Humane and Dignified Care Model | Nicole Breen Therapy

The Humane and Dignified Care Model (HDCM)

A systems-based framework for trauma-exposed and morally constrained roles

Nicole Breen MACP, CCC, LCT

Why This Model Exists

Standards of Practice for Counselling Therapists and Psychotherapists in Canada require that clinical work be grounded in theoretical knowledge, relevant intervention models, ethical guidelines, and evidence-informed practice. In principle, this allows clinicians to integrate theory, client needs, and context in a sound and responsible way.

In practice, however, many of the individuals I work with (various helping professionals, military veterans, and neurodivergent individuals) experience distress that cannot be adequately understood or addressed at the individual level alone.

Across these populations, similar themes emerge: burnout, moral distress, emotional exhaustion, and a growing sense of disconnection from work that once felt meaningful. These experiences are often framed as individual problems requiring greater resilience, better coping, or improved self-care. My clinical and systems-level experience has led me to a different conclusion.

The Humane and Dignified Care Model was developed to address a central gap in contemporary care culture: the tendency to locate suffering within individuals while overlooking the systemic conditions that reliably produce it.

Core Orientation of the Humane and Dignified Care Model

The Humane and Dignified Care Model (HDCM) is a care culture and systems-based framework that understands burnout, moral distress, and professional disengagement as predictable outcomes of strained systems, not personal failure.

While the impacts of inhumane systems are most visible in trauma-exposed helping professions, the underlying dynamics addressed by this model are increasingly present across the modern workforce. Care professions function as early warning systems, making visible the moral, emotional, and psychological costs of systems that demand sustained human output without providing adequate structural, ethical, or relational support.

At its core, HDCM emphasizes:

Trauma-informed systems, not only trauma-informed individuals
Shared responsibility rather than individualized burden
Role clarity and boundary integrity
Sustainable care over crisis-driven endurance
Dignity for both those receiving care and those providing it

Understanding stress in systems is not about lowering standards. It is about creating conditions where people can meet them without enduring harm.

Positioning Within Existing Literature

A growing body of interdisciplinary research supports the view that professional distress is often better understood as a systemic response rather than an individual deficit.

The Job Demands–Resources (JD-R) model demonstrates that burnout arises when job demands consistently exceed available resources, autonomy, and support.
Moral distress and moral injury frameworks locate ethical strain within constrained practice environments rather than individual weakness.
Trauma-informed organizational models emphasize that trauma exposure and chronic stress are shaped—and often amplified by leadership practices, policy decisions, and workplace culture.
Research on neurodivergent burnout highlights predictable patterns of exhaustion that arise from persistent mismatches between cognitive profiles and environmental expectations.

While these models are robust, they often remain siloed by discipline or profession. The Humane and Dignified Care Model functions as a unifying, cross-professional framework that makes visible the shared structural conditions shaping distress across care systems and beyond.

The Humane and Dignified Care Model (Visual Framework)

The HDCM is intentionally cyclical rather than linear. It illustrates how individual experience, organizational culture, institutional structures, and broader economic and societal forces interact continuously, producing compounding effects over time.

The framework is designed to be written into, allowing individuals, teams, and organizations to locate themselves within the system and identify how external pressures shape internal experience.

The Five Core Pillars of Humane and Dignified Care

1. Trauma Exposure as an Occupational Reality

Distress is evidence of exposure, not personal weakness. Trauma and grief must be recognized as occupational realities rather than individualized mental health failures. Systems carry responsibility for acknowledging what workers are implicitly expected to absorb.

Key inquiry: What emotional, ethical, or relational burdens are being silently transferred to individuals?

2. Moral Distress and Ethical Strain

Burnout often emerges when professionals know what good care requires but are constrained by time, policy, economics, or resource scarcity. Ethical strain reflects misalignment between values and permitted action.

Key inquiry: Where are people repeatedly asked to act against their professional or moral judgment?

3. Role Clarity and Boundary Integrity

Role creep, identity fusion, and the rewarding of self-sacrifice undermine sustainability. The most competent and conscientious individuals are often the most overextended.

Key inquiry: Where are boundaries blurred, responsibilities expanded, or meaning exploited without structural support?

4. Collective Containment and Culture

Humane systems create collective containers for grief, complexity, and strain rather than isolating individuals. Language norms, rituals, and leadership behavior determine whether suffering is acknowledged or silenced.

Key inquiry: How does the culture metabolize stress—privately or collectively?

5. Meaning Without Martyrdom

Meaningful work should not require disappearance, depletion, or silent endurance. Dignity must extend to both care receivers and providers.

Key inquiry: Does the system allow people to care with integrity without self-erasure (ie: people pleasing and self abandonment)?

Economic, Sociological, and Cultural Context

The HDCM is situated within broader sociological and economic realities that shape care and work systems:

Rising education debt among helpers and professionals
Aging populations and insufficient care infrastructure
Technological intrusion eroding boundaries between work and rest
Capitalist models that treat humans as inexhaustible resources

In my home province of New Brunswick, these pressures are intensified by demographic change and limited systemic capacity. These conditions are not background factors; they actively shape distress, sustainability, and ethical strain.

Beyond Individual Healing: A Societal Shift

Many therapeutic approaches focus on helping individuals reframe, cope, and adapt. While valuable, insight alone is insufficient when environments continue to punish difference, demand moral compromise, or normalize depletion.

The Humane and Dignified Care Model identifies a broader societal developmental issue: a structural mismatch between human nervous systems and the systems they are required to function within.

Helping professions serve as moral mirrors for society. The norms established within these fields shape how children learn about worth, pace, boundaries, and success. When care requires chronic self-sacrifice, those values are transmitted intergenerationally.

Intergenerational Modeling and Social Learning

Children learn about pace, self-worth, and boundaries by observing how adults exist within systems. If work requires chronic depletion and "quiet suffering," children internalize that success requires their own disappearance. Conversely, dignified and humane systems of care create a more sustainable society through intergenerational modeling.

Creating humane and dignified systems is not about comfort—it is about sustainability, moral coherence, and the conditions required for human life to flourish without forced adaptation or disappearance.

About This Work

The Humane and Dignified Care Model informs my clinical practice, consultation, training, and writing. It reflects an ongoing commitment to understanding distress within its full relational, systemic, and ethical context

January 5th, 2026