Dr. Wayne Carson, CEOACH Child and Family Services
Lena Zettler, MA, LPA, DirectorCook Children’s Medical Center, Psychology
Fort Worth, Texas
1999: Trauma in Tarrant County:Catalyst for Change In September 1999, a man suffering from untreated mental illness entered a local church,
armed with a semi-automatic gun and a pipe bomb, during a youth rally. There were around 150 individuals present. Eight people were killed, including the gunman and 4 teenagers. Seven others were injured. He had no previous criminal record.
Fort Worth Mayor Kenneth Barr turned tolocal mental health providers, requestinga plan for improving access to qualitymental health services for all residents ofTarrant County.
Memorial at Wedgewood Church
2000: Mental Health Connection Initial collaboration of pediatric service providers and community
agencies provided leadership, planning, and financial resources to develop infrastructure and goals:• Cook Children’s Medical Center• Lena Pope Home Inc.• MHMR of Tarrant County• City of Fort Worth • Fort Worth ISD• Child Study Center
MENTAL HEALTH CONNECTION of TARRANT COUNTY was established in 2000 and today has over 70 participating agencies and numerous private practitioners, advocates, consumers, and family members.
2007- 2011: Bridging the Gap Mental Health Connection
5 Year InitiativeAnnual SymposiaEvidence Based PracticeCreate Learning
Communities in 6 areas Met for 6 months Reviewed research Identified policy issues and
barriersPilot/Implementation in 5
areas based on EBP’s
2008: Trauma Implementation Team Trauma/PTSD Pilot programObstacles:
Identification and diagnosis of trauma in children and adolescents
Increased trauma experiences for children/ adolescents in Tarrant County: 2007 Texas DFPS - alleged
child abuse and neglect (up 55%)
2005 United Way survey shows increased perception of violence in home/ community/school (18-51%)
2006 Texas DHHS Hurricane Katrina evacuees remaining in Texas under age 18 = 25,740
2008 CCHAPS Survey5.5 percent of CCHAPS respondents say their child has been abused
or neglected, including physically, psychologically, sexually or has been a victim of gang threat. This equates to almost 34,000 children across 6 North Texas counties.
6.48 percent of CCHAPS respondents say their child has experienced something traumatic such as a natural disaster, accident, violence, neglect, or abuse. This equates to over 40,000 children across 6 North Texas counties
15.24 percent of CCHAPS respondents say that their child had accidental injury that needed medical attention in the past 12 months. This equates to over 94,000 children across 6 North Texas counties.
2008:TF-CBT in Tarrant CountyTF-CBT model proposed (Cohen, Mannarino, and Deblinger,
2006) EBP sponsored by NCTSNCultural AdaptationsProfessional Facilitation/supervisionCollaboration of 22 agencies, including pediatric mental
health service providers, hospitals, CPS, FWPD, and domestic violence service providers
T.A.R.P. (Trauma Assessment and Referral Process)Screening tool
Social marketing componentEducation/training
2009: Trauma ImplementationTrauma Focused CBT:
54 providers or administrators trained across 15 agencies
Bi-weekly consultation for 9 months
Partner with UT – Austin study
85 youth/families enrolled; 65 participated in 12 month follow up
Obstacles: Intake/referral navigation
different across agencies For example, some agencies
require CPS or police referral or child may be triaged to a higher level of care (inpatient psychiatric unit)
Access For example, some agencies
serve identified children in specialized settings (group homes)
2009 Bridging The Gap SymposiumAround 180 participants received Trauma training
Trauma and the Brain: Bruce Perry, PhD
Trauma Informed Policy: Janice L. Cooper PhD
The Science of Implementation: Allison Metz PhD
Trauma/EBP Lessons Learned
Therapist/Agency attitude towards EBP’s was positiveNeed for ongoing supervision/fidelityHighlight the overall problem of access to services in
Tarrant CountyNeed policy changes to support ongoing workRealize Implementation is a SCIENCE; real change
involves more than technical solutions to obstacles
2010: Pediatric Trauma in the Medical SettingGrand Rounds at Cook Children’s Medical Center by
Nancy Kassam-Adams, PhDHealthcare Toolbox (NCTSN, Children’s Hospital of
Philadelphia)“Supporting the Traumatized Child” School Nurse
Symposium and video conferences for school nurses provided by Cook Children’s Child Life, Trauma Dept, and CISD trained staff
2011 Trauma Committee Grant Submission:
Integrating Trauma-informed and Trauma-focused Practice in CPS Delivery; application declined
MHC Trauma Informed Committee evolved/ established
MHC: Table Discussions with MembershipLarge and varied interest
in spite of grant denial“What does a trauma-
informed community look like?”
“What resources do we have now and what do we need to develop?”
MHC: Trauma Informed CommitteeDefinition:
Trauma is defined as the experience of an event by a person that is emotionally painful or distressful which can result in lasting mental and physical effects. Trauma is defined by the experience of the survivor. What is traumatic to one person may or may not be traumatic to another. Trauma can affect anyone.
Vision:A community that understands and acts quickly with sensitivity to the needs of those who have experienced any form of trauma.
MHC: Trauma Informed CommitteeBroaden stakeholder base to reflect vision of “community”
TeachersFirst respondersJuvenile JusticeIntake staff who may not be clinically trainedUniversities
Explore NCTSN resourcesLocal networking and resource sharingDevelop webpage for information sharingDiscussions were relevant, respectful, and synergistic
Following intensive Implementation Leadership training by Ellen Kagan, MSW Georgetown Leadership Program
2012: MHC Trauma-Informed CommitteeComplex Trauma
Treatment Network (CTTN) Midwest Region Learning Community
Brad Stolbach, PhDTechnical assistanceFunded by the US
Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA)
National Child Traumatic Stress Network
CTTN Trainings and AssistanceComplex Trauma Training by
Brad Stolbach, PhD:Arlington, Euless, &
Watauga Police Departments
CPS supervisorsMHC membership and
community (around 90 individuals)
Cook Children’s Medical Center CARE Team
MHC Site visitCook Children’s Medical
CenterMHC Board of DirectorsJuvenile ServicesUT- Arlington faculty and
studentsTCU faculty
CTTN Southern and Gulf Coast Regional Conference in Houston15 attendees from MHC,
including parent/family partners
2012 Other Trauma Work:TarrantCares.org to include Trauma-informed servicesResource library for professional trainings offered by
agenciesAgency/organizational assessment project with UTA
graduate students in Mental Health and Social PolicyExplore universal screening and assessmentContinue First responder training:
Arlington PDMHMR Law Liaison programMental Health Assn. (MHA) trainings for police officers
2012: Other Trauma work:Cook Children’s Medical Center Trauma Department and
Trauma Support Services of N. Texas (TSSNT)collaborative Provides education, group counseling, and individual or family counseling to
families who have experienced medical trauma at Cook Children’s Emergency Department; LPC from TSSNT collaborates with family, and Home Health/Child Life staff
Cook Children’s Trauma Conference (110 participants)
TF-CBT competency required for all Lena Pope Home and Cook Children’s Psychology clinicians
NCTSN grant submission/declined
Where are we now?Cook Children’s grant pending to provide Trauma informed
Organizational Assessment and Trauma informed training in 2 local homeless shelters
2013 Cook Children’s to provide Trauma-informed training to Cook clinical and non-clinical staff ,and Executives, who serve/support collaboration in 3 homeless shelters (include MD’s, RN’s, van driver, VP’s, etc)
Trauma and compassion resilienceHow do we retain clinical workforce?Support for non-clinical staff
2013 MHC Forum on Trauma
Where are we now?Pilot with Crossover Children
(Juvenile Justice and Child Welfare)Birth to age 6Judge Boyd advocate; Tonya Green of
CASA; Aaryn Lamb, AttorneyTRBI and partnership with Dr. Karen
Purvis at TCU Child Development Team Treatment implementation Trauma-informed education for CPS
workers and attorneys
Ms. Lamb to speak at Texas Juvenile Law Conference in 2013
Mental Health Connection of Tarrant County www.mentalhealthconnection.org
Dr. Wayne Carson [email protected]
Lena Zettler [email protected]