Creating Trauma-Informed Systems to Systems Initiatives for Women, Children and Families

1. Creating Trauma-Informed Systems to Systems Initiatives for Women, Children and Families 2008 Early Childhood Comprehensive Systems Partners MeetingMarch 14, 2008 Kath Schilling M.Ed., CAS, LADC I Trauma Integration Specialist Director – Project WAVE Institute for Health and Recovery http://www.healthrecovery.org Institute for Health and Recovery

2. Mission Statement The Institute for Health and Recovery is a statewide service, research, policy and program development agency. IHR’s mission is to develop a comprehensive continuum of care for individuals, youth and families affected by alcohol, tobacco, other drug use, mental health problems & violence/trauma. Our work is based on principles of: • Establishing collaborative models of service delivery • Integrating gender-specific, trauma-informed and relational/cultural models of prevention, intervention and treatment • Fostering family-centered, strengths-based approaches • Advancing multicultural competency with the service delivery system Institute for Health and Recovery

3. We provide: • Capacity building with existing agencies and systems on numerous issues • Direct care client services grounded in Evidence Based Practices • On-site Group interventions facilitated in a train-the-trainer model • Staff training and technical assistance Institute for Health and Recovery

4. Systems Change HIV Prevention/Education Homelessness Central Access to Residential Treatment & Housing Trauma Tobacco Education & Treatment Youth Family & Children Screening & Early Identification IHR Services/Programs National and Statewide Systems & Program Development Women RISE (Risk Identification, Strategies & Empowerment) Project RISE (Recovery through Information, Support & Engagement) FLT Project (Families Living Together) Family Residential Treatment Programs Sober Living Programs Community Housing Programs Trauma Integration Services Project WAVE (Women Achieving Vital Empowerment) Shattuck/ hopeFound – Project Genesis Department of Corrections Department of Mental Health TAPE Project (Tobacco, Addictions, Policy & Education) MTCP Smoke-Free Families Initiative Youth Central Intake & Care Coordination SCAP (Suffolk County Adolescent Project) RAYS (Regional Access to Youth Services) SAFE (Strengthening Adolescents ~ Family Empowerment) Parenting & Child Development Nurturing Program – Curriculum Development & Distribution Child Welfare Engagement Project Family Recovery Project SBIRT – Community Health Centers CAPTA Project FASD Projects Institute for Health and Recovery

5. IHR works across state systems in Massachusetts to integrate trauma-informed and trauma specific practices • The 3 main systems IHR currently works with are: • Department of Public Health (DPH) / Bureau of Substance Abuse Services (BSAS) • Department of Mental Health (DMH) • Department of Corrections (DOC) Institute for Health and Recovery

6. IHR currently participates in several state-wide trauma-related commissions and policy committees • Governor’s Commission on Correction Reform • Governor’s Commission on Sexual and Domestic Violence • DPH/DMH Emergency Room Access for People with Behavior Health Needs Work Group • DMH Restraint and Seclusion Advisory Committee Institute for Health and Recovery

7. Trauma: Creating a Paradigm Shift Shift: Towards trauma-informed, trauma-specific family treatment which includes resilience and strengths based prevention and treatment services for children “Incorporating Services for Children Into Substance Abuse Treatment: Paradigm Shifts and Lessons Learned” Beth Reed, Norma Finkelstein, Lisa Russell, Vivian Brown, Nancy Van de Mark Institute for Health and Recovery

8. System Change Strategies • Build connections at multiple levels with information flowing between them • Bring together diverse constituencies affected by proposed changes • Openly and respectfully discuss differences • Use relational skills to create collaborative and mutually empowering environment in which all members have impact on group’s decisions Institute for Health and Recovery

9. Department of Public Health / Bureau of Substance Abuse Services (DPH/BSAS) • Goal: All substance abuse treatment programs in MA will provide trauma-informed care • 2002: Provision of trauma-informed care included in terms and conditions of all contracts • 2003: Presented results of WCDVS across state • 2004-2006: • Conducted regional SA/DV summit meetings • Provided trainings on trauma-informed care twice a year – opened to state-wide audiences • NE Regional Conference on Integrating SA, DV, and MH (SAMHSA) • Trauma needs assessment with sample of SUD programs • Offered training on trauma-informed care and trauma-specific interventions to SUD programs upon request Institute for Health and Recovery

10. DPH/BSAS Trauma Integration Revised Change Plan • Prioritized women, and women and children’s residential treatment programs throughout MA • Held initial state-wide meetings to familiarize SUD programs with family centered trauma initiative • Applied change strategies learned from previous projects including: • Identifying champion for change • Forming change team • Team identifies targets for change • Gathering data before and after change is implemented Institute for Health and Recovery

11. Implementation of Revised Strategy • Agency submits letter indicating interest • Completes Trauma-Integration self-assessment • Chooses champion – individual at supervisory level responsible for implementing change • Staff, including supervisors, attend four hours of trauma training on site • Champion meets with staff (team) to begin trauma-informed planning • Consultation provided for plan development as necessary • After plan, may request additional training and/or TA • Support provided for plan implementation over following six months, including training in trauma specific groups • Program repeats assessment at end of consultation period. Institute for Health and Recovery

12. Women, Co-Occurring Disorders and Violence Study (WCDVS) • Three grants in Massachusetts (WELL Project) • IHR put considerable focus on state-level systems change • State Leadership Council • Local Leadership Councils • Organizational Assessment – Trauma Tool-Kit • Included WELL Child Children’s sub-study Institute for Health and Recovery

13. Project WAVE • SAMHSA/CSAT Targeted Capacity Expansion grant • Targeted women and their children affected by SUDs seeking services for, or fleeing from, interpersonal violence • Worked in partnership with the primary SUD agency on Cape Cod, two domestic violence agencies and Barnstable County • Services delivered at two domestic violence agencies - SUD/Co-occurring disorder screening, outreach, engagement, intervention and care coordination - Seeking Safety, Nurturing Program, WELL Child groups co-facilitated with SUD/DV staff in train-the- trainer model Institute for Health and Recovery