Human Trafficking in New Hampshire - Guest Post by Jennifer Durant

    Jennifer Durant is the public policy specialist at the New Hampshire Coalition Against Domestic and Sexual Violence.  She has been responsible for bringing awareness of the issue of human trafficking to New Hampshire and working very hard for the passage of NH's human trafficking law (see below).  The following was written for Human Trafficking Awareness Day in 2011.

January is nationally recognized as human trafficking awareness month. Human trafficking is modern day slavery that involves the sexual and labor exploitation of millions of men, women, and children worldwide. Human trafficking has no borders. Victims can be abused within their own communities or moved throughout the world to avoid detection, forced to live a life of servitude.

It is estimated that about 800,000 to 900,000 individuals are trafficked across international borders worldwide. In the United States alone between 18,000 to 20,000 victims are trafficked into or within this country every year. Sadly, approximately 80% of these victims are children.

New Hampshire is certainly not immune to human trafficking. While human trafficking is very difficult to quantify or count, there is evidence that New Hampshire has experienced both labor and sex trafficking. In fact, ALL 50 states have reported seeing some form of human trafficking. New Hampshire was the location of the second labor trafficking case in the nation brought under federal law in 2003. Timothy Bradley and Kathleen O’Dell both of Litchfield, New Hampshire were convicted of human trafficking for withholding promised wages and refusing to release passport and legal travel documents of four Jamaican men.

There has also been evidence of sex trafficking in New Hampshire. Over the past few years NH’s domestic and sexual crisis centers have worked with several victims of sexual exploitation, who have been forced into street prostitution or forced to work in brothels.

Almost all of New Hampshire’s border states have experienced human trafficking, indicating that this crime clearly exists in the Northeastern region of this country. In Vermont police invaded a brothel where Asian women were forced to work as sex slaves. Experts say the Vermont case fits the pattern of a problem that is reaching into the smallest corners of the country.

In Kittery, Maine, Russell Pallas, a former lawyer and one-time chairman of the Kittery Town Council, was convicted in 2005 of operating a brothel that was disguised as a health club where women and children, as young as 13 years old, were forced to work as prostitutes.

In East Boston, Brighton, and Allston, Massachusetts police made nearly 100 arrests in 2006, posing as johns and then arresting suspects allegedly operating brothels in apartments and houses tucked away on quiet residential streets.

If this problem is prevalent in our border states, then New Hampshire is certainly vulnerable to such activities. These highly publicized cases serve as examples of trafficking taking place in our area but it is important to remember that many cases of trafficking go unnoticed. Most are invisible victims because of their uncertain position of either being undocumented immigrants or seen as social degenerates who voluntarily enter the sex industry.

What can you do?

*Become familiar with our laws…

-In August 2009, Governor Lynch signed HB 474 into law, the first comprehensive human trafficking law in New Hampshire. Human trafficking is now defined in NH’s Criminal Code, making it a class A felony with enhanced penalties for trafficking someone under the age of 18.

*Talk about human trafficking in your community and ask others to educate themselves

-Invite a speaker from a local organization to talk to your group

-Read a book, hold a documentary screening, or write a blog

-Continue to educate yourself and others on the growing crime of human trafficking

Ratified in 1865, the 13th Amendment abolished slavery and outlawed involuntary servitude. And here we are today nearly 150 years later and there is a need for me to be writing this in 2010, for National Human Trafficking Awareness Day. While the term human trafficking is fairly new, the act itself is clearly not. Until we effectively identify victims and provide them with the services they need; until we hold traffickers accountable in a meaningful way for their unspeakable crimes; and until we adequately prevent human trafficking from happening in the first place, the fight will continue – throughout the world, throughout the nation, and throughout the state of New Hampshire.



New Hampshire’s Human Trafficking Efforts

During the 2007-2008 Legislative Session, NHCADSV’s Public Policy Department helped drafted legislation that formed the Interagency Commission to Study the Trafficking of Persons Across Boarders for Sexual and Labor Exploitation to research the issue of human trafficking in the state. Public Policy Specialist, Jennifer Durant, organized the Commission, served as the group’s clerk, and authored a 50-page report setting forth recommendations for the legislature during the 2009-2010 Session. Jennifer has worked in collaboration with several state and social service agencies, law enforcement, and community members to garner support for this legislative effort.

As the result of her work on the Statewide Interagency Commission (SB 194, Chapter 122:1, Laws of 2007), Jennifer then became the primary author of an 8-page bill and lobbied for the passage of the first-ever attempt to criminalize human trafficking in New Hampshire. Signed by Governor Lynch in August 2009 and just in effect since January 1, 2010, it is now a class A felony to traffic a human being for labor and sexual exploitation. The law also allows the state to convict a trafficker with enhanced penalties if they exploit someone under the age of 18.
After two years of legislative successes on human trafficking NHCADSV continued to work with the state’s top leaders to train first-responders and create a statewide protocol to address human trafficking in New Hampshire. Jennifer became the State Coordinator for the newly formed New Hampshire Coalition Against Trafficking (NHCAT), a statewide Coalition that is part of a 2-year project operating with 4 other New England states. This Coalition was made up of key members and organizations in the work against human trafficking. Through NHCAT Jennifer worked to (1) increase awareness of the issue of human trafficking, (2) train providers to work with trafficking victims, (3) identify victims of human trafficking within the New England region, and (4) link trafficking survivors to needed services.

From 2009 to 2010 Jennifer organized and implemented one of the largest trainings on human trafficking for NH’s law enforcement, held on January 20, 2010. The January 20th NH statewide law enforcement training on human trafficking was a successful event in which attendance ranged from NH Prosecutors to State, County, Local, and Federal Law Enforcement officials. A total of 95 Law Enforcement officials attended the training. A little over 70% of attendees came from local police departments (65 officers).

The 8-hour training curriculum included detecting and investigating cases that involve human trafficking. The training was designed to help police officers understand, identify, and investigate human trafficking cases in New Hampshire

Informational pocket cards were created for the January 20th law enforcement training that were designed to be useful in other disciplines. The cards contain information on red flag indicators, as well as who to contact locally if it is believed that someone is being trafficked in the state.

Just to name a few, NHCADSV has worked closely with and has received support from the NH State Liquor Commission, NH State Police, NH Chief’s Association, Manchester PD, Nashua PD, NH Police Standards & Training, NH Sheriffs Association, NH Attorney General’s Office, U.S. Attorney General’s Office, Immigration and Customs Enforcement (ICE), and Department of Children, Youth and Families (DCYF).

After 2 years of work, the NH Coalition Against Trafficking (NHCAT) officially cae to a close in Spring 2011. .

Thanks to the work of NHCAT, a little over 4,300 materials on human trafficking were distributed throughout the state, either at trainings, awareness events, or fundraisers.

Thanks to the work of NHCAT, a little over 400 individuals were trained on human trafficking issues throughout the state of New Hampshire. These trainings covered a wide-range of disciplines including law enforcement, victim advocates, medical professionals, or professionals working in the child protection field.

NHCADSV continues to raise awareness on human trafficking throughout the state. On August 15, 2011 NHCADSV collaborated with a non-profit called Sex + Money - A National Search For Human Worth. The NH screening of this important film on child sex slavery here in the United States brought out 170 NH residents to the event.

Ellen Pence - Why Gender and Context Matter

The following is Ellen Pence's Keynote from the Batterers' Interventions Services Conference in November 2010.  Ellen was one of the early leaders in the violence against women movement and she will be sorely missed. She passed away after a long fight with cancer earlier this month.  This video shows her wit, wisdom, and passion for the movement.

The Traumatic Effects of Stalking

January is Stalking Awareness Month. This is a good time to take a look at the long term impact that stalking can have on the person being stalked. There have been a number of studies done on this issue and I will review some of the conclusions here.


In "Stalking – An Overview of the Problem" [Can J Psychiatry 1998;43:473–476], authors Karen M Abrams and Gail Erlick Robinson write:

"Initially, there is often much denial by the victim. Over time, however, the stress begins to erode the victim's life and psychological brutalisation results. Sometimes the victim develops an almost fatal resolve that, inevitably, one day she will be murdered. Victims, unable to live a normal life, describe feeling stripped of self-worth and dignity. Personal control and resources, psychosocial development, social support, premorbid personality traits, and the severity of the stress may all influence how the victim experiences and responds to it… Victims stalked by ex-lovers may experience additional guilt and lowered self-esteem for perceived poor judgement in their relationship choices. Many victims become isolated and deprived of support when employers or friends withdraw after also being subjected to harassment or are cut off by the victim in order to protect them. Other tangible consequences include financial losses from quitting jobs, moving, and buying expensive security equipment in an attempt to gain privacy. Changing homes and jobs results in both material losses and loss of self-respect."

Surprisingly, verbal, psychological, and emotional abuse have the same effects as the physical variety [Psychology Today, September/October 2000 issue, p.24]. Abuse of all kinds also interferes with the victim's ability to work. Abrams and Robinson wrote this [in "Occupational Effects of Stalking", Can J Psychiatry 2002;47:468–472]:

"… (B)eing stalked by a former partner may affect a victim's ability to work in 3 ways. First, the stalking behaviours often interfere directly with the ability to get to work (for example, flattening tires or other methods of preventing leaving the home). Second, the workplace may become an unsafe location if the offender decides to appear. Third, the mental health effects of such trauma may result in forgetfulness, fatigue, lowered concentration, and disorganisation. These factors may lead to the loss of employment, with accompanying loss of income, security, and status."

Mullen and colleagues have done extensive research on stalking impact in Australia. (Mullen, P.E., M. Pathe, and R. Purcell. Stalkers and Their Victims. (Cambridge University Press, 2000).Their 1997 survey of 100 stalking victims found that stalking resulted in significant activity changes for its victims, including the following:

• Major lifestyle changes or modification of daily activity for 94 percent of victims
• Curtailment of social activities for 70 percent of victims
• Decrease or cessation of work or school attendance for 50 percent of victims (due either to absenteeism or stalker invasion of work or school site)
• Relocation of residence for 40 percent of victims
• Change of workplace or school for 34 percent of victims.

The researchers also found important psychological problems resulting from the stalking, including these:

• Increased anxiety and arousal for 80 percent of victims
• Chronic sleep disturbance for 75 percent of victims
• Recurring thoughts or flashbacks to the stalking, resulting in distress for 55 percent of victims (often triggered by ordinary events such as a ringing telephone or doorbell)
• Appetite disturbance for 50 percent of victims
• Excessive tiredness, weakness, or headaches for 50 percent of victims
• Numbing of responses to others, including feeling of detachment for 38 percent of victims
• Nausea before going to places associated with the stalking for 33 percent of victims
• Increased alcohol or cigarette use for 25 percent of victims
• Contemplation of suicide for 25 percent of victims.

The researchers' analysis of these findings suggested that most of the stalking victims experienced at least one major symptom associated with Post-Traumatic Stress Disorder (PTSD). The authors explain that this is not surprising because "stalking possesses many of the features that may produce chronic stress reactions and related psychological sequelae."Those features include persistent, repetitive trauma; loss of control; state of persistent threat with associated symptoms that may far outlive the actual duration of the harassment; and loss of social supports normally available for crime victims because of mistrust and fear generated by the stalking itself. While many factors affected the specifics of the stalking impact on the victims, there was not one victim who did notexperience some level of harm "that in some cases amounted to profound deterioration in functioning."

It is also important to note that the impact of cyber stalking has the same affect, if not greater, than physical stalking.

According to the Iowa Rape Victim Advocacy Center (www.rvap.org), cyber-stalking can consist of a variety of activities, but it is generally defined as the continued and deliberate harassment, threatening behavior, or unwanted advances towards a person through the internet or other forms of on-line and computer communications. Cyber-stalking does not include occasional junk mail, but it does include any methodical or deliberate attempt to harass the victim.

Cyber-stalkers can find their victims through chat rooms, online communities, discussion forums, e-mails, or through a random search. Even people without access to the internet can be victims of cyber-stalking. All the stalker needs to do is find out personal information about the victim and they can then use that to impersonate the victim and solicit meetings with strangers without the victim ever getting on to a computer.

Cyber-stalking can take many forms, some of which are below.

• threatening or obscene e-mails
• spamming or e-mail bombing- sending large amounts of email to shut down the victims e-mail from working
• live chat harassment
• "flaming"- online verbal abuse
• leaving obscene or threatening messages in guest books or on message boards
• sending electronic viruses
• sending unsolicited e-mail
• tracing computer and internet activity
• impersonation of the victim to solicit sex acts
• identity theft

Cyber-stalking can escalate to physical danger for the victim. If a stalker obtains personal information, such as an address or phone number or even the social security number of the victim, this information can be used to stalk and harass the victim even after the cyber-stalking has ceased.

SADness and the Holidays

 It’s that time of year again and amidst all of the Holiday lights and Santa sightings it is good to remind everyone that this is a difficult season for a lot of trauma survivors. It also is a time of year when depression increases due to lack of sunlight.


Seasonal affective disorder (SAD) is a real physical problem. As the days become shorter and we experience more darkness, our bodies produce more melatonin. Melatonin is involved in regulation of sleep, release of hormones, and body temperatures. According to an article on the Mayo Clinic website, SAD symptoms include: depressed mood, irritability, hopelessness, anxiety, loss of energy, social withdrawal, oversleeping (feeling like you want to hibernate), loss of interest in activities you normally enjoy, appetite changes (especially a craving for foods high in carbohydrates such as pastas, rice, bread and cereal), weight gain, and difficulty concentrating and processing information.

It is important to be aware that this may be an added factor when working with trauma survivors. Many of the effects of trauma are intensified by SAD and by the impending holidays. Trauma survivors are often triggered by holiday memories that were more distressing and a far cry from Hallmark moments. They often feel guilt and possible shame because they are not able to enjoy the holidays as much as the rest of the world. It does not matter how much work has been done to heal from the trauma, the holidays can still be a major source of stress for many people due to finances, family obligations, and the intense commercial attention to the season.

If you are a survivor of trauma or working with others who are survivors, I encourage you to develop a list of strategies that can help you get through the season. Here are a few tips that I posted last year.

1. Have an exit strategy. Some survivors are able to say “no” when expected to attend family gatherings where a perpetrator may be present. A sense of obligation to other family members may make it difficult to stay away. If someone is planning to attend a family gathering where a perpetrator is present, it is good to limit the amount of time spent in the situation. Arriving late, having one’s own form of transportation, having an agreement with another family member to assist in maintaining distance are all possibilities.

2. Good self care. With all the stress of the holiday season, immune systems become compromised. Illness and fatigue can increase susceptibility to triggers and make it more difficult to manage reactions and heightened emotional vulnerability. High intakes of sugar through this time can also reduce the ability to combat infection, increasing vulnerability. Any activities that increase a sense of well being such as support groups, mindfulness activities, exercise, and creative projects can help fight off depression.

3. Support. Isolation is often a strategy for managing this time of year that can end up being very unproductive. Existing support groups or informal support of understanding friends may help alleviate some of the loneliness that occurs during the holidays.

4. Limit alcohol intake. Alcohol is a depressant and can also affect the immune system. It also decreases inhibitions and affect sleep patterns which can then lead to increased vulnerability to the effects of trauma or additional trauma.

Please feel free to post your own strategies below.

Dealing with the Effects of Trauma

A SAMHSA Publication – see below for more information




Introduction

This is a serious issue. This booklet is just an introduction—a starting point that may give you the courage to take action. It is not meant to be a treatment program. The ideas and strategies are not intended to replace treatment you are currently receiving.

You may have had one or many very upsetting, frightening, or traumatic things happen to you in your life, or that threatened or hurt something you love—even your community. When these kinds of things happen, you may not “get over” them quickly. In fact, you may feel the effects of these traumas for many years, even for the rest of your life. Sometimes you don’t even notice effects right after the trauma happens. Years later you may begin having thoughts, nightmares, and other disturbing symptoms. You may develop these symptoms and not even remember the traumatic thing or things that once happened to you.

For many years, the traumatic things that happened to people were overlooked as a possible cause of frightening, distressing, and sometimes disabling emotional symptoms such as depression, anxiety, phobias, delusions, flashbacks, and being out of touch with reality. In recent years, many researchers and health care providers have become convinced of the connection between trauma and these symptoms. They are developing new treatment programs and revising old ones to better meet the needs of people who have had traumatic experiences.

This booklet can help you to know if traumatic experiences in your life may be causing some or all of the difficult symptoms you are experiencing. It may give you some guidance in working to relieve these symptoms and share with you some simple and safe things you can do to help yourself heal from the effects of trauma.

Some examples of traumatic experiences that may be causing your symptoms include:

• physical, emotional, or sexual abuse
• neglect
• war experiences
• outbursts of temper and rage
• alcoholism (your own or in your family)
• physical illnesses, surgeries, and disabilities
• sickness in your family
• loss of close family members and friends
• natural disasters
• Accidents

Some things that may be very traumatic to one person hardly seem to bother another person. If something bothers you a lot and it doesn’t bother someone else, it doesn’t mean there is something wrong with you. People respond to experiences differently.

Do you feel that traumatic things that happened to you may be causing some or all of your distressing and disabling emotional symptoms? Examples of symptoms that may be caused by trauma include:

• anxiety
• insomnia
• agitation
• irritability or rage
• flashbacks or intrusive memories
• feeling disconnected from the world
• unrest in certain situations
• being “shut down”
• being very passive
• feeling depressed
• eating problems
• needing to do certain things over and over
• unusual fears
• impatience
• always having to have things a certain way
• doing strange or risky things
• having a hard time concentrating
• wanting to hurt yourself
• being unable to trust anyone
• feeling unlikable
• feeling unsafe
• using harmful substances
• keeping to yourself
• overworking

Perhaps you have been told that you have a psychiatric or mental illness like depression, bipolar disorder or manic depression, schizophrenia, borderline personality disorder, obsessive—compulsive disorder, dissociative disorder, an eating disorder, or an anxiety disorder. The ways you can help yourself handle these symptoms and the things your health care providers suggest as treatment may be helpful whether your symptoms are caused by trauma or by a psychiatric illness.

Help From Health Care Providers, Counselors and Groups

You may decide to reach out to health care providers for assistance in relieving the effects of trauma. This is a good idea. The effects of trauma, even trauma that happened many years ago, can affect your health. You may have an illness that needs treatment. In addition, your health care provider may suggest that you take medications or certain food supplements to relieve your symptoms. Many people find that getting this kind of health care support gives them the relief and energy they need to work on other aspects of healing. To find health care providers in your community who have expertise in addressing issues related to trauma, contact your local mental health agency, hospital, or crisis service.

If you possibly can, work with a counselor or in a special program designed for people who have been traumatized. A counselor or people leading the program may refer you to a group. These groups can be very helpful. However, keep in mind that you need to decide for yourself what you are going to do, and how and when you are going to do it. You must be in charge of your recovery in every way.

Wherever you go for help, the program or treatment should include the following:

Empowerment–You must be in charge of your healing in every way to counteract the effects of the trauma where all control was taken away from you
.

Validation–You need others to listen to you, to validate the importance of what happened to you, to bear witness, and to understand the role of this trauma in your life.

Connection–Trauma makes you feel very alone. As part of your healing, you need to reconnect with others. This connection may be part of your treatment.

If you feel the cause of your symptoms is related to trauma in your life, you will want to be careful about your treatment and in making decisions about other areas of your life. The following guidelines will help you decide how to help yourself feel better.

Have hope. It is important that you know that you can and will feel better. In the past you may have thought you would never feel better—that the horrible symptoms you experience would go on for the rest of your life. Many people who have experienced the same symptoms that you are experiencing are now feeling much better. They have gone on to make their lives the way they want them to be and to do the things they want to do.

Take personal responsibility. When you have been traumatized, you lose control of your life. You may feel as though you still don’t have any control over your life. You begin to take back that control by being in charge of every aspect of your life. Others, including your spouse, family members, friends, and health care professionals will try to tell you what to do. Before you do what they suggest, think about it carefully. Do you feel that it is the best thing for you to do right now? If not, do not do it. You can follow others advice, but be aware that you are choosing to do so. It is important that you make decisions about your own life. You are responsible for your own behavior. Being traumatized is not an acceptable excuse for behavior that hurts you or hurts others.

Talk to one or more people about what happened to you. Telling others about the trauma is an important part of healing the effects of trauma. Make sure the person or people you decide to tell are safe people, people who would not hurt you, and who understand that what happened to you is serious. They should know, or you could tell them, that describing what happened to you over and over is an important part of the healing process.

Don’t tell a person who responds with statements that invalidate your experience, like “That wasn’t so bad.” “You should just forget about it,” “Forgive and forget,” or “You think that’s bad, let me tell you what happened to me.” They don’t understand. In connecting with others, avoid spending all your time talking about your traumatic experiences. Spend time listening to others and sharing positive life experiences, like going to movies or watching a ball game together. You will know when you have described your trauma enough, because you won’t feel like doing it anymore.

Develop a close relationship with another person. You may not feel close to or trust anyone. This may be a result of your traumatic experiences. Part of healing means trusting people again. Think about the person in your life that you like best. Invite them to do something fun with you. If that feels good, make a plan to do something else together at another time—maybe the following week. Keep doing this until you feel close to this person. Then, without giving up on that person, start developing a close relationship with another person. Keep doing this until you have close relationships with at least five people. Support groups and peer support centers are good places to meet people.

Things You Can Do Every Day to Help Yourself Feel Better

There are many things that happen every day that can cause you to feel ill, uncomfortable, upset, anxious, or irritated. You will want to do things to help yourself feel better as quickly as possible, without doing anything that has negative consequences, for example, drinking, committing crimes, hurting yourself, risking your life, or eating lots of junk food.

Read through the following list. Check off the ideas that appeal to you and give each of them a try when you need to help yourself feel better. Make a list of the ones you find to be most useful, along with those you have successfully used in the past, and hang the list in a prominent place—like on your refrigerator door-as a reminder at times when you need to comfort yourself. Use these techniques whenever you are having a hard time or as a special treat to yourself.

_____ Do something fun or creative, something you really enjoy, like crafts, needlework, painting,drawing, woodworking, making a sculpture, reading fiction, comics, mystery novels, or inspirational writings, doing crossword or jigsaw puzzles, playing a game, taking some photographs, going fishing, going to a movie or other community event, or gardening.

_____Get some exercise. Exercise is a great way to help yourself feel better while improving your overall stamina and health. The right exercise can even be fun.


______Write something. Writing can help you feel better. You can keep lists, record dreams, respond to questions, and explore your feelings. All ways are correct. Don’t worry about how well you write. It’s not important. It is only for you. Writing about the trauma or traumatic events also helps a lot. It allows you to safely process the emotions you are experiencing. It tells your mind that you are taking care of the situation and helps to relieve the difficult symptoms you may be experiencing. Keep your writings in a safe place where others cannot read them. Share them only with people you feel comfortable with. You may even want to write a letter to the person or people who have treated you badly, telling them how it affected you, and not send the letter.

_____Use your spiritual resources. Spiritual resources and making use of these resources varies from person to person. For some people it means praying, going to church, or reaching out to a member of the clergy. For others it is meditating or reading affirmations and other kinds of inspirational materials. It may include rituals and ceremonies—whatever feels right to you. Spiritual work does not necessarily occur within the bounds of an organized religion. Remember, you can be spiritual without being religious.

_____Do something routine. When you don’t feel well, it helps to do something “normal”—the kind of thing you do every day or often, things that are part of your routine like taking a shower, washing your hair, making yourself a sandwich, calling a friend or family member, making your bed, walking the dog, or getting gas in the car.

_____Wear something that makes you feel good. Everybody has certain clothes or jewelry that they enjoy wearing. These are the things to wear when you need to comfort yourself.

_____Get some little things done. It always helps you feel better if you accomplish something, even if it is a very small thing. Think of some easy things to do that don’t take much time. Then do them. Here are some ideas: clean out one drawer, put five pictures in a photo album, dust a book case, read a page in a favorite book, do a load of laundry, cook yourself something healthful, send someone a card.

_____Learn something new. Think about a topic that you are interested in but have never explored. Find some information on it in the library. Check it out on the Internet. Go to a class. Look at something in a new way. Read a favorite saying, poem, or piece of scripture, and see if you can find new meaning in it.

____ Do a reality check. Checking in on what is really going on rather than responding to your initial “gut reaction” can be very helpful. For instance, if you come in the house and loud music is playing, it may trigger the thinking that someone is playing the music just to annoy you. The initial reaction is to get really angry with them. That would make both of you feel awful. A reality check gives the person playing the loud music a chance to look at what is really going on. Perhaps the person playing the music thought you wouldn’t be in until later and took advantage of the opportunity to play loud music. If you would call upstairs and ask him to turn down the music so you could rest, he probably would say, “Sure!” It helps if you can stop yourself from jumping to conclusions before you check the facts.

_____ Be present in the moment. This is often referred to as mindfulness. Many of us spend so much time focusing on the future or thinking about the past that we miss out on fully experiencing what is going on in the present. Making a conscious effort to focus your attention on what you are doing right now and what is happening around you can help you feel better. Look around at nature. Feel the weather. Look at the sky when it is filled with stars.

¬¬¬¬_____Stare at something pretty or something that has special meaning for you. Stop what you are doing and take a long, close look at a flower, a leaf, a plant, the sky, a work of art, a souvenir from an adventure, a picture of a loved one, or a picture of yourself. Notice how much better you feel after doing this.

_____Play with children in your family or with a pet. Romping in the grass with a dog, petting a kitten, reading a story to a child, rocking a baby, and similar activities have a calming effect which translates into feeling better.

_____Do a relaxation exercise. There are many good books available that describe relaxation exercises. Try them to discover which ones you prefer. Practice them daily. Use them whenever you need to help yourself feel better. Relaxation tapes which feature relaxing music or nature sounds are available. Just listening for 10 minutes can help you feel better.

_____Take a warm bath. This may sound simplistic, but it helps. If you are lucky enough to have access to a Jacuzzi or hot tub, it’s even better. Warm water is relaxing and healing.

_____Expose yourself to something that smells good to you. Many people have discovered fragrances that help them feel good. Sometimes a bouquet of fragrant flowers or the smell of fresh baked bread will help you feel better.

_____Listen to music. Pay attention to your sense of hearing by pampering yourself with delightful music you really enjoy. Libraries often have records and tapes available for loan. If you enjoy music, make it an essential part of every day.

_____Make music. Making music is also a good way to help yourself feel better. Drums and other kinds of musical instruments are popular ways of relieving tension and increasing well-being. Perhaps you have an instrument that you enjoy playing, like a harmonica, kazoo, penny whistle, or guitar.

_____Sing. Singing helps. It fills your lungs with fresh air and makes you feel better. Sing to yourself. Sing at the top of your lungs. Sing when you are driving your car. Sing when you are in the shower. Sing for the fun of it. Sing along with favorite records, tapes, compact discs, or the radio. Sing the favorite songs you remember from your childhood.

Perhaps you can think of some other things you could do that would help you feel better.



The Healing Journey

Begin your healing journey by thinking about how it is you would like to feel. Write it down or tell someone else. In order to promote your own healing, you may want to work on one or several of the following issues that you know would help you to feel better.

• Learn to know and appreciate your body. Your body is a miracle. Focus on different parts of your body and how they feel. Think about what that part of your body does for you. Go to your library and review books that teach you about your body and how it works.

• Set boundaries and limits that feel right to you. In all relationships you have the right to define your own limits and boundaries so that you feel comfortable and safe. Say “no” to anything you don’t want. For instance, if someone calls you five times a day, you have the right to ask them to call you less often, or even not to call you at all. If someone comes to your home when you don’t want them to be there, you have the right to ask them to leave. Think about what your boundaries are. They may differ from person to person. You may enjoy it a lot when your sister comes to visit, but you may not want a visit from your brother or a cousin. You may not want anyone to call you on the phone after 10 p.m. Expect and insist that others respect your boundaries.

• Learn to be a good advocate for yourself. Ask for what you want and deserve. Work toward getting what you want and need for yourself. If you want to get more education for yourself so you can do work that you enjoy, find out about available programs, and do what it is you need to doto meet your goal. If you want your physician to help you find the cause of physical problems, insist that he or she do so, or refer you to someone else. When you are making important decisions about your life, like getting or staying married, going back to school, or parenting a child, be sure the decision you make is really in your best interest.

• Build your self-esteem. You are a very special and wonderful person. You deserve all the best things that life has to offer. Remind yourself of this over and over again. Go to the library and review books on building your self-esteem. Do some of the suggested activities.

• Develop a list of activities that help you feel better (refer to the list in the section “Things you can do to help yourself feel better”). Do some of these activities every day. Spend more timedoing these activities when you are feeling badly.

• Every family develops certain patterns or ways of thinking about and doing things. Those things you learn in your family as a child will often influence you as an adult—sometimes making your life more difficult and getting in the way of meeting your personal goals. Think about the ways of thinking and doing things that guide you in your life. Ask yourself if they are patterns, and if you need to change them to make your life the way you want it to be. For example, in your family you may have been taught that you never tell anyone certain family secrets. In fact, it may be very important to share some family secrets with trusted friends or health care providers. Or you may have been taught that you must always do what certain members of your family want you to do. As an adult, it is important that you figure out for yourself what it is you want to do. In effect you can become your own loving parent.

• Work to establish harmony with your family or the people you live with. Plan fun and interesting activities with them. Listen to them without being critical.

• Work on learning to communicate with others so that they can easily understand what you mean. When talking with another person about your feelings, use “I” statements, like “I feel sad” or “I feel upset” rather than accusing the other person. You may want to practice good communication with a friend. Ask your friend to give you feedback on how you can be more easily understood.

• You may have lots of negative thoughts about yourself and your life. Work on changing these negative thoughts to positive ones. The more you think positive thoughts the better you will feel. For instance, you may always think, “Nobody likes me.” When you think that thought, replace it with a thought like, “I have many friends.” If you often think that you will never feel better, replacethat thought with the thought, “Every day I am feeling better and better.”

• Develop an action plan for prevention and recovery. This is a simple plan that helps you stay well and respond to upsetting symptoms and events in ways that will keep you feeling well.

Using the activities in the section “Things you can do to help yourself feel better,” make lists of things that will help you keep yourself well and will help you to feel better when you are not feeling well. Include lists:

• to remind yourself of things you need to do every day - like getting a half hour of exercise and eating three healthy meals - and also those things that you may not need to do every day, but ifyou miss them they will cause stress in your life, for example, buying food, paying bills, or cleaning your home;

• of events or situations that may make you feel worse if they come up, like a fight with a family member, health care provider, or social worker, getting a big bill, or loss of something importantto you. Then list things to do (relax, talk to a friend, play your guitar) if these things happen so you won’t start feeling badly;

• of early warning signs that indicate you are starting to feel worse - like always feeling tired, sleeping too much, overeating, dropping things, and losing things.

• Then list things to do (get more rest, take some time off, arrange an appointment with your counselor, cut back on caffeine) to help yourself feel better;

• of signs that things are getting much worse, like you are feeling very depressed, you can’t get out of bed in the morning, or you feel negative about everything.

• Then list things to do that will help you feel better quickly (get someone to stay with you, spend extra time doing things you enjoy, contact your doctor); and

• of information that can be used by others if you become unable to take care of yourself or keep yourself safe, such as signs that indicate you need their help, who you want to help you (give copies of this list to each of these people), the names of your doctor, counselor and pharmacist, all prescriptions and over-the-counter medications, things that others can do that would help youfeel better or keep you safe, and things you do not want others to do or that might make you feel worse.



Barriers to Healing

Are there any things you are doing that are getting in the way of your healing, such as alcohol or drug abuse, being in abusive or unsupportive relationships, self-destructive behaviors such as blaming and shaming yourself, and not taking good care of yourself? Think about the possible negative consequences of these behaviors. For instance, if you get drunk, you might lose control of yourself and the situation and be taken advantage of. If you overeat, the negative consequences might be weight gain, poor body image, and poor health. You may want to work on changing these behaviors by using self-help books, working with a counselor, joining a support group, or attending a 12-step program.



Moving Forward on Your Healing Journey

If you are now about to begin working on recovering from the effects of trauma, or if you have already begun this work and are planning to continue making some changes based on what you have learned, you will need courage and persistence along the way. You may experience setbacks. From time to time you may get so discouraged that you feel like you want to give up. This happens to everyone. Notice how far you’ve come. Appreciate even a little progress. Do something nice for yourself and continue your efforts. You deserve an enjoyable life. Always keep in mind that there are many people, even famous people, who have had traumatic things happen to them. They have worked to relieve the symptoms of this trauma and have gone on to lead happy and rewarding lives. You can too.





Further Resources

Substance Abuse and Mental Health Services Administration (SAMHSA)
Center for Mental Health Services
Web site: http://www.samhsa.gov/

SAMHSA’s National Mental Health Information Center
P.O. Box 42557
Washington, D.C. 20015
1 (800) 789-2647 (voice)
Web site: http://www.mentalhealth.samhsa.gov/

Consumer Organization and Networking Technical Assistance Center
(CONTAC)
P.O. Box 11000
Charleston, WV 25339
1 (888) 825-TECH (8324)
(304) 346-9992 (fax)
Web site: http://www.contac.org/

Depression and Bipolar Support Alliance (DBSA)
(formerly the National Depressive and Manic-Depressive Association)
730 N. Franklin Street, Suite 501
Chicago, IL 60610-3526
(800) 826-3632
Web site: http://www.dbsalliance.org/



National Alliance for the Mentally Ill (NAMI)
(Special Support Center)
Colonial Place Three
2107 Wilson Boulevard, Suite 300
Arlington, VA 22201-3042
(703) 524-7600
Web site: http://www.nami.org/



National Empowerment Center
599 Canal Street, 5 East
Lawrence, MA 01840
1-800-power2u
(800)TDD-POWER (TDD)
(978)681-6426 (fax)
Web site: http://www.power2u.org/


National Mental Health Consumers’
Self-Help Clearinghouse
1211 Chestnut Street, Suite 1207
Philadelphia, PA 19107
1 (800) 553-4539 (voice)
(215) 636-6312 (fax)
e-mail: info@mhselfhelp.org
Web site: http://www.mhselfhelp.org/



National Technical Assistance Center (NATC)
National Association of State Mental Health Program Directors
66 Canal Center Plaza, Suite 302
Alexandria, VA 22314
703-739-9333 (voice)
703-548-9517 (fax)
Web site: www.nasmhpd.org/ntac

Resources listed in this document do not constitute an endorsement by CMHS/SAMHSA/HHS, nor are these resources exhaustive. Nothing is implied by an organization not being referenced.

You could also contact your state consumer advocacy network/agency. Find it by looking under Mental Health in the Yellow Pages of your phone book.



Acknowledgements

This publication was funded by the U.S. Department of Health and Human Services (DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), and prepared by Mary Ellen Copeland, M.S., M.A., under contract number 99M005957. Acknowledgment is given to the many mental health consumers who worked on this project offering advice and suggestions.



Disclaimer

The opinions expressed in this document reflect the personal opinions of the author and are not intended to represent the views, positions or policies of CMHS, SAMHSA, DHHS, or other agencies or offices of the Federal Government.



Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, DHHS.

For additional copies of this document, please call SAMHSA’s National Mental Health Information Center at 1-800-789-2647.

Introduction to Excellent Website on Providing Trauma Informed Services to Women and Girls

Coalescing on Women and Substance Abuse – Linking Research, Practice and Policy


http://www.coalescing-vc.org/index.htm

This site captures material from historical and ongoing projects related to women’s substance use in Canada. The projects described here have been sponsored by the British Columbia Centre of Excellence for Women’s Health with the involvement of many partners. The site was first mounted to share the findings of the Coalescing on Women and Substance Use: Linking Research Practice and Policy project (2003-2008) a project that sparked short-term virtual communities of practice (vCoP) on six key topics related to women's substance use in Canada. Now material continues to be added from both virtual and F2F projects, for example on projects related to girls and heavy alcohol use, and on applying a gender lens to work on the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada.

The aim of this site to share and promote action on promising approaches to responding to substance use by girls and women, on the part of service providers, researchers, health system planners and decision makers.

The following discussion questions found on the site can be used by direct services providers to reflect on their current practices and policies in providing trauma-informed services.

1. What have you noticed about the links among trauma, mental illness and substance use problems from your experience of supporting women with these and related challenges?

2. Does your service assume that violence has played some role in the woman’s/girl’s life, even if she has not identified abuse as a source of difficulty?

3. How does your service currently address the needs of girls and women experiencing trauma, substance use and mental health concerns?

4. Does your service provide training to women accessing services in skills useful to healing from trauma as well as substance use and mental health concerns - such as self-soothing, self-esteem, self-trust and assertiveness?

5. Has education (basic information about trauma and its impact) been offered to all staff at your service? Have clinical staff received training on specific modifications of existing services for trauma survivors?

6. What opportunities are there for building awareness/taking action to improve the response for girls and women with substance use problems and related trauma and mental health concerns?

7. Notice the language used within your context. What would happen if ‘symptoms’ were reframed as ‘adaptations’? How would things change at a practice and policy level if ‘disorders’ were considered ‘responses’?

8. Improving the system of care for girls and women requires a paradigm shift from “what is wrong with her?” to “what happened to her?” Consider what this shift might mean for your services or system.

9. How does your organization support efforts to minimize the possibility of re-traumatization?

10. In what ways are girls and women involved in the development of service policies and protocols?

11. How is diversity, such as one’s cultural background, considered in the trauma-specific services you offer?

Harm Reduction in the Context of Domestic Violence Services

This post was taken from Reducing Barriers to Support Women Fleeing Violence, A Toolkit for Supporting Women with Varying Levels of Mental Wellness and Substance Use, a publicaton of the British Columbia Society of Transition Houses.  This particular section of provided by Rhea Redivo of the South Okanagan Women in Need Society.

Harm reduction is a valuable philosophy in approaching women who have substance abuse and mental health issues.


Traditionally, addictions services have focused on abstinence as the primary treatment goal. Harm reduction, however, acknowledges that abstinence, like substance use itself, exists on a continuum. Instead of being a discrete event, it is seen as a progressive, non-linear journey that is unique to each individual and entails both success and failure. For many, immediate and complete abstinence is not only unlikely, but an unrealistic expectation. Relapse and/or some degree of continued use in an inherent part of the recovery journey and therefore expected. The purpose of harm reduction strategies is to reduce the medical, personal and social risks and harms associated with substance use, particularly for the individual, but also for society. Not unlike the purpose of safety planning for women remaining in abusive situation, harm reduction strives to enhance client’s safety while still using and to reduce negative repercussions. In essence, harm reduction strategies ensure clients survive the various stages of their journey with minimal negative effects until such time as they achieve their ultimate goal: abstinence.

As with anti-violence services, the primary focus is safety. Other aspects are raising awareness, respecting choice, and empowering in order to enhance motivation to change. Change is a choice that requires time and commitment to one’s best interests. It must therefore be internally motivated, not externally exposed (Bland &Edmund, 2008). To that end, service is guided by individual need, readiness and choice. Emotional safety is essential. It entails acceptance, respect and gentle honesty while providing information and education that promote women’s understanding of the impact of use on them and their lives, especially health and safety. Recognizing individual strengths and small successes provide encouragement, while acknowledging underlying positive intentions and normalizing substance use as a response to abuse reduces guilt and shame. Empowerment and respecting choice help promote and self-confidence; giving information and raising awareness help increase desire to change. Together, they enhance internal motivation and the likelihood of change.

The basic tenets of ‘harm reduction’ have long formed the basis for anti-violence practice, where the primary goal is to help women reduce, avoid or escape violence and to minimize its effects. Like abstinence, freedom from domestic violence may be the ultimate goal. However, rather than being a discrete event, it is a progressive, non-linear, process that is unique to the individual and occurs over time. Setbacks are also considered an inherent part of the journey and safety planning is standard practice.

Individual choice, education, and empowerment are likewise key practice values, as is the underlying service goal to reduce potential harm pending more substantial change. Women’s needs, readiness and choices guide service provision. Women are not told what to do; they are given information, education and resources so they can decide for themselves what to do. Applying harm reduction requires them same practice values and principles be extended to women who have substance us or mental health issues. Imposing expectations that women immediately leave their abuser or ‘do what we think only revictimizes and disempowers, which undermines, rather than promotes, internal motivation.

Degree of risk
Although domestic violence, substance use, and mental illness often appear together, causal relationships remain unclear. Individually, each can be chronic, progressive, and potentially lethal. When combined, their severity and lethality increase. Since substance use and mental health issues may increase women’s risk for violence as well as the severity of violence, women accessing anti-violence shelters who also have co-occurring substance use or mental health issues are therefore are great risk that those who do not. Mental health issues pose the additional risk of self-harm (Parkes, 2007d). Yet, service is often denied these women due to the very issues that place them at greater risk, which further compromises their safety.

The immediate danger posed by domestic violence is generally great than that posed by substance use or mental health issues, yet either can be equally as lethal as any abuser (Bland, 2008). Policies must therefore strive to balance supporting abstinence with creating safety so that women unable to remain abstinent can ask for help.

Risk reduction involves providing appropriate, effective services for women experiencing both domestic violence and substance use or mental health issues so they can increase their own and their children’s safety and well-being. A harm reduction approach ensures they receive the service they need regardless of these issues or their choices regarding treatment. Inviting women to examine their situation honestly through open, non-critical discussions that also offer information and choices is a key strategy. In addition, substance use and mental health issues must be considered in women’s overall safety plan, which may include identifying triggers for substance use or mental health behaviors, alternate responses, or skill development.

Potential Benefits

Temporary respite from violence provides a window of opportunity for women to reflect not only on violence, but also on substance use or mental health issues, and their impact on health, well-being and safety. Within the safe context of the shelter, women receive safety, support and information that allow them to consider their options. In addition to learning about resources and treatment options available to them, they may also learn alternative coping strategies. These tools allow women to make decision about what will help them on their recovery journey (Bland & Edmund, 2008).

In this way, shelters serve not only as a form of harm reduction, but also as a catalyst for change, and for women with co-occurring substance use, their stay in a shelter appears to be a first step to recovery. Whether brief or more substantive, substance use interventions within shelters appear to help women alter their substance use (Bland & Edmund, 2008). Indeed, after their stay, motivation to use and levels of stress likewise decreased, while perceived ability to face challenges increased. While decline in use is greatest among those with the highest initial level of use and the most significant intervention in the shelter, reductions occurred regardless of the degree of intervention provided (Jategaonkar & Poole, 2004).

More substantive interventions result in more substantive personal change. Incorporating harm reduction and increasing levels of intervention would reduce clients’ risks and provide the necessary support for them to achieve their goals of heal and safety for themselves and their children.

Harm Reduction in the Shelter Context

Research has shown that the most effective intervention offers integrated support nd treatment grounded in policies that recognize the overlap of violence, substance use and mental health issues as well as the context of social and structural determinants (SAMHSA as cited in Poole & the Coalescing on Women and Substance Use Virtual Community, 2007). To be effective service must be grounded in an understanding of how these various issues interact to affect women’s lives and safety.

Harm reduction values and principles must inform all aspects of policy, procedure and service provision. Approach to, and expectations of, clients must likewise reflect these values. Temporary abstinence or other limitations on behavior may be reasonable for some clients; however, for others they are unrealistic and pose a significant barrier, especially for those who still live with violence and have substance use or mental health issues. Imposing such expectations in these cases is contrary to the goals and values of anti-violence services. Encouraging reduction or safer choices may be both more reasonable and more successful.

Service provision must also recognize the potentially differing needs of women with co-occurring substance use or mental health issues. Accompanying memory distortions or cognitive deficits can affect their ability to judge safety, recall incidents, report violence, and enact safety plans. They can also affect their ability to advocate for themselves (Bland & Edmund, 2008), which in turn compromises their capacity to get the help they need or interact effectively with service providers. To accommodate their needs, it may be necessary to repeat information, provide structure, simplify goals, or advocate on their behalf with other service providers so they can access necessary resources. Reducing social stressors like housing, relationships or finances, which likewise interact reciprocally with both substance use and mental health issues, continues to be a key service goal.

Employee Expectations

Harm reduction requires that the issue be addressed. As Bland (2008) states, the “intervention is in the asking.” While shelter employees are not expected to become addictions or mental health counselors, they are expected to be aware of how substance use and mental health issue affect women’s lives and interact with violence. They must be willing and able to create emotional safety for women, to discuss substance use or mental health issues non-critically and without labeling women or judging their treatment choices, and to make links between these issues and the violence they experience or other aspects of their lives. This requires a context of emotional safety. Equally necessary is a thorough knowledge of relevant services and resources, including the degree to which they provide gender-specific services and physical or psychological safety, as well as the potential risks and benefits they present. Providing women with information and choices allows them to decide what they need and how to get it (Poole & the Coalescing on Women & Substance Use Virtual Community, 2007).

In order to admit a problem and ask for help, women need to feel emotionally safe. Emotional safety entails acceptance, sensitivity, gentle honesty and respect. Given the stigma and institutional oppression often associated with substance use or mental health issues, women may initially deny problems. Honesty requires trust, and for women who trust in others and themselves has been repeatedly violated, emotional safety may take time. Blame and moral retribution not only compromise safety, but confirm the stigma they have experience, aggravate the shame and guilt they already feel, and further alienate and disempower them while empowering their abusers.

Screening and Assessment

Given the high co-occurrence of domestic violence with substance use or mental health issues, routine screening and assessment for these issues must be universal. As with screening for violence, the primary purpose of screening for these issues is not to deny service, but to obtain information, in particular information that can help identify those women in need of specific types of support and are then given appropriate choices that help ensure their survival (Bland & Edmund, 2008). In essence, the purpose of screening and assessment to improve the service women receive and thereby enhance their chances of survival despite the challenges they face until they are ready to make larger changes. Their underlying intent is inclusion, not exclusion.

Women are unlikely to identify themselves as addicted (Bland & Edmund, 2008) or mentally ill (Parkes, 2007a) unless their safety is assured. In –depth exploration of these issues is unlikely to occur until trust and safety are established. Initial screening is therefore to be specific and brief and conducted within a context of openness and acceptance. Assessment, which is broader and more comprehensive, begins only after the immediate crisis is over and a trusting relationship has been initiated. In any case, in order to promote safety, and thus disclosure, women are to be offered choices and informed of the reasons behind any questions they are asked.

Safety and Safety Planning

Safety is always paramount, not just for the individual, but also for the group. Effective safety planning must consider individual patterns and consequences of behavior, both in terms of how they affect women personally and their potential effect on other residents. Safety planning is to follow established guidelines within a context of collaboration, sensitivity and respect for all individuals concerned.

Resident Expectations

Creating a safe environment requires consistency, yet flexibility. Rules should be unambiguous, straightforward and specific. Above all, they must be few in number with both expectations and consequences clear and consistently applied. In contrast, guidelines should be wide-ranging and flexible so that enforcement can be responsive to individual needs and circumstances. ‘Fairness,’ like equity, is governed by relativity, and the underlying principle when enforcing rules and guidelines is always a consideration of each woman’s best interests in any given situation.

For more information or to find out how to obtain the above-mentioned toolkit, please contact Linda Douglas at linda@nhcadsv.org