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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

May 3, 201910

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.

May 3, 201911

Getting on Board - Public policymakers are catching on to science of toxic stress

Prestigious organizations collecting and reporting on data

May 3, 2019 Presentation Title12

The prevalence of trauma

May 3, 201913

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

May 3, 201914

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.


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.

May 3, 201916

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


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


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


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”


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


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


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


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


Bi-Monthly System of Care meetings


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.


• 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


Topper Academy


Law Enforcement


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


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


Questions


Contact Information:

Becky HaasTrauma Informed AdministratorBallad [email protected]


mailto:[email protected]

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