FADAA/FCCMH

1. FADAA/FCCMH Trauma informed Care: The Southern Region

2. Pre-Contemplation Phase: The Beginning • Tallahassee funded training • Planning Council Request • Creation of Trauma Informed Care (TIC) workgroup • Development of the TIC plan 1-6 • Barahona (Sanctuary Model component of mitigating vicarious trauma)

3. Stages of Change • Organizing principles for stages of change • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

4. Contemplation: Trauma Informed Care Workgroup • Mirror CCISC- Multi-level Approach with lots of technical Assistance • System • Agency • Individual/Clinician

5. Contemplation: System Buy-In • Internal DCF • Consumer Network • Department of Juvenile Justice • Substance Abuse and Mental Health Providers • Community Based Care and Child Welfare • Adult Protection/ALFs • CIT Officers • ACHA and Managed Care

6. Preparation: Trauma Informed Care Subcommittees • The Best Practices/Evidenced Based Sub-Committee • National Center for Trauma Informed Care “Models for Developing Trauma Informed Behavioral Health Systems and Trauma Specific Services” compiled by Anne Jennings, Ph.D. • The National Child Traumatic Stress Network • The Anna foundation (Agency Assessment) • NREPP: SAMHSA’s National Registry of Evidenced-Based Programs and Practices • The Community Awareness Subcommittee (Survey Monkey) • The implementation, Linkage and Treatment

7. Preparation: What we have done • Provided multiple trainings around trauma

8. Have you ever… Had to wait or been put on extended hold, to get results of a critical medical test? Been given medical test results in a way that made you feel worse? Been given a wrong medical diagnosis or wrong meds or stayed sick a long time because your health care person didn’t listen? Felt like you were only a combination of symptoms that needed to be figured out?

9. Trauma Definition • Trauma occurs when an actual or perceived threat of danger or loss overwhelms a person’s usual coping ability. (From Beverly James, 1994) • How long does the overwhelm have to last for a traumatic memory to be recorded? • How does someone identify an area of low coping ability?

10. The Adverse Childhood Experiences Study • Recurrent physical abuse • Recurrent emotional abuse • Contact sexual abuse • An alcohol and/or drug abuser in the Household • An incarcerated household member • Someone who is chronically depressed, mentally ill, institutionalized, or suicidal • Mother is treated violently • One or no parents • Emotional or physical neglect www.acestudy.org http://services.choruscall.com/products2/streaming/applet/mmapplet.jsp#

11. What happened to you? • Every major diagnostic category in the DSM-IV can sometimes be related to trauma. • PTSD, Dissociative Disorders, Borderline Personality Disorder, Depression and Anxiety may be better classified as trauma-spectrum disorders. – Douglas Bremner • Any client unwanted behavioral viewed through the lens of trauma reveals that the behavior is usually a means of coping with the symptoms of trauma

12. Treaters… • Often have their own traumatic histories • Seek to avoid re-experiencing their own emotions • Respond personally to others’ emotional states • Perceive behavior as personal threat or provocation rather than as re-enactment • Perceive client’s simultaneous need for and fear of closeness as a trigger of their own loss, rejection, and anger

13. Creating Positive Cultures of Care • Staff care and growth is of primary importance • Everyone, especially those who hear traumatic stories every day, must resolve the impact of their own trauma first • Healthy opportunities in the workplace • All employees need to be trauma-informed • Effective help must be available for clients to prevent burn-out and compassion fatigue • Rituals and appreciation

14. Action: Implementing TIC • July 2010 provided introduction to trauma training • Formed the TIC Workgroup • Added TIC language to the contract for SFBHN Providers • Ongoing TIC presentations to community stakeholders • Applied and received a Technical Assistance Grant from SAMHSA • Training provided as a result of the grant by local experts and by SAMHSA experts • Introduction to trauma training • Trauma Champions training • Training at the Mental Health Transformation Day • Completing the agency assessment using the NIATx Walk Through Process as outlined in the Fallot Agency Assessment Tool

15. Action: Provided Training Around Trauma • Continue to work with agencies and other stakeholders to understand the importance of the TIC Initiative • Trauma Informed Care Initiatives • Trauma Treatment Team • Collaboration between Our Kids, Department of Children and Families, Citrus Health Network, Magellan Health Services, and South Florida Behavioral Health Network. • Providing trauma treatment for children removed from the home. • South Region Applied (DCF, Our Kids and SFBHN) for a grant to bring in the Sanctuary Model • Assists agencies/systems in developing therapeutic communities for consumers and staff members • Specifically the grant is to improve assessment for trauma and to improve behavioral health treatment for children removed from the home. • In collaboration with DJJ, DCF and SFBHN applied for a Bureau of Justice Assistance Grant – for youth identified with trauma and co-occurring disorders. • Applied for a grant – Administration for Children and Families. Integrating Trauma Informed Care and Trauma Informed Practices - Integrating Trauma-Informed and Trauma-Focused Practice in Child Protective Service (CPS) Delivery • Creates system of trauma informed care for those served and those who serve • Utilizes EBP including the Sanctuary Model.

16. Action: Contract Language Trauma Informed Care Many individuals with behavioral health issues have experienced trauma that affects their development and adjustment. SFBHN and the Southern Region are committed to developing a system of care that incorporates comprehensive assessment tools that identify those affected by trauma and a system of care that meets their needs. • The SFBHN Providers will be implementing the Trauma Informed Care initiative through the following: • Participation in the regional Trauma Informed Care meetings to develop the process for identifying and responding to those affected by trauma. • Attend the regional trainings regarding Trauma Informed Care. • Completing an agency-wide self-assessment using the Trauma assessment tool, when the tool is available. • Participate in all activities to ensure staff and agency become competent in all areas of trauma informed care. • Implementation Trauma Informed Care throughout the agency.

17. Action: Developed the Two Major Committees • Developed the two major committees • TIC Workgroup formed and is evolving into the governance board for the grants • TIC Champions

18. Action: TIC Workgroup/Governance Responsibilities • Oversees and provides direction to the overall initiative. • Assists in the development of the Regional Plan • Provides oversight and direction for all grants for Trauma Informed Care • Committee gathers input from: • Consumers • Family Members of Consumers • Provider Members • Other Stakeholders

19. Action: TIC Champions • The agents of change within the System of Care • Primarily comprised of providers within the Southern Region • Completes the agency assessment • Charged with moving individual agencies/organizations to become trauma informed • Helping, where appropriate, to develop trauma specific treatment services within the agency/region

20. Action: Assessing the System and Agency • We have completed system assessments for Miami-Dade and Monroe Counties • The Trauma Champions are completing the agency assessments. • The assessments are to help write the plan for the Southern Region, identify opportunities for improvement , gather baseline data and measure our response over time.

21. Action: A Multilevel Approach to Influence Community-Level Change • Public policy (local policies), • Community factors (relationships among organizations and networks), • Institutional processes (formal and informal social networks, social support systems) • Interpersonal networks (family, friends, coworkers) and, • Intrapersonal factors (e.g., knowledge, attitudes, behavior, self-concept).

22. Action: The Core Principles of a Trauma-Informed System of Care • Safety: Ensuring physical and emotional safety • Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries • Choice: Prioritizing consumer choice and control • Collaboration: Maximizing collaboration and sharing of power with consumers • Empowerment: Prioritizing consumer empowerment and skill-building

23. Action: A Culture Shift: Scope of Change in a Distressed System • Involves all aspects of program activities, setting, and atmosphere (more than implementing new services) • Involves all groups: administrators, supervisors, line staff, consumers, families (more than direct service providers) • Involves making change into a new routine, a new way of thinking and acting (more than new information)

24. Action: Protocol for Developing a Trauma-Informed Service System • Services-level changes • Service procedures and settings • Formal service policies • Trauma screening, assessment, and service planning • Systems-level/administrative changes • Administrative support for program-wide trauma-informed services • Trauma training and education • Human resources practices

25. Action: Assessing the Core Principles: • Safety: How can we ensure physical and emotional safety for consumers? For staff? • Trustworthiness: How can we maximize trustworthiness? Make tasks clear? Maintain appropriate boundaries? • Choice: How can we enhance consumer choice and control? • Collaboration: How can we maximize collaboration and sharing of power with consumers? • Empowerment: How can we prioritize consumer empowerment and skill-building at every opportunity?

26. Action: System Assessment Tool A system is defined as any organized behavioral health and social services delivery system, and can include different payor sources such as the Medicaid system, the state funded system, the county operated system, or by target population, such as the adult, child, or adolescent system.

27. Agency Assessment Tool Use of the Fallot, Harris CCTIC Program Assessment Tool

28. Resources • www.sfbhn.org • Assessment tools and Regional Plans • If you plan to use the System Tools Please call for permission.

29. Thank You! Questions