2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Promoting Recovery for Individuals with Unidentified Trauma and Co-Occurring Disorders

Advancement of recovery for individuals with Co-Occurring Disorders has been recognized as a significant principle for the transformation of behavioral health services. Co-Occurring Disorders is defined as a mental health disorder being experienced along with the presence of a substance use disorder. Customized attention and treatment for individuals experiencing co-occurring disorders provide the necessary supports to promote stability and continuity of care.

Individuals diagnosed with co-occurring disorders face many obstacles that impact their daily lives. They may experience increased challenges with obtaining affordable and appropriate housing, lack strong social supports as well as access to quality, accessible mental health and substance use treatments and supports. A greater risk of unemployment or problems at work as well as poverty or unstable income (Department of Mental Health, CPS Facts, DMH.MOU.Gov) are additional challenges experienced by individuals with co-occurring disorders. Co-occurring disorders impact 7.9 million individuals in the United States (SAMHSA’s 2014 National Survey on Drug Use and Health -NSDUH). Only 7.4 percent of individuals receive treatment for both conditions with 5.8 receiving no treatment at all (http://media.samhsa.gov/co-occurring/topics/data/disorders.aspx). Unrecognized trauma and its impact on co-occurring disorders creates additional challenges for individuals in their journey to recovery and wellness maintenance. The lack of support through innovative, comprehensive and personalized programs prevent individuals with unrecognized trauma and co-occurring disorders from thriving in their communities.

Evidence-based treatments such as Integrated Dual Disorder Treatment have shown to effectively provide quality of life for individuals with co-occurring disorders and help to address both disorders at the same time (https://www.centerforbp.case/edu/practices). Integrated models of treatment provide individuals with co-occurring disorders and unrecognized trauma with better outcomes (Jerrell, J.M. & Ridgely M.S. 1999, Impact of robustness of program implementation on outcomes of clients in dual diagnosis programs, Psychiatric Services, 50 (1), 109-112).

Programs that enhance an individual’s understanding of their diagnoses by providing ongoing psycho-education coupled with opportunities to be a part of a social /peer support model provide the necessary customized intervention for individuals to remain stable in their communities. Creating meaningful, self-directed futures is key to successful intervention. One such approach to intervention is the Personalized Recovery Oriented Services (PROS) model, a comprehensive solution that integrates rehabilitation, treatment, and support services for individuals with serious mental illness and substance use disorders. Key components of the model include services that are designed to engage and assist individuals in managing their illness, restoring their skills and supports necessary to live in the community. PROS services also provides an array of clinical services addressing individual needs; counseling, therapy and health assessments. There is availability of psychiatric evaluation, medical management and symptom monitoring.

The Mental Health Association of New York City’s Harlem Bay PROS program is a comprehensive recovery program designed for adults diagnosed with mental health and co-occurring disorders by helping to promote control of their lives and develop the skills that they need to effectively negotiate life’s challenges. Staff work collaboratively with participants to encourage and empower them to identify and pursue personal life goals, select the services that would best help them achieve their goals, and set their own pace for recovery. Participants are able to receive their treatment and individual support at PROS. A wide range of classes, matched with the participants’ interests, are available. The class schedule is flexible to better meet participant’s needs.

There are four services for participants to choose from:

  • Community Rehabilitation and Support (CRS) assists with restoring skills and supports necessary for independent living. They may include job exploration, exploring the world of education, and stress management.
  • Intensive Rehabilitation (IR) assists with attaining specific life goals, such as finding a job, returning to school and obtaining independent housing.
  • Ongoing Rehabilitation and Support (ORS) offers off-site support by a job coach, to address the needs of maintaining stability in the workplace after achieving employment.
  • Clinical Treatment (optional) includes psychiatry and nursing services that promote medication management, overall healthy living, and goal-focused therapy.

The class topics offered on a daily basis for all enrolled participants at the Harlem Bay PROS program include trauma informed topics such as Trauma Recovery, Healing Through Art, Dual Relapse Prevention, Seeking Safety and Resolving to Recover. With about 44% of all enrolled participants having been diagnosed with co-occurring disorders along with having experienced unidentified trauma, these topics provide a holistic approach to wellness and recovery.

Participants have provided ongoing feedback on how the Harlem Bay PROS program has provided them with individualized supports that have assisted them in reaching their goals. One such success story is Patrick* who struggled with anxiety and alcohol use for many years. Patrick spent a large portion of his adolescence in foster care due his mother’s substance use and subsequent death. His maternal grandmother also had a history of substance use and dependence on prescription medication which impacted on her ability to provide him with a stable home. He experienced unidentified trauma as a result of being placed in more than 7 foster homes and the specific traumas that he experienced during those years in placement are still unclear. Patrick enrolled in the Harlem Bay PROS program and bonded with staff members and several participants while actively being engaged in classes. He has received Ongoing Rehabilitation and Supports services along with actively engaging in the clinical services provided at the program. He was able to participate in an internship opportunity and most recently has obtained competitive employment. Now, he is sober and has a job that he loves. He still attends the program to help him maintain his sobriety, his mental health stability and to maintain his active social life with other enrolled participants. He is a reminder that programs that provide a holistic approach to individualized supports can assist individuals with unidentified trauma and co-occurring disorders.

MHA-NYC is committed to providing integrated, customized supports through our Harlem Bay Network PROS Program and we successfully provide these supports to 258 participants at any given time. We have a dynamic team of Advisors, Counselors, Team Leaders, Job Developers and Clinical staff that incorporate a strength-based, individualized and trauma-informed lens to the work they do each day to ensure that each participant is successful in reaching their goals.

Angela Mora-Vargas, LMSW is the Assistant Vice President of Programs for MHA-NYC and can be reached at amora-vargas@mhaofnyc.org.

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