Trauma-Informed Oregon’s Roadmap

road with loops_twists_2017-05-05 13.48.46 copy.jpgLike the thousands of miles of mountain roads I’ve driven on this 3-week trip to visit trauma-informed communities in the Pacific Northwest and Canada (I drove a total of 3,011 miles, to be exact!), the road to develop a trauma-informed community has loops, twists and turns.

And as with any journey, there are bound to be wrong turns, dead ends, roadblocks, detours, and days when you just plain get lost.

Thankfully, there are increasing numbers of tour guides and roadmaps to help organizations and communities that are committed to becoming trauma-informed. The statewide initiative, Trauma-Informed Oregon, which I visited on Wednesday, has assembled a lot of them on their website.

Oregon has committed as a state to “promote prevention and to bring policies and practices into better alignment with the principles of trauma informed care.” To carry out that commitment, Trauma Informed Oregon (TIO) was created in 2014 to serve as a centralized source of information, resources and training about trauma, resilience, brain science and related topics for child- and family-serving systems, healthcare, and adult-serving behavioral health systems.

Lee Ann Phillips, TIO Center Manager, and Mandy Davis, TIO Director, work with state agencies, human services agencies at the state and local levels, individual communities, family and youth organizations, and a variety of other stakeholder groups to provide training, consulting, and technical assistance. They also take an active role advocating for trauma-informed policies and practices within organizations and communities, as well as at the legislative level.

They have developed a “Roadmap to Trauma Informed Care” with detailed information and related resources and documents for each part of the journey.  Here’s their summary diagram of the process:

20170503_Portland_TIO_roadmap_Screen Shot 2017-05-04 at 5.22.42 PM.png

Lee Ann explains, “It starts with the community making a commitment. But how this looks in one community might be different than how it will look for another.”

Some communities form a task force. Some make proclamations or create Memorandums of Understanding for partnering organizations who are willing to become “trauma-informed.” Lee Ann describes one county where all of the partnering organizations agreed to chip in a certain amount of funding for the initiative, and in return, their staff got free training.

“At a minimum,” Lee Ann says, “organizations within the community come together and share information about what each agency is doing.”

Mandy adds that it’s important to have someone in a paid position who is going to run the initiative and be responsible for moving it forward. She also says that saying your community is going to become trauma informed is different than individual agencies or organizations being trauma-informed. It’s important to define what you mean by “community” if you’re pursuing becoming a “trauma-informed community.”

Training is one of the first steps, but the training needs to prompt organizational and culture change, Mandy explains. Sharing trainings with people from different agencies, systems and sectors in the community, is really helpful. It’s also important, she says, to reduce competition and redundancies, and share resources across organizations.

For individual organizations that want to become trauma-informed, the TIO website offers a huge set of organizational resources  from initial organizational assessments and strategic planning to environmental scans, examples of relevant HR and other policies, as well as workforce wellness and staff self-care resources (addressing vicarious trauma and fostering self-care and resilience for staff should be central components of any organization’s efforts to become trauma-informed).

Sometimes resistance pops up when people go back to their organizations after taking initial training. They may think, “This will take too much time. It will cost too much.” And of course, it requires people to talk about really difficult and painful subjects: the trauma of physical abuse, sexual abuse, violence, racism, poverty and so many other things we’d rather not have to talk about.

The TIO website offers this link to a video from Laura Porter, co-founder of Ace Interface, that offers some strategies for overcoming resistance and creating buy-in. 

Trauma Informed Oregon has also developed a set of “Standards of Practice for Trauma Informed Care.”

“The road to becoming trauma-informed is going to be messy,” Mandy cautions. “It isn’t a simple matter of A+B=C.”

Luckily, there are organizations like Trauma-Informed Oregon that provide clear and helpful maps and directions. Best of all, their resources are all free and available to anyone in or outside of Oregon who wants to use them! 

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Walla Walla Part 2: Integrating a Focus on Success

Youre brave_brilliant_oh so resilient_WallaWalla_Screen Shot 2017-04-30 at 6.41.31 PM.pngIntegrating the knowledge about ACEs, brain science, and resilience into practice has been a cornerstone of Walla Walla’s trauma-informed community initiative. At every monthly meeting of their Community Resilience Initiative (CRI) team, the first item on the agenda is “Integration” and attendees are asked, “What have you done since the last meeting to help integrate our principles and learning into your daily work and into the work of your staff?”

Here’s how several members of the CRI team answered that question when I met with them:

  • Mike Bates, Director of the Walla Walla County Corrections Department: Mike is in charge of the Juvenile Justice Center (a youth detention facility) in addition to the county’s adult jail.

“In the youth detention program, we had a point system where, if a kid didn’t make their bed for example, or they would commit any number of other infractions, they would lose points. But they had to have a certain number of points at the end of each day to get certain privileges. When we started looking at the brain science behind ACEs, and trauma and resilience, we realized it would be more effective to focus on the positive things we wanted kids to do and reinforce that, instead of the negative reinforcement and all the focus on what they were doing wrong. So, it’s a little thing, but instead of saying, “You didn’t make your bed, so you’re losing a point,” we started saying, “Hey, you made your bed – good job! You’ve earned a point toward today’s privileges.”  Mike explains that all of the teachers in the youth detention center have taken the ACES, trauma and resilience training, and while the teachers at this point don’t explicitly talk with the youth about ACES and resilience, they are at least thinking about it as they interact with the kids.

When I asked about what’s happening at the adult jail, Mike explained that things have been a bit different there. “I took over the county jail two years ago,” he explains. “I spent the first few weeks just going in and looking at how staff interact with the inmates. I realized we needed a culture change.” But, he admits that changing the culture has been a real challenge.

“There are some basic things we need to do, like treating inmates with respect, saying thank you – you did a good job today.”

He has been talking with Teri Barila about how to get all of his employees at the county jail trained about ACEs, trauma and resilience, but hasn’t yet come up with a workable plan to do this, given all of the mandatory trainings his staff are required to complete every year, and the budget limitations that don’t allow for paying overtime for staff.

“Unfortunately, our criminal justice system with adults is more rigid. There’s this attitude of ‘you did the crime, now do the time.'”  But he explains that they’re getting ready to start a drug court program. “We understand we need to have a different way of treating people with drug addiction. I think the training over the years about ACEs has influenced our judges to be more willing to look at alternatives to jail.” Their drug court is going to take on the tougher cases, not the easy, low-hanging fruit cases that he’s seen other drug court programs take.

Mike also represents Walla Walla county in the national “Data Driven Justice Initiative” started under President Obama and now led by the National Association of Counties (NaCO) to effectively use data to identify and divert people charged with low-level offenses, and those with mental illnesses and substance abuse disorders, out of the criminal justice system and into effective, community-based care.

In Walla Walla County, they’ve identified 140 people in the community who are constantly in crisis, and who are the “super users” of the community’s resources, from emergency room visits and mental health services to homelessness and incarceration.

He explains,”Given what we know about ACEs and trauma, these 140 people probably have pretty high ACEs scores. Hopefully, we’ll be able to draw on that knowledge to effectively serve these individuals as well.” One immediate thing they’re doing is developing a common release of information and consent form so hospitals, lawyers, county jail staff, and others can share information with each other and get these folks the services and resources they need in a coordinated way.

  • Becky Turner, Executive Director of the Successful Transition and Reentry (STAR) Project:

STAR staff, in addition to Becky, include a case manager, a housing coordinator, an employment specialist,  a pre-release transition specialist who works at Washington State Penitentiary to develop reentry plans and coordinate services for people who will be released to Walla Walla, and a special populations program manager for people convicted of sexual offenses. STAR (along with other reentry programs around the state) has been funded by the proceeds of a class-action lawsuit against AT&T for charging extortionary phone rates in the Washington prisons, though Becky and her team are currently looking for other longer-range sustainable sources of funding.

Becky and her staff integrate the ACES and resilience knowledge into their reentry work starting with initial intake into their reentry program, when they do an ACEs assessment to  help identify each client’s needs and appropriate services.  Then, in the case management part of their program, they do 1:1 and some small group work on developing resilience skills. Their knowledge of ACEs and resilience also informs the work they do to teach clients skills to be good tenants and successful employees in their housing and employment programs.

  • Tony McGuire, instructor for the Building Maintenance Technology program taught inside the Washington State Penitentiary:

Tony was an employer for 16 years, so he knows what employers are looking for in good employees. Now, as an instructor at the Washington State Penitentiary, Tony helps the incarcerated men in his Building Maintenance Technology course understand that a big part of their employability is dependent on their ability to regulate their emotions on the job. “They can only do this when they understand the impact of their childhood and other trauma they’ve experienced,” he explains. So, Tony gives the guys the ACEs quiz and they talk about the challenges they’ve had. But more importantly, they talk about resilience and building skills and strengths to move forward.

“One guy recently took the ACEs quiz and found out he had an ACEs score of 10. His first question to me was ‘Now what do I do?’  So we started talking about the strengths he already has and what he can do to keep building on that.”

Tony uses the Resilience and ACEs playing cards developed by CRI with the men in his class and on a daily basis, they talk about how to develop their skills in resilience and self-regulation.  Tony also has the training presentation he got from Teri and the CRI Team, and he goes over that with the men in his class. “There’s one slide about hitting a ‘breaking point’ that the men really relate to – so we talk about that, and then we focus on the building blocks of resilience.  I tell the guys, ‘eat the chicken, throw away the bone.’ Take what applies and is meaningful and useful for you – and don’t worry about the rest of it.”

  • Jeff Gwinn, supervisor for the Court Appointed Special Advocate (CASA) program

“When we train and recruit CASA volunteers, we train them about ACEs,” Jeff explains. He had Teri Barila provide the basic training about ACEs, brain science and resilience to his CASA volunteers so they understand the brain science as they are getting into working with the children for whom they serve as advocates. “But it also helps our CASAs to understand the parents of the children they’re advocating for,” he adds. “When the CASA goes out and talks with the child’s teachers, pediatrician, parents, others – they can ask the right questions to understand some of the stressors on the child and what may be behind the child’s behaviors.” And that understanding, in turn, helps the CASA understand how best to advocate for the child in court.

Jeff also comes to the CRI meetings every month to stay informed about what’s happening with CRI, trainings and opportunities he can promote to their CASA volunteers. “Our CASAs are are required to have 12 hours of additional training every year. This year, we’re sending some of the CASAs to the Beyond Paper Tigers conference that Teri and her team are putting on in June.”

They incorporate the language of ACEs into the court reports the CASAs provide. “Our judges are familiar with the ACEs language, and it helps the judges to understand what it might take for a child and family to be successful.”

Jeff describes the CASAs role, in part as being ‘stress detectives’ – asking questions and understanding patterns and behaviors with a child, and what may be happening with them. “We want to focus on positive reinforcement – catching them doing something right,” he explains.

It occurred to me as I listened to all of them sharing their integration work that the common thread is that focus on strengths, resilience and SUCCESS.

 

Walla Walla – Where Resilience Trumps Aces

walla walla welcome_2017-04-29 17.27.36.jpgLike the sweet onions for which Walla Walla is famous, the story of this community’s 10+ years of  investment in becoming a Trauma-Informed Community has many layers.

Teri Barila is the person widely recognized as the initial champion and catalyst for Walla Walla’s trauma informed approach, after she attended a conference in 2007 where Rob Anda, one of the original authors of the ACEs study, challenged attendees to take the information he had presented about ACEs and “get something started in your local community.”

I had the privilege of meeting and talking with Teri Barila, as well as several members of Walla Walla’s CRI Team:

  • Mike Bates, Director of the Walla Walla County Corrections Department,
  • Becky Turner, ED of the Successful Transition and Reentry (STAR) Project,
  • Tony McGuire, instructor for the Building Maintenance Technology program taught inside the Washington State Penitentiary, and
  • Jeff Gwinn, supervisor for the Court Appointed Special Advocate (CASA) program

I came away from our conversation deeply moved and greatly inspired.

In the decade since starting this work in earnest, Teri told me, “Two central goals have withstood the test of time:

  1. create a community that is conversant in ACEs, brain science, and resilience; and
  2. INTEGRATE that knowledge and the related research into changing the practices in our schools, human services organizations, businesses, justice systems, healthcare systems, and elsewhere to better respond to the ‘bad things that happen to good people.'”

From the beginning, however, Teri says, “we thought it would be important to focus on the hopefulness of RESILIENCE, not the negative outcomes and ‘shame and blame’ of the ACEs.” Hence the names of the cross-sector, community coalition they formed (Children’s Resilience Initiative, or CRI) and their website: ResilienceTrumpsAces.org.

From the beginning, they’ve operated at multiple layers and levels:

  • MEET 1:1 WITH STAKEHOLDERS AND POTENTIAL PARTNERS: Teri came to this effort with a strong background in community organizing and coalition-building. So she and Mark Brown, a co-facilitator she engaged from the beginning, developed a list of individuals and organizations who could be key stakeholders and partners in the effort to make Walla Walla a trauma-informed community. Then, they met with them one by one to share information about ACEs, brain and resilience research, the issues they saw in Walla Walla related to ACEs, and their goal of creating “a community conversant in ACEs and resilience.” At these meetings, they answered questions, addressed resistance and doubts, and refined their core message.
  • FORM AN INCLUSIVE CROSS-SECTOR TEAM: After the 1:1 meetings, they put together a team of interested stakeholders and partners, and made sure to include parent representatives.
  • CRAFT A CHARTER PLAN: The CRI team created a Charter Plan mapping out their vision, goals, and an elevator pitch that team members could use to engage additional partners, about how the entire Walla Walla community could benefit from understanding ACEs and resilience, and why it was important to use that knowledge to change practices, policies, and systems in the community.
  • SECURE ORGANIZATIONAL COMMITMENTS FROM COALITION PARTNERS: They crafted an MOU for partner organizations to sign, to commit that they would send staff to training about ACEs, brain science and resilience; and that they would form internal agency “core teams” of staff who would then evaluate and revise their agency’s internal policies, practices and programs to make them “trauma-informed.”
  • DEVELOP AND PROVIDE TRAINING: They pulled together all of the resources and research they could find and created a 3-hour basic training and started offering it to local nonprofit agencies, businesses, community and civic groups, schools, churches, and governmental departments (including police and sheriff’s departments, the local prison, juvenile justice and others). They realized early on that the information about ACEs could feel ‘shaming and blaming’ to parents, so they have been very intentional about how this is presented, and have involved numerous parents to help develop the materials and craft the message. Periodically, they also brought in outside experts to give presentations, provide trainings, and help “deliver the message.”
  • MEET REGULARLY/DISCUSS INTEGRATION: The CRI team meets monthly to discuss how each partner organization is integrating the knowledge about trauma and resilience into their day to day work, and to identify opportunities for further collaboration and expansion. The “integration” discussion at every meeting has been transformational, as it helps to document the successes of a trauma-informed approach and gives everyone additional ideas to try in their own organizations. (NOTE: In a future blog post, I’ll share information from Mike Bates, Becky Turner, Tony McGuire, and Jeff Gwinn about some of the specific things they’ve done in each of their organizations and programs to integrate the knowledge about ACEs and resilience into practice.)
  • Oct-resil month_2017-05-01 14.20.35.jpgSECURE HIGH LEVEL GOVERNMENT & INSTITUTIONAL SUPPORT: For one of their early trainings where they brought in an outside expert, John Medina, for a half-day forum on ACEs and brain science, the Walla Walla School Board voted unanimously to close the schools for the day so that all school district employees could attend. As a result, they had attendance of 1200 people at that training.  In addition, they approached the Walla Walla City Council and requested that they declare the month of October “Resilience Month.” This has now become an annual proclamation and provides a terrific opportunity to draw additional attention to the topic at the beginning of every school year.

Teri cites several other keys to success in this work:

  • MULTIPLE EXPOSURES: they realized early on that, in order to really “get it,” most people would need to be exposed to the information about ACEs, trauma, brain science and resilience multiple times, through multiple channels, from multiple experts, in multiple locations and multiple formats (trainings, flyers, bulletins, PSA’s, posters, games, social media, etc). They’ve held formal events like classroom trainings, speakers events, conferences, and film screenings – and, yes, they’ve shown the films “Paper Tigers” and “Resilience” here too, because, as Teri explains, “even though the films are about our community, not everyone here knew our own story!”.

They have also used informal apprYoure brave_brilliant_oh so resilient_WallaWalla_Screen Shot 2017-04-30 at 6.41.31 PM.pngoaches, like quick surveys of shoppers at the community’s Saturday Farmer’s Market and the community 4th of July celebration to gauge what people know about ACEs and resilience, providing basic information about developing resilience to new parents at the local hospital and at parent-teacher conferences at the local schools, an art show related to resilience, and a traveling signboard that appears at different places around town.

They also developed a whole series of games and tools that they now sell on their website.  (note: I bought a copy of everything they’ve created and am bringing it all back to Lancaster! Good thing I packed an extra empty duffel bag!)

  • MEASUREMENT: They have conducted multiple surveys, focus groups and other measures to assess overall awareness and understanding of ACEs, resilience and related topics in the community at large. In addition, individual agencies have gathered their own internal data on the results of taking a trauma-informed approach.
  • ADJUST WHEN NEEDED:  Though their initial focus was on addressing ACEs and building resilience for children and youth in the community, they have realized it is every bit as important to build adult capabilities as well (see next item). So, they are about to change the name of their initiative from “Children’s Resilience Initiative” to “Community Resilience Initiative”, to reflect this. They have made other adjustments along the way, as needed, listening carefully and with humility to coalition partners, parents, youth and others.
  • BUILD ADULT CAPABILITIES: They have come to understand how critical it is for all of the adults involved in the schools, human services agencies, parents and other adults to be in touch with their OWN “stuff” related to their experiences of trauma, and to have the necessary skills and abilities to be resilient themselves, before they can help children develop resilience. Teri highly recommends this 5 minute video overview from the Harvard Center on the Developing Child that addresses this topic.  In addition, here’s specific information from Harvard about ways service providers, caregivers and other adults can build their own capabilities and help other adults do the same.
  • SUSTAINABILITY: Over the past several years, they have implemented a robust “train the trainer” initiative so they have an extensive cadre of people across many of the CRI partner agencies and in the community at large who can deliver the initial 3 hour trauma/ACES/resilience training. They have also created a “Speakers Bureau” of CRI team members who can help carry the message out to new audiences.

As inspiring as it was to hear from Teri, Mike, Becky, Tony and Jeff about the importance of this trauma-informed work from their adult perspectives, for me, the most moving testimonial about why it matters so deeply for our communities to understand ACEs and work to build resilience comes from several young men in Walla Walla’s Jubilee Leadership Program sharing their own stories of hope and resilience after trauma in this incredibly touching video.