities and various inequities/forms of oppression that impact women, rather than focusing on individual characteristics or choices Actively work to reduce women’s barriers to access support, stemming from women’s social contexts and experiences with oppression Honour diversity by being respectful and reflective of each women’s cultural and social context Recognize the various identities that women claim, and avoid focussing on only one aspect of her identity

33 Anti-oppression We are all impacted, to some extent, various forms of discrimination. Recognize and make conscious efforts to NOT replicate power structures that foster inequality and bias. An anti-oppression framework is essential to providing woman-centred service. The various points of oppression that exist in our society, and that she may experience, must be taken into account. Levels of mental wellness and/or substance use may fluctuate as women cope with violence they experience, but also with other social inequities – including homelessness, poverty, discrimination based on a women’s ability, Aboriginality, experience of colonization, immigration/refugee status, education, ethnicity, gender, geographic location, occupation, religion, sexuality etc. It is important to acknowledge that it can be challenging, as a person who works in a ‘helping profession’, to consider that our practice may be experienced as oppressive. However, this kind of critical self-reflection contributes to ongoing learning and responsive practice.

34 Thinking about languageInstead of … Consider … Crazy/Psychotic/Insane/Bipolar Women living with … Junkie/Addict/Druggie Women struggling with substance use Clean Not using substance/cutting back/abstinent Relapse Lapse Off her meds Choosing not to take her prescription due to … A dogmatic approach to language is unlikely to be helpful, it can lead to defensiveness or shame about the language we use. Women may use some of this language about themselves and others. Curious, thoughtful questions can open up useful conversations. For example: “I notice that you describe yourself as crazy/having a mental illness. Can you tell me why you use that word/do you think of your condition/situation as an illness?”

35 Deficit-based languageAdapted from: Royal College of Nursing, Informed Gender Practice: Mental health acute care that works for women, 2008, National Institute for Mental Health: London, UK.

36 Relational Supportive, respectful, non-judgmental relationship is the foundation of healing. Includes relationships between worker & women and women & women What are some of the qualities that women might be looking for from shelter/front line staff? What may be some of the challenges for building healthy relationships?

37 Holistic & integrated Women are often asked to separate and compartmentalize each issue when seeking services. The distress she presents is only a small part of how she is in the world. Collaborate with local agencies, formally and informally, to better serve women. Partnerships can start with cross-training opportunities in order to challenge the ‘silos’ we may work in. e.g. anti-violence agencies educating partners about the importance of gender and about violence informed practice; and mental wellness and/or substance use agencies educating their anti-violence partners about practical skills for supporting women with varying levels of mental wellness and/or substance use. Key points: Collaboration while maintaining privacy and confidentiality for the women we work with. Her distress is only part of who she is and how she is in the world. Get to know the woman rather than her ‘problem’. The ‘In Her Shoes’ activity will help us to think more about how women experience the way they are expected to separate out pieces of their lives and their frustrations with ‘the system’.

38 Challenges of access to servicesWomen may bounce back and forth between offices being told they need to deal with their ‘other’ issues first. Services may be piecemeal or located far away from each other. Funding may be narrow and restrictive. Accessing services with multiple issues is often very challenging. Again, the upcoming ‘In Her Shoes’ activity will help us to think more about this experience.

39 Responsive Constantly adapting how we work with women and how we do the work. Need for clear program policies, procedures and practices that are consistent across shifts and staff. What are the factors to consider? For the women – where she is coming from, what she needs and wants, her past experiences… For programs – level of funding, staffing, and other community services available... For community – its location, its population… How do we reconcile responsiveness with consistency? Example – different women having different curfews. This is responsive to the varied needs of women. A woman who works shifts may need a flexible curfew. The consistency is that the curfew is negotiated with each woman rather than a blanket policy or fixed time and takes into account her safety and that of other women staying at the shelter/transition house.

40 Harm reduction Reducing the harmful effects of behaviours that a person is not able to stop. Recognizing that ignoring or condemning the behaviour will not make it go away. Respecting decisions. Harm reduction challenges the simplistic message of ‘just say no’. Key point for respecting decisions. This is (especially) inclusive of those decisions that women make and which we don’t agree with.

41 The reduction of harmful consequences of substance (ab)use without necessarily requiring any reduction in use. These harms may be related to health, social or economic factors that affect the individual, community and society as a whole. Harm reduction seeks to reduce the more immediate and tangible harms an individual may face. Centre for Addiction & Mental health “The reduction of harmful consequences of substance (ab)use without necessarily requiring any reduction in use. These harms may be related to health, social or economic factors that affect the individual, community and society as a whole. Harm reduction seeks to reduce the more immediate and tangible harms an individual may face.” - Centre for Addiction & Mental health

42 Walking in her shoes What are some of the barriers the women experienced? How may her experience influence her behaviours when she contacts you? INSTRUCTION: Cut out the story cards from Walking In Her Shoes activity Put all the cards in sequential order and place them inside an envelope. One story per envelope. Set up stations around the room. The stations are: Home Alcohol & Drug Family & Friends Health Care Parenting Program Income Assistance Transition House Employment Housing Ministry of Children and Family Development Mental Health Pair up participants and give them each an envelope containing a different story Explain that they will be following the story of a woman and move from station to station. The top of the card indicates where they are and the bottom of the card indicates where they should be. Participants will all start at “Home” and read the card. Following that, they are to leave the card at the station and move to the next station based on the story. Continue until all the cards are used and the activity is completed.

43 Check out

44 Bringing an Inclusive Service Model to your community DAY 2Open Doors Bringing an Inclusive Service Model to your community DAY 2

45 Feminist Trauma-Informed PRACTICEAcknowledge our personal histories and ongoing experiences of trauma – reminder to pay attention to self-care. Check who already has some experience/training in trauma-informed practice. We are talking about trauma because it precedes much SU & MH. Co-occurrence with other difficulties Trauma survivors tend to experience significantly more co-occurring mental health difficulties, such as depression, dissociation, anger, suicidality, self-harm, as well as substance use problems and addictions, than people experiencing mental health problems without trauma histories.

46 Feminist trauma-informed practiceLocating the “problems” within the systems of oppressions, not pathologizing the women. Understanding that men’s violence against women can cause trauma. Recognising the ways in which trauma can show up in our bodies/minds/belief systems/behaviours. Coming from a strength-based approach. Some symptoms are actually coping mechanisms and/or normal responses for the women living with violence. Disassociation Poor memory Easily distracted Trouble sleeping Anger & outbursts Early identification and understanding of trauma centred on - mostly men’s – wartime experience. WW1 soldiers returning with ‘shellshock’. Experience of colonization – residential schools, Indian hospitals Homophobia, transphobia

47 Trauma-informed work Does not necessarily require disclosure of trauma. More about the overall essence of the approach, or way of being in the relationship, than a specific strategy or method. Focus on safety and engagement. Creates an environment where there is not further traumatization or re-traumatization (events that reflect earlier experiences of powerlessness and loss of control) and where they can make decisions at a pace that feels safe.

48 Trauma-specialized workWork in a trauma-informed environment that is focused on treating trauma through therapeutic interventions involving practitioners with specialist skills. Trauma-informed practice recognises the need to respond to an individual’s intersecting experiences of trauma, mental health, and substance use concerns. It acknowledges that this is achieved not only in specialized services that specifically treat trauma but also in practical, attuned ways at all levels of support and care, across all settings.

49 Trauma-informed work Work at the client, staff, agency, and system levels from the core principles of: Trauma awareness Safety Trustworthiness Choice and collaboration Building of strengths and skills TRAUMA AWARENESS - BC Provincial Mental Health & Substance Use Planning Council. (2013). Trauma-Informed Practice Guide. The commonness of trauma experiences; how the impact of trauma can be central to one’s development; the wide range of adaptations people make to cope and survive after trauma; and the relationship of trauma with substance use, physical health, and mental health concerns. EMPHASIS ON SAFETY AND TRUSTWORTHINESS Physical, emotional and cultural safety is key because trauma survivors often feel unsafe, are likely to have experienced abuse of power in important relationships, and may currently be in unsafe relationships or living situations. Safety and trustworthiness are established through such practices as welcoming intake procedures; adapting the physical space to be less threatening; providing clear information about the programming; ensuring informed consent; creating crisis plans; demonstrating predictable expectations. The safety and needs of practitioners must also be considered. Require demonstrated awareness of vicarious trauma and staff burnout. Key elements of trauma-informed services include staff education, supervision and policies and activities that support staff self-care. OPPORTUNITY FOR CHOICE, COLLABORATION AND CONNECTION Create safe environments that foster a sense of efficacy, self-determination, dignity, and personal control. communicate openly, equalize power imbalances in relationships, allow the expression of feelings without fear of judgment, provide choices as to treatment preferences and work collaboratively with clients. In addition, having the opportunity to establish safe connections—with helping professionals, families, peers, and the wider community—is reparative for those with early/ongoing experiences of trauma. STRENGTHS BASED AND SKILL BUILDING Assist the identification of strengths and the (further) development of resilience and coping skills. Teach skills for recognizing triggers, calming, grounding, and staying present. Statements that make collaboration and choice explicit: • ‘I’d like to understand your perspective.’ • ‘Let’s look at this together.’ • ‘Let’s figure out the plan that will work best for you.’ • ‘What is most important for you that we should start with?’ • ‘It is important to have your feedback every step of the way.’ • ‘This may or may not work for you. You know yourself best.’ • ‘Please let me know at any time if you would like a break or if something feels uncomfortable for you. You can choose to pass on any question.’ • Use appropriate metaphors: ‘You are the expert or the driver. I can offer to be your map to help guide you to available resources’. Working in a feedback-informed way: • Purposefully elicit their perspective of the overall experience (e.g., “What was it like for you to get here today?” or “How was it for you to talk about this?”) • Continuously check in throughout the course of your work with someone.

50 Key messages for trauma-informed practiceNormalize the experience, reduce stigma. Emphasize resilience and hope. Communicate that what happened is not their fault. Reassure them that they don’t need to ‘go it alone’. Key messages: Your brain chose how to respond to trauma, not you. The brain is repairable.

51 Understanding trauma DSM V: Experience an event that involves actual or threatened danger such as serious injury or death to self or others. “An inescapably stressful event that overwhelms people’s coping mechanisms”. What is considered ‘traumatic’ depends on subjective perspective and social responses. Trauma is common Trauma was originally considered to be an abnormal experience: “outside the range of normal experience”. Evidence demonstrates that majority of adult are exposed to traumatic events. About 75% of Canadian adults report some form of trauma exposure in their lifetime. Around 9% meet the criteria for the clinical diagnosis of PTSD - BC Provincial Mental Health & Substance Use Planning Council. (2013). Trauma-Informed Practice Guide. Bessel van der Kolk, a professor of psychiatry at Boston University School of Medicine and an expert in post-traumatic stress: Trauma is a feeling of intense fear, helplessness, or horror. The experience of trauma is power and gender informed. Social locations interact with trauma. Trauma is the normal and common response to intense fear, helplessness and horror. The experience of PTSD can be different for each individual. Not everyone experiences the same consequences in type, severity, duration or frequency. Symptoms often develop immediately but their onset may be delayed, perhaps until many years after the violence and until the women feels safe.

52 Simple PTSD vs. Complex PTSDCompounding effects of multiple trauma Possibly perpetrated by someone the survivor trusted Examples: childhood abuse, domestic violence, residential schools, prisoners of war camps, human trafficking Results from a one-time event Examples: natural disaster, accident, an assault Simple trauma: single incident trauma, out of the blue, dramatic accident, one off event, natural disaster Complex trauma: repeated or ongoing abuse, domestic violence, community violence, war or genocide. Usually involves fundamental betrayal of trust in primary relationships. Repeated prolong trauma has a different impact than a single event. The women we serve often survived multiple trauma which result in complex PTSD. May have delayed onset – i.e. when the woman is not in danger. Not everyone experiences the same consequences in type, severity, duration or frequency. Symptoms often develop immediately but their onset may be delayed, perhaps until many years after the violence and until the women feels safe.

53 … there is a shift from a brain (and body) focused on learning to a brain (and body) focused in survival. … the survival brain seeks to anticipate, prevent, or protect against the damage caused by potential or actual dangers. - Julian Ford, Neurobiological and Developmental Research: Clinical Implications

54 Trauma & memory Limbic system registers danger. The amygdala short-circuits incoming information and sets off a ‘red alert’ Hormones and chemicals released into body to activate fight, flight (epinephrine, cortisol, serotonin) or freeze (norephephrine). ‘Freeze’ response also known as ‘tonic immobility’ and occurs in around 44% of sexual assault cases. These are AUTOMATIC reactions. The cortex (reasoning, logic/reasoning/memory) is bypassed. Amygdala is not good at determining real and imagined danger so just trying to remember a traumatic event will trigger “fight or flight” response Hippocampus does not “tag” memory with time and location stamps – when recalling a traumatic memory, it will be like it is happening right now Memories formed during a traumatic event are often fragmented and specific (i.e. very vivid memory the smell on the assailant's breath but no recollection of the details of the surrounding) Trauma is remembered in fragments, infused with intense emotion and sensory information. We may be ‘haunted’ by these memories but not know their source. Recalling the memory of the event is challenging and often not chronologically sequenced (i.e. jumping all over the place) Who/what/when/why/how – not good questions. Instead: “what can you tell me about your experience?”

55 Window of tolerance The “Window of Tolerance” (Ogden, et al. (2006); Siegel, 1999) is the optimal zone of arousal where we are able to manage and thrive in every day life. 53). When arousal falls within this window, information received from both internal and external environments can be integrated. When we are outside of our window of tolerance, our nervous system responds by going into survival mode – fight, flight or freeze. We can either feel overwhelmed and go into hyper-arousal or we can shut down and go into hypo-arousal. Our window of tolerance can be narrow or wide and is different for all people and at different times in our lives. Experience of trauma narrows that “Window of Tolerance.” Most traumatized clients experience “too much” arousal (hyperarousal), or “too little” arousal (hypoarousal), and often oscillate between these two extremes (Ogden, Minton, & Pain, 2006; Post, Weiss, Smith, Li, & McCann, 1997; van der Hart, Nijenhuis, & Steele, 2006; van der Kolk, van der Hart, & Marmar, 1996). Co-occurrence with other difficulties Trauma survivors tend to experience significantly more co-occurring mental health difficulties, such as depression, dissociation, anger, suicidality, self-harm, as well as substance use problems and addictions, than people experiencing mental health problems without trauma histories. .

56 Honouring Women’s Resistance to Violence and Oppressionhttps://www.youtube.com/watch?v=YnzbsBBGKP8 Video length: 19 minutes Vikki Reynolds is an activist, therapist, facilitator, instructor, and clinical supervisor for refugees and survivors of torture, mental health and substance abuse counsellors, rape crisis counsellors, frontline and housing workers and transgender and queer communities. Vikki Reynolds’ approach to resistance: Wherever there is oppression there is resistance: women always fight back when they are sexually assaulted. Resistance ought not to be judged by its ability to stop oppression. Resistance is important for its ability to maintain a person’s relationship with humanity, especially in situations outside of human understanding

57 Understandings of ResistanceVikki Reynolds’ approach to resistance: Wherever there is oppression there is resistance: women always fight back when they are sexually assaulted. Resistance ought not to be judged by its ability to stop oppression. Resistance is important for its ability to maintain a person’s relationship with humanity, especially in situations outside of human understanding Honouring women’s resistance against rape and other abuses of power helps construct women’s identities as wise, prudent, and resourceful. These conversations about how women always resist, always fight back, are useful practice for the sustainability of community workers and counsellors as it invites us into hope-filled conversations, which can be transformative for all of us—women and counsellors.

58 Using body mapping Holistic visual illustration of impact of traumaTrauma can show up very differently for different people The connections between physical, emotional, psychological and spiritual aspects of wellness Examples: Anxiety expressed as digestive problems Injuries lead to isolation ACTIVITY – a body map of the impacts of trauma Body mapping is a useful activity that illustrate the connection between trauma reaction/respond and the overall wellbeing of a person. Describe this activity to participants and let them know that it may cause them to recall how they experience their own trauma. Materials: Flipchart paper with outline of a body Markers or crayons Instruction: Divide participants into groups of three. Each group will receive a flipchart paper and some markers. The group will represent impacts of trauma on the body outline without using words. For example, for physical impact, it may be a broken arm – so one would draw some bandage wrapped around the arm. The facilitator may need to do a demonstration. Remind the groups to also look at it from a strength-base perspective – For example, one may developed a stronger support network after trauma. Give the group 10 to 15 minutes to work on the body map. Ask each group to present their body map back to the room. After the activity, ask the participants to reflect on the activity. How was it to look at the completed body map with all the impact all layered on top of one body?

59 Social/ Inter-personal Spiritual/ Belief SystemImpact of trauma Biological Psycho-logical Social/ Inter-personal Spiritual/ Belief System Brainstorming some of the impacts - include but not limited to: Difficulties regulating emotion, including explosive anger or inability to feel anger, self-harm or suicidal ideas or behaviours, inhibited sexuality, persistent uneasiness. Changes in consciousness including loss of memory, numbing, feeling a sense of unreality, constantly thinking about the abuse, intrusive memories, flashbacks. Changes in view of self, including a sense of helplessness, shame, guilt, a sense of defilement/violation or stigma, and complete difference from others (aloneness, feeling inhuman, belief no one can understand). Altered perception of perpetrator, including preoccupation with relationship, belief in their omnipresence and omnipotence, trauma-induced gratitude or dependency, sense of supernatural relationship and taking on the abuser’s belief system. Altered relationships including isolation, difficulty in intimate or close relationships, distrust, repeated failures of self-protection, search for rescuer. Altered belief system, altered faith, hopelessness, despair. Key point: Clarity about the role of the worker is important. Their role is not to diagnose or provide specialist trauma care. Their role as a trauma-informed practitioner is to recognise its commonality, the many ways in which it shows up in people’s behaviour, to assist with information and referrals to other supports where appropriate.

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61 Violence and Mental Wellness

62 Mental Wellness ContinuumGood Mental Health Minimal mental illness symptoms & good mental wellness No diagnosable mental illness & good mental wellness No diagnosable mental illness & poor mental wellness Severe mental illness symptoms & poor mental wellness Detectable Symptoms No Symptoms Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal. This conceptualisation may help people to re-think policies which include/exclude women on the basis of specific mental health conditions. Rather, this approach asks us to consider how she is experiencing and coping with symptoms at any one time. Poor Mental Health Mental Wellness Continuum (Adapted from K. Tudor, ‘Mental Health Promotion: Paradigms and Practice’, 1996)

63 How is mental health exploited?Women struggling with mental health illness are vulnerable to exploitation by their abusers. How might it be used? How might we incorporate this knowledge into our work? Small group brainstorming exercise – ways that mental wellness issues might be used by offender

64 How is mental health exploited?Over or under medicate her Threaten to report her as unfit mother Minimize her credibility (e.g. she’s crazy) Exacerbate her symptoms (e.g. encourage suicidal ideation) Erode her sense of self worth and self esteem Rationalize his violence (e.g. she deserves it) Focus on lowering barriers – using discretion – so mental wellness doesn’t in and of itself block access to a transition house/shelter. Doesn’t mean there won’t be a critical incident to deal with…

65 Rethinking ‘normal’ Normal behaviour is a societal construct – therefore behaviour is neither normal or abnormal Cultural norm changes all the time. Normal can differ from family to family, from neighbourhood to neighbourhood and from individual to individual. Normal is subjective and has the power to exclude people, creating “the other” The idea that there is a normal range of experiences and normal range of actions and reactions Reinforce and uphold dominant group’s definition of normal and alienate “others” In parenting, think about sleeping behaviours. Co-sleeping was the norm and then it was consider abnormal and then back to normal again. What WAS normal? Examples… Smoking in planes Women not being able to apply for a mortgage in their own right Slavery

66 How do we come to understand what are considered ‘normal behaviours’?Who gets to say what is ‘normal’? What does it mean to be ‘abnormal’? Normal behaviour is a societal construct – therefore behaviour is neither normal or abnormal Cultural norm changes all the time. Normal can differ from family to family, from neighbourhood to neighbourhood and from individual to individual. Normal is subjective and has the power to exclude people, creating “the other” The idea that there is a normal range of experiences and normal range of actions and reactions Reinforce and uphold dominant group’s definition of normal and alienate “others” In parenting, think about sleeping behaviours. Co-sleeping was the norm and then it was consider abnormal and then back to normal again. What WAS normal? Examples… Smoking in planes Women not being able to apply for a mortgage in their own right Slavery

67 The Myth of “Normal” https://www.youtube.com/watch?v=6i146j5SA9oVideo length: 4 minutes Dr. Gabor Mate is a doctor, writer, and speaker based in Vancouver. For twelve years Dr. Maté worked in Vancouver’s Downtown Eastside with patients challenged by hard-core drug addiction, mental illness and HIV, including at Vancouver’s Supervised Injection Site. Rather than offering quick-fix solutions to these complex issues, Dr. Maté weaves together scientific research, case histories, and his own insights and experience to present a broad perspective that enlightens and empowers people to promote their own healing and that of those around them.

68 Some drawbacks of the medical modelFocus on the symptoms of individuals Less emphasis on looking at or addressing the causes and the social contexts Lack of training Discomfort with discussing issues of violence or trauma with the women Clinicians are seen as experts Little space for women to direct service received The issues of violence and trauma are rarely or indirectly addressed Doctors put women on heavy medications instead of asking about violence and abuse Women are more likely to receive mood disorder labels (i.e. depression, bipolar, anxiety) than men. Women are prescribed anti-anxiety medications by physicians more than any other medication Psychologists and counsellors referring clients to rape crisis centre because they don’t want to talk about the trauma Ex. Pain in women not taken seriously, heart meds not tested on women, Aboriginal women not receiving care

69 Pros & cons of diagnosisUseful Harmful May be able to access services Gives a common understanding to patients and care providers about symptoms Treatment plans Being “screened out” for services Reduce identity to a label Conflicting diagnosis and/ or multiple diagnosis From: Debi S. Edmund and Patricia J. Bland (2011). Real Tools: Responding to Multi-Abuse Trauma. Alaska Network on Domestic Violence and Sexual Assault. Here are some of the drawbacks of labels: • Perhaps the biggest negative consequence is stigma. People with certain labels may find it more difficult to obtain employment, housing or social acceptance. • A label can lead to stereotypes. The person with the label often becomes “other” in the eyes of those applying the label. People may start to underestimate the individual’s capabilities or intelligence. • Once a person acquires a label, there is often a tendency for others to view everything the person does through the prism of that label. Everything the person does becomes pathologized. • Others may accuse the person with the label of using a “fad” diagnosis to avoid accepting personal responsibility for their behavior, or as a shortcut to privileges or entitlements, or to get attention. • Some argue that labeling promotes the formation of a negative self-identity, one that overemphasizes limitations and ignores strengths . • Labeling may encourage individuals to think of themselves (and encourage others to think of them) as being only their disorder or their disease, and this may increase their exposure to the negative effects of the stigma still associated with these labels However, some believe that labels can be helpful under certain circumstances: • A label can help an individual get needed services or accommodations. For example, insurance companies usually require a DSM-IV diagnosis before providing reimbursement for therapy or counseling services. • In some cases, a label can actually serve to reduce stigma – for example, viewing alcoholism as a disease rather than as a moral failing. A diagnostic label may be preferable to the labels a person has already been getting, such as “lazy” or “stupid.” • Knowledge is power: A diagnostic label can help some survivors make sense of their experiences. For example, labeling a person’s experience as “multi-abuse trauma” can help the individual see certain behavior as a coping mechanism rather than as an indication of defective character. Once a problem has a name, one can develop a plan to address it. • A label can help clarify thinking and move people out of denial – either individually or as a society. Consider, for example, how societal reactions begin to change when people stop calling certain situations “a lovers’ quarrel” or “a date gone wrong” and start labeling them “battering,” “sexual assault,” and “domestic violence.”

70 About medications Medications are often prescribed to people who seek medical support for their mental wellness and is diagnosis with a disorder. What do you think/believe about medication in general? What has influenced your thinking about medications? How have these beliefs affected your work with survivors who are taking medications in the shelter? Think-pair-share activity: a. What do you think/believe about medication in general (i.e., that it always helps, that it never helps, etc.)? b. What has influenced your thinking about medications? c. How have these beliefs affected your work with survivors who are taking medications in shelter? Bring the group back and ask each pair to share some highlights. Allow time for discussion.

71 What’s our role? Some issues with workers locking up medications:We are not medical professionals Taking away woman’s autonomy over her own health Need to have staff available whenever she needs the medication

72 Lunch time!

73 Violence and Substance Use

74 Remember – no one expects you to be a drug and alcohol expert – you just need to be able and willing to have conversations with women about their substance use and relate these conversations to the risks women are exposed to, their safety and ongoing physical, mental, emotional and spiritual needs. Really useful quote and slide prior to the content that follows in order to orient training participants to expectations. Freedom from Violence: Tools for Working with Trauma, Mental Health and Substance Use EVA BC - Tessa Parkes, Freedom From Violence Toolkit

75 Violence and Substance useWhy might women use substances? How could substance use be exploited by abusers? How might we incorporate this knowledge into our work?

76 How do abusers exploit substances?Encourage or forced substance use to develop dependency Shame her for substance use Threaten to report her as unfit mother Withhold substances and force her into withdrawal Use substances to alter her mental wellness Handout: Power and Control Wheel

77 How do survivors use substances?Cope with effects of trauma Self medicate for mental health issues Numb or escape temporary from pain Appease the abuser Cope with chaotic lifestyle (e.g. use before engaging with survival sex work) Control withdrawal symptoms Other reasons: prescribed by doctor, for fun and to be social, to be accepted, out of habit, to cope with intense emotions such as anger and frustration Biggest reason women use substance is to cope

78 Spectrum of substance useBeneficial use Use that has positive health, spiritual or social impact Casual/Non-problematic use Recreational, casual or other use that has negligible health or social effects Problematic use Use that begins to have negative consequences for individual, friends/family or society Dependence Use that has become habitual and compulsive despite negative health and social effects Substance use may occur at one point on the spectrum and remain there, or it may move either slowly or quickly to another point. People may use one substance in a non-harmful way and another substance in a harmful way. The primary focus of our strategies to address substance use should focus on efforts to prevent and reduce the harms from problematic or harmful use and make treatment available for those with a chronic dependence. (Adapted from Health Officers Council of British Columbia, 2005)

79 Think-Pair-Share What are some of the coping mechanisms you use?Are any of them healthier than others? Are any of them more easily accessible than others? How hard would it be to give any of them up tomorrow? Has anyone try to get you to stop using the coping mechanisms? Have the coping mechanisms acted as barriers to anything? Use this activity as a way to bridge the thinking between asking the women to stop using substances and what does it mean for her ability to cope while dealing with the trauma and stress of being at the shelter or transition house. If running short of time, you can ask participants to make individual notes in response to prompts and questions within a set timeframe.

80 Risks of stopping substance useCut back or stopping substance use may put women at risk through: Increased violence from abuser Absence of other coping mechanisms Severe withdrawal Intense emotional reactions Mental health illness symptoms Termination of services (i.e. doctor refuses to see the woman anymore) When it is a woman’s experience that alcohol and/or substance use are helping them to cope, it is often not useful to focus on stopping substance use as a primary goal or condition of service. Instead it is important to start where the women is at, to hear from her point of view, where she thinks it is most possible to start her healing work. That may be using less or using differently.

81 The Rat Park experimentHow does dependence on substances develop? Are you surprised about the findings? What are the ‘cages’ in real life? https://www.youtube.com/watch?v=sbQFNe3pkss Video length: 3 minutes 30 seconds Scientists have always been curious about how people become depended on substances. Experiment done in 1977 by Prof. Bruce Alexander performed a modification on a classic experiment. Work that transition houses and SA centers and other anti-violence services do to support women on violence issues and on making pragmatic changes in their lives helps many women reduce their substance use. In a study involving 13 transition houses in BC, women describes significantly reducing their use of alcohols and cocaine following a transition house stay, even when the transition houses, offered minimal support specific to substance use – BC Centre of Excellence for Women’s Health

82 Zero-tolerance What are we ACTUALLY asking from women when we say we have ‘zero-tolerance’ for substance use? Women who use substances are already accessing transition houses and they will continue to do so. Shifting the focus on how to make their experience more positive. Points from OAITH’s Safe For All manual: A woman who is surviving violence and who uses drugs will not access VAW shelters because she knows she will run the risk of being further criminalized and will be treated poorly by shelter staff and other residents. Stigmatizing language and policies are other forms of violence. A woman in this situation is most likely to continue to navigate and cope with familiar physical, emotional and sexual violence rather than open herself up to other levels of violence from formal supports and strangers (VAW shelter workers), and systems. If she takes the risk to access a VAW shelter and is discharged for using, she will most likely return to her abuser.

83 Assumptions about substance useWhat are some of the assumptions we may have of people that use substances? Are some substances more acceptable than others? Where do those ideas come from?

84 What are substances? Legal Illegal Coffee Alcohol TobaccoOver the counter drugs Prescription drugs Methadone, methadose & Suboxone Medical marijuana Marijuana Cocaine Heroin Crystal Meth Ecstasy What social values may be attached to the legality of the substance? Questions to raise/discussion points: What is considered legal and illegal? Does it mean it is good if it is legal? Does it mean it is bad when it is illegal? How do we decide what social values to attach to the substance? The legal status of a substance plays a role in how we perceive the women using the substance. Hierarchy of substance even among people who uses substances and service providers.

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86 Types of substances Depressants StimulantsSlowing down of the central nervous system Low dose – feeling of calm, drowsiness and well-being Higher dose – intoxication, unconsciousness, coma and death Excite or speed up the central nervous system Low dose – feeling alert and awake, decrease appetite, feeling euphoric and sense of well-being Higher dose – Irritability, paranoia, agitation, rapid /irregular heart rate, and delirium Depressants – alcohol, barbiturates, benzodiazepines, inhalants, opiates Stimulants – amphetamines, caffeine, cocaine, nicotine Hallucinogens – LSD, acids, magic mushrooms Cannabis – marijuana, hashish, hash oil

87 Types of substances Hallucinogens Cannabis “Psychedelic” drugsDistort the senses and can cause hallucinations and confusions Can cause “bad trips” similar to nightmares Most widely used illegal drug Has both properties as hallucinogens and depressants

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89 Video: Safe for All What are the messages this video is trying to convey to the viewers? How did the video response to the following arguments to exclude women who use substances? It’s for the safety of the other women and children. If she choose that lifestyle, she is not ready for healing. Having harm reduction supplies available will encourage drug use. She is not being “productive” or working on her goals. Video is produced by the Ontario Association of Interval & Transition Houses

90 Supporting mothers with varying levels of mental wellness and substance use

91 Parenting in a transition house is already like parenting in a fishbowl – everyone will be watching and judging how a woman parent. The image depicts a joke that would be acceptable for some women and will be seen as bad parenting for other women. Who gets to decide?

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93 Supporting mothers Protecting and supporting mothers is one of the more effective ways to protect and support children. Using substance or struggling with mental wellness do not automatically means she is not a good parent. She has a glass of wine after she put the kids to sleep. She sends her kids to school, comes home and sleeps until she needs to pick them up. Women’s fear that they will come into contact with child protective services through accessing a transition house or shelter is a barrier in itself. It can also be difficult to manage pressure and expectations from child protection services that you will provide information about women and their children who are using the shelter/transition house, whether or not they meet the criteria for a child protection report. Some points to consider: The analogy of how to use an oxygen mask on a plane may be useful. The direction is to fit the mask on yourself first so that you can then assist those who need your help. By supporting women, we are indirectly providing support to the child. The stronger and more supported a mother is, the better placed she is to take care of and protect her child/ren. If women are seeking shelter and support from your program, that is by its very nature a protective response to her child/ren. Shelter/transition house workers spend a lot of time in an intimate setting with women and their children. They have significant expertise in violence against women as well as how this impacts children and youth. They are well-placed, therefore, to make informed decisions about child protection reporting and safety.

94 She is good enough Tremendous pressure on mothers to be perfect.Working with her from her strength. Collaborate with her and support her: Child care Harm reduction supplies and practices Accurate information Referrals and connecting to community services

95 Pregnancy and substance useMany women will be reluctant to access healthcare for themselves or their children because of fears that they will be judged, treated poorly, or lose custody of their children. Stigmatizing her substance use negates the other determinants of health, focussing the "blame" solely on the woman and erasing the systems of oppression. BC Centre of Excellence for Women’s Health reports that pregnancy, mothering, substance use and social stigma interact to influence the accessibility of healthcare for women. access to health care, nutrition, safe housing, freedom from violence and fear, and personal health practices she knows she has a safe and non-judgemental system of support she will be more likely to seek it out in aid of her own wellness and that of her future child. As anti-violence advocates, we have both the power and the responsibility to create one small piece of that supportive and non-judgemental system of support.

96 If child protection is needed…Follow your program’s policies, procedures and practices for engaging with child protection agency. Whenever possible, speak to the women first and talk about your concerns for her children. Encourage her to make contact herself. Provide support through the process if she wants you to do so.

97 Check out

98 Bringing an Inclusive Service Model to your community DAY 3Open Doors Bringing an Inclusive Service Model to your community DAY 3

99 Let’s take a closer look at house ‘rules’House rules may have good intentions but they may become barriers for women. Rules may be enforced inconsistently depending on the worker. House rules may also reinforce the dominant assumed “norm” and shame or punish those who do not fall within that category. Consider switching to the language of ‘guidelines’… This can be a particularly difficult area. Women live where we work, we work where women live. These roles can bring different expectations and tensions. How we describe our policies and documents is significant. Consider a ‘welcome book’ rather than a list of ‘rules’. It could have headings such as ‘Respect’, ‘Responsibility’, ‘Safety’. Do you have a ‘welcome book’ translated into different languages? A large print version? A spoken word version? Handout: Power and Control Wheel within the Domestic Violence Shelter

100 Systemic Oppression within a Transition HouseStaff Belief that her own cultural practices are better and more desirable than others. Staff Belief that other cultural practices are not as good as her own. Staff has the power to influence others and impose their beliefs on other people. Formally: appearance of the ‘better and more desirable’ cultural practices in organizations, laws, programs and policies. Informally: those whose practices are different are judged and criticized. Invisibility of these cultural practices which allows them to be subtle and hidden because they are no longer questioned. Source: The North West Territories Health and Social Services Systemic Oppression within a Transition House Example from The North West Territories Health and Social Services seemingly innocent rules may actually be a form of systemic oppression because they are often developed without much thought about or value given to various cultures and ways of being. Belief that one’s own cultural practices are better and more desirable than others; Belief that other cultural practices are not as good as one’s own Power to influence others and impose their beliefs on other people Appearance of the ‘better and more desirable’ cultural practices in organizations, laws, programs and policies; Invisibility of these cultural practices which allows them to be subtle and hidden because they are no longer questioned (such as assuming dishwashing directly after eating is “just the way it is” and is the best way to do things without questioning why or if the rule is necessary This dishwashing example is less obvious as a possible form of oppression, but the five criteria for systemic oppression are also clearly visible in rules that restrict access to services for women fleeing violence who have varying levels of mental wellness and/or substance use.

101 Example: The curious case of the dish washing ruleWorker believes washing the dishes is best done right after eating. Worker believes not washing dishes right after eating is a sign of laziness. Worker persuades other staff & managers about need to make sure women are cleaning their dishes directly after eating. Formally - Directive to wash dishes directly after eating is put into house rules and will result in a formal warning if not followed. Informally – women who do not wash their dishes directly after eating seen as lazy. Dish washing directly after eating is ‘just the way it is’ – assumed this is the best way to do things with no questioning why or if the rule is really necessary. Source: The North West Territories Health and Social Services Example: The curious case of the dish washing rule Example from The North West Territories Health and Social Services seemingly innocent rules may actually be a form of systemic oppression because they are often developed without much thought about or value given to various cultures and ways of being. Belief that one’s own cultural practices are better and more desirable than others; Belief that other cultural practices are not as good as one’s own Power to influence others and impose their beliefs on other people Appearance of the ‘better and more desirable’ cultural practices in organizations, laws, programs and policies; Invisibility of these cultural practices which allows them to be subtle and hidden because they are no longer questioned (such as assuming dishwashing directly after eating is “just the way it is” and is the best way to do things without questioning why or if the rule is necessary This dishwashing example is less obvious as a possible form of oppression, but the five criteria for systemic oppression are also clearly visible in rules that restrict access to services for women fleeing violence who have varying levels of mental wellness and/or substance use.

102 House rules & guidelinesDoes this guideline benefit women or increase barriers for women we are supporting? Does this guideline reflect the Foundational Principles? How might you review your policies, procedures and practices for barriers or systemic oppression? Using examples from own practice (house ’rules’ or ‘guidelines’) Activity: Divide the group into small groups. Each group is responsible for a section of the House Guidelines. Write down: 1. The goals of that section 2. Does it align with the Foundational Principles? 3. If not, what can we change? Example: Most transition house/shelter programs have “curfews,” but that rule/guideline was implemented at a time when transition house/shelter programs were not staffed 24/7. The rule was to ensure that all residents were safe before staff went home for the night, or for those who carried a pager after hours, staff could sleep knowing that all residents were in and therefore safe. But many transition house/shelter programs continue to operate with early curfew for residents, even though with 24 hour staffing, the curfew no longer serves the original purpose.

103 Opening doors Focus on lowering barriers.Using discretion – so mental wellness or substance use in and of itself does not block access to a transition house. Doesn’t mean there won’t be a critical incident to deal with…

104 Eligibility and suitabilityHas the woman experienced violence? Suitability: Does the woman feel your program is a good fit for her? Can our program accommodate the woman (and her children) at this moment? Key point: Of course, we must keep in mind the safety of the staff and the other residents in our program. Behaviours that are not conductive to communal living environments can come from any of us, whether we struggle with substances and mental wellness or not. Therefore, the focus must be placed on behaviours that cause problems, rather than on mental wellness diagnoses or substance use levels themselves. Discussion question: what information do we share with the women to help her assess if we are a good fit for her needs?

105 Intake What information do we need immediately?Are there any questions you can ask after the woman arrived? How does the information change the way we provide services to a woman? Universal assessment benefits instead of targeted screening How to ask those questions How to incorporate them into practice How to respond to women who respond negatively to those questions Handout: sample intake form

106 Records Can Include: Intake forms and demographic dataInformed consent form Release of Information forms Service plans Case Notes Third party reports if necessary Correspondence regarding women/child if necessary Court and legal documents Referrals Safety plans Closing report

107 Benefits of record keepingDocuments that you have informed consent Documents that the limitations of confidentiality have been explained. Supports accountability. Helps develop and implement a safety plan. Helps with consistency of service. Risks - any records we make can be subpoenaed and potentially be used against her interests and for the abuser.

108 Privacy Principles Safety, confidentiality, privacy and well-being of women and children is primary. Women and children have the right to be informed of services, documentation process and have access to their records.

109 Agencies Should: Determine what privacy legislation guides your agency’s record keeping practices: PIPEDA, PIPA, FIOPPA Develop a privacy policy and have a privacy officer. Determine the scope of the information for collection. Decide if you are going to keep files or not. Set limits on the use of the information you have collected. Provide women/child access to their records. Sample privacy policy What information do you really need to provide services Some programs only keep aggregate statistics and not files Limits: time limits, limits on who can access Women and children have a right to their files – can photocopy and give them a copy

110 Agencies Should: Develop standard retention and destruction process.How long will you keep the records for and why? How will you destroy them in a secure way? Schedule a set time to go through and destroy unneeded records. Only disclose to board members in exceptional circumstances. ED can provide Board with general overview of any incidence of crisis. Board members who support staff for supervision may need access or information. How long will you keep the records for, WHY , set a time to go through them each year and how will you destroy them in a secure way Board members if they need to support staff for supervision , and it doesn’t mean all board members need access or information. ED can provide board with general overview for any incidence of crisis Consent to sharing information between programs , residence and participants need to know who has access and why Do volunteers, admin staff, fundraisers etc all need access to the files . Suggest a tiered system access to records Clear systems so that you can justify what you’re keeping and why

111 Agencies Should: Develop clear system of sharing information within the agency. Do you have a “Consent to Sharing Information” policy? Determine who needs to have access to records in order to carry out their work. Tiered system access to records Keep online and paper records secure. How do you make sure that only the authorized persons can access the records? How long will you keep the records for, WHY , set a time to go through them each year and how will you destroy them in a secure way Board members if they need to support staff for supervision , and it doesn’t mean all board members need access or information. ED can provide board with general overview for any incidence of crisis Consent to sharing information between programs , residence and participants need to know who has access and why Do volunteers, admin staff, fundraisers etc all need access to the files . Suggest a tiered system access to records Clear systems so that you can justify what you’re keeping and why

112 Consent Obtain consent (written/oral) for collecting, using and disclosing personal information. If the woman/child has not consented to release their personal information, do not disclose it unless there is a legal obligation to release. Handout: Sample Informed Consent form

113 Before obtaining consentExplain services, the benefits and risks of care. Satisfy yourself that woman/child understands what they are consenting to. Make reasonable effort to determine that the care is in best interests of the child/woman. Ensure the consent is voluntary. Inform woman/child about limits to confidentiality at the time they request service. Explain the records management practice. Document the fact that consent was obtained. Have the client or their parent or guardian sign a written consent form if possible OR Document that oral consent was obtained. Document that there is an expectation of confidentiality with respect to the information provided. Additional note: In each province and territory, family law acts may include provisions that determine how services are provided to children and youth, the age at which they can give their consent to receive services and whether consultation with another guardian are unreasonable or inappropriate under the circumstances (the context of violence and safety should be taken into account).

114 Before recording information, ask yourself:What is the purpose of collecting the information? Is this information necessary to deliver/determine services? Will what I write improve services for her? Is this fact based? What will I do with this information?

115 Before recording information, ask yourself:Could the information I collect be harmful to the woman and her children in terms of: Her access to services? Current or future legal actions? Being accessed by a third party (e.g. the abuser, her employer, other family members)?

116 Content of File Notes Develop a common format and write legibly.Session-by-session basis, up to date, dated. Only include information that is necessary to deliver services or is needed by other staff. Consider flagging entries with legal significance. Indicate information provided by a third party and consider whether it is necessary to be included in the file. The purpose of file notes is to document what we have done – for example ‘discussed a safety plan’. File notes are for accountability and memory/responsiveness of service. They are a factual rather than subjective record. A useful question to ask is: If the woman I am working with reads her case notes right now, what might her response be? Do you routinely let her know what you have written down?

117 Content of File Notes Files are not meant to document historical or legal facts. Counselling records contain observations (not speculation). Make objective notes about the session. Language used should reflect her experience. Be brief: note major topic areas discussed. Avoid verbatim accounts.

118 Information Sharing Determine if collaborating with other programs will increase her (child’s) safety. Include her in the process of sharing her information. Balance the need for confidentiality and impact of retelling the story. Release of Information form. How do you determine what information needs to be shared? Does participating or bringing her file to a community coordination, VAWIR, ICAT type committee increase her safety. Does she have the right to participate in decisions that are going to be made about her Knowing what we know about trauma and the fact that each time a person who experienced trauma have to recall details of the story, they are back in the trauma again, how do we determine how much information to share and how to ensure that the confidentiality of the clients are protected? Handout: Sample Consent to Release of Information form

119

120 Supporting Each Other

121 Reality & challenges for staffSingle-staff shifts/understaffed Lack of crossover times Limited rooms/spaces Concerns for other residents No clear guidelines/policies Lack of training and professional development Due, in part, to the limited resources and staffing that transition house/shelter programs work with, supporting women who require a lot of support can be challenging. And the women can feel these frustration. We will all feel differently about the particular resident that we are working with. Some we will feel very positive about, while others may frustrate or even annoy us. We may even find that we treat residents differently from one another as a result and often without even being aware of the way in which we might tend to favour one resident – based on our feelings about them – relative to another resident. We may make decision which, if examined, reflect our assumptions about who is “deserving” and who is not (of our time, community resources and transition house/shelter resources). This, of course, can cause or contribute to conflict between residents and between staff and residents. It conflicts with the overarching goal of women’s equality.

122 Supporting Each Other We may not approach each situation exactly the same way. Conflicts can be an opportunity for creative problem solving. Part of the learning process and consciousness raising for ourselves and colleagues

123 How our feelings influence our workWhat may influence how we feel about a particular resident? What are some of the ways that have been useful for you to keep your feelings from influencing your interaction with a resident?

124 Venting is not debriefingIt is natural to "vent" our negative feelings about a woman with coworkers.  Justify our feelings rather than challenge our feelings, learn, grow and make conscious choices to improve our practices. Reflecting on our frustration can lead us to “what is going on?” and steer us away from “what is wrong with her?” Sometimes when we are experiencing negative feelings about a resident, it is natural to "vent" our feelings with coworkers.  This may provide some measure of relief, but unless we challenge ourselves to examine our frustrations - that is, unless we examine whatever it is that causes our frustration in a way that reflects on us instead of on the resident and what it is that is "wrong" with her, we have done little else than to justify our feelings rather than challenge our feelings, learn, grow and make conscious choices to improve our practices.

125 Debriefing practice Steps of debriefing: VentingPersonal Context/Reframing Social Context Action Step One: Venting Listen to your coworker. Ask your coworker how she likes to be listened to. She may prefer you listen in complete silence. She may prefer if you listen actively Step Two: Personal Context/Reframing Ask your coworker what she thinks might be happening for the resident she is debriefing about. Ask “what could have happened to the resident” that she might behave in the ways your coworker is describing. If appropriate and desirable, and only after listening until your coworker is finished, try reframing any assumptions you might have heard in the venting stage Step Three: Social Context Spend time with your coworker moving the personal experiences into the social/political context – in other words, moving from personal feelings into the political thinking Step Four: Action Consider together what, if anything, could have made the experience of working with the resident(s) different for your coworker. What got in the way of a better experience? This is the most important step in the process for both your coworker and for bringing social change

126 Debriefing practice Venting: Personal Context/ReframingVery important and the first step to debriefing – but not the only step. As the listener, ask your coworker if they would prefer you listen in silence or listen actively. Personal Context/Reframing Ask your coworker what she thinks might be happening for the resident she is debriefing about. Changing the narrative from “What’s wrong with her?” to “What’s happening for her?”. Reframing any assumptions you might have heard in the venting stage Step One: Venting Listen to your coworker. Ask your coworker how she likes to be listened to. She may prefer you listen in complete silence. She may prefer if you listen actively Step Two: Personal Context/Reframing Ask your coworker what she thinks might be happening for the resident she is debriefing about. Ask “what could have happened to the resident” that she might behave in the ways your coworker is describing. If appropriate and desirable, and only after listening until your coworker is finished, try reframing any assumptions you might have heard in the venting stage Step Three: Social Context Spend time with your coworker moving the personal experiences into the social/political context – in other words, moving from personal feelings into the political thinking Step Four: Action Consider together what, if anything, could have made the experience of working with the resident(s) different for your coworker. What got in the way of a better experience? This is the most important step in the process for both your coworker and for bringing social change

127 Debriefing practice Social Context: Action:Move from the personal feelings into the social/political context Recognizing and naming the social injustice that contribute to the woman’s response Action: Consider together what, if anything, could have made the experience of working with the resident(s) different for your coworker. What got in the way of a better experience? This is the most important step in the process for both your coworker and for bringing social change Step One: Venting Listen to your coworker. Ask your coworker how she likes to be listened to. She may prefer you listen in complete silence. She may prefer if you listen actively Step Two: Personal Context/Reframing Ask your coworker what she thinks might be happening for the resident she is debriefing about. Ask “what could have happened to the resident” that she might behave in the ways your coworker is describing. If appropriate and desirable, and only after listening until your coworker is finished, try reframing any assumptions you might have heard in the venting stage Step Three: Social Context Spend time with your coworker moving the personal experiences into the social/political context – in other words, moving from personal feelings into the political thinking Step Four: Action Consider together what, if anything, could have made the experience of working with the resident(s) different for your coworker. What got in the way of a better experience? This is the most important step in the process for both your coworker and for bringing social change

128 Making time & space for debriefingIt can be very tricky to find the time and space for debriefing. Useful to have a debrief when feelings like these creep up: She doesn’t deserve X She’s too demanding She’s unappreciative What is the current practice for debriefing? Questions for reflection If you are feeling like a resident is "unappreciative", you can, together, consider what an "appreciative" resident might do that a resident you assume isn't appreciative does differently  Ask yourself why you think a resident ought to show her appreciation. Is she not entitled to our assistance? Sometimes there are unconscious sexist or classist assumptions built into our perceptions. See what you might be able to identify in your assumptions that are ingrained society messages about how women “should” behave. Regardless of the steps you take to debrief effectively, you are on the right track if, at the end of your process, you have relocated the problem from that of a particular resident to the broader context of violence against women with a renewed perspective of the multitude of ways through which we, as women, adapt to the violence and inequality in our lives

129 Build your confidence

130 Build your confidence Take the time Learn the materialUse your own words and be yourself Be honest when you don’t know Incorporate experiential learning Ask the room when in doubt

131 Training Checklists 3-4 weeks prior to training Training days1-2 weeks after training See Trainers Manual for checklists See checklists in the Trainer Manual

132 Strategies for responding to questionsSet focus and clearly articulate expectations for the training. Parking Lot – keep questions for later. Be honest – it’s ok to say “I don’t know, but I can try to find out”. Guide the group to think through the question and draw out expertise from participants. Break down multiple questions.

133 Training expectation Check in with the participants in the beginning of the training about their expectations and clarify any misconceptions. Helps to understand the reason why they are taking the training. Provide directions or areas to spend more time and energy on.

134 Creating Safety Establish group guidelines in the beginning of the training. Clearly defined framework to return to if issues or conflicts emerge within the group. Can be revised as a group throughout the training. Suggestions for Group Safety Guidelines • Starting and ending on time, or group agreement to change the starting and ending times • When breaks will be taken and how long they will be • The way that people communicate. As there are participants from many different sectors, different cultural backgrounds, and with different levels of education, it is important to speak clearly about what you mean. This includes: – Avoid using jargon without explaining what you mean – Avoid assuming that everyone comes to the training with the same work experiences or knowledge – Be sensitive to and respectful of cultural differences • The level of participation required by each group member • Participants take from the training what they put into the training • Participants should reflect on how much time they are taking while speaking on issues compared with others in the group. If they find themselves speaking substantially more than others, they should reflect on giving others more space for participation. • Participants should be self-reflective of their relationships with others in the training whom they already know. – If they have good relationships established with others, be cautious not to exclude others while doing small-group work. – If they have a history of conflict with another person, try to put this aside during the training, and be respectful of the other’s presence. • Avoid engaging in verbal confrontation or bringing up past personal conflicts, especially when not related to the subject matter (working through topic-related conflicts may be appropriate at certain points in the training). • Be respectful of the other person’s right to share opinions and ideas. • Be cautious of not excluding or putting down the person’s ideas when involved in small-group work. • Procedures for seeking support from the group – Creating boundaries around sharing personal experiences during the training (i.e., participants may share personal experiences or stories as a means of giving an example or highlighting a point, but there is not time in the training for a detailed exploration of individual experiences or therapeutic support for an individual). – If you are debriefing with others during breaks or in the evenings, check in with their comfort level around the experiences you are sharing and the emotional support you are seeking. – It is important to feel okay with telling a colleague that you are not ready/comfortable to talk in more detail about an issue, or not prepared to offer extended emotional support at the time due to your own processing of issues/personal boundaries. • If someone you are speaking with draws boundaries around the experiences/stories you are sharing, try to respect their feelings in the context of their own needs (and not as a slight to your desire to share and debrief). The topic area often brings up memories/emotional responses for all participants. • How differences of opinion will be managed

135 Closing Activities Exit Ticket: Ask the participants to answer one or two reflection questions and to hand their reflection to you as they leave. Review Game: Play a quick review game by adding presentation slides that ask participants to answer content-related questions. 3-2-1: Ask participants to write down three new things they have learned during the learning event, two things they have reaffirmed, and one burning question.

136 Planning for training

137 Pre-training assessmentPlanning session with agency to determine strengths and areas to improve. Be informed about potential “tension points” to better prepare and strategize training. Communicate clear expectations of the training objectives and goals.

138 Be prepared Info to gather:Needs and priorities Past experiences with the content Recommended planning questions Identify related tools, protocols or policies, practices currently being used. Verify the agenda and training outcomes. Confirm training logistics. Communicate technical requirements and provide a list of training materials needed.

139 Adapting the training Know your audience. Be flexible with the agenda.Determine time needed for each sections based on existing knowledge in the room. Lengthen or shorten time for group work and discussions. Be attuned to the audience’s energy level.

140 Lunch time!

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142 Part One: Introduction to the PEP Project Part Two: Implementing Inclusion

143 Introduction to the PEP Project Scaling Up Feminist Knowledge Exchange in Women’s Shelters

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145 Using the Manual – Overview of SectionsYou can find the manual here:

146 Think of an inclusive service process that your organization does well and is proud of. How did you develop it? Do you already share it?

147 The Ten Steps

148 Think of an inclusive service process that your organization may like to implement. Which of the 10 steps would be most useful for you? Where do you foresee some challenges and how might you overcome them?

149 Implementing Inclusion: Activities from the PEP Manual and Next Steps for Open Doors Community Service Leaders

150 Step One: RelationshipsMake some notes on relationships that may be involved in implementing Inclusive Service practices for your organization. participants: residents, program users, staff, volunteers and board members. collaborators: organizations who also impact the direct needs of house participants. influencers: funding, research, media, advocacy and policymaking entities that shape the context.

151 Step Six: Adapt the Plan

152 Step Six: Adapt the Plan

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154

155 Open Doors Follow-up: After the initial workshops, the Network will offer conference calls, deliver follow-up webinars and manage a resource website for Community Service Leaders that will offer tools for implementing and sharing the workshop contents within and beyond their own communities.

156 Conference Calls - Peer to peer support and sharing - Progress on sharing knowledge learned - Adapting and implementing practices - Questions for colleagues from other houses - Frequency? - Tentative date for our first call?

157 Workshops - Participation, topic(s), timing   Website - Sharing and requesting resources.

158 Thank you and we will be in touchThank you and we will be in touch! Heather Stewart, Project Officer / Agente de projet E: T: F: , Monday to Thursday

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160 Procedure and practice reviewPolicies and procedures should be seen as living documents Review, adapt and update regularly What is water? Discussion questions: What is the purpose of the policy? What is the intention behind the policy? How does the policy influence the service women receive? How do women access our services benefit from the policy? Does the policy make it difficult for some women to access your services? We are asking questions about things we may be very accustomed to – like the water that the goldfish swims in everyday and may not usually question.

161 Check out