Melissa Lujan:  The National Center is delighted
to partner with the New England Addiction Technology Transfer Center to create a learning
community to highlight the issues facing child welfare, substance abuse treatment provided
by the court. The learning community leverages knowledge and innovation in practice and policy
approaches from both the National Center and the New England ATTC.
The National Center was established in 2002 to provide information, consultation, training,
and technical assistance to child welfare, court, and substance abuse treatment professionals
to improve the safety, permanency, wellbeing, and recovery outcomes for children, parents,
and families. Both the National Center and the New England ATTC events and resources
will be shared at the end of this presentation. With that, I would like to introduce Dr. Sara
Becker, the evaluation director of the New England ATTC that oversees regional initiatives
to support the prevention, treatment, recovery for youths affected by substance abuse disorder.
Sara? Dr. Sara Becker:  Hi everyone, on behalf
of the New England Addiction Technology Transfer Center, I just want to thank Melissa and the
rest of the team at the National Center for this great opportunity to collaborate on such
an important webinar series for the New England region.
The New England Addiction Technology Transfer Center, otherwise known as ATTC, was established
in 1993 by SAMHSA, and we’re part of a national network that’s comprised of 10 regional centers
that serve all 50 states, the District of Colombia, Puerto Rico, US Virgin Islands and
several Pacific islands. We also have four national focused area centers
that address priority areas identified by SAMHSA, such as promoting the screening brief
intervention and referral to treatment model, and addressing the important needs of underserved
population. Across our region our activities are facilitated by a national coordinating
office. Our network mission is really threefold, and
that’s first to raise awareness and skills of the work force that treats those individuals
affected by substance use disorders. Second, to accelerate the adoption and implementation
of those practices identified as supported by research evidence. Third to foster regional
and national alliances among diverse commissions, researchers, policy makers, funders and the
recovery community. This collaboration with another National Center
is really exciting for us as part of this effort.
Moving to the next slide, this webinar series was really the outgrowth of conversations
with the National Center that started about a year ago, when jointly our organizations
wanted to address the needs of families in this child welfare system affected by substance
use disorders. We conducted a survey of key stakeholders
in the New England region to try to determine the greatest areas of training needs facing
those providers who work with families in the child welfare system affected by substance
use disorders. Our survey was answered by 63 respondents across all six states in our
region, and participants could select up to three responses to a question about their
areas of greatest training need. As you see here, trauma informed approaches
to care was the response selected most often by our participants, and was actually selected
by over 70 percent of those who completed our survey. Which really highlights the value
of this important topic for our region. Moving forward, today’s webinar agenda really
builds upon this needs assessment. We’ll next shift to a discussion about the National Center’s
TraumaInformed Care assessment project, which will be led by Amanda Kellerman from the National
Center and by Dr. Vivian Brown who is the founder and retired CEO prototype and a consultant
at the National Center. Following that, we’ll learn about the process
that the Institute for Health and Recovery uses for health organizations and hence their
capacity to provide traumainformed care. That discussion will be led by Dr. Laurie Markoff,
the Director of Trauma Integration Services at IHR.
Then we hope we’ll have time for questions and answers, before a brief review of upcoming
regional events and an overview of some regional and national resources. Without further ado,
am delighted to turn it over to Vivian and Amanda.
Dr. Vivian Brown:  Thank you so much. It’s a pleasure to be talking with all of you this
morning, and afternoon, excuse me am in California. I wanted to start with some background on
trauma and traumainformed care. You can see that many of the children in child
welfare systems have a parent in need of substance abuse treatment. Substance abuse and trauma
and child maltreatment are really cooccurring multigenerational problems, and we really
feel that unless we meet the needs of the parents, we really are unable to meet the
needs of the children. When the focus has been on the children and
not the parents’ trauma as well, we were not doing the adequate care that we needed to
do. The definition of trauma that you’ll see up
on your screen, this is from SAMHSA, Substance Abuse Mental Health Services Administration,
and describes that trauma results from an event or series of events that is experienced
by the individual, and that it’s really the individual who experiences these events that
determines whether it is traumatic. I wanted to share with you two major studies
that are quite relevant to defining trauma and traumainformed practice. The first is
the adverse childhood event study, which many of you may already know, but a very important
study because it was done by Kaiser Permanente and the Center for Disease Control.
Was one of the larger scale of studies of the influence of traumatic childhood experiences
on health. Over 17,000 people were part of that study. What is important is they interviewed
these people when they were in approaching their early 50s, and then could look at the
impact on adverse childhood events, which is seen on the screen and their health.
You can see substance abuse is one of the leading percentages there. If the score of
the person was more and more everything became more likely. You can see attempted suicide,
drug used, alcohol, but it also allowed for the information around serious health issues
including heart disease, cancer, diabetes, etc.
That’s why this study became so important, because it really was the major study to show
that link between early childhood events that were traumatic and later health disorders.
The trauma exposure we now know from research is almost universal in adult parent samples
of those parents who, of course, children are in child welfare, and in the drug court
populations. Those populations figures range up to about 91 percent who’ve experience that
least one traumatic event. On average, they’ve experience six different types of events,
which is extremely important. The other study that really led to the dissemination
of TraumaInformed Care as well as trauma specific interventions [inaudible 8:05] women with
cooccurring disorders and violence study, and this was a fiveyear study funded by SAMHSA.
My program was part of it. Dr. Marcos’ program was part of it, and we have intensive knowledge
about this study. There were almost 3,000 women enrolled in
this study. It really showed a number of things that were very important for all of us to
know that integrated counselling, meaning we integrate mental health substance abuse
and trauma issues. If you do that in all the sessions and in your interventions, it was
more effective and no more costly, which is important, than services as usual.
The other things that were really key lessons were that the collaborations between those
with lived experience, because everyone of our sites had peer stuff, and these peers
had substance abuse, mental illness, and trauma. It really increased the quality of the services
and the search. We also used group environment and interventions
to help restore the trust and promote healing, which is extremely important. The last piece
I think deserves real mention, which is that we really learned the differences between
the trauma specific services, which are those interventions like seeking safety or beyond
trauma, or trim, that focus directly on helping the client understand what happened to them
and how it impacted them, and to learn coping skills to reduce the impact.
From an informed practice, it takes into account the role and impact the trauma and violence
in all of the lives of the people we are touching. It may not just be in mental health and substance
abuse and emergency services or prices intervention, but in schools and in criminal justice and
education, everywhere, that the TraumaInformed practice really accommodates the vulnerabilities
of trauma survivors and allows services to be delivered in ways that avoid triggering
trauma memories or retraumatization. The responses to traumatic events, most of
you have probably heard about fight or flight. If you’re looking at someone and they are
angry, hostile, cursing at you, that would be the fight response. Flight response is
that the person doesn’t follow through on their court plan or treatment plan or doesn’t
return to treatment or court. Freeze, the individual may not even be able
to communicate what they’re feeling. We see this mostly in very young children who can’t
really fight or flee. They’re going to show the freezing response. All of these responses
affect an individual’s response to treatment and to courts, etc. We know that traumatic
events shatter trust and, particularly, when the trauma has been caused by another person.
If your trust has been shattered, you’re not going to trust someone, even if they say they
want to help you, which is all of us. We’re saying, “We want to help you.” The person
is hearing, “You’re going to hurt me.” Particularly, in the case of trauma survivors, power and
control were taken away from them. The individual is in a state of heightened alertness, which
we call hypervigilance and sensitivity to possible danger.
In this state, minor or even neutral stimuli can be misinterpreted as threatening. Even
if you reach out to the person, this can be threatening, and can lead to avoidance, withdrawal,
or aggression. It’s important that we understand that trauma is the expectation not an exception.
If you see a client with any of these responses or if you’re thinking about them being noncompliant,
think trauma first. The importance of the trauma informed care,
is because everywhere we looked in the research, there was highprevalence of trauma and the
cooccurring problems of substance abuse and mental health. We really need to maximize
safety and reduce possible retraumatization. If we do that, we improve retention in services
and really improve outcomes. We know much more about trauma now, so that we know, in
some instances, we inadvertently may have retraumatized people.
I usually use the example of seclusion and restraint in psychiatric care. We now know
that is retraumatizing for most people. Now you’re seeing the six principles of trauma
informed care, SAMHSA’s document that recently came out. We have safety and the trustworthiness.
I’m sure you all know that number one is safety. The second, trustworthiness and transparency,
that we really want to ensure consistency and predictability for our clients.
Peer support being extremely important for trauma informed care. Collaboration and mutuality,
we want to collaborate not only with our clients, we want to collaborate with our staff and
other agencies that may also be seeing our clients. The empowerment, very important that
clients have a voice and share in decisionmaking. Trauma survivors have lost power and control
when they were traumatized. The last, cultural, historical, and gender
issues makes it extremely important to bring up historical trauma as an extremely important
concept. We know there are populations, Native American and African American populations
with historical trauma and need to be understood and part of the treatment as well.
The background about our trauma assessment that Amanda is going to talk about in a few
minutes, I wanted to give you some background on this. Roger Fallot and Maxine Harris, another
part of the women with cooccurring and violence study, they as part of that, developed an
agency selfassessment and covered the five core elements. You notice that cultural, these
issues, are not there, because that was assumed by them that it should have been part of all
clientcentered care. This is for trauma informed. I adapted the
assessment into a systems walkthrough that allows teams, staff, administrators and peers
to move through the system processes through the eyes of the client. Some of you who have
participated in NIATx, which was that national initiative for addiction treatment improvement,
may know about walkthroughs. It really gives you a sense, as you walk through
an agency or you walk through the entire system, which we have done with family drug court
systems, to understand the experience of care through the clients’ eyes. You’re really looking
now through a different lens. It helps the staff members walking through to also understand
how they may inadvertently reenact the trauma dynamics. To really look at ways where we
may be triggering the person, and how to improve the system process.
The trauma walkthrough is a mutual information gathering strategy. It is not a judgment.
It is not an audit, which we all dislike. It is where we all walk through the agency
or system looking through the trauma lens, understanding how we may be retraumatizing
clients. We may be triggering them. From this walkthrough,
training and technical assistance grow out of that assessment and action plan, which
makes it part of the whole team to decide what kinds of training they want in trauma.
The core question of the walkthrough is could this practice, procedure, or design element
upset or trigger the client, the participant? I just want to give you a couple of sample
questions for the walkthrough. The whole walkthrough questionnaire is in the reference section
in the article written by myself, Roger, and Maxine. Just a few questions.
When you walk up to the site, does it feel welcoming or unsafe? What does the waiting
room feel like to you? How many people are there in the room? Filling out the intake
forms, how did that feel to you? Were you given any choices with regard to your treatment?
When you would be seen, by who, gender of counselor, etc.?
All the questions are there for you. Each step of the walkthrough, we have everyone
identifying possible triggers. For each trigger, brainstorming possible changes that can be
made. We leave them with a preliminary action plan, and the team can then add to it as they
go along and look at what they want to do. How they grade the greatest rift? How doable
is something? They then have an action plan, which may take
them a year or two to get through. I’m going to now turn it over to Amanda Kellerman.
Amanda Kellerman:  Thank you, Vivian. Hi, everyone. My name is Amanda Kellerman, and
I am the project manager for the National Center on Substance Abuse and Child Welfare.
It was my pleasure to partner with Dr. Brown over this last year through the National Center
to provide this Trauma Care Walkthrough Project. I’ll do a little bit of background on the
project, and then we’ll get into some of the findings that we came across in doing this
project. I really hope that this part of the presentation can give you a really clear example
for what trauma informed care looks like. We heard from a lot of you and a lot of people
on site as well, that that’s really the missing piece right now.
There’s a lot of training out there on trauma right now. A lot of people have a great understanding
of how trauma impacts a family, but what’s missing is, “What does that really look like?”
We hope that today we can give you some clear examples between my part of the presentation
and Dr. Markoff’s part to see how trauma informed care really looks.
We’ll move ahead here. There we go. Quick background, the Trauma Informed Care Walkthrough
Project was funded through the National Center. We partnered with Dr. Brown as a consultant.
We selected five sites over this past year. We actually facilitated the walkthroughs last
summer. We did do a selection process to select our five sites that we worked with.
You can see the selection criteria here. We did an outreach and sites submitted a letter
of interest and indicated to us that they were ready and willing to participate in this
project. We did select five sites from across the country. We had both rural and urban sites.
The key piece was that we wanted our sites to be crosssystems collaborations. We chose
sites that actually had a family drug court at the heart of their collaboration.
That they involved substance abuse treatment providers, child welfare services for family
drug court or family treatment court as well as some other community partners. In some
instances, as well such as mental health services, housing, some other partners. The core were
the family drug courts, the substance abuse treatment, and the child welfare component.
We were looking to make change really across systems here.
In preparation for the walkthroughs, we got the team together on a planning call. We started
by getting every team member who was crucial to the project together and talking through
the process. We developed the agenda for the twoday visit. We also completed a baseline
survey. I’m going to get into a little bit of the findings here of our baseline survey.
Our intention here was to get some baseline information for where the sites were currently
at. We wanted to gather what type of training they had received? What type of funding that
the agencies had for trauma informed practices? What types of traumaspecific screening affects
an intervention they were doing? Then the different types of policies and practices
that the organization already had in place related to trauma.
You’ll see here the breakdown of who responded to this survey. It was actually done, we asked
the leaders from each team to send it out to all levels at their agencies. For child
welfare services, for instance, we had everyone from the front line to worker all the way
to supervisors to upper administration, so lots of variability in who completed it. I
wanted to go over some of the findings here, because they’re really interesting.
They gave us a snapshot of where the field was at with regard to trauma informed care.
A really interesting finding was that, as you’ll see here, 92.4 percent of respondents
indicated that they understand how trauma impacts a person and a family. As I mentioned
before, we saw that on site, everyone seems to understand trauma, how it impacts their
engagements of services and that process. Where the gap is is understanding how to provide
trauma informed care and trauma informed services. You’ll see only 50 percent agree that they
had an understanding of that piece. That gave us a clear indication that on these walkthroughs,
we needed to focus really on that on that “how to” piece. You’ll see here nearly 60
percent indicated that they knew the difference between trauma informed care and traumaspecific
services. Vivian already touched on this a bit. That
was another piece that we focused on when we were on site. You’ll see nearly 70 percent
have received training on the topic of trauma and you all on the [inaudible 24:09] agreed
today that that’s something that you see in your area too. You’ve seen presentations,
conferences, and webinars on trauma. Less people had received training on the traumaspecific
interventions. With regard to screening and assessment, just over 40 percent indicated
that their agency does conduct a screening for trauma.
This is a gap that we identified as well. Many providers and agencies aren’t asking
questions to their clients to see whether they have had experiences of trauma. That
indicated to us we needed to get to that as well when we were on site. With regard to
traumaspecific interventions, about 40 percent agree that their agency currently implements
one or more evidence based practice. You’ll see below the top three interventions
that people indicated that they weren’t using were seeking safety, traumafocused, cognitive
behavioral therapy, and parentchild interaction therapy. Those were the most commonly reported
ones that were reported. This was a little bit about our findings in
the baseline survey. Now we’ll get into the trauma informed care walkthrough process.
As I mentioned before, the sites completed a twoday walkthrough. It was led by Dr. Brown,
myself, and another National Center staff, who rotated through each visit. The visits
each began with a briefing session. We got the entire team together.
What was most important for us was that we had a leader from each system present for
the entire walkthrough. As Vivian mentioned before, the real value
to doing the trauma informed care walkthrough is that the whole group is able to really
slow down and take a step away from their daily practices and their busy lives of meeting
with clients and all of that, to really walk through the agency together as a group and
identify, from the eyes of the client, where there could be potential trauma triggers.
We really stressed to the group that we wanted each key player to be there for the entire
visit. It was also beneficial to have, for instance, a substance abuse treatment professional
walking through the child welfare agency, so that they could see across the system,
maybe from a different perspective what other trauma triggers that are observable in the
site. We also completed each walkthrough with a
debriefing session, where Vivian and I went over what we saw on the walkthrough. We identified
the trauma triggers that we had observed, as well as some potential solutions. Maybe,
as we walked through the system, we saw, “Oh, that’s a trigger.” but then also identified,
“Well, this could be an easy fix,” or maybe, “This is a solution that could get to solving
that trigger.” Lastly, we developed a preliminary action
plan based on the findings we presented at the debriefing session. We presented that
to the group. From there, it was up to the team to take their preliminary action plan
and move forward with creating steps and creating change in their organization based on their
priorities. We’ll get into some of the findings, and as
I go through these next slides, present some of the most commonly identified trauma triggers,
I invite you to think about your agency, your organization.
Think as I walk through these bullets, are any of these triggers present in your organization
currently or maybe some of your partners. I will be getting to some of the solutions
that sites have come up with, and have already implemented to respond to some of these triggers.
We will get to that as well. First wanted to go over what the most common triggers were.
Based on those preliminary action plans, we analyzed that qualitative data and pulled
together the most common themes here that we saw across all sites.
Interestingly, there were some very common things that came up across the sites. No matter
urban, rural, across the country, there were things that were present in many places. That’s
what we’ll be presenting on here. I’ve pulled them out by theme, so you’ll see here the
first slide is on safety and physical space. Here are some of the examples of the trauma
triggers that we identified on site. You’ll see the unwelcoming buildings.
We experienced some hallways and rooms that felt very dark, cold. We had actually an interesting,
kind of funny story. In one of our walkthroughs the group had a peer recovery specialist.
We had invited him to join us on the walkthrough, which was a very beneficial experience to
hear from someone who had gone through the program, had survived his own trauma, and
had also been a graduate of the program. He felt very comfortable to share what he
had experienced. We walked into one of the intake and assessment rooms and he blurted
out, “This room feels like a closet.” We all kind of laughed, but then looked around and
went, “Wow, it really does.” Hearing that peer’s example and statement
there really brought it to life. On security guards, that was something that came with
us in a lot of our walkthroughs. There are many situations where there are securities
that we can’t get away from, for instance, walking into a court building.
We identified some security guards that maybe were triggering a situation. That was one
of the triggers as well as some echoes and loud noises in rooms, flickering lights. Paying
attention to those kind of little things around the building that can impact a client’s experience
to trauma. Lack of artwork or traumatriggering artwork was a big one that came up on a lot
of the visits. We walked into offices where clients would
meet with their clinician or worker and either the client’s backs or the staff’s backs were
facing the door, and for someone’s who’s experienced trauma, if their back is facing the door,
it can be quite triggering, as they’re not knowing who’s coming in behind them.
As well as if staff are blocked behind their desks, they if they’ve experienced trauma
themselves, may feel a little bit closed off and blocked and unsafe. That was one that
we identified in almost all five of the walkthroughs. Another was not enough space for clients to
sit in the courtrooms. This was in the family drug court. Maybe clients walked in, and it
was really loud, there was a lot of movement, shuffling, and loud noises. We felt that could
be triggering for some clients. Moving onto the intake and assessment process. One thing
that we noticed at every walkthrough was that there was quite a bit of repetition across
assessment and intake forms at every agency. With the partnerships that we worked with,
we had clients who we’ll see be involved with the family drug court, the substance abuse
treatment agency, child welfare among other partners. We noticed in looking through their
intake and assessment set, they were being asked the same questions at every agency.
Of course the limitation is there, some forms are required either by the state or that each
agency must complete, but there was quite a bit of repetition for information that maybe
could have been cut down to minimize the need for the client to repeat their trauma story
every time. This may make the client feel unheard, maybe lose trust in the agency, kind
of that feeling of, “Why aren’t you listening to me? I’ve told you this before.”
The lengthy intake procedures, that was another big one. Clients would have to complete two
sometimes three hour assessments with little breaks or maybe not a chance to go outside,
maybe some food. Another one was with a lack of childcare, the kids were sometimes were
with the parents during those assessments. That could pose a challenge as well for that
lengthy procedure. Lack of screening and assessment questions
was also a trigger that we identified. It kind of paired back with our results from
the survey, in that not many agencies were screening for trauma. We had talked with them
about adding a few questions on the intake to get to some of the trauma experiences.
Lack of clarity and inconsistent processes was also there. This could make the client
feel like they don’t know what to expect, and feel a little bit of lack of control in
the situation. That was another trigger we identified.
With traumaspecific intervention, there were a lack of traumaspecific services for children
and parents. Again, partnering, reflecting what we found on the survey, there weren’t…some
communities did have some really wonderful traumaspecific services. We have some that
were implementing seeking safety and some other really great evidence based practices,
but still there was a lack of services for that.
What was really clear for us was a lack of partnership with mental health services. They
were often not at the table at all with these partnerships, which could pose a real challenge
for providing traumaspecific services for these clients. Many of the partners didn’t
know what mental health services were available and clients didn’t have access to these services.
That was a big one that came up for us when we were encouraging some change, was to get
mental health at the table, and improve that partnership, and increase the amount of partner
specific services that would be available to the client.
Within the family drug court setting, and this could generalize to other courts, I mean
any type of collaborative court, we noticed a lack of consistency in responses. That would
be the incentives and sanctions that are given to the client. A lot of times there was no
clear messaging about what responses were given and this can help have the client feel
like they don’t know what to expect. They might lose trust in the team because
maybe one client is receiving one incentive and they themselves maybe aren’t receiving
one for the same behavior. That inconsistency can be a trauma trigger for clients.
Triggering sanctions. Of course there are some situations where jail time is given as
a sanction and some courts as a part of their protocol, and that’s OK, but we encourage
[inaudible 34:34] to think about the sanctions that are given and think about how they could
be triggering for clients. As well as thinking when an incentive or sanction is given, thinking
about what behaviors might have precipitated the action that required a sanction.
For instance, let’s say a client has not shown up for drug testing. Maybe thinking about,
is there something triggering in that drug testing situation that is encouraging the
client not to go back. If they’re triggered and then they’re not wanting to go, rather
than just get the sanction and not investigate further, maybe it’s about having a conversation
with the client to really hear about why they haven’t been going. Maybe they’re being triggered
by that situation. As Vivian mentioned, think trauma first. When
there are behaviors that happen in the courtroom or in any system, think trauma first before
you give a response to that behavior. Always best to consider the trauma.
This type, as well with the drug testing space, so at a lot of the agencies that we saw that
do the urine testing on site, we got to peek in their bathrooms and take a look at where
they were doing the testing. We noticed that many of the bathrooms were in high traffic
areas. We had one site, for instance, where the bathroom they used for testing was in
the middle of the cafeteria area. It was the residential treatment center.
This could be triggering for a client where they feel a lack of privacy. They feel that
other clients may be hearing or listening or watching what’s being done as they go into
the bathroom. Many bathrooms were uncomfortable. A little bit small, maybe unwelcoming, where
not enough artwork, not enough comfort in the bathroom, not enough space.
For someone who’s been triggered and the drug testing experience or the urine testing, if
someone is standing right over you watching very close to you while you’re doing that,
it might be triggering for you if you have had a history of sexual abuse or other type
of abuse. With drug testing in particular, this is one
where we know we can’t not do it. We have to drug test in certain situations. This really
came to, how do we address the crisis in this situation? How do we really take into consideration
what would make them feel comfortable? It’s maybe even a matter of talking with the
client saying, “I have to do this, but what might help you feel a little bit more comfortable
in this situation?” Maybe the client will say, “Can you just step back a few feet?”
Sure, that’s an easy change that can be made, of just addressing with the client, having
that conversation what would help you feel better.
Client Choice and Empowerment. This ties in with that one. We talked a lot about offering
[inaudible 37:19] client’s choice in the program. This is still a triggering system with the
staff, they mentioned, “Well, how do we make sure that the clients aren’t taking advantage
of us if we are offering them choice?” We know that a lot attempts at choice is small
things. It’s offering the clients choice that maybe between a counselor or offering clients
choice of treatment group, which group to start at. It’s not always big things. but
it’s finding little areas to empower the clients and give them choices.
The last trauma trigger that we identified in nearly every agency was secondary trauma
for staff. This came up a lot where staff were concerned about, or supervisors were
concerned about their own staff with either their own experiences of trauma or just feeling
traumatized by the work that they’re doing. There was a lack of physical space for staff
to decompress after difficult meetings. No really safe space for staff to go to, to have
a few moments quiet. As well as front office and security staff,
the [inaudible 38:28] really don’t have any training in trauma. They were identified as
feeling anxious and not understanding when clients come in feeling triggered. That was
another staff trigger that we experienced. I’ll jump ahead now to some of the changes
that have been reported so far, that way we can highlight for you what can be done about
some of these triggers. If, as I walked through these steps you said, “Oh. Wow. I have that,”
or, “I have that at my agency,” now you can hear some of the examples of what’s been done
to mitigate some of these triggers that we experienced.
We reported these with the site after six months. They’re still in progress. They’re
still working really hard to get some of these changes. It takes a long time. These are what
we’ve seen so far. I separated them out by the domains of traumainformed
care that’s in pane one over, so we’ll start with safety here. Two of our sites reported
rearranging their staff offices, so already moved their desks around so that staff didn’t
feel blocked in, distracted by noise, or having their backs to the door.
Two of our sites reported changing their drug testing bathroom spaces so they’ve moved to
more private areas. We’ve heard of them adding artwork up on the walls and making the bathroom
just a little more homey and comforting. All sites noted that they were working on adding
artwork to the walls throughout the agency. Some of our experiences were hallways that
looked like hospital hallways, and we’ve heard from all of our sites that they’ve already
been working on getting some great artwork, in some cases, artwork from clients, which
is really wonderful as well. One site has already created a safe space
for their staff and child welfare office, which was really exciting for us. I think
they are calling it a Zen room at this time or a wellness space. But a place where their
child welfare staff can go and have a moment to decompress.
Two sites are already working on implementing a training for their front office staff and
security guards. They’re actually doing training for all levels of staff on kind of a trauma
101, hearing about how trauma impacts a person. One site already noted that they’re using
peer specialists to greet individuals at the security screen. As I mentioned before, you
can’t always get away from having security there, but maybe having a peer specialist
meet your clients at the door and help walk them through, help them feel warm and comforted
as they walk through that triggering situation. As far as trustworthiness and transparency,
one site has already make it a priority to develop information sharing agreements. This
is getting at the challenge that we identified about repetition across agencies of the intake
and assessment questions. They’ve already started gathering as a team
and they are looking at each system’s intake and assessment forms and identifying as a
team, what agencies can cut down on certain questions. From there, they’re developing
an information sharing agreement to put down on paper what they’re specifically going to
be sharing then. They have to agree upon, if I’m not collecting
this information, I trust that you will be collecting it and I trust that you will share
it with me. That will help minimize that duplication. All sites have noted changes in their family
drug courts incentives and sanctions that they are using. One is implementing a tiered
list of rewards and sanctions to ensure consistency that clients know exactly what they will be
getting depending on their behaviors. With peer support, we have sites working on
securing paid positions for peer mentors. As well as one site, this was really exciting,
implemented a support group for their peer mentors. They’re encouraging more frequent
supervision meetings with their peer mentor supervisors and they’ve already reported that
they are seeing benefits with this, with their peer support groups, that they are feeling
that increased support. Increase in moral and decrease in feelings of burnout.
The last two here, collaboration, empowerment, voice, and control. We have a site that created
a liaison position between mental health services and alcohol and drug services to get that
mental health partnership, to strengthen their partnership.
All sites have noted now offering clients a choice of therapists and then all sites
have reported changing in how they interact and talk with clients about some of the drug
testing procedures. Lastly, we have a site who implemented a gender specific therapist
for seeking safety. They have the women’s specific group for seeking safety to get to
some of the gender issues there. Overall, our key lessons learned were that
the use of peer mentors as recovery coaches was a crucial piece of being traumainformed.
They can really get to some of those triggers that we notice throughout the site. The lack
of mental health partnership was a key barrier that we noticed on all sites. That’s something
to think about as well. Sites demonstrated an understanding of what
it meant to be traumainformed, but just didn’t understand quite the how to. That was something
that we hoped that this action plan would help them to address. Need for information
sharing agreements came up in all sites. Again, that was for that repetition of the
intake and assessment questions. The lack of multilevel training. As I mentioned, the
front receptionist, or the janitorial staff, or the security screens not having an understanding
of training. What I’ll say is that, with our work here
in trying to make organizations across systems become more traumainformed, one thing that
really came up was that it’s not just the agency changes and organizational changes,
but also those clinical interactions that need to change to be more traumainformed.
That’s where I’m really excited to pass it over to Dr. Laurie Markoff, who will be going
over some of the key competencies for traumainformed interactions. How can I speak to my client
in a more traumainformed way? We’ve gone over here the more organizational type of changes
and now Laurie will take it further give some wonderful examples for how you can communicate
better with your clients to be more traumainformed. I’ll pass it off to Laurie. Thank you very
much. Dr. Laurie S. Markoff:  Hey. Hello, this
is Laurie Markoff. I am going to talk to you about the Institute for Health and Recovery,
where I am the Director of Trauma Integration Services. What I’m going to talk to you a
little bit about our own systems change process and how from that, we developed a number of
resources to support both systems and practice change.
We started something similar to what Amanda and Vivian have just described in terms of
the system change process. The way that we do it is that an agency completes a trauma
integration selfassessment on their own. Then they choose a trauma champion, and that person
develops a trauma integration team that includes people at multiple levels in all the different
roles in the organization from the receptionist to direct care staff to admin staff.
Then we provide onsite trauma training for the team initially, and then that team goes
on to develop a trauma integration implementation plan, sort of like what Vivian and Amanda
were talking about called action plans, but we have a template for that.
It’s like a workbook that they go through looking at all the different parts of what
they do from work force development to service delivery to all kinds of different policies
and procedures and go through and develop goals and then begin to do the kinds of implementation
that was just mentioned in the previous presentation. During that time, they can request additional
training from the Institute for Health and Recover. That includes training on traumaspecific
interventions. Then periodically they repeat the selfassessment so that they can actually
watch their own progress. In the process of doing that, we noticed that there were somethings
that organizations needed in order to become traumainformed that we wanted to make more
widely available when we weren’t available to come on site.
This is a group of things that were collected into something we call the toolkit that you
can order from IHR’s website. The trauma integration selfassessment is in there. There is also
a staff practice survey which is a survey that you can administer anonymously to your
staff and that measures sort of where you are at in terms of six domains of traumainformed
practice. That includes staff safety, staff empowerment,
staff selfcare, staff trauma knowledge and competence, staff attitudes, and traumainformed
practice. Then you can readminister that after you move
forward to see whether the training that you’re providing is actually changing any of those
things. We also developed traumainformed supervision tools because one of the things that we’ve
been talking about is how do you really get penetration? How do you really get practice
change? One of the tools you have available is to do supervision, and supervision in a
traumainformed organization should be done in a traumainformed way.
We have two supervision guides that are included in the toolkit about how to provide traumainformed
supervision and also, how to encourage traumainformed competencies in staff. Then we have these
two tools that help organizations to implement traumainformed supervision.
One is a supervisor selfcheck, so after you’ve done a supervision session you have a way
of looking at how did I do in terms of the traumainformed competencies that I’m supposed
to be exhibiting when I’m doing supervision. Then there is a supervisee learning review
so that for every staff member you supervise, you can look at which competencies have they
pretty much mastered and which ones do you want to be encouraging and you can do that
periodically. The toolkit also includes our template for
developing a trauma integration plan, which is, as I said, like a workbook for the trauma
integration team to use in talking about all the different aspects of the organization,
and what changes you might want to make in order to be more traumainformed.
Part of what we’re talking about here is that there are two aspects to traumainformed care.
one is being a traumainformed organization. That involves a lot of institutionalization,
policies and procedures, your physical environment, all of those kinds of things. The other part
of it is for staff to be traumainformed and not just have a knowledge of trauma, as Amanda
and Vivian both referred to, but actually know how to interact with clients in a traumainformed
way. In the process of developing all of these
resources, one of the things that we started talking about is what really are the core
competencies for a traumainformed workforce? These are the three core competencies that
we are looking at. How do you use an empowerment approach? How
does staff build safe relationships with clients? Then, how does staff both understand a client’s
behavior in terms of it being an attempt to cope with trauma that certain behavior has
developed as the result of trauma and the attempt to cope with it. How does staff both
understand that, and then how do you communicate that to clients so that they understand the
connection between their behavior and their experience of trauma?
The first core competency is using an empowerment approach. One of things about this approach,
as Vivian said earlier, because trauma is an experience of helplessness, staff really
want to help clients to begin to feel that they do have control and choice in their lives.
There’s lots of things you can do to conduct interactions with clients in a traumainformed
way. One of them is to ask questions, so rather
than telling clients what to do or telling them what you think, to ask pointed questions
that help clients to selfreflect, and come up with their own solutions, and noticing
their own observations of their lives. This process can be used to help clients to identify
in a particular situation what are their choices, and what would be the result of making choice
A versus choice B. If you’re going to go to a residential treatment
program, what would be the outcome of that as opposed to whether you are going to outpatient?
Things like that. All of their choices, thinking them through in terms of outcomes. Staff can
help them do that rather than telling them what to do and what staff think the outcomes
will be. The idea here is for staff to offer clients as much choice and control as possible.
A traumainformed staff member is also going to focus on strength. Trauma survivors know
a lot and hear a lot about what they’ve done wrong in their lives, and they tend to focus
that way. A traumainformed counselor will help clients to identify the skills they used
to survive to this point in time, so that they’re aware of those skills and can now
use them in new situations, and feel more empowered in their lives and aware of their
strengths and their skills. A traumainformed counselor will also always
notice very directly whenever a client makes a choice, even a small one that demonstrates
their capacity to lead toward their own goals. Every step they take should be pointed out
so that they are able to see how they are using their choices to move toward their goals.
A traumainformed counselor will also be as transparent as possible, explaining why you’re
doing what you do, what you do, and what you’re doing, so that there are no surprises.
Partly it’s because if you can’t control the situation, being able to predict is the next
best thing. Now it helps people to do that. One of the trauma informed core competences
is to be giving clients information, so that they can use that information in the future
in making their own choices. Now I’m going to show a…unfortunately I
can’t show you a video clip, so what you have is a still picture and you’re going to hear
it here in audio clip of the session, which is actually a role play. In this role play
the client, his name is Karima has just selfinjured in a residential program, and I’m playing
the counselor in the clip.
Laurie:  You felt pretty overwhelmed. You actually made the choice that this might be
the safest thing you could do? Karima:  Yeah.
Laurie:  You felt like it was a better choice than you might hurt somebody, you might knock
something over. You actually thought about that, and that’s pretty impressive! It’s impressive
that you were able to think of the things you didn’t want to do and make a different
choice. That’s pretty impressive. That shows a lot of strength!
Karima:  Thank you. Laurie:  Really! After you cut, after you
used the fork, did that help you? Did you feel better?
Karima:  Yeah, a little bit. I might have still wanted to hurt somebody else, and it
kind of took my mind off of all that so I could stay here. I didn’t just get up and
leave again like I did at other places. Laurie:  All those overwhelming feelings,
all those things you didn’t want to do. You didn’t want to hurt somebody, you didn’t want
to knock the furniture around, you didn’t want to get up and leave. The alternative
you could think of that would help you deal with the feelings, was to use the fork to
scratch yourself. It’s pretty amazing that you could make that choice, that you thought
about what your best options were and you chose that. You know that shows a lot of strength.
Are there any negative things about using that, cutting yourself? What’s the downside
of that? Is there any downside? Karima:  Normally, after it’s over, lots
of times here I have to wear like long sleeves and stuff like that because I don’t want people
asking me, “What’s that? What happened right there?” All that stuff. I just keep it bandaged
up and try just to keep this covered. It’s kind of uncomfortable in the summertime because
it’s hot. Laurie:  You have to hide it.
Karima:  Uhhuh. Laurie:  If someone does notice and asks
you about it, what’s that feeling? What do you feel when somebody notices?
Karima:  I feel ashamed. I don’t know, sometimes embarrassed.
Laurie:  Why would you be embarrassed? Karima:  Because I know that everybody doesn’t
do that. You know what I mean? It’s been something all my life. When I see people with tattoos
or braces and stuff like that, they don’t have other stuff like scars and stuff on their
arms. Sometimes I wonder how that’s going to look later in life on my arms. Will I ever
stop that? How am I going to wear shortsleeved shirts? When it heals up, I know I’m black,
but it’s not going to disappear. Laurie:  You don’t really like having scars?
Karima:  Uhhuh. Laurie:  You don’t really like people knowing
that this is what you’re doing? Those are the downsides. Those are the reasons why you
might not really like doing this. Sounds like you wonder if you are going to need to do
it forever? Karima:  Yeah.
Laurie:  First, I want to say again that it’s amazing what you’re able to tell me.
I just want to tell you that not every kid I talk to can even say, “I feel shame,” can
even name their feelings. Another thing, it seems like you’re really aware of your feelings,
and you know how to name them. It also sounds like you really think about what you do. Given
all that, if we together could come up with other things you could do instead of cutting,
maybe you would be willing to try them? Karima:  Yeah.
Laurie:  You can hear how in that interaction,
I pointed out Karima’s strengths, and then knowing she had those capacities, talked about
the pros and cons of the behavior. I was looking for her to express her own ambivalence, so
that when I presented the possibility that that behavior could change, she would see
that she might have the capacity to change that.
The next trauma informed core competency has to do with building safe relationships. As
we said earlier, a safe relationship is a collaborative relationship, in which the client
is the expert on their own life and what we bring is our own knowledge and our own experience,
but it’s a partnership. In order to have that kind of partnership,
you have to be curious and open minded. You’ll notice in that clip, she’s cut herself and
rather than my being freaked out in any way, I’m asking her, does that help? Trying to
find out what her own experience is. I don’t make any assumption. I even say is there any
down side rather than just, what’s the down side? Because I want her to be the one who’s
making that assessment. You’ll notice that I was also completely nonjudgmental
about her behavior, and was trying to very much avoid shaming her for the behavior that
she was talking about. It’s important also for a trauma informed counselor to be trustworthy.
You do what you say, you say what you do. It may take thousands of repetitions to break
through the betrayal trauma that people have experienced in their past.
You’ll also notice that I ask a lot of questions about feelings and validate the feelings.
It’s very important to do that before you move to behavior change, because clients have
often not felt seen and heard. If some behaviors are meant to communicate something and if
the communication doesn’t get through, if clients still feel like they’re getting it,
then they’re not going to want to change it. If they feel seen and heard, and you validate
the feelings, and they know you’ve gotten the message, then they may be able to consider
changing the behaviors. Of course, the not being freaked out part requires me to use
my own selfregulation skills. Whatever feelings I might have about the fact
that Karima cut herself, I’m regulating enough to be calm and supportive, so that she doesn’t
experience from me any panic, or disgust, or anything that might make her feel badly
about herself. Now I’m going to play another audio clip.
This is a client in detox and we are talking about…this is sort of doing after care planning
with a client who is leaving detox. May we have the audio please?
Steve:  I guess I’m going to try to stick
with meetings. That’s probably my best bet even though I’m not all that crazy about them.
Laurie:  Wait, you’re saying that when you went to meetings, it didn’t help you?
Steve:  No, not really. Laurie:  And that actually going to meetings
made you want to use more? Steve:  Yes, but what else could I do other
than meetings? That’s what everybody says go to meetings.
Laurie:  Is there anything that you’ve ever done that you think did help you to stay sober?
Steve:  When I used to be much more into staying fit, exercising, and I kind of let
a lot of that go. I wasn’t taking care of myself. Get in a good routine for staying
healthy. Probably I should go back to church get some good morals. Stay away from bad crowd,
stay away from party scene. Laurie:  Has church helped you in the past?
Steve:  Yes. I’ve been in good periods with them, but then I used to get mad because people
seem judgmental a lot of time. Sometimes I feel like I can’t really relate too much to
people at church, but I meet somebody every now and then. I’ve been at churches where
I meet a couple of cool people. I always seem to kind of get disappointed or disillusioned
or something. Anger rise used to creep in there at some point.
Laurie:  Is anger one of the precedents for your using…
Steve:  Yeah. Laurie:  …your drinking?
Steve:  Yeah. Laurie:  If you get angry…
Steve:  I probably should just do anger support group of some kind.
Laurie:  Do you think that would help? Steve:  Yeah, that would probably help. I’ve
never really done that. Laurie:  It sounds like you would like to
have on your plan an anger support group. Maybe we could help you find one, and make
a referral before you go, if you want. Steve:  OK.
Laurie:  Sounds like you want to go back to church.
Steve:  Yeah. Laurie:  Any other supports you think we
can get you? Steve:  My girlfriend can be a good support
as long as she doesn’t stick to nagging me, stuff like that always gets to me. She can
watch me like a hawk, and then I get irritated. It’s like trying to control my every move.
Hopefully it doesn’t go that way. Laurie:  That sounds like sometimes that
relationship is good, but then there are moments in it where you get angry. Does that lead
back to your drinking again? Steve:  Yeah, yeah, it is a hard relationship.
She can be supportive, but then she can be really controlling too at the same time. When
she gets like that, I tend to just say, “Screw it.” That relationship can be a problem. It’s
a bit of a risk, but at the same time when it’s good, it’s good. I’m hoping I won’t get
into the negative pattern again. Laurie:  On a scale of 0 to 10, with 0 being
you’re absolutely certain you’re going to relapse and 10 being you’re absolutely certain
that you’re not going to drink again. With that plan going home to live with your girlfriend,
maybe going to an anger management group, and going to church, with that plan, how confident
are you that you’re going to stay sober? 0 to 10.
Steve:  My track record isn’t good, but I don’t know.
Laurie:  Can you put a number on it? 0 to 10?
Steve:  Let’s say 50/50, five. Realistically. I know I’ll be good for a while but it just
seems like something always comes and gets me, and I just get back into the negative
thinking and drinking, then it keeps getting worse. It’s hard to say with my track record
that I won’t go back, but I’m certainly going to try not to.
Laurie:  Can you think of any other possibilities where you could go after you left here that
might be better? I’m asking whether you would consider maybe going to some more treatment.
Something like a residential treatment program, where you could live there, and there would
be group supports available to you? Steve:  I’d be willing to do that if I…I’m
going to try all these supports that you’re suggesting, and I would say, it’s not going
to be wrong to tell my girlfriend, she’s not going to put up with anything. I’d be willing
to do that if l start to slip, but I’d like to have one more shot to do it right this
time. Do all the things that I’ve been told to do.
Laurie:  I’m a little worried about 50 percent, you almost doubt…
Steve:  Now you just sound like my girlfriend. What is this? Come on.
Laurie:  What am I saying that sounds like your girlfriend?
Steve:  Just nag, nag, nag. You’re just saying, give me easy answers, and you’re just saying
look at the positive side, just tell me I want to hear. It’s just sort of you want me
to tell you what you want to hear. I must be honest with you, 50/50.
Laurie:  No. I really do appreciate your honesty. I really do want you to be honest
and I hear it’s a little bit frustrating for you to have somebody sort of pushing at you
a little bit. Steve:  You just seem like you’re just trying
to get me to go to another program. Like I told you, I like your programs. I don’t think
half the boarders who are in those programs even want to be there. They all seem burned
out to me. They go off and sit in their office and just leave us to stay here [inaudible
67:57] in a room. You just seem to want to push me into that kind of thing.
Laurie:  It feels to you like I’m pushing? Steve:  It does.
Laurie:  OK, I want you to know that it’s entirely up to you what you do.
Steve:  What are you going to do? Camp me over there?
Laurie:  No. What I was thinking of is you and I can go over to the program. I’ll go
with you, we can meet the staff, you can hear about what it’s like. Then we can have another
conversation like this. I want you to know it is totally up to you what you do. I just
would like… Steve:  You’re saying that you are going
to go with me? Laurie:  Yeah, I’ll go with you.
Steve:  Baloney, you’re not going to go with me.
Laurie:  I’m going to go with you. I absolutely mean that. We’re going to call the program,
and find out what time is good, and then I’ll go over there with you and we will look at
the program together. Then we’ll talk about the pros and cons again.
Laurie:  You can see in that interview I
had to use fair amount of my own selfregulation skills, and also how much of what we came
up with came from Steve as opposed to from me. The last trauma influence competency has
to do with understanding and explaining behavior in terms of past trauma and attempting to
cope. A trauma informed staff definitely will ask
questions that help connect behavior to adverse event, and will understand and explain behavior
as unsafe coping or attempt to survive, rather than anything else so the client have some
understanding about how it developed, and also because that’s a less judgmental kind
of approach. Trauma informed staff member will recognize
when someone is in fight, flight or freeze and help them focus on selfregulation so they
can think, and will pitch an illicit selfregulation skill, and also help people to identify their
own individual triggers. I’m going to play one more clip for you. This is Trisha. This
is her first outpatient appointment, and we’ll see what she’s talking about.
Laurie:  I should tell you that…remember
how I said earlier in the interview that people who’ve had adverse experiences, like sexual
abuse in their past or physical abuse in their past, that sometimes that’s connected to what
happens going forward? Trisha:  No.
Laurie:  It’s really common for girls who’ve experienced sexual abuse, later in life to
end up using or being in a position where they end up using that for survival purposes.
What you’re experiencing is actually probably a lot more common than you think. Just like
you didn’t want to talk about it, the reason you don’t know that other people are doing
that is because they don’t often talk about it.
That way you think you’re the only one in the world who ever ended up in this position,
but in reality, lots of girls who’ve experienced sexual abuse grow up, and it changes something
that they end up in situations. Now obviously you didn’t create the situation. Your landlord
is the one who is proposing to use his position of power to get you to do something that isn’t
what you want to do. You’re not responsible for his doing that,
you’re not. You’re just doing what you’ve learned to do to help you survive. We can
work together for you figure out what other options you have, and what else you can do.
Trisha:  OK. Laurie:  Does that make sense?
Trisha:  Yeah. Laurie:  Good. Thanks for being so open.
Are you ready to continue with the rest of the interview?
Trisha:  Yeah.
Laurie:  You can hear in that clip that Trisha reveals that her landlord is asking her for
sex, because she’s unable to pay the rent. We have a conversation about the connection
between that and her sexual abuse as a child. If you’ll notice, when I finish that conversation,
the next thing I do after thanking her for being so open, is to ask for permission to
continue. I’m checking in to see how she’s doing and then to be able to complete the
interview. The actual videos that those clips were taken
from are available for free on the website www.healthrecovery.org. There will be a second
video on trauma informed supervision that I’m filming in May. It should be out in the
fall. We will also have some online curricula for training the staff about the connection
between substance use and trauma and trauma informed practice around that.
They’ll be four one hour modules and be available in the fall as well. That concludes my part
of the presentation. I’ll turn it back to, I don’t even know who, Melissa maybe.
Amanda:  Thanks, Laurie. This is Amanda. I’ll jump back in. I think we are ready to
move forward to our question and answer section of whoops I skipped ahead too much, there
we go Q&A. As Melissa mentioned to you earlier you can feel free to type any questions that
you may have into your question box which is on the right hand side of your screen in
your control panel. I invite you all to type out any questions
you have there. I will then read them over the phone. I’ll open up the phone lines for
both Vivian and Laurie to respond to those questions. Several of the questions, I will
say over the phone, have been related to the PowerPoint presentation. It will be available
online as well as the recording of this webinar within the next week.
You’ll be able to access our website and gather the materials. We also put the link to the
video that Laurie just mentioned as well. You’ll be able to access that. I’ll be sending
out an email later today, so watch for that. We’ll provide all of those resources.
Our first question, I will just go ahead and read. Vivian and Laurie, I invite you both
to jump in and answer the question once I’m finished reading.
The question is, “Even though we have signed releases between DHS and the substance abuse
provider, we are often given much resistance from the substance abuse provider to collaborate
on care, even when establishing an after care plan. What are some ways that DHS could break
through the substance abuse therapists’ resistance to use a team approach?”
Vivian:  I’ll jump in. I think one of the things is that you really want to get some
of the directors sitting in the room as well, to talk about how the collaboration can really
be enhanced, and that is people aren’t sharing information, even though they’ve signed releases.
That it really is inhibiting the best approach for the clients. I think that people need
a discussion around what they’re not trusting. I think trust and collaborations is one of
those issues that’s really important to keep talking about.
Laurie:  I agree with Vivian. It’s a lot about trust. If there has to be a discussion
about the fears, “I’m afraid if I tell you that she took one toke of a marijuana cigarette,
that you’ll remove the kids again,” or vice versa, “I’m afraid the client may be using
and you’re not telling me that and that makes me reluctant to let her have more visits.”
You have to develop trust among yourselves that you’ll be able to collaboratively work
together, based on the shared information about how to move forward. When people feel
that they really will be collaborated with, they’re more likely to share the information.
Next question. Amanda:  Next question. How can we explain
practices that are definitely triggering but are also necessary, for example, watching
someone take a drug test? Vivian:  One of the things is to explain
that you know it’s uncomfortable. We have to do this. How can I make it more comfortable
for you? If the person says, “Go out of the room.” You have to explain why you have to
stay in the room. Asking that question constantly, “How can I make this more comfortable for
you?” is an important one. It gives control back, even when the drug testing is mandated.
Laurie:  You can also talk to a group of your clients about the drug testing and ask
them for suggestions. Telling them what your mandates are, and ask them for suggestions.
I’ve worked with programs where, although their chain of custody urines, the staff member
who is observing is actually watching a mirror as opposed to directly observing the client.
That’s something that was come up with by the participants themselves.
Amanda:  The next question I will go ahead and answer. It was someone asking us what
cities the walkthroughs were done in. I will go ahead and give that information. I wanted
to share, as well, that we have a findings report that we just finalized this week that
we’ll be posting up on the National Center website.
I’ll offer the link to our websites in our email today. You can go and read the full
report that show us the findings of the Trauma Walkthrough Project. The five sites that we
worked with were Robeson County, North Carolina, Dunklin County, Missouri, Sacramento County,
California, Travis County, Texas, and Tompkins County, New York.
I will move to the next question. Let’s see. Are there any outcome evaluations regarding
trauma informed care available online some place that we can review?
Vivian:  The women with cooccurring disorders and violence study has many publications and
outcome results and they’re up online. One site is the National Trauma Consortium, www.nationaltraumaconsortium.org.
Laurie, do you remember other places where they’re up on site?
Laurie:  Yeah, the main one I think of is that they’re on SAMHSA’s website under NCTIC,
I think. I know they’re on SAMHSA’s website, but I think the part of it is the National
Center on TraumaInformed Care. Vivian:  Good. There are quite a few. You
may want to look at them. They’re good results. Laurie:  If you email me, I can send you
a list of those references. I’ve got them in my computer.
Amanda. I will go ahead and pass it back to Sara, at this time, who is our last couple
minutes here. Sara’s going to go over a couple of closing remarks and followup resources.
Sara? Sara:  Great, thanks so much Amanda. If we
could move to the next slide, please? I’m absolutely thrilled on behalf of the New England
ATTC to say, that we’ve really enjoyed this conversation over the course of the last three
webinars. We’re excited to continue the conversation at our first ever regional conference that’s
focused specifically on improving the care of adolescents.
Our conference will address the care of substance use, HIV and/or HPV, which are all big issues
nationally and are major stamps of priority. We’ll be talking about effective approaches
to assessing, treating, and engaging teens. We will explicitly continue the conversation
we’ve had today, because Carolyn CastroDonlin, who’s a longtime friend and collaborator with
the National Center, will be leading a workshop specifically on trauma informed approach to
care as one of our breakout sessions in the afternoon.
This conference will be Thursday, April 16th located in Connecticut. The information is
here for you in the webinar. You can email me or call me with any questions. If you go
to the New England ATTC website, you can register directly through our website as well. We’re
really looking forward to this, and hope many of you will attend.
Moving forward, I just want to emphasize that this has been a wonderful webinar series.
Our first in the New England region of this kind. All the materials are available along
with this slide and the recordings on the CFFutures website, which is again listed here.
The National Center folks and I are available if you have any questions. Melissa Lujan and
myself have our contact information here if you have any questions specifically about
any of the three webinars. The National Center folks have also put together
some really nice resources for you at the end of this slide deck. If we advance forward,
you can see some of that. As you log out of your survey today, you’ll be directed to an
evaluation. We would greatly appreciate your time to please complete that, as that will
help inform us on future educational efforts that we might do in the future. That also
really helps us to improve what we’re able to offer.
As I mentioned, if you continue forward, if you download this presentation after this
thank you, there’s a set of resources for you that talk about some national and regional
resources, specifically compiled by the National Center, about a range of topics such as some
of their guiding principles and the resources that they have available for download on their
website. We are done with the formal presentation part
of our webinar today. We’re really grateful for your time and participation. It’s been
a delight to be with you all. Melissa:  Thank you so much, Sara. Thank
you everyone. Have a wonderful day.

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