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. so, if you start to remember things as you hear your child talk, the first thing you need to do is to get some help for your child because a mother who herself is damaged and injured

cannot help her child. very good. and, dr. clark, you were talking about different types of scenarios in terms of how parents need to cope with different types of trauma that their children may have experienced. what other types of actions should parents be taking in a different scenario? well the most important thing, as dr. harris pointed out, you listen but you should also believe your child unless the evidence is overwhelmingly to the contrary, which means, as dr. harris points out, you are taking it outside to explore, to get vindication. so, if it's bullying you are talking to the school. you're talking to the teacher. if it's sexual assault, you're bringing in the appropriate authorities to address that. if it's a family member, you are not keeping it a secret because you're afraid of embarrassing the family.

the issue is that the child will suffer long-term consequences, and you too will suffer consequences because you are either, you're a victim yourself based on the past or you're sitting there harboring this piece of information, which is going to have a destructive impact on you. so, those things become very important to your getting the child help, your getting help for yourself, as dr. harris pointed out, and your setting things in motion where you can mobilize resilience by dealing with the issue directly. and, miss cain, you spoke of domestic violence, that you were a victim of domestic violence once upon a time. what do we tell women that are experiencing domestic violence? what should they be doing? well, getting to safety, and that's so easy for us to say, you know, and it's so hard when you're living with somebody and you depend on them financially or whatever the case may be or it's your husband.

but you need to get away because you don't deserve that. i always tell women that is not what you were meant... you're not a punching bag. you're so much more than that, and to get the help. find out what some of the domestic violence shelters are. and one of the most important things that individual can do when they feel like they feel lost and alone and they're just in this all by themselves is seek a peer. peer support is vital. it's invaluable, and it's one of the things that should be utilized not only in community programs, outreach centers, mental health correction, substance abuse, wherever, there are individuals that have trauma, they need a peer. they need a peer when they come into intake, a peer when they're leaving. they need somebody to say, "i understand what you've been through," because for me i had a lot of people sit down and ask me questions and i'm, like, looking at them like you have no idea. you don't understand anything. so, peers would certainly help in that regard.

peer support, peer support, peer support. dr. gillece, in terms of how folks are going to be able to cover some of these services, what does the affordable care act offer in the area of trauma-related services? well, you know, i might have to defer to someone on that because that is really not my area of expertise. so, if someone else would like to answer that, i'd appreciate it. but i would like to just say one thing about what tonier was saying about domestic violence. i think we really can't underestimate the needs of the children who witness domestic violence in the home. so, it's not just the safety for the parent, but to get that treatment. so, i'm going to throw the carrot to you. dr. clark. well, our hope is that the affordable care act will provide opportunities for treatment to victims of trauma, whatever the source of the trauma is. as you know, the effort of the affordable care act is to make health care available to a wider range of individuals. and because they'll be providing coverage

to people with lower incomes, many of whom are the victims of trauma, they'll be able to get assistance from community health centers, providers, community mental health centers, social workers and psychologists, and other providers of care. so, this will provide a mechanism both for adults and for children and adolescents. but i would like to point out that children and adolescents are often eligible for care now through other insurance programs. but the key issue is, if we're not willing to get beyond the secret, having access to reimbursement is irrelevant because nobody's going to show up at the door and, no matter how skilled the clinician is, they can't treat an empty chair. if i could talk for just a minute about domestic violence. i think that this is really a horror that affects somewhere around 30, 35 percent of women.

and, while i absolutely agree with miss cain that it is critical for women to get to safety, no one deserves to be punched or emotionally abused. very, very few women leave the first time. and i think sometimes professionals don't understand that. and they are judgmental and start to think, "what's wrong with her?" maybe she likes that treatment. i just want to be clear: nobody likes it but, as with a lot of terrible dynamics, they're hard to break right away. if they were easy, those of us in the health care business would be out of business. it takes people time, and we need to recognize that and not make women feel bad if they go back to a violent situation a couple of times before they finally free themselves. very good point.

and, dr. clark, let me go back to the whole notion of what samhsa is doing currently. one of our strategic initiatives is on trauma and justice. you want to talk a little bit about that? well, we have eight strategic initiatives at samhsa. one of them is indeed trauma and justice, making it clear that we believe that we have to deal with trauma as an integral part of the behavioral health strategy to assist people in need of services. so the strategic initiative lead is lar quong dr. lar quong, appointed to that role by pamela hyde, the administrator of the substance abuse and mental health services administration, with the focus on working not only with issues of domestic violence but also working with the issues of the criminal justice system because, indeed, as i mentioned, it's not the abuse excuse, it is trying to break the cycle. we spend a lot of money reincarcerating individuals

who have primary issues that have never dealt with, so especially in nonviolent situations. we wanted to break that cycle and, as dr. harris pointed out, we also want to create a workforce that has a stable appreciation of traumatic phenomenon so that, again, we don't blame the child, we don't blame the wife, we don't blame the spouse who is the victim of trauma. and the gains center also has some training programs as well as other initiatives, correct? yes, we have a number of programs that address trauma, and one can access that from our web site at wwww.samhsa.gov gains center. we have a national center on traumatic stress. we've got the activity that dr. gillece is engaged in, and we've got the activity that miss cain is engaged in.

and we've got community programs like dr. harris is engaged in. but the key issue is, while we're not solely responsible for addressing these issues, we are working very aggressively. we also have partnerships with the administration for children and families, the department of defense, the department of justice, and the veterans administration, and hrsa, so that we deal with trauma across the board. we want it to be in primary care settings. we want people asking about it. and then we want to make sure we have a workforce that's skilled enough to begin to do something about it. and we are very glad that you have enlightened our audience related to this topic. i want to remind our audience that national recovery month is celebrated every september, and we're hoping that you engage and be visible and vocal