Creating Trauma Responsive Communities -Systems of Care that Work
May 3, 2019
Becky Haas, Trauma Informed Administrator
Ballad Health
Understanding ACEs
May 3, 20192
Impact of ACEs
May 3, 20193
Trauma and Brain Development
May 3, 20194
Moving from Awareness to Action
Implementing Trauma Responsive Services; SAMHSA Forum
2014
SAMHSA released a concept paper entitled Concept of Trauma and Guidance for a Trauma-Informed Approach
Recommendation:
“…communities (should) address trauma through a multi-agency public health approach inclusive of public education and awareness, prevention and early identification and
effective trauma-specific assessment and treatment.”
May 3, 20195
Implementing Trauma Responsive Services; SAMHSA Forum
Spring 2018“Though many communities across the nation are beginning to implement some of these SAMHSA recommendations, Johnson City clearly stands out as a leader in
embracing this model.”
~ Dr. Joan Gillece, Director
SAMHSA-funded National Center for
Trauma Informed Care
September 5, 2018 hosted a Forum in Johnson City to tell our story. First Ladies Crissy Haslam and Tracey Carney attended
May 3, 20196
Moving from Awareness to Action
Why educate your community about ACEs?
Eradicating child maltreatment (mitigating ACEs) in America could potentially reduce many things predicted by ACEs:
1. Alcoholism and drug use
2. The need for incarceration
3. Homelessness
4. Depression
5. Suicide
6. Domestic violence
~ SAMHSA Trauma Informed Approach
May 3, 20197
SAMHSA, the Center for Disease Control and the Hazelden Betty Ford Foundation all indicate ACEs are a significant risk factor leading to addiction.
“Over half of adult Tennesseans reported at least one ACE between 2014 and 2017, and about 17% had
experienced 4 or more.”
“In 2017, ACEs among Tennessee adults led to an estimated $5.2 billion in direct medical costs and lost productivity from employees missing work.”
~ The Economic Cost of ACEs in Tennessee, Medical Costs and Worker Absenteeism from Health Issues
Attributed to Adverse Childhood Experiences. The Sycamore Institute, February 1, 2019
May 3, 20198
Why educate your community about ACEs?
Imprisonment has not reduced state drug problems
May 3, 20199
1. 2014 Pew Charitable Trusts Report - prison data shows no evidence that incarceration reduces drug misuse
2. The absence of any relationship between states’ rates of drug imprisonment and drug problems suggests that expanding drug imprisonment is not likely to be an effective national drug control and prevention strategy
3. Study compared 2014 data from Tennessee and New Jersey. Tennessee drug imprisonment rank is 5th while New Jersey ranked 45th. Yet both states have comparable drug use rates.
~Pew Charitable Trust
Issue Brief, March 8, 2018
Trauma and Homelessness
1. The SHIFT Study, conducted by the National Center on Family Homelessness, identified trauma as one of the top two predictors for long-term residential instability. ~ SAMHSA website April 2016
2.Childhood adversities are found to be substantially overrepresented in homeless samples, and a history of childhood adversity has been related to particularly poor outcomes among the homeless.” ~ American Journal of Public Health, Dec. 2013
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Improving Community Health
In a subsequent study to ACEs involving 125,000 patients, Drs. Felittiand Anda, found that those who completed the ACE Study questionnaire as part of their medical history and discussed their ACE Scores with their doctors had a 35% reduction in their doctor visits and an 11% reduction in emergency room visits over the course of the following year.
~ Felitti & Anda (2010). The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: implications for healthcare.
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Getting on Board - Public policymakers are catching on to science of toxic stress
Prestigious organizations collecting and reporting on data
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The prevalence of trauma
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Around 65% of all substance abuse treatment clients report experiencing childhood abuse
Around 75% of women in substance abuse treatment report a history of trauma
Around 92% of homeless mothers have severe trauma histories
71% of children are exposed to violence each year
3 million children are maltreated or neglected each year
1 in 4 girls & 1 in 6 boys are sexually abused before adulthood
In a study of juvenile justice settings, 94% of children had experienced trauma
Trauma is not an excuse
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Adverse Childhood Experiences are not an excuse for drug addiction or criminal behavior –but rather provide an explanation for it.
What is predictable, is preventable.
Why create a community-wide system of care?
1.Most systems engage with victims of trauma
2. If a child is experiencing ACEs at home, it’s unlikely the child will be brought by the parent to see a mental health professional right away
3. However the child by law DOES have to go to school and may be enrolled in afterschool programs. Both can become trauma responsive.
4.TIC awareness needs to be included in all frontline services in order to mitigate the effects of ACEs.
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Community can make a difference
1. If children are living in a home subject to ongoing, toxic stress, we can mitigate the effects of these ACEs by having a trauma-responsive community.
2. Convey by training that you don’t have to be a therapist to be therapeutic.
3. Supportive relationships are the evidence-based practice shown to heal the effects of trauma.
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Benefits of a system of care
1. Individuals are very often involved across a wide spectrum of services. All service providers need to speak the same language and share the same understanding of trauma.
2. Agencies collectively and individually can champion resilience for clients served.
3. Community members will experience a reduction of re-traumatization by service providers
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Lessons Learned from the Johnson City System of CareHow We Began
1. 2014 First learned about Trauma-Informed Care
2. 2015 Attended 2 national conferences hearing Dr. Felitti and Dr. Joan Gillece and
became convinced educating our community was urgently needed
3. “The Notebook” - Created a large binder representing every kind of police
community partnership (i.e. juvenile justice, schools, advocates, healthcare,
housing, etc.)
4. Police are educators and have many community partners
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Collaboration
Becky Haas
Director, Community Crime Prevention Programs, Johnson City Police Department
Now – Ballad Health
Strengths: Training development, networking and building capacity among system partners, and organizational coaching
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Andi Clements, PhD
Professor, Department of Psychology, East Tennessee State University
Strengths: Survey instrument development, data collection, data analysis, grant writing and organizational coaching
Creating the “system”
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SAMHSA’s “Trauma-Informed Approach, Key
Principles and Assumptions”
1. 4 hour introduction to trauma and trauma-informed approaches. No prior knowledge about trauma is necessary.
2. Intended for a wide range of professionals
3. Forms the basis for more advanced work
4. Non-prescriptive
5. SAMHSA six pillars provide building blocks where to start in making an application
6. Provide trainees with practical examples of application in their setting
7. Training leaves participants with an expectation of use
8. Evaluation includes a commitment to make application within a self-imposed deadline
9. Developed dozens of variations of this training
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Community Saturation
1. No progress is too small
2. Train the trainer – 6 hour course
3. Organizations prepare for ongoing training for their employees
4. Trauma-Informed Care training is not “taught” but it’s “caught.” It needs to be shared with passion. Are you contagious?
5. Community Forums – film screenings, discussion groups, etc.
6. Identify community ACE Champions
7. Don’t forget to measure
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Johnson City Timeline
August 2015 Conference Call with SAMHSA’s National Center for
Trauma Informed Care to strategize
October 2015 Drs. Joan Gillece and Brian Simms provide training to 383 professionals at DP Culp
Center
January 2016 NCTIC provides “Key
Assumptions” draft course
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Becoming Trauma Informed is not a destination…it’s a journey
Spring of 2016 began to offer trainings to area
professionals
Summer of 2018 over 4,000 trained locally
June 2016 started bi-monthly Trauma-Informed System of Care meeting
April 2016-July 2018 64 trainings, 2 Paper Tigers
screenings, dozens of community talks and 146
trained in 4 Train the Trainer events
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Bi-Monthly System of Care meetings
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Key to moving from training to culture change – awareness to action
System affiliation does not require an MOU
Meetings include coaching and cheering
Johnson City System of Care now has over 50 agencies affiliated
Bristol, TN has launched a second area System of Care
Kingsport, TN and Smyth County Virginia are having early conversations
Writing a toolkit for the state
The Continuum of Care
• Trauma-Aware: Organizations aware of how prevalent trauma is and begun to consider that it might impact their clientele and staff.
• Trauma-Sensitive: Organizations have begun to 1) explore SAMHSA’s Six Principles of Trauma-Informed Organizations ; 2) build around the principles; 3) consider the adopting the principles; and 4) prepare for change.
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• Trauma-Responsive: Organizations begin to change their culture to highlight the role of trauma and resilience. All levels of staff are re-thinking routines and infrastructure of the organization.
• Trauma-Informed: Organizations have made trauma-responsive practices the norm. The trauma model no longer depends on a few leaders. Organization partners with other agencies to strengthen trauma-informed practices community-wide.
Cheering the Progress
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Topper Academy
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Law Enforcement
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POST Certified Trauma Informed Policing Training
Training for LEO in growing demand
Oklahoma City PD this summer
Implementing Handle With Care in partnerships with police and schools
Handle With Care – Johnson City, Erwin, Elizabethton, Hancock County, Sullivan County, Johnson County, Bristol, TN, and Lee County, VA
ETSU Brain Trust
Building Resilience through ACEs Informed Networking (BRAIN) Trust.
• College of Medicine: departments of pediatrics and psychiatry (and the center of excellence for children in state custody, which is in psychiatry)
• College of Arts and Sciences: departments of psychology and biological sciences
• College of Pharmacy: department of pharmaceutical sciences
• College of Education: department of counseling and human services and the center of excellence for early childhood learning and development
• College of Public Health: department of biostatistics and epidemiology
May 3, 2019 Presentation Title30
Ballad Health Trauma Informed Strategies
Strong Starts for Schools
Schools receiving training before 2019-2020 school year: Erwin, Elizabethton City, Johnson, Hancock, and Buchanan Counties, Bristol VA
Systems of Care
Johnson City and Bristol, TN
Trauma Responsive Workforce
Resiliency Centered Healthcare – 1st hospital trained by end of April (21 hospitals/18,000 team
members)
July 11 – First Conference planned
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Questions
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Contact Information:
Becky HaasTrauma Informed AdministratorBallad [email protected]
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