This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network. |
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Trauma Matters – April 2008The e-Newsletter from CMHS' National Center for Trauma-Informed Care
April is the Month: Dare to Transform Registration to Open!Limited Space at "Dare to Transform" is First Come, First Serve The National Center for Trauma Informed Care will open registration this month for the "Dare to Transform" meeting taking place at the Phoenix Park Hotel in Washington, DC. Registration for the 2-day learning exchange and networking transformation forum is free. The event will be held on July 11-12, 2008 and will highlight useful and practical strategies for moving forward together with the implementation of trauma-informed care in organizations, programs, and services. The meeting is designed for those with expertise in how to do it, for those in the process of learning how to do it, and for those who are considering what to do and how to do it. This will be one meeting you won't want to miss! Information with registration details will be announced soon! Power To Transform: Speech Reveals Dramatic Spiraling Statistics and the Need for Trauma-Informed TransformationJust over one in every one hundred Americans is in prison. One in nine African-American men, one in one hundred African-American women, and one in thirty-six Hispanic-American men is incarcerated. These were just a few of the spiraling statistics raised by A. Kathryn Power, the director of the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA), in a speech given at the CMHS National GAINS Center Conference in Washington, DC, on March 18. These statistics only serve to underscore the human misery associated with incarceration. The more than two million people coming into the criminal justice system often suffer from earlier traumas and mental health and substance use disorders. Many cannot afford bail and spend "two to five times longer in jail." Part of the problem, A. Kathryn Power suggested, are the criminal justice system's ineffective, "client-resistant services." So she devoted much of her speech to one central question: how can the system be transformed? The answer, she argued, lies in integrating tried-and-true client- and recovery-based trauma-informed methods into the criminal justice system, but the problem is that the goals of the mental-health system that gave birth to these programs and the goals of the criminal justice system, which is based on control and public safety, are not always compatible. To merge these often conflicting entities into one, coherent and more-effective system, Power noted that the members of her audience-policy-makers and professionals in both the mental health and law enforcement communities-would need to become "transformers." Referencing the popular comic book heroes who morph from automobiles into robots, A. Kathryn Power suggested that the system needs an equally dramatic change. One proposed transformation is the inclusion of "trauma-specific services" offered in a more trauma-informed system of care for prisoners suffering from mental-health and substance-use disorders. A. Kathryn Power again turned to statistics to underline such a need. Studies reveal that as many as ninety percent of prisoners suffered some type of trauma such as sexual abuse, physical abuse, or neglect. Fifty-two to ninety percent of those with mental-health and / or substance-use disorders likewise suffered from various forms of trauma. "Group and individual therapy," according to A. Kathryn Power, is one method that could work wonders for incarcerated trauma victims. A. Kathryn Power also addressed mental health care and veterans. Since mental health and substance use issues for veterans often leads to homelessness, suicide, or incarceration, their treatment, according to A. Kathryn Power,is a problem that "we simply cannot afford to ignore." Again the statistics support this conclusion: one recent study revealed that almost forty percent of soldiers returning from combat duty reported significant psychological issues such as post-traumatic stress disorder (PTSD). The costs of such issues can be high, with an estimated 5,000 suicides occurring each year among America's population of veterans. A "consumer-driven system" consisting of "veterans helping veterans" could help reduce these numbers, Power suggested. Statistics, which A. Kathryn Power used throughout her speech, underlined the reality: many incarcerated in the criminal justice system have trauma histories and illness that are only aggravated by the system. They also sent a message: the system itself is ill and in desperate need of attention, or rather, trauma-informed transformation. Relationships that HealBy: Mary Blake, NCTIC
When it comes to implementing trauma-informed practices, the consumer/survivor perspective is the cornerstone for transforming mental health systems, institutions, and treatment cultures. As Jane Doe's story above illustrates, this is not merely a matter of political correctness or appropriate language, or even of maintaining the proper paperwork in each "patient's" file. Rather, the perspective of the individual seeking help informs the relationship between that person and the provider in fundamental ways, both at the personal level and at the organizational level. The experience of trauma impacts many consumers/survivors profoundly in our relationships with ourselves and with others. Trauma often leads us to feel isolated and alone. Healing from traumatic experiences for many of us requires that we reconnect with ourselves in meaningful ways and that we foster our potential to build meaningful and positive relationships with others. The very essence of healing is relational; therefore, the very soul of trauma-informed practice must also be built on relationships. Relationships that empower, that respect, that provide safety, that build on hope and belief in our ability to heal. When we think about changing organizational cultures and practices to be trauma-informed, we often look at systems dynamics, policies and procedures. We can provide technical assistance and resources to foster changes in practice, such as safety planning, comfort rooms, soothing devices, and so forth. But is that enough? Where does fostering and developing relationships fit into the context of these changes? How does the consumer perspective shape the "day-to-day" of their lived experiences within the treatment culture? As consumers/survivors, we certainly have a role to play in designing the comfort rooms we might be using, in developing our own safety plans to educate those around us on practices that we find helpful or not, and in deciding which self-soothing items work best for us. Yet, too often we find that the "help givers" around us continue to worry about managing our behavior and setting limits on what we "can or cannot do." Safety plans become additional pieces of paper in our files. Comfort rooms may become seclusion and restraint rooms on any given day when staff determine they are "needed." The trusting, healing relationship is threatened by reductionist, old-world philosophy based on institutional needs for "compliance" and the medical model's stigma regarding mental illness. Recovery-oriented philosophy, in contrast, champions the role of personal relationship in its call for peer support. Peer support builds on the recognition that shared experiences provide common ground for understanding, hope, mutuality and trust. In the context of trauma-informed approaches, peer support fosters connection. Peer support is not defined by clinical method per se; rather it is defined by shared experiences that attend to healing based on the consumer/survivor's unique needs, hopes and wants. Trauma-informed peer support allows for mutual learning and listening in real time. Peer support provides flexibility in being with each other, whether through finding ways to connect with one's own body (yoga, reiki, exercise, music, etc.) or by connecting with someone else (talking, laughing, engaging in activities of mutual interest, etc). Through these activities, we learn about ourselves, and we learn about ourselves in relation to the person accompanying us through our learning. Traditional mental health treatment organizations/institutions must find ways to bring this "lived healing practice" into their engagement with the people they are expected to help. When consumers/survivors struggle to make sense of their experiences and what will help them, provider staff can find teachable moments in practical, hands-on ways. As consumers/survivors work on their "safety plans," they can role-play the interventions they believe will be helpful with staff. By actively "testing" these methods out, they and those with them are able to try different approaches and determine together those that work best. The safety plan becomes a "living document," a testament to the consumer/survivor's experience. The staff are mutually engaged and able to understand their own experiences in relation to the consumer/survivor's. Through this dual engagement, each party experiences a deeper understanding of themselves as well as of the other. A Stitch in Time Saves Lives: Pat Risser and the Stoney Creek ClubA stitch in time saves -- lives? It does in one unique approach toward treating trauma victims. In a program pioneered by Pat Risser and his wife Trish, youths suffering the effects of poverty and also various forms of abuse can escape their troubles at the Stoney Creek Club, run from the Rissers' Ashland, Ohio, home, where kids aged 5-14 gather to sew quilts and mend their torn lives. Each quilt begins with a first stitch, and Pat Risser, a consumer and survivor, sewed that first stitch when he offered to pay a few kids to walk his pet Pekingese dogs. Risser and his wife Trish-whom Risser calls "the heart and soul" of the club- had moved into a house adjacent to a low-income apartment complex. One day while Risser was walking his dogs, a few kids from the complex asked if they could pet the dogs. Risser offered them a way to make some pocket change by walking his pets. Once while picking up the dogs, they noticed Trish sewing and asked if they could try it. A few weeks later, a few more kids appeared at the Rissers. Then a few more. And a few more. The Stoney Creek Sewing Club was born. The club, which Risser characterizes as a "community center for low-income under-privileged kids" based in what would have been his basement den, unites troubled kids with positive adult role models. The participants sew quilts, but adult friends like volunteers Molly Smith and Bob Brownson also teach other activities such as cooking and guitar. The Rissers even hosted a "girls day" run by a licensed cosmetologist. The activities are fun, but for most participants, they also provide a sanctuary. Many of the kids come to the Stoney Creek Club to mend lives torn by extreme poverty, emotional and physical abuse, or both. Conversations that take place at the sewing club reveal the most horrific, heart-rending trauma. One boy's stepmother asked him to test the water temperature by sticking his hand in a pot of water. He refused. Instead, she stuck her hand in the water and burned it. Enraged, she slugged him in the face. This is just one story told amidst quilts and tears. "The kids pay huge consequences for the actions of their parents," Pat Risser notes. The trauma is real, and so are the tears. But so are the smiles. Interested readers can see them on the club's website. The smiles come from the self-esteem fostered by participation in the club's projects. Participants create things and receive positive feedback from interested adults, a combination that in turn creates self-esteem. Sometimes, they work together toward a common goal. For example, they're working on baby-sized quilts for newborns at a local hospital. These efforts appear to have paid dividends; many of the kids have improved in school and their esteem has been building through the program. Will a few stitches a day keep the trouble away? Pat Risser hopes that this unique program will provide the emotional patch the kids need to mend their lives. "I'm hoping that our ounce of prevention will forestall the need for a pound of cure," Risser notes. The sewing club may just be the stitch in time that saves lives. Information with registration details will be announced soon! Women's health affects everyone, report notesHer trauma is also their trauma-a woman's mental health issues affect not just the woman but also everyone who loves her. This was just one of the central messages delivered to the Surgeon General at The Surgeon General's Workshop on Women's Mental Health held November 30 to December 1, 2005, in Denver, Colorado. The workshop arose from a larger program-the Surgeon General's Women's Mental Health Project-an initiative done in conjunction with several other government agencies. Experts from various health-related fields gathered at the workshop to discuss the affect of sex and gender differences on mental health and mental health issues confronted by women. The goal of the Workshop was to provide recommendations for materials that The Surgeon General could create to "advance knowledge, understanding, and behaviors regarding women's mental health issues-and ultimately to improve the mental health of our Nation's girls and women." To achieve this goal, participants voiced their opinions about women's mental health issues and what might be undertaken with regard to the prevention and treatment of various forms of trauma and other mental health issues. Important messages that emerged from the workshop, including messages about trauma, include:
A complete version of the official report is posted at the following link: http://www.surgeongeneral.gov/topics/womensmentalhealth/#10. Calendar of Events2008 May 1-3 May 4-7 July 11-12 |
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