A Heart for “Children from Hard Places” in Coeur d’Alene, Idaho

 

idaho aces prevention project_safe_image.pngCoeur d’Alene’s journey to implement trauma-informed practices in their schools
and youth-serving agencies got kicked off in a big way with a keynote presentation in October, 2014 to the Idaho School Counselors Association Conference titled “Catching Kids As They Fall.” The speaker was Jim Sporleder, who had spearheaded the trauma-informed turnaround at Lincoln High School in Walla Walla, Washington, featured in the documentary film “Paper Tigers.”

Kelli Aiken.jpgCoeur d’Alene school counselor Kelli Aiken had secured Sporleder as the keynote based on the recommendation of her brother, who works in the juvenile justice system in Washington state. Kelli had seen the pervasive effects of trauma in the kids she saw in her office every day and knew the subject of trauma and resilience would resonate with other school counselors.

“We had a great turnout for that event and afterward, people wanted to know what’s next?” Kelli explains. So, after the School Counselors conference, Kelli gathered other partners to start figuring out next steps.

They started a Facebook page called “Idaho ACES Prevention Project”, described as “A group of community leaders, professionals, family members and friends dedicated to reducing exposure to toxic stress and providing trauma informed care.”

There, they started posting relevant articles and resources related to trauma and resilience.

Then the partners co-hosted several other events in quick succession to increase awareness and understanding of trauma and to build momentum for addressing it:

  • April, 2015: a full-day workshop with Jim Sporleder and Teri Barila from Walla Walla, titled “Building a Trauma-Informed Model and Making a Paradigm Shift in Our Communities” – over 400 people attended
  • May, 2015: a presentation by Christian Moore titled “Flipping the Resilience Switch”. Moore is author of “The Resilience Breakthrough” and the “Why Try” curriculum.
  • 2016: several screenings of the film “Paper Tigers”
  • Early 2017: several screenings of the film “Resilience”, attended by more than 600 people

By using the online event planning and registration tool “EventBrite” for all of these events, they’ve been able to build a huge list of interested people and agencies throughout the community who have attended these events. They’re now using that list to keep people informed and engaged with monthly “Lunch & Learn” sessions on various topics related to trauma and resilience, and a monthly newsletter with upcoming events, training opportunities, tips, resources and other information.

Simultaneously, over the past five years or so, staff at Children and Family Services (CFS) were starting to look at the role of trauma in the lives of children they served. They started offering trauma trainings and talking about implementing a trauma-informed approach with child protection workers, therapists, and foster parents. They saw that different agencies that served children, youth and families were each doing their own thing and had different philosophies and approaches.

“We were inspired by the idea of a collaborative community, to adopt and apply a common model across systems, so every child and family being served in the community has consistency of care with all agencies and systems using a common language and philosophy of care,” Andi, from CFS, explains.

They looked at several models, including Bruce Perry’s model, the Sanctuary Model from Sandra Bloom, the “Attachment, Regulation and Competency (ARC)” model, and an evidence-based approach called “Trust-Based Relational Intervention” (TBRI).  While each model had many similarities, and common core concepts, each model also had different requirements and costs to get trained, certified, and be able to implement.

Ultimately, they decided to adopt TBRI, as it seemed to offer the best balance of accessibility, cost, and relatively low barriers to getting started and full implementation. Initially, Andi and another CFS colleague, Roxanne, went to Texas for a week-long TBRI training.

Roxanne explains, “TBRI incorporates the best of Bruce Perry’s concepts and work, but in layman’s terms and in a very practical and usable way on a day to day basis.” Roxanne described the TBRI training as one of the best trainings of her entire career.

They are now developing a set of standards and guidelines for other agencies in their collaborative that want to implement TBRI to follow. They already have commitments from 8 other agencies to send staff to Texas this autumn for TBRI training, including representatives from the school district, children’s mental health workers, juvenile justice, child protection workers, Head Start, Special Needs recruitment, and therapists from a local shelter home for children in crisis.

“Our long-range goal is to create a collaborative, common system of care across the entire state of Idaho,” Andi explains. “But for right now, we’re working really hard to do this in Coeur D’Alene.”

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Leveraging collaboration and brain science to end cycles of poverty and trauma at CUPS-Calgary

CUPS_DSC00453.jpgThe Calgary Urban Project Society, or CUPS, was founded in 1989 with a vision to help people overcome the challenges of poverty and attain brighter futures. Over the past couple of years, with their involvement in the “Change in Mind” initiative, CUPS has updated their approach to incorporate the brain science about trauma and resilience to focus more specifically on helping adults and families in Calgary living with the adversity of poverty and traumatic events to build resilience in 4 key areas:

  • Economic Resilience
  • Social-Emotional Resilience
  • Health Resilience
  • Developmental Resilience

“Many of our clients have huge trauma burdens – and for those who have children, we know the ACEs research shows this impacts their kids as well,” Tanya Leavitt, Mental Health Program Manager, explains.  So CUPS has specifically incorporated a focus on trauma-informed care into their strategic plan and made it an organizational priority.

They have a Trauma-Informed Care (TIC) Team at CUPS with representatives from every department and every program and service in the agency. Their TIC Team also includes five clients who have been participants in various CUPS programs and services, and who represent diverse perspectives in terms of ethnicity, gender and age.

The TIC Team focuses on agency policies and procedures, and how to ensure that everything they do at CUPS is trauma-informed and utilizes the brain science around trauma and developing resilience.

TIC Team members serve a one-year term, then rotate off so other agency staff and clients can become part of the team. Tanya explains, “Our goal is that eventually every single employee here will have served on the TIC team at some point.”

With 166 staff members and 480 volunteers, CUPS served 9,364 clients last year with services that include a primary care healthcare clinic; a women’s health clinic; a dental clinic; mental health care services; substance abuse supports; parenting education; an early intervention child development centre with full day pre-school and kindergarten that includes on-site healthcare, psychological services, speech and language services, occupational therapy and physiotherapy; income and financial supports; education, skills &  training services; food and nutrition services; legal advocacy & justice services; and three housing programs for individuals and families experiencing homelessness (these programs include case management and graduated rent subsidies).

Through close collaboration with many partners, they serve as a “one-stop shop” to offer an integrated set of services that address many of the barriers and needs people living in poverty are facing.

Amanda Rae Storteboom, CUPS Operations Manager, explains that when a client first walks in the door, CUPS staff walk the client through an initial conversation to complete a “Resiliency Matrix” identifying the characteristics the individual possesses across four domains of resilience: economic, social-emotional, health and developmental. “This helps identify all of the different resources and services that may benefit that client,” she adds. Historically, clients would come to CUPS for one particular service or program, but other challenges or barriers in their lives could end up de-railing the progress they might have made through that program or service. They used to have over ten different entry points into CUPS programs and services.  The Resiliency Matrix allows them to get a comprehensive look at all the major aspects of the client’s life, at a single point of entry, so they can take a holistic approach to assisting the client across multiple life domains.

biopsychosocial+model.jpgThis holistic approach is mirrored in the mandatory full-day trauma and resilience training that all CUPS staff must complete.”We’ve basically taken the biopsychosocial model of health, and pulled it apart for this training,” Tanya explains. The training covers trauma, how it can play out in people’s lives, the brain science about trauma and resilience, and scenarios and practical information about what is and is NOT helpful for people to be able to build resilience, overcome adversity and reach their potential. The staff training also covers vicarious and secondary trauma and self-care for staff.

Tanya developed their staff trauma training curriculum using resources from SAMHSA, the Alberta Family Wellness Initiative’s free 30-hour “Brain Story certification” training (available to anyone around the world at no cost!),  Alberta Health Services (here’s a link to an entire issue of their Apple magazine devoted to brain science, trauma and resilience) and the Government of British Columbia’s guide to trauma-informed practice.

The results at CUPS have been impressive. In their housing programs alone, CUPS housed 703 adults and children last year. 95% of the households remained successfully and stably housed or graduated out of the program and no longer require subsidy. Participants have reported significant reductions in their use of public systems, including a 80% decrease in EMS use, 27% reduction in ER visits, and a 76% reduction in interactions with police and the justice system.

Measuring all of their results, specifically related to overcoming trauma and building resilience, has presented some challenges, though.They’ve had to work out information-sharing agreements and client consent/release forms across various programs and services. They’ve had to address issues with the databases and computerized systems they use to capture the right data. And they had to develop a common, comprehensive intake process for every client, regardless of what services or programs the client may have initially come to CUPS for (using the “Resiliency Matrix” mentioned earlier).  They are capturing the scores from that initial Resiliency Matrix assessment, then re-assessing clients every six months to look at gains in resiliency across economic, social-emotional, health and developmental domains.

Both Tanya and Amanda Rae describe what’s happening at CUPS around trauma-informed care and building resiliency as a “work in progress.” Ultimately, their vision is to help the people they serve to end the cycle of poverty and trauma for themselves and their families.

Trauma-informed mentoring at Big Brothers Big Sisters in Calgary

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At Big Brothers Big Sisters of Calgary and Area, Karen Orser and Cynthia Wild are on a mission:  to make sure all of their staff and their mentors (“Bigs”) understand the brain science that explains how the behaviors of the children they serve (“Littles”) may tell a story of other things going on in the child’s life, including traumatic experiences, toxic stress, and adversity. That knowledge is foundational to their focus on trauma-informed mentoring at BBBS Calgary.

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Cynthia, Director of Service Delivery, explains, “It’s been important for us to differentiate between ‘trauma-informed’ and ‘trauma-specific’. At BBBS, we don’t do trauma-specific care or treatment. We don’t do therapy, we don’t focus on the abuse someone has experienced. Our approach is a relational-based intervention that’s trauma-informed. This means recognizing the role trauma has played in the life of that young person and helping our mentors think about and re-frame the behavior they may see with their “Littles”. Instead of thinking “What’s wrong with you?” we want our mentors to think “What has happened to you?” We can’t take the child’s behavior personally.  We want our mentors to engage in specific, practical activities with the child that can help to build the child’s brain architecture.”

They’re developing activities based on Bruce Perry’s “Regulate, Relate and Reason” framework, resources from the Harvard University Center on the Developing Child, and the Alberta Family Wellness Initiative (AFWI) “Core Story of Brain Development” resources.

Trauma-informed mentoring is changing BBBS Calgary’s organizational narratives in a few key areas:

  • the WHY of mentoring: because relationships with caring, responsive adults (mentors) can help build brain architecture in kids
  • WHAT responsive mentoring looks like: “Bigs” are responsive to “Littles” when they notice and respond to their verbal and non-verbal cues
  • WHO they mentor: a shift away from “any child who needs a mentor gets a mentor” to “we serve children and youth facing adversity”
  • HOW they mentor: being intentional about training mentors to engage in activities with their mentees that build and strengthen Executive Function and Self-Regulation skills

CALGARY_BBBS_Karen-Orser-Headshot-300x300.jpgKaren, BBBS Calgary’s President and CEO, explains, “The focus on trauma-informed mentoring has given us a new language, new resources, and new ways to think about and talk about what’s going on with kids.” She adds that it has also required on-going conversations with staff, board members, volunteers and funders. Those conversations have raised challenging questions like:

  • Are we getting too clinical?
  • Will volunteers not want to volunteer if we’re talking about brain science?
  • Will it seem too hard [for mentors to incorporate brain research into their day to day interactions with kids]?

Both Karen and Cynthia are relatively new to their positions at BBBS. They had worked together previously at the YWCA, serving people experiencing homelessness, addiction, and mental health challenges. There, they saw how trauma played out in the lives of those clients. And in their first year here at BBBS, they’re working to develop an agency culture that isn’t afraid to take risks and to take a new look at long-established agency practices and policies, making changes when necessary.

BBBS Calgary is breaking new ground for Canada’s national Big Brothers Big Sisters organization, and the national office is talking with Karen and Cynthia about how to incorporate brain science into the standard national training given to all BBBS mentors.

And BBBS Calgary is part of a larger three-year initiative with 15 agencies in Alberta and across the United States called Change in Mind: Applying Neurosciences to Revitalize Communities. Tomorrow, I’ll be meeting with people from CUPS, another of the agencies here in Calgary that’s involved in the Change in Mind initiative. So I’ll post more about Change in Mind as well as CUPS after tomorrow’s meeting.

Karen, Cynthia and their BBBS Calgary team are firmly committed and deeply invested in taking a trauma-informed approach based on the brain research, and they see it as essential to successful intervention with the children and youth they serve in their community. There’s no doubt their investment will reap big benefits for the children, their families, the BBBS mentors, and their entire community.