There we go. All right. Well, good morning again. My name is Chelsea Kimura. I'm a TTS with the Opioid Response Network. This is our fourth session today with Stephanie Stilwell, and today we're going to be talking about stigma and trauma-informed practices. Before I pass this over to Stephanie, I would like to open our session in a good way today by sharing our land acknowledgement. Our work intends to reach the addiction workforce in the Northwest TOR region. This includes Alaska, Idaho, Oregon, and Washington. This region rests on the ancestral homelands of the indigenous peoples who have lived on these lands since time immemorial. Please join us in support of efforts to affirm tribal sovereignty and in displaying respect and gratitude for our indigenous neighbors. We respectfully acknowledge and honor all indigenous communities, past, present, and future. And with that, I will go ahead and pass it over to Stephanie to get started today. Thank you. Awesome. Thanks, Chelsea. Good morning, everybody. Today, again, I'm going to be talking to you about stigma and something called trauma-informed care practices in substance use disorder treatment. There we go. I'm going to skip ahead through some of the ORN slides, as you know all about us by now. Again, today, we're going to dive into different aspects of stigma, misconceptions about substance use disorder, the impact that stigma has on the care that we provide for our patients, how language can shape perceptions, and talk a little bit about different case scenarios regarding challenges with stigma. Also, we'll dive into something called trauma-informed care practices. That'll be the second part of the presentation today. Sorry. There we go. I'm sure you all know, but the relationship between substance use disorder and stigma is really complex and complicated and has gone through a lot over the course of history. Our understanding of what substance use disorder is has shifted significantly from historically, people thought of it as this is a moral failing. Now, we realize that it's actually not a personal failing, that it's actually a disease that impacts the brain. There is still this so much stigma and misinformation about substance use disorder that really makes living with and or recovering from substance use disorder particularly difficult. If we back up just a second and talk about stigma-stigma, what it is is this harmful misconception that somebody forms about a group or a person because of situations that that person is facing in their life. Of course, there's many different types of stigmas that people who are living with or in recovery from substance use disorder face. We're going to talk about the different types of stigma today as well. Really, one of the most impactful and effective ways to reduce stigma involves just our language, how we choose to talk about substance use disorder and really how we talk about it really impacts and can make a huge difference and can help reduce or even eliminate stigma altogether. That's what we're really diving into today. Feel free to come off mute during this part if you want, but I would really like you to think about what are some of the words that come to mind when you hear about somebody that has survived or is fighting cancer? A survivor. Survivor, yep. What are some others? Possibly it's a warrior, they're strong-willed, they're empowered, they're a fighter, resilient, all these really, really empowering, strong, powerful words. But when we think about words that are often associated with somebody with substance use disorder, we might hear something completely different. Perhaps you've heard some of these, clean versus dirty or abuser. It's just, so I guess, why do we, why is there such a big difference in how people speak about these two conditions? We talked about previously how both are chronic health conditions. Why is there such a different language of how we are talking about them? The language used to describe individuals with cancer versus somebody with substance use disorder really highlights that the stigma is still alive in our societies today. It also shows there are very clear differences in how people are perceiving these two very, both are very impactful health conditions. This is probably rooted in that historical stigmatization that we used to view addiction as a moral failing rather than an actual condition, health condition, and it's continued in how the media is portraying substance use disorder, or even how it's criminalized in our society. However, it's nice to say that during the recent years, again, we're really seeing this movement towards changing how we are talking about substance use disorder. You're in this training today so that you can all relearn or reiterate or remember how to really speak about substance use disorder so that we can really continue to reduce the stigma around how we talk about and describe people who have substance use disorder. The problem with staying clean, I'm sure this is something that you all have heard, somebody referring to somebody who is in recovery as clean. It really does imply that at one point they were actively dirty and that we would never use the term dirty to describe any other health condition. It's really important to recognize that saying clean or dirty, unfortunately, reinforces that misconception that addiction or substance use disorder is actually an issue of failing or a personal cleanliness, actually, issue rather than a complex health condition. I really enjoy this quote here. It says, when coworkers ask me if a client is clean, I'll say, yeah, there was no detectable mal-odor and their hygiene was good. Their clothes were laundered and they were weather appropriate. This just really shows a good example of how we can, in the moment, help stop the stigma that is continuing even in our professions today. It's just really important to change the language and how we're speaking because that really instantly reduces the stigma and increases the amount of empathy that we have as we're working with people in recovery or with substance use disorder. Again, I talked about how there's many different types of stigma associated with substance use disorder. We'll talk about four different types or aspects of stigma. There's self-stigma. This is stigma from within. This is when individuals blame themselves or feel ashamed of themselves because of their substance use disorder. It's like they're thinking that they're failures because of what society says. The self-stigma often makes it really hard for people to ask for help or they're too embarrassed to do so. We have stigma from the community. This could be people in the community like friends or family even or neighbors that they perceive that they're looking down on people with substance use disorders or even people who are currently in treatment or in recovery but use a medication for addiction treatment. They actually sometimes still have stigma from people in the recovery community because they're not quote unquote abstinent because they're using medications for their treatment even though we wouldn't think of that as somebody who is taking medication for their diabetes as something that we would need to stigmatize them for. We need to be aware that there is still clinician stigma. Sometimes us healthcare workers can be biased because of stigma. Sometimes we aren't even aware of it. Some people, especially providers or healthcare staff that don't specifically work in a treatment facility might treat a patient that has a substance use disorder differently than they would other people. Of course, that impacts the actual care that the patient receives. Then we have external stigma. This is stigma from the outside or society. This involves the public's perception of substance use disorder and addiction and it's often really influenced by what we see on the media or in conversations with other people. Of course, media tends to perpetuate some of those negative stereotypes and using derogatory language. That just continues to deepen that negative image of substance use disorder. Not only can that impact just generally the public's attitude, but it can really impact some policy decisions or how our government chooses to support or not support programming that goes toward helping people who are in need of services for their substance use disorder or other treatment. It's just really important to understand that there's so many different levels and layers of stigma and we have to do something to really address things from all of the different aspects. Because the impact of stigma on substance use disorder can be extremely damaging. Stigma can diminish the belief that substance use disorder or addiction is a valid and treatable health condition, which can hinder people from getting treatment or seeking help. It can be a barrier to employment and housing and relationships. It can perpetuate just that cycle of instability. Stigma, again, like I said, it can discourage the public support for treatment funding. It can cause issues with insurance limitations or continuing to allow punitive and criminalization of different things to persist. Again, people who have substance use disorder often might refrain from seeking essential services because they might feel unworthy of themselves or encounter judgment or stigma from others in the community as they go seek other services. It can, again, lead to different, less effective clinical support sometimes if we have clinician stigma. Generally, it can lead to just making life a lot more challenging for people to receive support, care, understanding, all of the things that they need, especially when they're going through something like substance use disorder treatment. So, there's, like I said, language is one of the biggest ways we can work to decrease the stigma. So, it's really important to pay attention to what you're saying. And there's a lot of old terminology that sometimes we still say, or, you know, even people in the recovery community or who are in recovery say these words. And I always encourage people to just still change how we're speaking so we can really feel more empowered in the work that we've done or the work that we're doing to support people in recovery. So, instead of saying addict, alcoholic, or junkie, of course, we want to use terms with, you know, things like people with opioid or substance use disorder or a person who uses drugs. We want to not say clean versus dirty. If we're talking about somebody who is clean, we want to say somebody who has a negative urine toxicology screen, or they're not currently using, or they're substance-free. Instead of saying former addict or reformed addict, it's the person in recovery. We can talk about medications for addiction treatment versus saying medication-assisted treatment or substitution or replacement therapy. Something that is kind of one that most people don't know, relapse, a good way of talking about a relapse is actually just a recurrence of symptoms. And then if a baby is born to a woman who was using drugs during her pregnancy, we don't want to call them addicted babies or babies who are born addicted. We want to talk about babies born with an opioid dependency or with neonatal abstinence syndrome. So, just the little ways that we can change how we speak makes a huge impact. And of course, you know, we want to talk about the devastating impacts of colonization. We touched on this previously, but again, when it comes to stigma, there's still a whole lot going on here. Oppression, marginalization, the effects of historical and intergenerational trauma, of course, lead to these health inequities for indigenous people. And also, you know, as we talked about, have a disproportionately higher rates of substance use disorder. And we also know that indigenous people are less likely than non-indigenous people to seek treatment for both mental health concerns as well as substance use disorder. So, it's just really important to help combat the stigma of, you know, indigenous and Native Americans with alcohol by, you know, I guess, people are really often unaware of the impact that colonization has on this. The fundamental lack of understanding of what has happened resulted in many people and indigenous people populations being held responsible for our own health inequities. Meaning, they're putting the, you know, perpetuating this harmful stereotype that it's our own fault. It's our own, you know, we should be to blame for everything. You know, the drunk Indian stereotype requires a lot of education about colonization and understanding the issue, the bigger issue behind this. So, yeah, we just need to do a lot more education on colonization and the impact that it has had on substance use disorder. More about our language, how language can help reduce stigma. So, again, we talked about this, but medication-assisted treatment is not the language we want to use in regards to MAT. We want to make sure we're talking about medication for addiction treatment or medication for opioid use disorder. This quote is, I feel, a good one. Protest any labels that turn people into things. Words are important. If you want to care for something, you call it a weed. This is just more language and myth about MAT being a substitution for one drug for another drug. Again, it's the safest option for treatment of opioid use disorder has 50% less likely mortality when treated with long-term medications. Harm reduction is another topic that often is stigmatized. We hear a lot of times harm reduction programs are enabling people to continue to keep using when in reality harm reduction programs reduce the risk around the behaviors and also increase people's likelihood of engaging in substance use disorder treatment as well. Again, this is, I mentioned this earlier, but a lot of, not a lot currently, but it's getting a lot better, but sometimes you can, people who are going to 12-step meetings or other support groups sometimes have their own stigma and bias against people who are using MAT for their treatment journey. And so it's really important to find support groups that help, that are actually supportive of MAT or MOUD because some currently are not. And a lot of times that might just be because some of these groups don't have the education or understanding of what MOUD is. So more suggestions for reducing the stigma, again, can't emphasize this more, but we want to change our language and terminology. Using our person first language, meaning again, naming the person. We're going to talk about a person who has a substance use disorder or a person who is in recovery, not an addict. We want to continue to educate people on all of the different aspects that we've talked about. We want to personalize substance use disorders, primarily having people who have lived experience or are in recovery talking about this. We want to just make it more relatable, I guess. Having more people talking from a firsthand experience allows people to see that everybody can be impacted and can help reduce some of the prejudices and discriminations. Whoops. And of course, we want to highlight positive stories. So the more you can share in your communities or in your clinic stories of recovery and empowerment, this is a really important aspect. And also for the person in recovery, it's empowering to share their journey as well. And again, why should you share your story? Because it does help to reduce some of the negative stereotypes and attitudes. It encourages other people to seek help and it's healing. And since I have more of this presentation to do, we're not actually going to take a break and stop, but I want you to think about this. And if we have time at the end, we can come back to it. But imagine you go to the hospital and you're having severe chest pain and you're found to be having a heart attack, but this doctor says, nah, it's your fault because of the choices you made. You continued to eat that way and you continued to do those things. So you did this to yourself. And because you did this to yourself, we're going to give you a list of other doctors that you can call when you get out of here and cath labs that you can call. But the only way I'm going to give you some medication here at the hospital is if you agree that you're going to go to counseling and you're going to agree that you are going to go to counseling and learn how to take care of yourself. Otherwise, I'm not giving you this aspirin today. And then you complain that your chest is hurting even more. And so they kick you out of the hospital. So how would you feel if you were in this situation? This is really relatable to the experiences of somebody who has a substance disorder that goes to the hospital. So we're going to hope if we have time, we'll come back to this, but I want you to contemplate and think how stigma plays into this and what are some of the things that you can do to kind of help combat this. But we're going to transition into trauma-informed care practices now. So trauma-informed care is based on an understanding that recovery is possible and achievable regardless, for everyone, regardless of how vulnerable they may appear. So when we're thinking about treating substance use disorders, it's important to remember that many people who have substance use disorders or have any issues with addiction have likely experienced some type of trauma in their lives. And so trauma-informed care is a way that we kind of change how we're thinking and move from asking what's wrong with you to what happened to you. Again, we've talked about the shift in language. Now we're going to shift in this shift of perception because this moving from what's wrong with you to what's happened to you really does help us create a more supportive, safer environment for people to recover. So before we kind of dive into trauma-informed care, let's recap on what exactly trauma is. So trauma can be defined as an event or a series of events or a set of circumstances even that is experienced by an individual that is physically or emotionally harmful or life-threatening and that has long adverse effects on that person's functioning, whether it's their mental health, their emotional health, physical health, social, or even their spiritual well-being. And just like there was multiple layers of stigma, we have multiple different types of trauma as well. So if we look at our, in front of us, we have all the different circles. The smallest circle in the middle is individual trauma. This is something that impacts just one person. So whether it's injuries or an illness, or maybe it's even domestic violence or some sort of interpersonal issue, it's just something that has an impact on one person. Moving outward, we have family trauma. Family trauma is something that has happened to one particular family that impacts multiple members, but it's just one family. Beyond that, we have group trauma. So this is something that has an impact on a particular group. So it could be a group of people in the military that are serving in the war, or first responders, or emergency personnel during COVID, or, you know, et cetera. And then we have community trauma. Community trauma is where we have, it impacts a kind of a bigger, broader subsection than just group. And this can also be cultural and historical trauma or racial trauma. So something that has left a long, long lasting impact on that particular group or culture. And then even broader, we have mass trauma. And mass trauma is something that impacts like a huge number of people. So an example of a mass trauma that we have all been a part of is the COVID-19 pandemic. So that is something that was very widespread and impacted all of us on some level. So we can also think of trauma as a big T or little t. When I describe these, it doesn't necessarily mean that the big T's have more of an impact or a negative impact than the little t's, but just that they kind of are generally more a mass trauma, oftentimes, or affects more people than the little t's. So those are things like war, natural disasters. Some of the big T's for an individual are our childhood SA or physical abuse, getting in car accidents, witnessing deaths, or being a part of domestic violence. Little t's include emotional abuse, neglect, failure experiences, phobias, losses, kind of some more chronic stress at work or school, bullying, or DV. Again, somebody experiencing a big T doesn't mean they have less or more or less impact than somebody experiencing a little t, because everybody's experiences are very, very different and unique. So when we're working with somebody that has experienced some level of trauma in their lives, sometimes that trauma can come out in their visit and look like something very different. So it's really important to know that trauma, what trauma looks like as it presents in the clinic setting or in any other setting. But just because somebody doesn't say they've experienced trauma, it's important to recognize what a trauma response could look like so we can have more of an understanding of what we might be experiencing with that client versus what we initially thought we were experiencing with that client. So somebody coming into the clinic that has experienced trauma or is a trauma survivor, emotionally could be very dysregulated, angry, frustrated, could be in a panic, they could actually have a lot of shame, or just different emotions or emotions other than what we would typically expect a person to have in that situation. Behaviorally, they might be even more impulsive or even aggressive, hyper-vigilant, so hyper-aware, or they could completely kind of be diminished, pulled back, avoiding talking about having issues with sleep, or behaviorally engaging in more of this high-risk behavior. And of course, we see a lot of these same things in people that are experiencing substance use disorder as well. More examples, cognitively, we might see, again, they're very distractible, they're not able to focus, or they have difficulty following a series of asks or steps that might be set for them, or if they have trouble getting the language when they're trying to speak, that can be a symptom as well. Trauma can also look like somebody not having the ability to really put trust into somebody else, so they might not share with you, or they may share too much. They might struggle with getting close to somebody else, or they could be avoidant or ghosting people, including care providers, and just generally could have a higher level of sensitivity and or fear of being rejected or disliked. This is same information, more of the impact on trauma and what we might see in people. Again, this is emotional, behavioral, physical, developmental, cognitive, interpersonal, and also there's a spiritual component as well. Somebody that has experienced trauma in their lives could possibly have more depression, loneliness, that could lead to more feelings of abandonment or even a loss in their faith that they might once have had. Over time, this can really be experienced in decreased appreciation for life or just generally feeling like they have less purpose, I guess. The impact of trauma is, again, far-reaching and doesn't just impact one aspect of our well-being. It can really play a part in all of our well-being. Now, we're going to dive more into what the approach of trauma-informed care looks like. It's more than just a checkbox in our electronic medical record. It's more than just a set of practices. It's really an entire transformational approach in our organization that recognizes the impact of trauma on individuals and the people that we're serving. Trauma-informed care emphasizes the importance of creating an environment, both physically and emotionally, an environment that feels safe for everybody and supported and empowered. The approach is really grounded in understanding and responding to trauma in ways that prioritize safety. Again, the goal is to really help people build a sense of control and empowerment in their lives and to be a part of their care plan as well. Trauma-informed organizations are really designed to be aware of potential triggers that trauma survivors might face in our healthcare setting. We're not re-traumatizing people. Again, the more we can acknowledge trauma, the more we can provide a supportive healing environment for people. I'll click through these. There we go. Okay. Traumatic experiences really do impact an individual's overall health and well-being, as you saw earlier, but this also makes a difference on how they're possibly engaging in their services for treatment or any healthcare services for that matter. It's important for us to respond and understand when somebody might disclose that they've experienced trauma, whether it's in the past or in the present. It's important for us to recognize the impact that trauma has because that allows us to create and manage risks more effectively. Trauma-related symptoms and behaviors that we talked about earlier are often coping mechanisms that people develop as a way to get through those experiences where they might be re-traumatized. In the concept of trauma-informed care, there are what we call the four R's. Number one is realization. This is referring to understanding and acknowledging the widespread impact of trauma and its potential manifestations. Recognition is number two. This involves recognizing the signs and symptoms of trauma in families, individuals, and communities. Number three is response. Emphasizing the importance of integrating the knowledge of trauma into our policies and procedures and practices that make responding to their needs effective. And then number four is resilience, which focuses on promoting resilience and healing among individuals who have experienced trauma so that we can provide them an environment to recover and thrive. So the four R's, realization, recognition, response, and resilience. So with that, it's important to understand that sometimes our services are inadvertently re-traumatizing our patients. So it's important to know what those services or those practices could be so that we can change those. So for example, not having enough privacy in our waiting rooms or in our clinic rooms, that can be a trigger. Unwanted physical touch, even if it's well intended, can trigger distressing memories for somebody. So even if it's a touch on the shoulder, sometimes that can be just enough to re-traumatize somebody. Of course, we want to really look at the biases that we have in ourselves. So thinking back to those stigmas, what might we have, our own stigmas or biases? We got to have that honest conversation with ourselves and looking at our biases on race, gender, ethnicity, sexual identity, or class or anything else. It's important to recognize that. The way we talk to our patients is really important. So approaching them in a partner, in a partnership, we're here together to work on approaching how we can get you the care you need versus I am the expert and you are the patient and you will listen to me. Again, that's not trauma-informed. And also that's leading into the next bullet point is only having one right way. We want to make sure we have a multitude of paths that can be taken. We have either or thinking or having two rigid of policies and procedures. So if we think back to our policies about, or we think back to some of the behavioral aspects that might come out in some of our trauma survivors, could be somebody has a hard time walking through the steps needed to get this task done or showing up to different appointments at a certain time. So maybe looking at how our policies can be tailored to fit the needs of people who have experienced trauma versus keeping them rigid. So why a trauma-informed approach matters for clients and providers. So implementing a trauma-informed approach benefits everybody. It doesn't just benefit the people who are receiving our care, but also the providers who are delivering it. Because when a client experiences care that acknowledges the response to their trauma, they are receiving better, more effective services. And then for us staff at the same time, understanding and applying trauma-informed practices helps us cope more effectively with the kind of emotional demands of our work, which helps us in turn have more resilience as well. So this approach contributes to better staff retention. It reduces turnover because it creates a more supportive work environment. So the, you know, of course, the more we're supported and in the work we do, the more we're able to be there for the patients and the clients that we are working with as well. So one way of thinking of trauma-informed approaches is also individual self-care and organizational workforce wellness. So again, trauma-informed care approach is really at an organizational level, starts with, you know, everybody has to play a part in this. And so as an individual care provider or somebody who works at the front desk, we may not be able to make all of the decisions in the world to create and to change our organization and make us a trauma-informed organization, but we can all do something to help play a part in being more trauma-informed. And one super easy, simple step is creating a coping kit or soothing kit for our patients and clients to have available, whether this is in the front desk, in the waiting room, or, you know, in our offices. But having something for people to engage with if they are triggered when they are with us is really important. So it's something as simple as creating a kit that helps people kind of re-ground into their senses. So having things to smell and taste and eat and touch and just things that we can help promote grounding into the present, because you never know when, you know, a person might be triggered by something, a story they're sharing or something. So it's important to have a tool for everybody to use if needed. And here's an example of a situation that happened to Brenda. She's a 20-year-old female. I want us to kind of think about this scenario and what could have been done differently. And yeah, I guess what could be a better way to approach somebody in this situation? So an emergency department of a busy hospital has a policy that requires nursing staff to confiscate the clothes of people who are admitted for self-injury or suicidal ideation. So the policy initially was developed to protect patients, right? To ensure they don't have a weapon or something that they can use to inflict harm on themselves or others. Now, Brenda, she's a 20-year-old woman who has experienced sexual assault at some point in her life. She never reported it, never talked to anybody about it, never got help for it. And she's admitted to the hospital for self-injury and is asked to take off her clothing and put a gown on, but she refuses. Now, the way this hospital chose to manage the situation is Brenda was held down by a male security guard while another nurse removed her clothes. And her, of course, her heart's pumping. She can't think clearly. All of these trauma responses start taking over. Her breathing gets shallower and her fight, flight, fight, fight, flight, freeze response kicks in. So the ER staff then use a chemical, so they use medication and physical restraints to subdue her and they call the police. So after talking about the physical, let's see, I don't think I'll go all the way back there. After talking about the different responses, the trauma responses that you might see in a patient in the clinic, when they're triggered, we can tell that this is clearly a lot of trauma responses coming up in Brenda. And we want to look at, okay, so their policies that they initially had sounded good, like they were well-intended to try to protect the patient and other patients in this situation, but clearly they probably did more harm than good and re-traumatized Brenda by following through with their policies. So this is an example of why it's really important to take a look at our policies, make sure they are trauma-informed so we can, this is a very big example, but still, how are our policies and procedures possibly re-traumatizing or triggering our patients and what can we do to change them? So some other examples are you're meeting with Sarah to complete some paperwork for some services that she requested. She's talking and kind of busy wrestling through her bag while you're talking and she can't really sit down and she's checking her phone constantly. She just can't seem to settle down and focus while you're talking to her. What do you think she might be experiencing and how can you help? And Andre, he agrees to go to mental health counseling in a team meeting, but then he no-shows for intake. And then during the follow-up appointment, he's again interested, makes an appointment, but then no-shows. So what's really going on with him and how can you do something differently to help him feel more comfortable or help him show up or whatever needs to happen? And so now we're going to talk a little bit more about how, as an organization, you all can integrate trauma-informed care into your approaches. Again, it's building a culture, really, of trauma-informed care because it's, again, not just checking a box or changing a service. It's really a comprehensive shift, a culture shift in your organization that really touches all aspects of your organization. So it involves all program activities, settings, relationships, and just the general overall atmosphere of your organization. It's important that everybody participates in this change from administration and supervisors to direct staff, even to janitorial staff, and involving the clients as well. It's important that everybody is a part of this transformation because, again, it's an entire change in the way of thinking and acting that prioritizes safety, trust, healing, and it's not a one-time event where we, okay, we're now trauma-informed. We're doing all of these things this way from now on. It's a continuous assessment of self-assessment and looking at how your organization is flowing, looking at how the policies are impacting the staff, how they're impacting the clients, and what kind of care the clients are receiving. So it's important to realize this is an entire shift, and it's going to take continuous assessment to make sure that you're evolving along the way. And we kind of talked about this already, but the difference that trauma-informed care can make is, of course, improve workforce wellness. This increases the sense of satisfaction with work, with the staff, reduces the amount of burnout and stress because it's really improving the organizational climate for everybody. This can also create better relationships between care teams. So medical might be more involved, or you'll be able to have a better working relationship between medical and mental health or whatever some of these different teams are within your organization. And for patients, there's just increased engagement. Patients have more follow-through on their appointments, so there's reduced no-shows. They're sticking to their treatment plans a lot more. They're able to follow through on referrals, reducing emergency room visits, and just generally more improved satisfaction with services. And then this slide just really kind of illustrates the concept of something called the parallel process. So the experiences of the clients, staff, and the organization really are interconnected. So for example, if a client feels unsafe, chances are the staff feel unsafe and the organization generally is unsafe. And the same thing goes with a client is overwhelmed, staff is probably overwhelmed, and the organization itself is overwhelmed. So by creating a more supportive environment for the clients, we're providing a more supportive environment for our staff, and the overall health of the organization is going to increase as well. There's a lot of other assistance that folks can get and organizations can get to help adopt trauma-informed care within their organization. But a really good tool is, you can find it on the SAMHSA website. It's the Guide for Implementing a Trauma-Informed Approach. It really does help kind of walk through all of the different aspects of trauma-informed care. So it's a great tool I like to share with folks. And this is just another example of the actual roadmap to trauma-informed care. So it doesn't just start out like, all right, we're going to implement this trauma-informed care practice. Step one could be this presentation today, being aware, getting kind of the foundation built to become a trauma-informed organization. What does trauma-informed care mean? Understanding what it takes to get to that point. And then once you start the implementation, and you're looking at your policies, and you're making all these changes, that is a circular improvement, process improvement plan. So you're, you know, you need to implement, and then kind of repeat. Implement, assess, and repeat, and you're just going to continue to go through that. So again, just reiterating that it's not a one-and-done situation. It's really important to take the time to get everybody involved and have an organization culture shift, and continual self-assessment, and making sure that you're providing ongoing assessment and training. And I see that we're almost out of time, or we're at time, so I'm not going to bring us together for a conversation. But again, this is just another food for thought. Thinking about the importance of incorporating trauma- informed care in your practices and in your organization. What are some of the things your organization is doing well as a whole? Where could you improve? And then also, because a lot of us are, you know, not the administrators and decision makers in our organization, but what are some of the small steps that we can take to improve in our own trauma-informed care practices that we do? And here is the, of course, the survey link that you can use to provide any feedback for today's presentation. So I think with that, that is my presentation. So we have one minute if there's any questions. If not, it was really great being able to work with you all, and maybe we'll continue to do more in the future. Yes, thank you, Stephanie. Thank you. Thank you so much, Stephanie. We will have this recording ready in about a week, I would say, so I will get that out to Jessica when we have that ready. But thank you all so much for attending all of these sessions and staying engaged. I know it was a lot of sessions in this series, but we really appreciate you, and thank you again for reaching out to the Opioid Response Network. Please feel free to reach out if there's anything that we can help with in the future or if there's any other training topics you might be interested in. But I hope you all have a great rest of your day, and we hope to see you soon. Thank you. Thank you.

stigma

trauma-informed care

substance use disorder

indigenous lands

tribal sovereignty

opioid use disorder

self-stigma

organizational change

patient outcomes