i had a substance abuse problem. they kept diagnosing me with all these mental health illnesses, so a perfect program, and i was able to keep my baby. and this program was also a program based on how to create and develop a secure attachment with your children, because if you don't know, you don't know. if you don't know how to be nurturing and loving, you come from an abusive household, it takes work sometimes not to be abusive. and i think about what dr. clark said and talking about, i don't think trauma so much as dr. clark would say is not in any other cultures. i just think there were different supports in place for those that had been traumatized and, you know, the caucasians or, you know. it was as important to place, as african american, where something happened to us, we don't go to services. we deal with it the way we deal with it or we go to churches. that's what african americans do, we go to churches for help. and churches don't know anything about trauma.

a lot of trauma happens in the churches. or it goes to the silence within families about traumatic experiences as a family. correct, dr. harris? you know, i think a lot of families keep trauma a secret. this may be true in the african american community but, honestly, i see this across the board. this is the dirty little secret that nobody wants to talk about in public. i think that's the key issue. in fact, we do have a faith-based program at samhsa. the objective is to educate members of the faith community about a wide range of issues-mental health issues, substance abuse issues, and trauma- because we find that the ministers, the rabbis, the imams, the religious leaders do want to know because they're unable to have a positive impact if they're not aware of some of these issues. we don't ask people to change their philosophical

or theological beliefs. we do want them to be familiar with some of the negative consequences that do result from physical abuse, sexual abuse, a violation of trust that happens in households, as miss cain pointed out. and i think it's significant what happens when you tell. were you believed? were you told to keep those dirty little secrets in the house, as dr. harris said, and how you were soothed when you told. there's many folks that we've worked with, many women in the criminal justice system were very clear when they were told they were not believed. they were told to keep that secret in the house. they were told they were making it up. they were told, why were you flirting with my man? and so, what happens when we tell, i think, is really significant. okay, but we can further traumatize, you know, once the person discloses. i think that's one of the main issues. the other factor, we've mentioned the military, we've mentioned women, and youth and children,

and the whole issue of families. another sector of society that also suffers tremendously is the gay and lesbian, the lgbt, community and in particular now with some of the incidents that we have seen on television or violence against them. how do we handle, i mean, are there particular efforts in place to really address those issues? we have a program at community connections specifically for lesbian and transgendered folks. and it focuses in on the additional feeling of disaffiliation, of stigma that people experienced when they tried to come out to family members. there are very few communities, regrettably, where you are easily embraced

when you reveal an alternate lifestyle, so that you may have been traumatized physically or sexually as a child but then, as you come to identify yourself more fully as a person, you're traumatized all over again for your honesty. and we get into also, i mean the whole bullying aspect within the schools, you know, not only against lgbt youth that are experimenting and really haven't made up their minds as to their sexuality, and so on and so forth. but on top of that, then you lay the layer of the trauma in school. correct, dr. clark? well, yes. that's part of the kind of traumatic experience that dr. harris was talking about. and again, working with different agencies, we're trying to educate providers and educators as well as family members about the experiences of lgbt youth

so that we can minimize bullying and offer young people an opportunity to figure out how they want to identify themselves. that's why the phrase that we currently use is lbgtq so that, especially when you're young and you're trying to figure out ... which means? it means questioning. so, there are people who wonder about their sexual orientation. there are people who have decided what their sexual orientation is. some decide early. some decide later. but the key issue is that a person should be able to make that decision without fear of social retribution, whether it's physical or psychological retribution or essentially being banished. so, as dr. harris pointed out, none of the, your peer group but also your family members, and so you're definitely isolated. and it puts you at greater risk because we find a number of lgbt youth are running away, living on the streets, and being the victims of pedophiles

and sexual predators, which just makes life really miserable. so, now they're not dealing with sexual orientation. they're basically dealing with sexual trauma. and i think it's even an issue when the youth are in facility care, residential care. we see it in the residential treatment centers and in services for adolescents, in juvenile detention. so, we see that whole retraumatizing played out again in those facilities. and the reason that we've gone so deeply into really establishing a framework of who's affected is that it's such an insidious problem and it's everywhere, when you really think about it. if you take a look at the populations that are affected, the family certainly encompasses everyone. i'm sure that everyone has one trauma or another in their family. so, when we come back i want to focus on now solutions, and how do we solve the problem? we'll be right back.

[music] before, addiction and depression kept me from living my life. and now, every step i take in recovery benefits everyone. there are many options that make the road to recovery more accessible. it begins with the first step. join the voices for recovery. for information and treatment referral for you or someone you love, call 1-800-662-help. brought to you by the u.s. department of health and human services. recovery benefits everyone. i started my own company. i got my dad back. my friends believe in me.

substance use and mental disorders can be treated. it all starts on day one. join the voices for recovery. for information and treatment referral for you or someone you love, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] community connections is the largest not-for-profit mental health agency in the district of columbia.

we serve probably about 3,500 women, children, and men who are frequently dually diagnosed, have histories of homelessness, and have histories of traumatic victimization. the mission of community connections, first of all, is mental health, making everybody whole, of the people who have suffered from trauma, people who have substance abuse, to give you the tools to be able to manage your mental health issues and your trauma issues such as ptsd, to make you to be able to function on the outside in public despite what things have happened to you. sisters empowering sisters is a program for women who are dually diagnosed with a psychiatric illness and addiction and who are the victims of violence to serve as peer mentors for other women who have similar histories.

i loved the peers. i have to talk about that because i could talk to any of them. they're very understanding. they have a whole lot of strength with them and confidence, and you could talk about... and they make you feel so welcome. and then they give you that love and that caring and that respect. peer recovery support services are consumers helping other consumers. we've been through training, and we facilitate groups on various topics, from women's health to trauma survival, substance abuse issues with different topics each week from, for instance, evaluating relationships, red flags for domestic violence, and things of that issue that women struggle with. and we also have a computer lab, and we're here to assist you in developing a resume or online job searches. one of the goals is to promote a positive supportive environment

to foster women's growth. and another goal is to increase the knowledge of local resources that are welcoming and responsive. i just like the atmosphere. it's a good spirit in that center because it's women that understand what you're going through. so, groups is where it's based on everybody giving feedback about a topic. so it's like we're just, it's a women's rap. so we're just constantly sharing our experiences and what we hope our goals would be, and it's just empowering because you don't feel alone. i think a lot of people don't understand that how men deal with trauma and substance abuse issues are different from how women deal with trauma and substance abuse issues. being able to feel heard and understood, being able to believe that the cycle of violence is something that can be interrupted

is something that restores hope to people. and i've talked to a number of women and said, "well, why couldn't you do this on your own?" and people will say, "you know, i had lost all sense of motivation. i had lost all belief that the future could be better than the past. it seemed that i was trapped in a kind of cycle where bad things repeated themselves over and over and over again." and sisters empowering sisters gives women a sense that the future can be different. my life was very unstable before i found recovery. now that i have recovery i have a purpose. i have a reason for living. i have direction. i have goals. i have peace. dr. clark, what is trauma-informed care? well, listening to dr. harris and dr. gillece, but the most important thing is care that

takes into consideration the traumatic experiences that a person may have had. it is care that recognizes that trauma is a very real possibility. when you take a look at the statistics and you find a lot of people who present for treatment, whether it's traditional mental health treatment or substance abuse treatment or a combination, or people who enter the criminal justice system, a significant number have had traumatic experiences. so, if we're going to intervene in a positive way, we have to take into consideration, and the very strategies that allow us to take into consideration. but the most important part of it is the beginning, acknowledging the trauma that could have happened in that person's life. and dr. gillece, how do we screen for that? well, i think when you do trauma-informed care, i think what's really important too is to create environments of care that do no more harm. there are many different screenings that we can use for trauma. but i think, then, it's really important for those systems to be prepared to do something about it once we screen. can you tell us a little bit about which ones we're using?

well, there's many different. there's many, many different trauma screens. we used to use everything from brief trauma screens to the ace study to short screens that are used to try to not retraumatize-for example, in jail-that just may ask four or five questions. so, there's many, many trauma screens that are very good and excellent for use. and what type of questions are they, for example? well, some questions are like, for the brief ones that we have used in prisons and jails would be: are you oftentimes haunted by terrible memories? do you often have lapses of memory that weren't resulting in alcohol or drug abuse? do you have nightmares? i mean, there are certain questions that are used that are geared towards not retraumatizing and ask people to spill out all of the traumas, but will then get people screened so they can be invited into the appropriate groups. but, in addition to the screening, i think what's so important is then, what do we do about it? how do we train the staff to recognize what is a flashback? what are the symptoms of trauma?

how someone is self-injuring really is not manipulative attention seeking but is really relief seeking, solution seeking. how do we help staff understand, again, that those symptoms are adaptations? so, what happens next to me is the most significant. we know the literature says that the majority of people coming into our public systems have histories of trauma. so we know that, and trauma-informed care is really creating that environment that recognizes the trauma and seeks to do no more harm. and, dr. harris, what is it that we need to do in terms of children who have experienced trauma to help them lead a more healthy life? you know, i think ... let me take a step back for just a moment because i think we don't want to make this sound more complicated, honestly, than it is. we humans are wired for resilience. and the truth is, we also go through a range of events

that could be labeled as traumatic, and most of us survive and adapt and we adapt in ways that allow us to lead productive lives. so, having experienced a traumatic event is not a curse, necessarily. it is something to which you have to adapt, to which you have to cope. but it is not, you know, something that means, "oh my goodness, this happened to me so my life is over," and the mental health professionals have to swoop in and save me. in terms of assessing children and adults, again, it's just not that complicated. we ask about four or five questions and we assess 40 to 60 people every single week. the questions are quite direct. have you ever been hit? has anybody ever touched you in a way that made you uncomfortable? and those questions do not retraumatize people.

in fact, they're very glad to answer them if they're asked in a nonthreatening way. so, dr. clark, once we have established that the children have had some type of trauma based on the questions that we've asked, how do we try to begin the intervention with them? well, i think they, one of the most important things is, especially if we're dealing with youth, is creating an environment where they feel safe, and i think that's what dr. gillece was pointing at. the environment has to be safe and, as dr. harris pointed out, the person has to feel comfortable talking about something that they have a need to talk about. but, as miss cain pointed out, they were essentially told, they were blamed for the event. so the secret has to be retained, and you're now giving them permission to talk about the secret. and you're also reassuring them that there will be no negative consequences

about talking about the secret, and so it's a lot easier for the person to talk in that environment. and there are strategies, various treatment-oriented strategies that are geared to functionally allowing the person to disclose, reaffirming that safety is ubiquitous at least in the environment where they're being cared for, and also making it clear that they are not to blame. so that this whole issue of self-loathing that miss cain talked about, in terms of not desiring or not believing that you're entitled to anything else, goes away so the person then can start to believe that they can recover, and this is from the notion of resiliency. resiliency needs to be essentially unleashed as opposed to bottled up. and resiliency really, miss cain, needs to start with the parents in terms of how they interact with that child, correct? well, yeah.

i mean, children have learned behaviors. and i just wanted to just quickly speak about assessments. these questions have been asked always. we always asked those questions. i've always been asked, "have you ever been a victim of sexual abuse?" have you ever been a victim of ... they always were checked, and we talk about assessment forms, and that's great. yes, we need to be able to assess. but we need to be prepared to hear the answers. you can ask these questions all you want, but if you're not prepared to hear the answers, you're going to create more harm in this individual. and so, that's what we're talking about in trauma-reformed care. you ask these questions and then what? it's preparing to hear the answer, putting into place plans for individuals, treating them as an individual according to their own individualized trauma because, believe me, the person that assaulted me probably didn't assault somebody else that's in the group. we have different predators, so we have different things we remember. that means our triggers are different. if that's the case,

then our warning signs are going to be different. and, if that's the case, the plan put into place to help us to self-manage should be different. so, yes, these questions need to ... we have to have these assessments too, but be ready to hear the answer and the people that are asking the questions, how do we know that they have not been traumatized? just because we have these letters behind our names and we become, doesn't mean that they have not experienced some trauma, untreated trauma, and could be triggered. i mean, i can't tell you how many providers email me and come up to me and say, "that happened to me and every day i make decisions based on what happened to me for another individual." i was going to say, miss cain, even though i totally agree with you that things need to be individualized, there are some things that we know that are general for all people. i need to know how to comfort myself. and the way i gain comfort may be different from the way you gain comfort. but in order for me to cope with the things

that happened in my life, it's really quite simple. i need strategies for comforting myself. and those strategies cannot be using drugs, prostituting, or sleeping all day because that's often what people try because they're sort of easy and sometimes readily at hand. i need healthy ways to comfort myself. right, and if you're talking about individuals in a program so you know that's not even an option, using drugs and all the prostitution and all that. we're talking about those that's in providing settings. and so, we've got to find ways, like you said, positive ways to help self-soothe. so, what i'm saying is we can't automatically assume, because i'm a rape victim and she's a rape victim, that nighttime is a bad time for me. so, what you're saying is individualized treatment plans for each individual. and, in addition to that, i think what's so important is the environments of care, particularly residential that can be so traumatizing,

the experience of seclusion and restrain. it's horrifically traumatizing for the individual being tied down and restrained. it's traumatizing for the other folks who are watching it. it's traumatizing for the staff that are doing it, the experience of whether it is bed time. i've heard people say, standing in lines or all sorts of things within our institutions that we could do to create environments again that are safe and that are calm and that are healing. and the issue that is something that dr. gillece mentioned earlier-is the staff trained? absolutely. and that allows, then, for staff who have had previous experiences not to be able to project those on the clients, allows the staff to be able to hopefully make decisions: "well, gee, that person's experiences are too similar to mine and i can't comfortably work in that with this particular person, but i can work with that particular person." that's the heart that we want to address in this section,

and it is making sure that all parties involved understand that trauma, as dr. harris pointed out, is such a ubiquitous experience, the key issue in the assessment you have to be comfortable with that and to recognize, okay, i'm either in over my head because of self-identification or i'm not really sure what to do. so, you have an environment where there's adequate supervision and adequate opportunity for discourse so that the client doesn't feel that, for some reason, they're pushing away help because that help is uncomfortable dealing with the issue. so, yes, miss cain is right. it's more than just checking a box, but it also means that you have to be schooled. and when we come back we're going to continue to talk a little bit about what we can tell parents to do in order to help their children deal with trauma. we'll be right back. for more information on national recovery month ,

to find out how to get involved or to locate an event near you, visit the recovery month web site at recoverymonth.gov. treat me, treat me with understanding. treat me with courtesy. drug and alcohol addiction is an equal opportunity disease. individuals in recovery come from all walks of life and deserve to be treated with respect and admiration for winning one of the hardest battles there is. treat me without judgment. treat me ... with humanity. alcohol and drug addiction deserves proper treatment. for drug and alcohol information and treatment referral, call 1-800-662-help. [music] understanding the impact of trauma on the justice system

is an integral part of the dependency drug court system in sacremento california dependency drug court brings together the superior court, child protection services, alcohol and drug services, sacramento child advocates, parents advocates of sacramento, dependency associates of sacramento, bridges' stars program, and sacramento treatment providers. parents in the program not only receive treatment, but gain an understanding of the root causes of their disease in an effort to break the intergenerational cycle of trauma. we were failing our families. before dependency drug court, we only had 18 percent of families who actually were unified and had their children come home and their cases closed out, with parents who no longer had substance abuse problems. as i went through the stars program and realized that these people that are trying to teach me about my disease have gone through it themselves. it was a blessing because it wasn't somebody who's never experienced what i've experienced

telling me what i needed to learn, somebody who had actually been there and was doing the deal, staying sober one day at a time. everyone agrees that we want parents to be safe, nurturing parents. everyone agrees that good quality treatment on demand is important, and everybody agrees accountability is needed for people to succeed. and so, if everyone came together and said those five or six things we agree with. the stars program collects data and shares with child welfare, cps, dependency drug court, and treatment providers. we generate a twice-monthly report, which consists of treatment attendants, testing results, number of contacts that clients are required to meet with their recovery specialist, and how many support group meetings they've attended that they were required to attend. those first few years were critical. so, we really watched everything,

and it was important that we shared our information and that we were all upfront with what we were doing. everyone was involved with building our policies and procedures. an additional component to the dependency drug court program in sacramento county is the use of two different curriculums regarding trauma-informed treatment. over eight of sacramento county's contracted treatment providers use either beyond trauma and/or seeking safety therapy for trauma and posttraumatic stress disorder and substance abuse. one treatment provider says that 99 percent of the women who come into treatment have lived through some type of severe trauma, often domestic violence or sexual abuse. the women learn they are not alone, that their traumatic event happened to others. it helps them to open up, talk about, and learn to heal from their experience. a relapse doesn't mean you're out and we're done with you. it means you had a relapse, now let's keep going.

we've had families where a parent has been close to graduating dependency drug court and has had a slip-up. and the true test of that particular parent is: okay, i made a mistake, i'm done, i'm going to walk away, or okay, i made a mistake, i'm going to reengage immediately and actively do what i've been taught to do, utilize it not only for myself because that's the most important thing, but recovery must be for the individual first and foremost. i remember when i graduated, and she came down off of the bench to come down and take a picture with me. it was, like, a great moment. a judge is actually coming off the bench to congratulate me on being successful. six months prior, the judge had told me that i couldn't take care of my own child. and now they're telling me, "congratulations, you've made it, you're a better person." dr. harris, what can parents do

if their child has experienced trauma, whether it be bullying or some other type of trauma? i think the first thing that a mother or father needs to do certainly is to be willing to listen, but not to feel that this is a problem that needs to stay within the family and be solved within the family. you know, we live in a world of caring others. there are teachers. there are mentors. there are people in church and neighborhood communities. parents should reach out for help. don't sit with the pain of what you've heard and feel that it is only on your shoulders to solve it. i think the other thing, especially for moms, that's really important is you have to read your own reaction to hearing what your child is telling you. your child's story may remind you of an unrevealed story of your own.