Social Inclusion and Trauma Informed Care
Moderator: Chris Marshall
September 10, 2009
1:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question-and-answer session, at which time you may press star 1 to ask a question. Today's conference is being recorded. If you have any objections you may disconnect at this time. And I would now like to turn the call over to (America Paredes).1 Thank you. You may begin.

(America Paredes): Thank you. Hello and welcome everyone. Good afternoon to those on the east coast and maybe good morning, early lunchtime, for everyone else.

I just want to welcome everyone to this virtual training teleconference, Social Inclusion and Trauma-Informed Care, sponsored by the SAMHSA Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health, which is also known as the ADS Center. Michelle Hicks was going to be moderating our call today, but I will be doing that. My name is (America Paredes) and I just hope everyone will find the information that we share today valuable.

If you have not been able to access the presentation files that will be used today during the presentation, please access our Web site at http://www.promoteacceptance.samhsa.gov. On the left-hand side of the screen you will locate the Featured Pages section and the second link down will give you access to the presentation files. You will need to scroll to the bottom of the screen to locate the presentation files on that page. If you would like to reach us, you will find our contact information listed on slide number 2.

Our presentation today will take place during the first hour and will be followed by a 30-minute question-and-answer session. At the end of the speaker presentations, you may submit a question by pressing star 1 on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it was received.

On hearing the conference operator announce your name, please proceed with your questions. After you've asked your question, your line will be muted. The presenters will then have the opportunity to respond. These instructions are repeated on slide number 4.

If we do not get to your question today, please feel free to email the ADS Center and ask questions or follow up with us. We can also put you in touch with the presenters of today's event.

Within 24 hours of this teleconference you will receive an email request to participate in a short anonymous online survey about today's training. Survey results will be used to determine what resources and topic areas need to be addressed by future training events. The survey will take approximately 5 minutes to complete.

Before we begin, please let me say that the views expressed in this training event do not necessarily represent the views, policies, and positions for the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

Please advance to slide number 5. We'll begin with our first—description of our first presenter and we will have three presenters today. Our first presenter will be Helga Luest.

Ms. Luest is a recognized expert in the field of trauma, including trauma-informed care, the healing process, and the navigation of the criminal justice process for victims and victim rights. She is a national keynote presenter and trainer with a background in public relations and communications.

As President and Chief Executive Officer of Witness Justice, Ms. Luest leads advocacy, program development, and contract initiatives, including subcontracts, to provide communication and outreach activities for numeral Federal technical assistance contracts.

In her career, Ms. Luest has received many awards for the exceptional social marketing campaigns, including two Telly Awards for television public service campaigns, an International Association of Business Communicators Award for best campaign, and a 2009 Silver Addy Award for conference materials.

Ms. Luest is also a survivor of a random attempted murder that took place in Miami, FL, in 1993, and her personal experience drives her passion for this work and informs her approaches in advocacy, education, and programs.

Our next presenter will be Rhonda Elsey-Jones, who is currently the program manager for Baltimore Rising Incorporated's Mentoring Children of Incarcerated Parents, a program providing mentors for children whose parents and/or close family members are incarcerated. A survivor of childhood trauma, Ms. Elsey-Jones overcame substance abuse and as such is familiar with the justice system. For nearly 20 years, she worked with individuals in the recovery process, offering assistance to people with issues related to substance abuse, trauma, mental health, and incarceration.

In 2001, Ms. Elsey Jones offered her services to the development of TAMAR's Children, a pilot program for pregnant women who were incarcerated. Her personal interest and lived experiences led her to a workshop on the development of the TAMAR's Children Project, ultimately working as their Case Manager and Assistant Director while pursuing undergraduate, graduate, and doctoral degrees.

Ms. Elsey-Jones is a strong advocate for trauma survivors, individuals with mental health diagnoses, people who have been addicted, and people involved with the justice system and youth. She speaks throughout the Nation on a variety of trauma-related topics. Ms. Elsey-Jones is an active board member for the National Women's Prison Project. She recently served as consumer co-lead with Helga Luest developing a situational analysis and marketing plan for the Center for Mental Health Services' National Trauma Campaign.

Our final presentation will be from Dr. Joan Gillece. Dr. Gillece is the Project Director for the National Coordinating Center for the Seclusion and Restraint Reduction Initiative. She is also the Project Director and Principal Trainer and Consultant to CMHS National Center for Trauma-Informed Care.

Prior to coming to the National Association of State Mental Health Program Directors, Dr. Gillece was the director of a special needs populations for Maryland's Mental Hygiene Administration. She was responsible for developing and sustaining services for Maryland citizens who have serious mental illnesses and may also be incarcerated in local detention centers, homeless, suffering from a co-occurring substance use disorder, or deaf. She has been successful in obtaining private, State, local, and Federal funding to create a patchwork of services for special needs populations.

Dr. Gillece obtained funding to develop a program for pregnant, incarcerated women and their newborns. This program, called TAMAR's Children, was designed to break the intergenerational cycle of despair, poverty, addiction, and criminality. She has spoken extensively on developing model systems of care through partnerships across agencies.

Dr. Gillece has provided consultation to numerous states on developing innovative institutional and community-based systems of care for individuals involved in the justice system through the GAINS Center and the National Institute of Corrections. She has national experience in working with diverse service agencies on developing systems of care that are trauma informed.

We will now hear from our first presenter, Helga Luest.

Helga Luest: Thank you so much, (America), and hello everybody. In preparation for this presentation, I actually heard from quite a few of you that are attending today and just had a lot of inquiries about how social inclusion and trauma-informed care tie together. So before jumping into the slide portion of my presentation, I wanted to kind of set the stage and bring a little context that I think might be helpful.

When we look at the social determinants of health, the conditions in which we're born and grow and live, where we work and how we age, those are determined by a distribution of money and power and resources at the national and local levels. And all of that is influenced by policy choices.

I see my presentation moving here, but I didn't move it. Okay. So if we could just keep it on that slide for a little bit here.

At any rate, the—these social determinants of health and, you know, how they're distribute—determined by the distribution of money, power, and resources, all of that is ultimately influenced by policy. And these policy decisions, of course, impact our agencies and the programs and services that are publicly funded in our communities.

As an advocate, this is why I believe that understanding how trauma impacts social inclusion is so important. Trauma itself affects these social determinants of health, the condition of living and learning and growing and working and aging. And so without considering trauma in that landscape, social inclusion and wellness in life is much more difficult to achieve.

Survivors, providers, families, community leaders, policymakers, all play a role in making sure that these social determinants of health look positive for every person. And so trauma education and awareness and implementing trauma-informed change is important for all of us.

To give a little example, I would like to do something that I rarely do, which is talk about my personal experience with violence. And back in 1993, I was on vacation with my mother, and we were pushed off the road while driving a rental car and two assailants smashed into the car and proceeded to nearly beat me to death in front of my mom. That incident changed everything for me. And I was 24 years old at the time.

I can tell you that the impact, almost immediate, in my life was that I became unplugged. And I use that word deliberately because I think it's how so many survivors feel when they experience a trauma. It's not just the common response that people have to isolate sometimes and retreat inward, but it's the lack of ability to connect and be socially included.

And so for me, I was 3 millimeters away from being quadriplegic. I had massive physical changes that I needed to deal with. My relationship with my family drastically changed. My mother had a very different trauma response to what happened than I had.

She didn't want to talk about it, didn't want to think about it, didn't want to discuss my injuries or the medical care that I needed, and my father stood by her. So for the first time in my life, the parents that I thought would always be there at time of crisis, they couldn't because of their own needs and my mother, you know, and her own way of coping, so unplugged from my family.

My friends, as a 24 year old, you know, we would often go out clubbing and doing sports and things like that, because of my physical injuries and also the lack of spirit that I was feeling at the time, I just didn't really want to engage in that and I became disconnected from my friends.

My faith community had a very interesting response. They more or less told me that I should thank God that I was alive. And, you know, for me, I felt like they just totally didn't get it, that one might wonder why a situation like that would happen or why God would let something like that happen to begin with.

So there was also the involvement that I had as a witness in the criminal justice system, one that is, I think, for many survivors, further traumatizing and very difficult. And then financial debt from medical expenses, and ultimately I ended up losing the job that I had, which was as a television news producer. So, you know, it affected every aspect of my life.

And because trauma and its impact was not understood by my family, friends, employer, my faith community, those in the criminal justice system, and others, even my doctor didn't recognize how sleep disruption was a part of my trauma, you know, and I think that I experienced a pretty significant social disconnect, the opposite of social inclusion. I felt very unplugged from anything that had meaning in my life and my quality of life was very little back then.

What I learned along the way in healing from that experience was that healing happens in relationships. And those healing relationships are fostered when trauma is understood. And trauma has to be understood for those relationships to really develop. For trauma survivors, social inclusion and plugging back in requires an understanding of trauma.

So I think where we're very fortunate is that the Center for Mental Health Services understands how important this is. And they've been working to raise awareness about the nature and impact of trauma and the need for trauma-informed care. And there are a lot of very positive things that happen from that as a result.

I see that the presentation is moving all over the place here.

America Paredes: Yes, if we can have—I'm interrupting you, Helga, I'm sorry. If we can just have everyone not touch the presentation and let the presenters scroll through their own. I know you guys are interested in seeing what else is out there, but if we can just have Helga and Rhonda and Dr. Gillece scroll through the presentation, so that we don't get out of place. Thank you very much. Go ahead, Helga.

Helga Luest: Thanks, because I, yeah, I'm going to jump into the slide portion of my presentation now. So back in 2008, the Center for Mental Health Services funded the development of a situational analysis and a marketing plan for a national trauma campaign.

Witness Justice was contracted to do that, so I did the writing of both the situational analysis and marketing plan with my partner Rhonda Elsey-Jones and James Radack who was a consultant working with us as well, and we had a fantastic steering committee that gave us some great insight and reviewed all of the work that we were doing along the way.

The situational analysis looked not only at the prevalence and nature and impact of trauma, but the role that both community and media environments play in education and improving social inclusion for consumers and survivors. The situational analysis was an exhaustive body of research really that looked at all kinds of studies and just different models that addressed trauma. And then also looked at what other national organizations were doing in outreach and how effective that was.

What we found in the situational analysis is that trauma is very common in the United States. When you think about the prevalence and how many people in our communities have been affected by abuse, neglect, disaster, terrorism, war, and violence, that's nearly every family in this country has been affected in one of those ways. So, you know, this is something that's broad sweeping in our communities.

Trauma is a universal experience for people living with mental health concerns and co-occurring disorders. People with mental health concerns are more likely to experience trauma, that is interpersonal, intentional, prolonged, and repeated, occurring in childhood and adolescence, and may extend over the lifetime.

And then we also found that many ethnic and racial groups have been negatively impacted by historical trauma as well as intergenerational cycles of violence and substance abuse. We see that a lot in our Native American communities and also in the African American community, where historical trauma is significant.

And then trauma histories among mental health consumers largely go unaddressed. The question of what happened to you, you know, so often is one that is not asked of consumers. Left unaddressed, trauma poses dire consequences to the recovery and well-being of consumers and their families and their communities.

And I think that that's also illustrated by the ACE Study, the Adverse Childhood Experiences Study, that was done a little over a decade ago, that showed that individuals with early childhood traumas have a shorter life expectancy. And that's, you know, just one aspect of how it's impacting an individual.

Further findings of the situational analysis: the trauma-informed interventions for people with mental health and substance use concerns are effective but not readily available. And I think that, you know, the research that we did showed that while there's interest in trauma-informed care, that implementation of trauma-informed care has a long way to go still.

While some research exists, attitudes and beliefs among the public, consumers, and providers about the link between trauma and mental health are largely unknown. And media interest in the link between trauma and mental health is significant. So we're in an environment here where the media is ready to sort of jump in and look at this issue and it's one that's affecting communities so significantly.

Finally, many organizations are involved in trauma response activities, like crisis intervention with the Red Cross for instance, but there has not been a national campaign that focuses on trauma and its link to mental health. And, you know, I'd just like to add to that, its link to mental health or its impact on social inclusion. And I think trauma has a really—trauma experiences have a really significant impact on social inclusion.

A call for national education. The quote on this slide here, on slide 14, comes from the addiction treatment and recovery caucus in a letter that they sent to then-President Bush back in 2006. So I, you know, see this quote here as sort of being foundational in a way of laying the case for further education in our communities.

And I think it's really significant to have our national leaders speak out as they did and the quote is, "It has become more clear than ever that psychological trauma is a primary but often ignored or overlooked factor of health, both physical and mental, with survivors of violent crime, abuse, disaster, terrorism, and war." And then it talks about, "A public education and awareness campaign is a necessary and cost-effective first step to help alleviate this crisis."

So the creation of the situational analysis and development of a marketing plan that the Center for Mental Health Services has created, really directly, I think, responds to the letter that was issued from Congress to the President and, you know, now 3 years later we're really in a good place to work on public education.

So what is social inclusion? I talked a little bit at the beginning about this, but social inclusion focuses on social relationships that adequately allow a person to feel included. Those relationships happen in every aspect of life and living, so where we work, where we live in our homes, the communities in which we live, where we—the faith communities where we may spend time, other social groups, also where we receive services.

And social inclusion embraces the trauma-informed philosophy of equality and meeting a person where they are. It's based on relationships where trust and mutual caring transcend specific settings or context. And, again, you know, this is—just all goes back to the community.

So the importance of social inclusion and where social inclusion really needs to in—occur, I sort of mentioned these already, employment, education, housing, social supports, but really just throughout the community. Without social inclusion, stigma and discrimination will be impossible to overcome and total wellness for survivors and consumers will be difficult to achieve.

Moving on to sort of where all our community players can effect change so that we can hopefully achieve social inclusion for survivors of trauma, public education being, you know, of course very important here and something that the Center for Mental Health Services is focusing on and building that understanding of the nature and impact of trauma and how people cope so that those means of coping are better understood and not looked as symptoms but as strategies to help somebody in the aftermath.

Increasing interest in and access to trauma-informed care, sort of a no-brainer there, but really important to try to facilitate the implementation of trauma-informed care.

And then fostering those healing relationships, and I think things like peer support and intentional—the intentional organizing of peer groups in communities, I think that that's a very important step to fostering those healing relationships. But giving a survivor also some information on how it can be a very natural response to feel unplugged in the aftermath of violence. And maybe some strategies of how to stay plugged in and connected to their social networks.

Understanding that education needs to happen beyond human services to reach the goal of social inclusion, and that's again getting back to the, you know, sort of the core of, while it's so important to have our systems of care not do more harm in further traumatizing someone and be effective in their service delivery, it's also really important for those that we—as trauma survivors those the we connect with every day at the community level for them to understand the nature and impact of trauma and for them to understand what it means to take a trauma-informed approach in their relationship with a survivor.

So for the National Trauma Campaign, the marketing plan that we developed focused on families as the potential bigger-picture audience as our target to really try to build understanding and awareness. And we examined the audience of families from three different perspectives: inner city, where there's a lot of violence; rural where there's significant struggles with access in general and also isolation; and then military families, where we're seeing just a really profound impact on military families with our returning soldiers and a lack of understanding of how high levels of adrenaline and startle response and trauma triggers all play into some of the struggles that families experience after reintegration.

Some strategies that you all can consider as you're thinking about responding locally, a campaign that leads to social inclusion has to start at the grassroots level and in the community. And that means doing what you can in your communities to help inform service providers and individuals and organizations and just helping them to understand the nature and impact of trauma.

Look at activities that build understanding and break through stigma and lessen discrimination. And then, develop a trauma-informed campaign with survivor and consumer leadership in implementation.

And this kind of leads to my final thought and a really good segue to a fantastic presenter, Rhonda Elsey-Jones, who's going to be following me, but the importance of telling the story. And I think that this is something that's—that resonates so much with people when they can hear how someone has been able to overcome and find their path, how they've been able to achieve resilience—resiliency.

But there's nothing more compelling than hearing someone's story of survival and healing and resilience. And if we can use those stories, if we can tell those stories in a way that helps people understand how social inclusion can be achieved, and those healing relationships, how those are developed along the path to healing, I think then we, you know, as a culture have a much better opportunity in seeing people heal and stay connected.

So that's the end of my presentation. My contact information is here for anyone who wants to be in touch after the presentation one on one.

America Paredes: Thank you, Helga.

Helga Luest: Thank you.

America Paredes: And I am advancing to slide 23. We will be hearing from Ms. Rhonda Elsey-Jones. Rhonda.

Rhonda Elsey-Jones: Hi, everyone. I'd like to start by talking about a couple of quotes actually. The first one is "Although the risk and contradictions of life go on being as socially produced as ever, the duty and necessity of coping with them has been delegated to our individual selves," said by Zygmunt Bauman.

The other one is, "The healthy social life is found ... " I'm sorry. I'm not moving. Okay. "The healthy social life is found when in the mirror of each human soul the whole community finds its reflection and when in the community the virtue of each one is living." Rudolf Steiner.

Those two quotes remind me of two things that have always been very important to me, because I grew up in a very violent home. One is I am my brother or my sister's keeper and the other is about carrying the wounded. When I was in a doctoral program, we read an article in the (Hero) and I remember the instructor asking "How far will you carry the wounded?"

And it hasn't been until recently that I've really come up with an answer to that. And that answer has to do with wellness or wholeness or empowerment and all those things that are included in social inclusion. And what I realized was, I will carry the wounded to life but not to death.

So in order to talk about social inclusion, I must first talk about social exclusion. Social exclusion is when people or groups of people are excluded from various parts of society or have their access to society or services impeded. It also occurs when people—I'm not moving again. It also occurs when people suffer from a series of problems such as unemployment, discrimination, poor skills, low income, poor housing, high crime, family breakdown, and ill mental and physical health.

Social—individuals who have experienced trauma and have been diagnosed with mental illnesses are also excluded from their families and society because of the secrets they have to keep, the experiences they have had, their feelings of fear, isolation, shame, guilt, blame, unworthiness, et cetera.

Trauma breaks down, really breaks down and breeds—breaks that—breaks a person down, a family down, a community down. It breeds secrets, isolation, disconnect, separation, and it just leaves a person fragmented. In my house, growing up as a trauma survivor, once—I think about this often, we did not really talk or communicate. But we did—and we also learned not to tell. I can't really remember if we were told not to tell or if we just knew not to tell. So we stayed wounded and violated for a lot of years.

Trauma, it's like, it breeds isolation and then from that our behaviors are what are diagnosed as mental health disorders, behaviors we know now are adaptive. And then from that oftentimes we have physical illnesses.

Can you move that? Okay. This is from the Women, Co-Occurring Disorders and Violence Study. Women with abuse and trauma histories face a range of mental health issues including anxiety, panic attacks, major depression, substance abuse, personality disorders, dissociative identity disorders, psychotic disorders, somatization, eating disorders, posttraumatic stress disorder.

But also what we know from the ACE Study, and that's not on one of the slides, is that that we also have physical disorders. The physical disorders are things like migraine headaches, gastrointestinal disorders, chronic fatigue, fibromyalgia, muscle disorders, things like that. So we know now that from trauma, we have substance abuse, we have diagnosis of mental health disorders, and we have physical disorders that also are—can be related with the trauma.

Social inclusion is based on the belief that we all fare better when no one is left to fall too far behind and the economy works for everyone. Social inclusion simultaneously incorporates multiple dimensions of well-being.

One of the things that I learned, when I first was invited to a social—to an introduction on social inclusion, the first thing that came to my mind was how related it was to peer services, peer support, things like that, and just how innately we know that we can help another person who has been wounded as we have.

Social inclusion occurs when individuals are educated, empowered, nurtured, learn to advocate for themselves, and begin to advocate for others. This cycle of wholeness and wellness continues. As I heal, I assist others in healing.

That's like that old thing that people used to say, each one to each one. And so as we heal, and I want to go to the wellness component of social inclusion. Wellness is a concept. It's not just a thought or "I'm going to be well." It's a way of living. It's the thought processes. It's the change in—it's the knowing of what you believe as opposed to growing up with the belief systems of your mother or your grandmother and things like that. When you believe that you can be healed or whole or complete, everything about you starts to change.

Trauma, I want to go to trauma-informed services and what aren't trauma-informed services, because a lot of individuals aren't healing because they aren't getting trauma-informed services.

Trauma-informed services are not agency centered or focused, they don't believe in the philosophy we got to break them down to build them up, they aren't condescending, they aren't demeaning, they aren't forced treatment, they do not have consumer involvement. These are services that aren't trauma-informed. Can I get some help? Okay. They—there's no power struggle, they're not punitive, they're not quantitative, they're not reformative, they're not shaming and blaming.

And all of these—those services that I've just described are more violating to an individual who is a trauma survivor and an individual who has mental—who has been diagnosed with mental health disorders.

Trauma-informed services are consumer driven, they are informative, they are hopeful, they are safe, nurturing, trust building—let me see—they are respectful, empowering, based on secure attachments, person centered, individualized, and flexible.

And why I'm saying this is because individuals who are trauma survivors have been wounded. They have been violated. They—it's very difficult to form or even try to form a relationship with one—with someone when you have been consistently violated. You don't trust them. And so in order to build the person up, you have to nurture them, you have to empower them.

I know sometimes educationally that's not what's being taught to us. But also we must kind of focus on what we were taught educationally produces professionals who burn out quickly. And that's because they really aren't aware of how to better service the population of consumers.

Another thing that I want to interject, which isn't on a slide, is trauma survivors are oftentimes re-traumatized with those who are providing services for them. We—when I realized that I was a commodity to a provider, I stopped allowing them to just do to me what they wanted to do.

They, you know, we are worth a lot of money, consumers, and as we grow and are educated and are empowered and heal, we are more likely to be able to speak and advocate for ourselves. And as we advocate for ourselves, we realize the power that we have. But that power is not there when we aren't given the proper services.

Trauma-informed services do no involve power struggles or mandates or absolutes. Collaborations or consensus, they—I'm sorry, they are collaborative and not—consensus. They are—they build our self-esteem. They bring out the true person, our whole being. They are focused on not what we haven't done or what we've done in our past; it's about bringing us to our fullest potential, which is what social inclusion is all about.

It's having everybody on an even keel, productive and living in harmony and, you know, not continuing to violate people. Some of the reasons, I believe, people are reluctant to change, especially trauma survivors, is they are afraid. Oftentimes they feel like they haven't been given the information or the equipment to change. They've been told for a long time that they aren't worth this or they aren't worth that, they can't do this or they can't do that. But when you're looking at change from well—from a wellness perspective, it's all about knowing that you can do, knowing that you are capable.

And I understand that for years you may have been involved in services that have told you you're always going to be where you are, but I would like to share with you my experience and the experience that I had working with consumers as a professional. I am a holistic practitioner and so I actually got involved, my first venture was in massage school.

And because of my experiences, I realized I didn't know safe touch. So for years I had pondered with the idea of going to massage school. And I just made up my mind that I would go. The first class that we had was about safe touch. So that kind of let me know that I was right where I was supposed to be.

And what I also learned was a lot of the things that I believed kept me right where I was. So as I started to learn new things, one of the things that kind of gave me this awesome awakening was when I realized a lot of things that I thought and a lot of fears that I had were really not related to my belief system. They were things that were put upon me and told to me and just embedded in me. And that first experience just kind of felt like some weights were being lifted off of me.

And I'm saying this because as you change or as you, as you're even willing and wanting to change, things will start happening. People will offer you information that will assist you in your development. Going from having to depend on others, because that's oftentimes what happens to consumers, to stepping out that first time on oftentimes your blind faith can take you a long way. And just the thought of knowing that you can possibly go past where you are will assist you in going through a healing process.

One of the things that I did with the women at TAMAR's Children was, I had a women's healing group. So I introduced them to things like meditation, and yoga, and sound therapy, and imagery therapy, and things like that, which coincidentally are now being written up as healing modalities by the quote unquote professionals.

What I—what we also learned was being present moment oriented. When you're in the present moment and body oriented, you aren't going back through anxiety and apprehension and worry and guilt and all those things. So—and I'm saying this because I would encourage you to look for things that accentuate what you already have. And that is because there are oftentimes more things coming out. And as you grow and develop in these things, you'll find that you become more social.

Peer support, I'd like to talk about that. The peer support that is offered helps you become more sociable, and as people become more sociable, they start on the healing process oftentimes because they realize that they aren't the only person—they aren't unique in what they've been through. And that uniqueness is kind of what keeps us—or that thing we think is uniqueness is oftentimes what keeps us so isolated. Social inclusion is all about advancement, getting involved with other people, knowing—learning that you have a potential and you can reach it, and ...

I'm kind of lost on where I was, so I'll go to the slides. Can—and I—oh, this is very important to me. Consumers are the expert on their experiences. The professional is the expert who guides the consumer using concepts, theories, and techniques. So I don't want to give you or even infer that you don't need a professional; you do. It is our hope that together they will form a roadmap to change in the trauma, mental wellness, social inclusion system.

Once you've come to a partnership with your therapist or counselor or whoever it is, even the person doing peer support, when you form that partnership, then you're, I believe, you're on the way, because you start trusting that person, you start opening up to that person. You're able to tell your story without all the hurt and pain. And you're seeing—you start advocating for yourself. That's real important.

So if I were to sum this up, what is very important is education. When you are educated and informed, it's a lot easier for you to—for you, and not just you, for us, to make better choices. And so when we start making different choices, we get different results, our behaviors change, and we start on our healing process. Thank you.

America Paredes: Thank you, Rhonda. Dr. Gillece will be our next presenter and after Dr. Gillece's presentation we will move to our question-and-answer session. Dr. Gillece.

Joan Gillece: Good afternoon everyone and I'm happy you could join us. I'm going to talk about now what do we do when we're working with individuals who we know have trauma histories, and what is trauma-informed care, and how can we implement it.

I work with the National Center for Trauma-Informed Care, which is funded through the Center for Mental Health Services. And the National Center for Trauma-Informed Care is really about working with systems on what do we do to make sure we address the trauma and do no more harm.

Much of our work is in the communities, but most of my work is in institutions, whether it's psychiatric facilities, prisons, jails, homeless providers, juvenile justice. That's where we see some of the most severe social exclusions in these facilities where people are often put away for years and years. It's almost the biggest assault in social exclusion.

So what we're going to talk about is what do we mean when we're talking about trauma-informed systems of care. When we're talking about systems that are trauma-informed, it's really important that staff understand the prevalence of trauma in the lives of those that we serve and also understand the serious implications of trauma.

The trauma affects the developing child neurobiologically, trauma affects our brain chemistry, the way our brain develops, it affects us psychologically, it affects us socially, it affects our spiritual sense, our developmental, how we move through these appropriate developmental paths. Trauma affects the developing child in multiple ways. And it's very important that we develop systems of care that are collaborative, supportive, and that are skill based.

Working with staff, whether it be correctional officers, juvenile justice officers, direct care staff, when they are trained on understanding trauma, the culture shifts. We understand that we're not blaming the individual for the behaviors, but we're seeing those behaviors, as Rhonda said, as adaptations to that trauma.

Many of the things we see, self-injurious behaviors, substance use, dissociative conditions, et cetera, are oftentimes adaptations and the way people learn to cope with the threat to who they were and the threat to their beings as trauma survivors.

The prevalence is—oops, sorry about that. The prevalence is pretty overwhelming in terms of trauma in the lives of people who are in public systems. Ninety percent of public mental health system clients have been exposed to trauma, and this comes from Kim Mueser's work out of Dartmouth. Most have multiple experiences with trauma, including physical and sexual abuse. Ninety-seven percent of homeless women have physical or sexual abuse, 80—87 percent both in childhood and in adulthood.

The rates of PTSD, which frequently is not diagnosed in people who are experiencing psychiatric diagnoses is frequently from 49 to—29 to 43 percent. We don't usually see that diagnosis. You see it coming out in a lot more of affective disorders or a lot more of borderline personality disorders, but you don't see a lot of diagnosis of posttraumatic stress in the facilities where we provide our services. It's epidemic across systems.

In terms of kids, Canadian study, 187 kids reported, 42 percent met the criteria for posttraumatic stress disorder. So trauma-informed care is also preventative. Trauma-informed care can help us work towards treating these symptoms as adaptations to the trauma and create even systems that do no more harm.

John Briere who is a psychologist says that if we appropriately treat a childhood trauma, the DSM could have been turned into a pamphlet. If we appropriately treated that trauma, that early childhood trauma, we could prevent kids from going into other systems of care.

When we do our work through the National Center for Trauma-Informed Care and we go into a facility, we not only train the staff on trauma and the prevalence and understanding how these behaviors indeed might be adaptations to the trauma, we also look at the environments and see is there anything in the environments that perhaps could be re-traumatizing.

And an example that really brought it home to me was in a juvenile facility where I was, and I was speaking with the staff and asked them when did they have the highest incidence of seclusion and restraint in the girls in this particular detention facility for teenagers. And they said, well, it's in the morning when the girls get up to go to the lavatory to get ready for school.

I said let me go in to the lavatory and see if there's anything in that room, anything that's going on there perhaps is triggering. And sure enough when I went into the bathroom there were no doors on the head stalls, there were no shower curtains, and staff watched the girls as they were doing their morning showers and using the lavatory.

So when they understood trauma, they understood that even if you're not a trauma survivor, to be this exposed could indeed trigger you and cause people to behave in a way that's self-protective. When the staff was empowered to be part of this culture shift, the officers came up with the idea of Velcro-ing shower curtains up, you know, and curtains on the stalls.

So if someone did try to hang themselves, which is why they removed all the doors in the first place, it would fall down because of the Velcro. And this was the officers that came up with this solution. Brilliant solutions that really reduces the likelihood of retraumatization and of triggering someone who is a trauma survivor.

In the juvenile justice system, childhood abuse and neglect increases the likelihood of arrest as a juvenile by 53 percent, as a young adult by 38 percent. When we were doing a focus group with boys in the juvenile justice system, we had about 20 boys ranging in ages from 13 to 17 and we asked them how many of you have an incarcerated parent or a parent who has been incarcerated. One hundred percent of the kids raised their hand. There you get the trauma, the abandonment issues, the neglect issues. Over half of the kids had watched someone be shot in their neighborhood.

So we're looking at that experience of trauma and how can we create systems that heal this trauma versus exacerbate it. Trauma-informed systems do no more harm. We need to look at those traumas again as adaptations—the behaviors as adaptations.

Boys in the juvenile justice system report trauma more as witnessing in violence, girls report it more as experiencing in violence. The literature shows that upwards some say of 75 to 85 to 90 percent of girls in the criminal justice system have been victims of early physical or sexual abuse. We need to understand how some of our practices enhance and are likely to trigger that untreated and unresolved trauma of childhood.

When we go into facilities on the—the prevalence in mental health is also alarmingly high. And we look at mental health facilities, most institutions, individuals even they're—coed units are not allowed to lock their doors at night. And there's bed checks frequently every 15 minutes the staff will come in with a flashlight.

You can imagine how triggering this can be to someone who has a trauma history. You're in an institution, you're in a facility, you're afraid, you're not feeling safe, and then you can't lock your door. It makes sense why people then would be triggered and the behavior again be adaptation.

In one facility in a psychiatric facility, a forensic facility for women, the staff told me that many of the women will crawl under their beds with their blanket,; and this against the rules. They're not allowed to get under their beds. And you can imagine what happens when someone does that and the staff wants to get them out from under the bed and the person gets triggered and starts to kick and then the staff gets hurt, then they get restrained.

Once the staff understood that this was not behavior that was done to be manipulative or attention seeking, but an adaptation to that trauma and that need for safety, their response to that behavior changes dramatically, which keeps everyone from getting hurt.

Frequently in facilities, the response to people's adaption—adaptations causes violence to staff, causes violence to the person that is being restrained, and causes retraumatization to the individuals who are observing one of their peers also going through such violence.

Majority of children and adults in our systems have trauma. We need to use universal precautions. As we learned with blood-borne illnesses to wear latex gloves, with trauma survivors what we need to do is learn to wear kid gloves. To treat everyone as if they are a trauma survivor, it will certainly do no harm, it will certainly do no more harm, and whether you're a trauma survivor or not, treating someone through a trauma-informed approach is really just good clinical practice and good care.

So the impact over the lifespan, Helga and Rhonda both mentioned the ACE Study, the Adverse Childhood Events Study by two physicians, Dr. Felitti and Dr. Anda. They were working out of Kaiser Permanente and doing a study for the Center for Disease Control. They were actually involved in doing some work in obesity and they started seeing a correlation between early childhood trauma and eating disorders.

And they started looking further and started realizing that trauma affected individuals, not just psychologically, but did affect them in terms of their health with eating disorders, self-harm, sexual promiscuity, severe and persistent health issues, social problems, and early death.

And so they got this hunch that they wanted to look at people coming in for services at Kaiser Permanente rather than just individuals coming into the obesity clinic, so they interviewed 17,000 somewhat middle-class recipients of HMO services at Kaiser Permanente and they wanted to look at that relationship between trauma and somatic conditions as well as psychological.

So they identified adverse childhood experiences, which were experience that the individual had prior to the 18th—18 years old and did you grow up in a household where there was physical abuse, sexual abuse, where an individual was an alcohol or drug abuser, where an individual was incarcerated, where there was an individual who was chronically depressed, suicidal, institutionalized, was someone suffering from a mental illness, did you observe your mother being treated violently, did you grow up with one or no parent or was there physical or emotional neglect.

I can tell you the kids that I've worked with in juvenile justice would check almost all of these off in terms of experiences that they had in childhood.

What's striking about this study was they found that a child with an ACE score of 6, who checked of 6 of these adverse childhood events, has a 4,600 percent greater likelihood of being an IV drug user than a child who had a zero on the ACE score. So this is really compelling to look at the effect of trauma across systems and how prevention is so critical. And again if we started treating that trauma early on as Dr. Briere said, we could certainly reduce the psychiatric diagnosis down to a pamphlet.

Rhonda talked a little bit about what is the trauma-informed systems of—system. It's—a trauma-informed system takes into account the survivor's perspective. It also recognizes that coercive intervention caused traumatization and retraumatization. We look at trauma-informed systems where we go from coercion to collaboration.

It recognizes the prevalence of posttraumatic stress and the importance of early diagnosis. When we go into facilities and read charts as we do site visits, it's remarkable when you read the psychosocials the prevalence of trauma but then it never translates into the treatment plan. So we need to start looking at trauma as primary versus secondary.

We need to start looking at co-occurring quote disorders under that trauma umbrella and see how individuals' coping mechanisms are often mechanisms that get them into trouble throughout other systems. We need to look at our systems as re-traumatizing seclusion and restraint. I also oversee the CMHS Seclusion and Restraint Prevention Initiative. Seclusion and restraint, talk about re-traumatizing, there is probably nothing in our system that re-traumatizes an individual as much as secluding or restraining them.

It also traumatizes the staff that has to do it. It also traumatizes the other peers who watch an individual having to be restrained or seclusioned—or secluded. So our practices oftentimes do more harm rather than no harm. Trauma-informed care, language is so critical. Not pathologizing people, so looking at not calling people that borderline, or that's just a personality disorder, it's avoiding shaming and humiliation at all costs.

We hear all the time that the person is a borderline or they're, you know, manipulative, or that individual who is self-injuring is really attention seeking. Trauma-informed systems of care do not blame the individual but use nat—neutral language. Trauma-informed systems of care are aware of re-traumatization, train the staff accordingly, and understand the trauma that the staff face when they have to be involved in some of these practices such as takedown, seclusion, and restraint.

Outside parties, advocacy, are all part of trauma-informed systems of care. Transparency, training and supervision, all part of developing systems that are trauma informed. Peer support, focusing on what happened to you in place of what's wrong with. Sandy Bloom, our colleague and friend, a psychiatrist from Philadelphia also says, "Hurt people hurt people."

Asking questions about current abuses is something that's really, really critical. And understanding that people who might appear to be very delusional really respond quite well when you talk about what happened to you and tell me what happened. I was just with a gentleman in a facility several months ago and people told me, you know, he would never be able to talk to me and he was self-injurious and he was very ill.

And he perfectly could tell me why he banged his head and what was happening when he banged his head and what triggered him from his, you know, past that made him use that adaptation. So it's really important to know that people who are in facilities and being treated for psychotic issues can clearly respond to these kind of trauma-based interventions.

The look at systems that aren't trauma informed—Rhonda went over this a bit, but just that whole over-show of power, the keys, security, the demeanor, the lines, the yelling for people to line up for medications, the rigid rules that these institutions live by are all part of systems that are not trauma informed.

The staff believing their key role is rule enforcers versus, as Rhonda was talking about, the staff being experts and collaborators in someone's healing. Systems without trauma sensitivity, they have no comprehension of least restrictive alternatives, much more into compliance and collaboration and disempower and devalue staff, which again, pass on that disrespect to service recipients.

So we need to look at our whole systems of care and move from that power control into one of collaboration and support to understand that it's not what's wrong with you, it's what happened to you and to create systems accordingly. The staff respond beautifully when they are—when they start to understand trauma.

I think it's been something that has been such a great experience for me to work with unit staff or correctional officers or officers in juvenile justice and to see them really get it and come up with great ideas, what they could do to reduce the likelihood of triggering someone.

Systems that don't have trauma sensitivity, you're going to see a high rate of staff recipient—and recipient injury and assault. You're going to see lower treatment adherence, high rate of complaints, turnover, longer lengths of stay are all part of systems that are not trauma informed.

It's critical to have a organizational commitment to changing this culture which is what we're talking about, to moving from coercion to collaboration. We need them to adopt that trauma-informed policy to include a commitment to appropriately assess the trauma and then once assessed to do something about it. To have the staff assist in looking for retraumatizing practices.

To make resources available to prioritize the training for the staff to include staff in every aspect of change—making this culture change as well as including service recipients on all of the committees and all of the prophecies that are implemented in order to institute this kind of culture change that is so critical.

Advance directives, working with individuals to develop their own personal comfort plans where you have the individual identify what is their trigger, identify what is their early warning sign that they're going to get upset, and then to help them find a strategy to self-regulate. Trauma-informed care puts that level of control onto the individual to help them and guide them to find that self-regulatory capacity versus the staff, you know, intervening to control.

As I want to close with our friend Bessel van der Kolk who is a psychiatrist in Boston and he says, "Trauma lives in your body." And one of the best ways, I think Rhonda was talking about body work. But Bessel says, "It lives in your body and some of the best ways to address that trauma are through alternative ways. And sometimes verbal is not the best way."

If the trauma happened preverbal you're going to have an individual who's going to have a very difficult time getting at it verbally. Or if the individual had that dissociative—was dissociative which can be a very protective type of strategy for the individual if they were dissociative at the time as the trauma was occurring it's oftentimes very difficult to be able to verbalize it. So alternatives are quite important.

He said, "Sometimes you just, you know, sometimes you just might need a yoga mat stat versus an intervening medication stat." So with that I will close and hand this back to (America). Thank you all very much.

America Paredes: Thank you Dr. Gillece and thank you to all. That concludes the presentation portion of our teleconference and what we're going to do at this time is open up the floor for questions from the participants. As a reminder of the instructions please refer to slide number 4. Please dial star 1 on your telephone keypad to be placed in the queue. Remember that once your questions are posed, your phone will be muted. Operator, you can go ahead and take questions.

Coordinator: Thank you. I am currently showing there is no questions in queue. As they said, it is star 1 for any question. And it looks like we have one question that just queued up. It comes from (David First). Your line is open.

America Paredes: (David) did you have a question?

(David First): Yeah, well, a question and a comment. I was a researcher for Boys Town for 10 years in the nineties and, you know, one of the research areas was we taught custodial staff at psychiatric inpatient settings for children and adolescents how to teach social skills via the Boys Town family training model, which was a, you know, it's a non-coercive way to talk to kids. And it's a much for the kids as it is for the staff to restrain out-of-range behaviors and speech.

And what we did find was in my research that when the staff were trained and used this model, the number of seclusions and restraints went way down. And so I totally am a believer in the strength of the language we use to work with people and I'm wondering is there—do you see moving towards a way to coming up with a language of this that can be universally used in treatment settings?

America Paredes: Did you have one person in mind who wanted—you wanted to?

(David First): Dr. Gillece actually.

Joan Gillece: Yeah, you know, it's interesting you bring up the Boys Town. Indiana has a grant to reduce seclusion and restraint in two of the facilities for kids. What they are doing is they are implementing ...

((Crosstalk))

(David First): Oh.

Joan Gillece: ...the Boys Town model, with me having trained them also on trauma, so to combine that.

(David First): Oh that's excellent.

Joan Gillece: So there are two facilities that are—one is Evansville Psychiatric and the other is—I'm blocking on the name of the facility right now.

(David First): Sure.

Joan Gillece: The—I think that the National Child Traumatic Stress Network is really looking quite a bit at developing trauma-informed systems and language is clearly a part of that. A universal language, I think—I haven't heard of anybody really moving in that direction. I think you should do it.

(David First): Okay that's a great idea.

Joan Gillece: And we certainly do—I mean, there's been some work on bullying and non- bullying and how to—but to really develop a person-first universal language, I have not heard of that. I don't know if Rhonda or Helga ...

((Crosstalk))

Helga Luest: There actually ...

((Crosstalk))

(David First): Or at least to come up with some best practice guidelines.

Helga Luest: There's actually a great article authored by Mary Blake at the Center for Mental Health Services on the National Center for Trauma-Informed Care Web site, which is www.mentalhealth.samhsa.gov/nctic . And if you go in the resource section there there's an article on person-first language.

((Crosstalk))

Woman: Can I?

Helga Luest: It's just a great body of work and some really good insight there.

Joan Gillece: Yeah.

Helga Luest: Suggestions.

Rhonda Elsey-Jones: And I'd like to talk about some of what I do because I've kind of developed a mental—and I call it a mental wellness program. And what I am—I am very conscious of the words that I use and I—so I kind—I try to instill that upon the people who I work with, who I communicate with, and those in my network because words are very, very, very powerful.

And when we are not using pow—when we are not using words that will lift us oftentimes we're using words that will tear us down. And so it's—I believe part of healing has to do with changing the words. Using words that are empowering and directional and educational and, you know, being consistent with it especially with you—if you—or when you're working with children because they have already been bruised and battered and wounded.

And so if you keep giving them and talking to them in discouraging ways, they won't be able to—it's harder to—and I'm talking about energetically in a holistic realm because when Joan was talking about things getting in the body, we were taught the issues and tissues. So even though that wound may heal physically the stuff is still in the body.

So the—what we were taught is you raise your vibrational level and that is by being more positive, hearing more positive things, learning more positive things, and doing more positive actions.

America Paredes: Thank you. I'd like to ask a question that has been posed online. One of the questions is "How would the presenters suggest adopting a trauma-informed care into a hospital setting, addressing possibly routine screening?"

Joan Gillece: I think the screening—this is Joan Gillece by the way—screening is important but trauma-informed practices assume the prevalence of trauma and create environments that will do no more harm. I'm not sure if you're in a psychiatric hospital or a general hospital. The screening is critical but it's—you need to have clinicians and really trained to know what to do once someone (unintelligible) positive for trauma.

So if you have that, go for it. What we do when we go out and work with a facility is first we train all of the staff on what we're talking about when we're talking about trauma. We do a training on how trauma affects us psychologically. We do a whole training on neurobiology, and the staff, the correctional officers, it's one of their favorite modules.

You know, we talk a lot about fight or flight in your amygdala and what happens when people get triggered and why they respond the way they do, because what happened to their brain as a developing child experiencing this trauma. So we do that, we do the neurobiology and then we talk about what do you do about it and helping individuals find their own personal way to self-regulate.

Following that training of all the staff, we go in and we develop through a grant through Center for Mental Health Services through the Woman and Violence project that Rhonda talked about, a 15-week psycho-educational module that we teach staff on how to run groups on working with individuals to help them understand the effect that trauma has on them. It's more psycho-educational than dynamic and works quite well to help people with symptom reduction.

So that's how we normally go about working with the hospitals. Then we go and look on the units and see what can we do to change some of the practices to make them more trauma informed for (unintelligible). We might go into hospitals and we might see the sign up that says "We believe in recovery." And then right under it there's a sign that says "Phone use 10 minutes—no excuses." You know, we look at all the signs on the walls that tell people what they can't do.

We look at the admission process, what could we do to when someone is admitted to the hospital they come and feel like they are in sanctuary as Dr. Bloom would say that they're creating a more of sanctuary than in a place where they're petrified and feeling like they're going to be just worn down.

So that's (things) we work with the hospital system. It's not just (screening). You can screen all you want and you can have a group that does the trauma treatment, you know, once a week or whatever. But unless you address those environmental issues, I think you'd be missing the boat.

America Paredes: Thank you and I believe we have—do we have another question in the telephone queue?

Coordinator: We sure do; we have several. Our next question will come from (Doreen Johnston), your line is open.

(Doreen Johnston): Hi. Actually I just wanted to follow up on the question that the first caller had and that was, is there a best practice manual or a place that we could turn to in order to learn more about inclusive language?

Joan Gillece: I think—it's you got—what Helga had suggested was Mary Blake.

((Crosstalk))

(Doreen Johnston): Yes, I did.

Joan Gillece: And we do it in all of our trainings, we talk about language. I think (unintelligible) I don't have a best practice on words that should be used. We like to try to work with the staff and talk about language and how it affects individuals. And I think if you look at that article from Mary, maybe that'll be helpful.

(Doreen Johnston): Okay.

Joan Gillece: Always get ...

((Crosstalk))

(Doreen Johnston): Very much.

Coordinator: Our next question will come from (Eric Long). Your line is open.

(Eric Long): Hello from Louisville, Kentucky. I'm really enjoying your panel. What are your responses to the traumas related to this exponential growth in home—persons who have lost homes and jobs? What do you suggest as far as best practice in helping individuals who have been unplugged from all those community connections?

Helga Luest: This is Helga, just to jump in and respond to that. I think, you know, as you look historically at times of recession there are some really distinct patterns to how people respond in times of recession. The unemployment, the stress, the financial strain, and then other factors—other life factors like there's traditionally an increase in violence when there is a time of recession.

We have lots of returning veterans, that combined with the experience of recession. So, you know, you start to see increase in substance abuse, increase in family violence, and those have a pretty significant impact of course on how people fare out.

Getting back to some of the points I made earlier in my presentation, I think education at the community level and really making sure that people understand the nature and impact of what, you know, what is trauma? What defines a trauma? And how people cope. And understanding what some of the triggers are but also what some of the coping strategies are so that, you know, that they can stay connected.

I think that that's really important, so education at the community level, I think is, you know, is really going to be an important factor.

Rhonda Elsey-Jones: This is Rhonda; I agree with that. I just want to add one thing, and that is to let—to make sure that you let them know that you're available. Oftentimes just like people don't realize they have lived a life in violence and trauma, they don't just know that you're available because you say you're available; you have to be available.

And the more available you are, the more they begin to trust you and they start responding to you and talking to you and letting you know what's going on with them.

Joan Gillece: You know, and I think you raise such a good point because really the solution is having people not lose their homes. I mean it's a whole different kind of trauma and the whole socioeconomics that are involved with it, and I'm not sure if there is any work going on one with the community housing agencies or the community social service agencies or the homeless providers that are addressing even the issues with children and that kind of displacement. I think that could be a really important place to start.

America Paredes: Thank you. I'd just like to mention that a lot of individuals have questions on where they can locate the presentations slides used today. They are on the ADS Center Web site, which is http://www.promoteacceptance.samhsa.gov and if you cannot access that you can just email us at the Center and we'll send you a copy of the presentation slides.

There's also another question in the queue: if there is a recommendation for a quality trauma assessment tool to inform clinical treatment plans.

Joan Gillece: You know, there are many, many tools. If you go to the National Posttraumatic Stress Network, all of the instruments are outlined there. You can see all the different instruments. What are the short instruments, the short assessments, longer assessments? So if you look up national—the posttraumatic stress, you can find all of those—all of the trauma instruments listed.

America Paredes: Thank you. We can take another question from the phone.

Coordinator: Our next question will come from (Michelle Lewis). Your line is open.

(Michelle Lewis): Yes, I really—we've been doing a public campaign educating around the issues of children of incarcerated parents and working with the parents. And we've found that the parent telling their story is a very powerful tool to make the community aware of the issues that these families and kids go through. What would this panel—I'd like to hear some comments about whether—how that telling the story could possibly also be re-traumatizing for the parent. And what practices could mitigate that?

Joan Gillece: Well, it depends. And this is Joan Gillece. The work that we have done in criminal justice and developing the TAMAR Program, which is Trauma, Addictions, Mental Health and Recovery, the storytelling is the last of 15 modules. And it was done purposely. And I'm happy—if anyone wants to get in touch with me, I am happy to free of charge send you the manual that we—and just get in touch with me, I'm happy to send it out to you.

But we purposely did it as the last guide because people were at the point that they were strong enough and had coping skills enough that the storytelling came at the end. The other thing I would suggest you—we've done quite a bit of work with women who are in multiple systems and with their children, and to keep them connected, I think, is really important.

In many of the programs that are going on in local detention centers in Maryland, they do a program called Books and Blankets at Bedtime. And it's very, very simple, where actually a peer, one of the women who had been in the trauma groups, comes back in, works with the women, has them read a story into a cassette tape player.

The cassette and the tape are taken to the child with the book and with a blanket that's made by a voluntary—volunteer organization so the child can hear the mother's voice tell them a story at bedtime. It's just a simple, simple little thing that is just—seems to be working so well in terms of the comfort for the kids and the mother feeling like they also have some kind of connection to that child. So there's other programs where they're developing through no child—what was it through?

One of the parenting programs through social services that they're working with women in the criminal justice system to have, you know, dinner once a week and help kids with homework. All—whatever you can do to try to keep a connection going so the child doesn't feel abandoned. I think—and I'm happy to share that if you get in touch with me as well. I can give you more examples.

Rhonda Elsey-Jones: I'd like to—are you finished Joan?

Joan Gillece: Yeah I am Rhonda.

Rhonda Elsey-Jones: I'd like to add something to the storytelling piece. Oftentimes people who get in 12-step programs or like especially NA, Narcotics Anonymous, and they write their steps, right? They write the first steps. They answer all these probing questions and the next thing you know the person is back out there using.

That's an example of telling your story before you get healed.

Joan Gillece: Right.

Rhonda Elsey-Jones: And you can oftentimes tell because a person is struggling to tell you. They're crying, their body language has changed and, you know, they're going through all of this stuff. The purpose of healing is so that you then have a voice. If you had a voice, you wouldn't have to go through the healing process.

So as you heal, it also takes you a little further in your healing process to tell your story, but you have to be healed to do that. So, you know, asking a person to tell their story really early on or, you know, keep bringing up their story is really not a good practice, and it's not healthy for the person.

Helga Luest: This is Helga. I also have something to chime in on this one because I think that story—telling the story can be so helpful but I really, strongly believe that this only should happen when the survivor is ready to tell their story and that the choice should be theirs. The choice of what to reveal, when to reveal it, and how to share the story should be, you know, be up to the survivor. And it's really important to make sure that you have an active listener who really wants to understand what's being said.

I think that also telling the story, you know, that we should think about cultural competency and age appropriateness. If you have a very young child, maybe it's not, you know, appropriate for them to know what their parent—what their parent's whole story is. Maybe sharing little pieces along the way help to build a stronger foundation for that young person and being able to manage what's being said and what their family has been through.

And then the other part of storytelling that I think is so important is that, you know, for many survivors, the final stage of the healing process or at least a very important stage of the healing process is when you can take the dark cloud of what's happened and turn it into something positive.

And for a lot of people, telling their story and using it in advocacy or in building connections and peer support and things like that, I mean it's a really important part of the healing process itself, so.

America Paredes: This is America. I'd also like to add that in the next few weeks on the ADS Center Web site we'll be posting a Webcast that was taped that's actually called Speaking from the Heart. And it addresses the issue of sharing your recovery story. And it may be able to assist other individuals who are interested in sharing their stories.

It features Daniel Fisher, Lauren Spiro, and Dally Sanchez from New York. So we'll have a listserv message out to everyone about that. But it may be something that people are interested in viewing, consumer survivors, so. Is there another question on the telephone?

Coordinator: Yes, we do. Our next question will come from (Rhonda Jordal), your line is open.

(Rhonda Jordal): Hello I was calling, wanted to ask a couple of different things. First of all, when Helga's information was up there it went really fast and I missed the phone number and if there's an email address, I would like to get that. Also would like to see if there's anything in the future that's going to be teleconferenced on veterans with trauma, the PTSD and TBI education maybe dealing with this—how it affects families and communities and things like that as well as the mental health of the veterans that get incarcerated because of the issues that they returned from war with. And just want to know if you're looking at anything like that for the future.

Helga Luest: This is Helga. And yes, that's absolutely an issue that Witness Justice, my organization, is looking at very closely. We're on a number of national groups, coalitions right now, looking at that. And you can find some information about a Federal issue briefing we had on Capitol Hill last fall that's on our Web site. It's www.witnessjustice.org . And since you asked also for my contact information, phone number, it's 301–846–9110. and email is hluest@witnessjustice.org.

Joan Gillece: Yeah, I'd like to add in terms of the criminal justice involvement and veterans, CMHS has just put out grants to I believe it was eight States to address just this issue of returning veterans who end up in the criminal justice system and trauma issues. So I believe it's eight States who have just, within the past month, been awarded this money to start to look at that and the GAINS Center (unintelligible) in New York will be working on the coordinating center and doing some evaluation.

Helga Luest: There's also the Iraq and Afghanistan Veterans of America. They're looking at justice involved returning vets and some of the vets courts and the jail diversion models that, you know, that are starting to take hold through the SAMHSA-funded grants.

America Paredes: Just as an FYI the contact information for all of the presenters is available on slide 66 of the presentation. And we'll just take two more questions and to be respectful of everyone's time, we'll go ahead and end the conference.

Coordinator: Our next question will come from (Shannon Simmons), your line is open.

(Shannon Simmons): Hi. I'm up in a rural area and I missed the last question so you may have answered this. I had to run out for a second. We have obtained training for our entire county from DC Community Connections on the trauma recovery and empowerment model program. We put together groups; we've implemented trauma-led services for our DV agency, our homeless shelter, our crisis workers, police officers, mental health, and then ran out of our grant.

And so I guess my question pertains to funding. We want to continue to provide ongoing support groups and services, and is there someplace that provides funding that we've missed somehow, some magical place that I'm unaware of?

Joan Gillece: Yeah, you know, the National Center for Trauma-Informed Care has a little bit of a different focus this year and we will be working with—for States to do some implementation of trauma-informed practices, but the real focus is going to be on developing peer-to-peer trauma-based support.

((Crosstalk))

(Shannon Simmons): Which is what we kind of did, I mean we had consumer-led activities and care facilitators and co-facilitators—or peer co-facilitators and lay facilitators.

Joan Gillece: Are you—where are you located?

(Shannon Simmons): Clatsop County, Oregon.

Joan Gillece: Oh, okay. If you want to get in touch with me offline I can try to tell you some ideas on funding that isn't necessarily through National Center for Trauma-Informed Care but how you could perhaps go about getting some technical assistance through other mechanisms.

(Shannon Simmons): Okay and this is?

Joan Gillece: Joan Gillece.

(Shannon Simmons): Okay.

Helga Luest: This is Helga. I also would recommend looking at the Grantmakers In Health and the Grantmakers for Children, Youth & Families, two affinity groups through the Council on Foundations. I think that, you know, this is one thing that foundations are really looking at now is where government is having to back off, where they can step in.

(Shannon Simmons): Okay.

America Paredes: Thank you. We'll take our final question.

Coordinator: Our last question will come from (Heather Cranz). Your line is open.

(Heather Cranz): Hi, yes, I'm a vocational rehabilitation counselor in Austin, Texan—Texas and my question is for Dr. Gillece. Although I'm not in necessarily the psychiatric setting, I wanted to know—you've mentioned changing the physical environment to reduce trauma-induced outbursts. My question is, are there any alternatives to physical restraints that can be non-traumatizing.

Joan Gillece: Oh, good question. I don't believe any restraint is not traumatizing. So I'm very much a big proponent of preventing the use of seclusion and restraint and, you know, your occupational therapists are brilliant in terms of helping people find alternatives through some different sensory alternatives.

So what we like to work with individuals is to help the individual identify what is that trigger. And when we train on neurobiology, everyone understands why you might see that individual go from that zero to 100 without having capacity to stop at 50.

So we try to work with them to understand what is it that trigger—that's trigger and how can we help you find something that allows you to when you get triggered, to soothe yourself. And there's all sorts of different items that we use that occupational therapists are great at. That includes everything from weighted blankets to weighted vests to different kinds of sensory items that people seem to use to help them calm themselves.

So what we are about is not finding a safer alternative to a restraint. We believe no restraint is safe, but helping people find ways to prevent the need and the use of a restraint in the first place. So we're very, very much on that prevention end.

Rhonda Elsey-Jones: I'd like to add something to that. In knowing the behaviors are adaptive and just like Joan was saying a person goes to zero—from zero to 100. When we were at TAMAR's Children we didn't do any punishing or anything like that. What we did—we held them accountable, but we also were as vigilant as they were on seeing their changes.

And, you know, helping them to identify their changes and helping them to identify their behaviors, what went with what. And how, you know, one of my clients would—she would get overwhelmed, you know, especially when she was getting ready to move out. And so I brought her in the office and I gave her a pencil and a piece of paper and I said, "Write each one down."

And then after she wrote them down she could see what they were, they weren't as overwhelming as they seem to be. And, you know, so we have to anticipant and be able to be their eyes for them because they've been using this behavior so long it's second nature. But we who are on the outside oftentimes can see that they start pacing, they don't realize they start pacing or that they're talking real fast or that they're wringing their hands or that they're starting to hug themselves.

So, you know, that—those are just a few little things. But the more you watch them, the easier it is to see that they are going through something and then you kind of bring it to their attention. I don't mean naggingly, but, you know, just kind of bring it up that they're doing whatever it is that they're doing. And as they learn that they are in the future or in the past and maybe what I need to do is ground myself or breathe deeply or, you know, then they start to get it; they start to understand it, and their behavior starts to change.

Joan Gillece: If I could just add one quick thing and I know we need to end. But Tina Champagne is an occupational therapist who's done a lot of work in this area, in finding self soothing alternatives. And I think she's at OT Innovations (unintelligible) Champagne. It's C-H-A-M-P-A-G-N-E. If you Googled her all of her work would come up. And she's really the occupational therapist who's kind of been at the forefront of this and that might be helpful.

America Paredes: Thank you everyone. That's going to conclude our training today. A special thanks to our presenters for taking the time out of their busy schedules to share this information with us. This conference has been recorded and the audio recording and transcription will be available in about 2 weeks on the ADS Center Web site.

If you have additional questions, feel free to contact us or the presenters directly. And I also encourage you to reference slide 67 for additional resources. Thanks again to all of the speakers and to the participants for joining us. And we hope that you will be completing our survey so that we can get your feedback and improve anything that you found needed improvement today. Thank you so much.

Rhonda Elsey-Jones: Thank you.

Joan Gillece: Thank you.

Helga Luest: Thanks.

Coordinator: That does conclude today's conference. You may all disconnect at this time.

America Paredes: Thank you.

Helga Luest: Thank you.


1From this point forward, parentheses are used to show two things: the person's name may not be spelled correctly, or what someone said was not intelligible.

2Since this teleconference, the ADS Center Web site was reorganized. The main teleconference page is now http://www.promoteacceptance.samhsa.gov/teleconferences/default.aspx, and the main page for archived teleconferences is now http://www.promoteacceptance.samhsa.gov/teleconferences/archive/default.aspx.

END