Assessing the Effects of Trauma

July 09, 2008

Trauma is among the most significant factors involved in mental illness, and it must be taken into account by caregivers and providers, four prominent speakers told the Trauma-Informed Care Symposium in Yakima on June 11.

The purpose of the symposium was to present information about the impact of trauma, take stock of trauma-related activities and programs already occurring in Washington, and develop priorities for promoting trauma-informed care in Washington.

Tonier Cain, a survivor of trauma, shared her story as one of the speakers. It begins with a severely neglectful mother, a long history of childhood and adult sexual abuse, alcohol addiction from age nine, marriage at age 14, and a drug addiction that led to 66 drug-related convictions.

After being incarcerated numerous times and losing several of her children to the foster-care system, Cain became pregnant again and found a program that helped drug-addicted pregnant women become drug-free and keep their children.

This was the turning point for Cain as for the first time, instead of asking, "What is wrong with you?" one trauma-informed clinician asked, "What happened to you?"

After entering the program, she began working on her trauma issues. In the four years since she completed the program, she has been drug- and alcohol-free, has become a national speaker on trauma issues, has become a board member on several boards of directors, and has become a homeowner and a nurturing mother to her young daughter.

"We would do well to assume that every person who comes to us seeking services is a trauma survivor," said Dr. Roger Fallot, who opened the symposium with an overview of trauma-informed services.

Dr. Fallot discussed the difference between trauma-informed systems and trauma-specific services. As he explained, human service systems become trauma-informed by thoroughly incorporating an understanding of the prevalence and impact of trauma and the complex paths to healing and recovery into every component of service delivery. Trauma-specific services, on the other hand, refer to specific interventions that directly address trauma and its impact and help individuals heal and move forward in their recovery.

Local trauma champion Laura Merchant gave an overview of a trauma initiative currently taking place in Washington State. Merchant is the Assistant Director at the Harborview Center for Sexual Assault and Traumatic Stress and is involved in a collaborative project with the Mental Health Division that trains clinicians throughout the state in trauma-focused cognitive behavioral therapy (TF-CBT), a psychotherapeutic intervention designed to help children, youth, and their parents overcome the negative effects of traumatic life events.

Merchant discussed the difference between regular cognitive behavior therapy and TF-CBT. TF-CBT emphasizes routine trauma screening for all new clients instead of assuming that, if a client has a trauma background, the client will raise the issue.

Finally, Dr. Brian Sims discussed how to create trauma-informed systems of care. Dr. Sims explained that it makes sense to ask people who have serious mental illness about a trauma history; up to 98% of people who have serious mental illness have a trauma history. Dr. Sims also discussed strategies that mental-health providers can use to facilitate trauma-informed treatment, such as giving consumers choices and treating consumers with respect.

At the end, participants filled out a worksheet in which they identified the three items that they felt were most important in implementing trauma-informed care in Washington State. On the same worksheet, participants could sign up to become "Trauma Champions," therefore becoming members of the newly-formed Trauma Advisory Group.

The Mental Health Transformation Project (MHTP) sponsored this event, and Jill SanJule, Consumer Liaison for the MHTP, organized the symposium with assistance from Mary Blake, the SAMHSA Project Officer for the Washington State Mental Health Transformation Grant, Susan Salasin, the Project Officer for the National Center for Trauma-Informed Care, and Joan Gillece of the National Association of State Mental Health Program Directors.

SanJule also received input and assistance from a statewide taskforce consisting of Tom Schumacher of the Department of Veterans Affairs, Cheryl Sullivan-Colglazier of the Juvenile Rehabilitation Administration, Ann Christian of the Washington Community Mental Health Council, Peg Evans-Brown of the Department of Vocational Rehabilitation, and Robin McIlvaine of the Mental Health Division. In addition to assisting with planning the event, the taskforce members have also committed to assisting with the next steps in implementing trauma-informed care in Washington.

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1. Jo Ellen Woodrow ~ July 15, 2008, 6:01 a.m.

This is all excellent. I do have a question. I know older adults who are talking after nearly 50 years of silence. Do we have trauma informed systems of care information for the older adults? I'd appreciate any information on this. What first came to my mind was the many cases of adults who first started speaking out after abuse from some Catholic Priest. Then as I spoke with others - they started sharing their stories - some after 30 or 40 years of not sharing. Thank you for all the excellent information and work that MHTG has been doing to bring awareness and changes in systems of care to our state.

2. David Brenna ~ July 16, 2008, 9:51 a.m.

Thanks for your comment Jo Ellen. I'm not aware of any trauma-informed models for elderly care, but I'm sure the principles are easily adopted. As I understand, the clinical approach, Cognitive Behavioral Therapy, is an EBP. Anyone from the aging services community care to comment?

3. Brenda Lopez-Goff ~ September 02, 2008, 10:24 a.m.

I am a Veteran Parent of the system and also a trauma survivor. I have been asked to comment on the HB 1325 and the topic of timelines that parents are faced with when they loose their children to the child protective services. I think removing a child from a parent in it's self is a traumatic experience the needs to be delt with or at least put into consideration when we talk about timelines and services and how strick we should be on parents when their trying to change their lives to be heathy productive parents.

Assessing the Effects of Trauma

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