SANTA CLARA COUNTY T: TRAUMA TRANSFORMED SYSTEM OF CARE Santa - PowerPoint PPT Presentation

Imagine Trauma Free Communities... Bay Area communities working together to change the way we understand, respond to, and heal trauma SANTA CLARA COUNTY

T²: TRAUMA TRANSFORMED SYSTEM OF CARE Santa Clara San Francisco Santa Cruz Contra Costa Alameda San Mateo Marin “ Nobody can go back and start a new beginning, but anyone can start today and make a new ending.” – Maria Robinson 2

HISTORY WALK In July 2013 Regional Directors of County Behavioral Health systems began planning to launch a Regional Trauma Informed System of Care initiative designed to: • Develop a regional understanding and shared approach to our response to trauma and its effects, • Embed leaders including youth and parent peers to be champions of change within and across our systems serving children and youth, • Support and maintain change efforts through deploying experts and consumer voices within our region. • Address common and pervasive patterns of disproportionality with respect to historical trauma and fragmented service delivery systems. 3

TRAUMA INFORMED SYSTEMS (TIS): ORIGINS Local County TIS T² Regional Center 7 Bay Area Counties Behavioral SFPHD Health TIS Directors SAMHSA 4

TRANSFORMING STRESS AND TRAUMA: FOSTERING WELLNESS AND RE RESILIENCE Trauma-Informed Systems Initiative Healing Organizations: Trauma Transformed

OVERARCHING GOALS Transform the regional, overlapping systems into a coordinated, trauma- informed, youth-guided and family driven, evidence-based system of care. With the SAMHSA grant: T2 Regional Center: Develop a regional center to support and sustain a system of care that is trauma-informed, youth-guided, family-driven, and culturally competent. Training: Develop training resources for dissemination to county staff, providers, and consumers. Coordination of Care: Establish a regional model to provide coordinated services for youth and children placed out of county, and children, youth, and families served by multiple systems within counties. Policy and Practice Sustainability: Develop and sustain promising practices from the project and incorporate them throughout the region. 6

TARGET POPULATIONS Children ages Birth to 5 Juvenile Justice Dually Involved Youth Foster Care LGBTQ TAY Victims of Violence 7

TRAUMA AND STRESS ARE A PUBLIC HEALTH CONCERN • Stress and Trauma linked to 6 leading causes of death • Heart disease, cirrhosis of the liver, accidents , COPD, cancer, suicide • Trauma impacts more than just the individual • Ripple effect • Some communities disproportionally affected • Racism + Urban Poverty + Trauma = Toxic • Intergenerational transmission of trauma • Systemic preventative approach is needed 8

CHRONIC AND TOXIC STRESS CASUALTIES OF CHILDHOOD Statistically, the home is one of the most violent places in America. All children are shaped by their early life experiences. In the absence of repetitive, patterned, and enriching experiences, they may develop in disorganized or even dysfunctional ways. Their emotional, behavior, cognitive, social, and physical development can become arrested and delayed. 9

NEUROBIOLOGY OF TRAUMA AND NEGLECT Source: Child Trauma Academy 10

ADVERSE CHILDHOOD EXPERIENCES-ACES A PUBLIC HEALTH CRISIS ACEs affect people from all backgrounds, regardless of race, income, education, or geography. Occurring in childhood, exposure to chronic adversity during the most formative years has the potential to reap long term and far reaching consequences of ACEs on adults. ACEs are traumatic experiences that have a profound impact on the child’s developing brain and physiology with lasting impact on their health and well being as an adult. 11 Sources: Center for Disease Control; Center for Youth Wellness

THREE TYPES OF ACES Household Dysfunction Abuse Neglect Mental illness Physical Divorce Physical Emotional Domestic Violence Emotional Sexual Incarcerated relative Substance Abuse Adverse Childhood Experiences-ACEs 12

KEY FINDINGS 1. 1 of 3 reported no ACEs. 2. 87% likelihood that at least 1 additional category was present. 3. 21% were sexually abused. 4. 19% had a parent with mental illness 5. 28% were physically abused. 6. 27% had a member in the household who was an alcoholic or substance abuser. 7. 23% were not raised by both biological parents. 8. Women were 50% more likely to have experienced 5 or more ACES 9. Significant health outcomes: a. Those with an ACEs score of 4 were 2x more likely to develop heart condition or cancer. b. Those with 5 or more ACEs were 8x more likely to become alcoholic. c. Those with 6 or more ACEs are at risk of their lifespan being shortened by 20 years. d. ACEs will still have a profound effect 50 years later. 13 Sources: Center for Disease Control

ACES IN CALIFORNIA 14 Sources: Center for Disease Control; Center for Youth Wellness

ACES IN CALIFORNIA 15 Sources: Center for Disease Control; Center for Youth Wellness

COUNTIES WITH THE HIGHEST NUMBER OF ACES BUTTE: 76.5% OF RESIDENTS HAVE 1 OR MORE ACES MENDOCINO & HUMBOLDT: 75.1% OF RESIDENTS HAVE 1 OR MORE ACES COUNTIES WITH THE LOWEST NUMBER OF ACES SANTA CLARA: 53.4% OF RESIDENTS HAVE 1 OR MORE ACES SAN MATEO: 53.9% OF RESIDENTS HAVE 1 OR MORE ACES 16

ACES ARE NOT A DESTINY • A tool to recognize and understand ACEs as a hidden epidemic and public health issue • Opportunity for healing. • Build hope • Promote wellness and recovery 17

TRAUMA INFORMED CHILD SERVICE SYSTEMS Primary Care/ VMC Consumer/ BHSD Youth Voice Child FIRST 5 Welfare Child Faith Based Juvenile Community Justice Criminal Public Health Justice Education

DEVELOPING TRAUMA INFORMED PRACTICES • Trauma-informed care approach, which involves looking at all practices through a trauma lens • Trauma-informed practices are not interventions but are approaches that are infused through all levels of the organization. • Trauma-informed practices include, among others, creating a safe, supportive, welcoming, and respectful environment; educating and training all staff including administrators, direct care staff, case managers, and support staff about the impact of trauma; implementing screening and assessment tools and procedures to identify clients who have experienced trauma and determine the impact of that trauma; and training clinical staff in trauma-specific treatments. • It is essential that providers are aware of their own cultural attitudes and beliefs , as well as those of their clients, and provide culturally relevant approaches

Trauma Informed Trauma-informed practice is more about the overall essence of the approach, or way of being in the relationship , than a specific treatment strategy or method.

THE 4 R’S OF A TRAUMA -INFORMED SYSTEM SAMSHA defines “a program, organization, or system that is trauma-informed as one that: • Realizes the widespread impact of trauma and understands potential paths for recovery; • Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; • Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and • Seeks to actively resist re-traumatization .”

TRAUMA INFORMED SYSTEMS Leadership Support training, innovation, implementation, evaluation, and policy change Champions Innovate, implement, and evaluate trauma-informed approaches TIS Train the Trainer Embed language and understanding We are here TIS Trauma 101 Workforce Training Build common language and understanding

CHAMPIONS OF CHANGE • Providing leadership • Building awareness • Trauma informed organizational self assessment • Trauma informed training • Clarity that this process is not just about increasing individual trauma knowledge but about setting the stage for organization-wide change. • Knowing what it means to be trauma-informed and what it will take to begin the transformation “We must become the change we want to see.” – Mahatma Gandhi

Adapted from UCSF Healthy Environments and Response to Trauma in Schools (HEARTS) Curriculum by Joyce Dorado, Ph.D. Director, UCSF HEARTS Child and Adolescent Services UCSF-San Francisco General Hospital Lynn Dolce, MFT Director, Foster Care Mental Health Children Youth and Families System of Care

SANTA CLARA COUNTY TIS 101 TRAINERS CROSS SYSTEMS COLLABORATION • Maretta Juarez (BHSD), Senior Mental Health Program Manager Lead Trainers • Lorena Gonzalez (BHSD), Lead Clinical Supervisor, Las Plumas MH Consumer, Family, Youth • Melody Hames (ECCAC), Peer Support Worker Team Lead for the African Heritage Family Outreach & Engagement Program (AHFOEP) Voice • Sabrina Herrera (DIY-TAY), Dually Involved Youth Advocate • Vicki Pham, Trauma Administration: Trauma to Triumph Violence SCCVHHS-VMC Intervention Program and Injury Prevention Nurse Coordinator • Juliana Van Meter, Staff Development & Training, Social Work Supervisor SSA/DFCS • Michelle Hauck, Staff Development & Training, Social Work Training Specialist • Alex Villa, Supervising Probation Officer Juvenile Justice • Guadalupe Garcia, Deputy Probation Officer • Misty McNay, BHSD, Criminal Justice, Lead Clinical Supervisor, Criminal Justice Evans Lane Public Health • Marilyn Cornier, California Children Services Administrator • Jennifer Pham, BHSD, ECMH Program Manager Birth to Five • Crystal Nava, FIRST 5 Santa Clara County, Associate Director, Early Childhood Programs