May 31, 2018

From Corrie Halladay, MSW/MPH Intern, Trauma Informed Oregon

I began my Master of Public Health internship at Trauma Informed Oregon (TIO) on a fairly unknown path. I knew I wanted to focus on an area of need that could simultaneously benefit the organization and my own learning. Somewhere along the way, I decided to center my work on TIC within substance use disorder (SUD) and addiction services. TIO has a hand in many service systems across the state: education, child welfare, mental health, criminal justice, public health, houseless services, etc. SUD systems inevitably intersect with those worlds, and TIO has an obvious interest/responsibility to increase our engagement with SUD services as we’ve done with the others.

At the beginning of the year, TIO met with several SUD service stakeholders from across the state to identify areas of need or interest for TIC initiatives within SUD services. A list was generated and I turned that into a survey that TIO sent out across the state. From that survey we received 250+ responses identifying top TIC priorities among survey participants. The most commonly cited interest was “trauma informed best practices for SUD/addiction services.” In particular, trauma informed procedures for urinalyses (UAs) were highlighted. Together with my TIO colleagues, we’ve begun to piece together a best practice tip sheet or a trauma-informed practice (TIP) sheet to serve as a reference for that commonly used practice within SUD services.

While our TIP sheet is in progress, we hope to invite input from all of you. Here’s some considerations that we’ve developed in conversation over the past month. The following is a discussion between me and Charlie McNeely, TIO’s Outreach and Community Engagement Coordinator:

What perspective or background informs your work on this TIP sheet?

Charlie: The background I have is very limited, but specific. Having family members that have gone through the prison system and have probation terms that require UAs, I have heard firsthand the injustices and shame they have had to endure. A few examples are being forced to fully unclothe during collection of a sample, not given the option of preferred gender [of the observer], lack of notice and consistency in their experiences, being observed by a guard that they felt bullied by, etc.

Also, the time I spent working in youth shelters and housing and UAs being required for services either contractually or by a PO [parole/probation officer]. In this placement, I witnessed a lack of training and procedures. I believe that in order to have trauma informed UAs, at the very least, a trauma informed care training and UA training should be required.

Corrie: Like Charlie, I have had loved ones go through the criminal justice system and probation/parole requirements. I have also had loved ones in SUD treatment, both residential and outpatient. As a social worker, many of the people I have worked with over the years have also had experience with UAs—good, bad, and ugly. Finally, I can pull from my own experiences getting drug tested for jobs. While not exactly the same, I can understand where the discomfort comes from and I see a lot of opportunities to make it a more trauma-informed process for everyone involved.

What elements are needed to make UA procedures “trauma informed”?

Charlie: Training both TIC and UAs . . . supplemental training on structural and institutional violence, criminal system reform, etc.

Corrie: We’ve had some great conversations recently about the importance of understanding this procedure from multiple perspectives. For instance, that a truly “trauma informed UA” would be more comfortable for participants and observers. So in that way, I think we have to make sure to consider the perspectives of the service participant and the agency staff. On another note, I think that transparency is key. Everyone deserves to have more context: “What is the process? Why? With whom? When? What happens after? What are my choices?”

What kind of population-specific considerations should we make when creating this TIP sheet?

Charlie: LGBTQIA+, Gender, Mental health diagnoses

Corrie: I agree with those completely. I think we’ve also talked about various cultural factors that are important to consider. Also age-specific/appropriate, so youth procedures versus those of adults. Finally, I think there are different service populations that we should think about when designing a TIP sheet. For example, some of Charlie’s experience with UAs is from work in juvenile justice, so making sure UA processes reflect the service population is important.

Other thoughts or musings about this subject?

Charlie: TIC’s goal isn’t to eliminate “uncomfortable experiences” but to reduce harm, create safety, implement structure and predictability, provide choice and so forth, which is something that the UA process does not currently have. Also, to continue asking, What is the purpose and is the necessary means to get the results desired? Is there a safety necessity in receiving a UA from the participant that would otherwise put them at risk if not collected?

Corrie: One thing that has really stood out to me in these last six months is how important it is to bring in the principles of TIC in all the work we do. I’ve found that it can be challenging to balance the principles when considering best practices. For instance, safety and choice need to be weighed or considered in every action. Sometimes, it seems we find ourselves in an ethical dilemma, How can we best ensure the safety of our services participants while still valuing their choice and voice? Trauma-informed  procedures for UAs are a great example of that.

If you have thoughts about what makes a UA procedure trauma informed, please feel free to join our TIO forum discussion here! You can also send comments/input to mcneely@pdx.edu or corrie@pdx.edu