Becoming a Trauma Informed Community in Tarrant Cou nty

1. Becoming a Trauma Informed Community in Tarrant County Dr. Wayne Carson, CEO ACH Child and Family Services Lena Zettler, MA, LPA, Director Cook Children’s Medical Center, Psychology Fort Worth, Texas

2. Memorial at Wedgewood Church 1999: Trauma in Tarrant County:Catalyst for Change • In September 1999, a man suffering from untreated mental illness entered a local church, armed with a semi-automatic gun and a pipe bomb, during a youth rally. There were around 150 individuals present. Eight people were killed, including the gunman and 4 teenagers. Seven others were injured. He had no previous criminal record. • Fort Worth Mayor Kenneth Barr turned to local mental health providers, requesting a plan for improving access to quality mental health services for all residents of Tarrant County.

3. 2000: Mental Health Connection • Initial collaboration of pediatric service providers and community agencies provided leadership, planning, and financial resources to develop infrastructure and goals: • Cook Children’s Medical Center • Lena Pope Home Inc. • MHMR of Tarrant County • City of Fort Worth • Fort Worth ISD • Child Study Center • MENTAL HEALTH CONNECTION of TARRANT COUNTY was established in 2000 and today has over 70 participating agencies and numerous private practitioners, advocates, consumers, and family members.

4. 2007- 2011: Bridging the Gap • Mental Health Connection 5 Year Initiative • Annual Symposia • Evidence Based Practice • Create Learning Communities in 6 areas • Met for 6 months • Reviewed research • Identified policy issues and barriers • Pilot/Implementation in 5 areas based on EBP’s

5. 2008: Trauma Implementation Team • Trauma/PTSD Pilot program • Obstacles: • Identification and diagnosis of trauma in children and adolescents • Increased trauma experiences for children/ adolescents in Tarrant County: • 2007 Texas DFPS - alleged child abuse and neglect (up 55%) • 2005 United Way survey shows increased perception of violence in home/ community/school (18-51%) • 2006 Texas DHHS Hurricane Katrina evacuees remaining in Texas under age 18 = 25,740

6. 2008 CCHAPS Survey • 5.5 percent of CCHAPS respondents say their child has been abused or neglected, including physically, psychologically, sexually or has been a victim of gang threat. This equates to almost 34,000 children across 6 North Texas counties. • 6.48 percent of CCHAPS respondents say their child has experienced something traumatic such as a natural disaster, accident, violence, neglect, or abuse. This equates to over 40,000 children across 6 North Texas counties • 15.24 percent of CCHAPS respondents say that their child had accidental injury that needed medical attention in the past 12 months. This equates to over 94,000 children across 6 North Texas counties.

7. 2008:TF-CBT in Tarrant County • TF-CBT model proposed (Cohen, Mannarino, and Deblinger, 2006) • EBP sponsored by NCTSN • Cultural Adaptations • Professional Facilitation/supervision • Collaboration of 22 agencies, including pediatric mental health service providers, hospitals, CPS, FWPD, and domestic violence service providers • T.A.R.P. (Trauma Assessment and Referral Process) • Screening tool • Social marketing component • Education/training

8. 2009: Trauma Implementation • Trauma Focused CBT: • 54 providers or administrators trained across 15 agencies • Bi-weekly consultation for 9 months • Partner with UT – Austin study • 85 youth/families enrolled; 65 participated in 12 month follow up • Obstacles: • Intake/referral navigation different across agencies • For example, some agencies require CPS or police referral or child may be triaged to a higher level of care (inpatient psychiatric unit) • Access • For example, some agencies serve identified children in specialized settings (group homes)

9. 2009 Bridging The Gap Symposium • Around 180 participants received Trauma training • Trauma and the Brain: Bruce Perry, PhD • Trauma Informed Policy: Janice L. Cooper PhD • The Science of Implementation: Allison Metz PhD

10. Trauma/EBP Lessons Learned • Therapist/Agency attitude towards EBP’s was positive • Need for ongoing supervision/fidelity • Highlight the overall problem of access to services in Tarrant County • Need policy changes to support ongoing work • Realize Implementation is a SCIENCE; real change involves more than technical solutions to obstacles

11. 2010: Pediatric Trauma in the Medical Setting • Grand Rounds at Cook Children’s Medical Center by Nancy Kassam-Adams, PhD • Healthcare Toolbox (NCTSN, Children’s Hospital of Philadelphia) • “Supporting the Traumatized Child” School Nurse Symposium and video conferences for school nurses provided by Cook Children’s Child Life, Trauma Dept, and CISD trained staff

12. 2011 Trauma Committee • Grant Submission: Integrating Trauma-informed and Trauma-focused Practice in CPS Delivery; application declined • MHC Trauma Informed Committee evolved/ established • MHC: Table Discussions with Membership • Large and varied interest in spite of grant denial • “What does a trauma-informed community look like?” • “What resources do we have now and what do we need to develop?”

13. MHC: Trauma Informed Committee • Definition: Trauma is defined as the experience of an event by a person that is emotionally painful or distressful which can result in lasting mental and physical effects. Trauma is defined by the experience of the survivor. What is traumatic to one person may or may not be traumatic to another. Trauma can affect anyone. • Vision: A community that understands and acts quickly with sensitivity to the needs of those who have experienced any form of trauma.

14. MHC: Trauma Informed Committee • Broaden stakeholder base to reflect vision of “community” • Teachers • First responders • Juvenile Justice • Intake staff who may not be clinically trained • Universities • Explore NCTSN resources • Local networking and resource sharing • Develop webpage for information sharing • Discussions were relevant, respectful, and synergistic • Following intensive Implementation Leadership training by Ellen Kagan, MSW Georgetown Leadership Program

15. 2012: MHC Trauma-Informed Committee • Complex Trauma Treatment Network (CTTN) Midwest Region Learning Community • Brad Stolbach, PhD • Technical assistance • Funded by the US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) • National Child Traumatic Stress Network

16. CTTN Trainings and Assistance • Complex Trauma Training by Brad Stolbach, PhD: • Arlington, Euless, & Watauga Police Departments • CPS supervisors • MHC membership and community (around 90 individuals) • Cook Children’s Medical Center CARE Team • MHC Site visit • Cook Children’s Medical Center • MHC Board of Directors • Juvenile Services • UT- Arlington faculty and students • TCU faculty • CTTN Southern and Gulf Coast Regional Conference in Houston • 15 attendees from MHC, including parent/family partners

17. 2012 Other Trauma Work: • TarrantCares.org to include Trauma-informed services • Resource library for professional trainings offered by agencies • Agency/organizational assessment project with UTA graduate students in Mental Health and Social Policy • Explore universal screening and assessment • Continue First responder training: • Arlington PD • MHMR Law Liaison program • Mental Health Assn. (MHA) trainings for police officers

18. 2012: Other Trauma work: • Cook Children’s Medical Center Trauma Department and Trauma Support Services of N. Texas (TSSNT)collaborative • Provides education, group counseling, and individual or family counseling to families who have experienced medical trauma at Cook Children’s Emergency Department; LPC from TSSNT collaborates with family, and Home Health/Child Life staff • Cook Children’s Trauma Conference (110 participants) • TF-CBT competency required for all Lena Pope Home and Cook Children’s Psychology clinicians • NCTSN grant submission/declined

19. Where are we now? • Cook Children’s grant pending to provide Trauma informed Organizational Assessment and Trauma informed training in 2 local homeless shelters • 2013 Cook Children’s to provide Trauma-informed training to Cook clinical and non-clinical staff ,and Executives, who serve/support collaboration in 3 homeless shelters (include MD’s, RN’s, van driver, VP’s, etc) • Trauma and compassion resilience • How do we retain clinical workforce? • Support for non-clinical staff • 2013 MHC Forum on Trauma

20. Where are we now? • Pilot with Crossover Children (Juvenile Justice and Child Welfare) • Birth to age 6 • Judge Boyd advocate; Tonya Green of CASA; Aaryn Lamb, Attorney • TRBI and partnership with Dr. Karen Purvis at TCU Child Development Team • Treatment implementation • Trauma-informed education for CPS workers and attorneys • Ms. Lamb to speak at Texas Juvenile Law Conference in 2013

21. Thanks for your participation! Mental Health Connection of Tarrant County www.mentalhealthconnection.org Dr. Wayne Carson wcarson@achservices.org Lena Zettler Lena.zettler@cookchildrens.org