1. Errin Skinner-Liell, Initiative Coordinator May 4, 2015

2. I. Overview of trauma II. Components of the Initiative III. Child outcome data IV. Summary

3. 3 What is Trauma Trauma is an event or experience that:  Threatens the life or physical integrity of a person or of someone critically important to that person (such as a spouse, child, parent, sibling)  Produces intense physical and emotional reactions, including: An overwhelming sense of terror, helplessness, and horror Physical sensations such as rapid heart rate, trembling, dizziness, or loss of bladder or bowel control

4. A sudden, unexpected, non- normative event that overwhelms the child’s capacity to cope.

5. 5 Types of Trauma Acute trauma is a single, time-limited event, such as: AA serious accident AAn act of community violence or crime AA natural disaster (earthquakes, wildfires, floods) TThe sudden or violent loss of a loved one AA physical or sexual assault (e.g., being shot or raped)

6. Chronic trauma is the experience of multiple traumatic events:  May be recurrent trauma of the same kind—such as physical or sexual abuse—or varied traumas such as witnessing domestic violence and then becoming a victim of community violence  The effects of chronic trauma tend to build on each other, as each event serves as a reminder of past trauma and reinforces its negative impact 6

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9. 9 “80% of the children we serve at CMH have multiple traumatic experiences” CMHSP administrator

10.  Supported by all levels of the CMH System ◦ Administration ◦ Supervisors ◦ Direct Service Staff ◦ Support Staff ◦ Caregivers 10 Caregiver Education Trauma Assessment and Treatment Trauma Informed Screening Trauma Assessment and Treatment Caregiver Education

11.  Integration and support of trauma informed practice across system  Family driven, youth guided practice  Quality practice and use of Evidence Based Practice 11

12. Goal is to ensure early identification of trauma Screening interventionists (in person and via telephone) Intake Workers 12

13. Goal is to reduce trauma symptomolgy through trauma treatment using TFCBT Clinicians and their supervisors are trained in the evidence based TF-CBT model and implement the model with children and their families. Home-based / Outpatient clinicians and their supervisors 13

14. 14 P = Psychoeducation & Parenting skills R = Relaxation A = Affect regulation C = Cognitive coping T = Trauma Narrative I = In-vivo exposure C = Conjoint session E = Enhancing safety & social skills

15.  Goal is for CMHSP’s to provide trauma education to caregivers in their local community who are raising traumatized youth  Training of trainers model enables sustainability ◦ Goal is for participating sites to incorporate this into their system of services available for children, their families, and their community ◦ CMH’s share this resource with caregivers in their system and community  Desired outcome is to equip caregivers and the community to effectively intervene and support the healing of children with a history of trauma 15

16. Introductions Trauma 101 Understanding Trauma’s Effects Making a Safe Place Dealing with Feelings and Behaviors The Importance of Connection Becoming an Advocate Taking Care of Yourself 16

17.  Total of 12 cohorts completed; 2 cohorts currently being trained  Approximately 20 screening interventionists trained, 406 clinicians and 130 supervisors trained to implement TFCBT, and 340 parents and staff facilitators trained to conduct local Resource Parent trainings  40 CMHSP’s trained covering 73 counties

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19. Home Based Started (n=329) Outpatient Completed (n=85)  52% female  Mean age 12.2  3% are 5 and under  20.6% are 6-9 years  35.8% are 10-13 years  41.1% are 14-17 years  53% female  Mean age 12.2  3.1% are 5 and under  22.5% are 6-9 years  34.9% are 10-13 years  41.1% are 14-17 years Outpatient Completed (n=146) Home Based Completed (n=169)  53% female  Mean age 12.0  1.3% are 5 and under  26.6% are 6-9 years  35.5% are 9-12 years  36.8% are 14-17 years  53% female  Mean age 12.8  0% are 5 and under  17.3% are 6-9 years  36.8% are 10-13 years  46.8% are 14-17 years

20. Northshore (of 18 types) Outpatient: 7.9(n=26)Home Based: 7.4 (n=58) UCLA PTSD (of 13 types) Outpatient: 3.3 (n=96)Home Based 2.7 (n=201) Northshore includes exposure to disaster, fire, accident, hospital - self, hospital – family, being beaten, being badly hurt, feeling adults don’t care about you, living with people other than parents, not enough to eat, being homeless, beaten by family, threatened by family, stalked, having sexual contact with older person, attempted sexual contact, forced sex, attempted rape, and other. UCLA does not include categories of emotional or physical neglect, and does not differentiate the categories of sexual abuse.

21. Outpatient 53% (51 of 96 cases) 29% endorsed 0 or 1 exposures Home Based 42% (84 of 201 cases) 38% endorsed 0 or 1 exposures

33.  Total of 18 children completed services ◦ 72% are Home Based ◦ 56% are female ◦ Range from 4 to 7 years old, with 77% ages 5-6

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41.  Implementation of validated trauma screening instrument during intake assessment process  Integration of the trauma principle “if you don’t ask, they won’t tell” at the first point of contact

42.  Continued statistically significant and clinically relevant outcomes across all measures: UCLA trauma symptoms based on DSM criteria, CAFAS child measure, and CAFAS parent measure.  Data for young children shows positive results with home, mood, and behavior toward others on the PECFAS, supported by results on the TSCYC.

43.  Parents, professionals, and community providers trained as facilitators of psychoeducational trauma curriculum  Positive feedback from caregivers on the impact of participating in the parent groups

44.  Support and commitment at all levels to build a trauma informed system  Development of an action plan to address secondary traumatic stress  Integration of essential elements (screening, assessment/ treatment, and caregiver education)  Individual and/or group supervision to support implementation of model and new tools

45.  Mary Ludtke, MDCH Consultant Email: LudtkeM@michigan.govLudtkeM@michigan.gov Telephone Number: (517) 241-5769  Errin Skinner Liell, Initiative Coordinator Email: skinnere@ceicmh.orgskinnere@ceicmh.org Telephone Number: (517) 346-8004  Kathy Fitzpatrick, Technical Assistance Specialist Email: fitzpatr@ceicmh.orgfitzpatr@ceicmh.org Telephone Number: (517) 346-8070 45