Moderator: Mary Pat King
September 26‚ 2011
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen only mode until the question and answer session.

Today’s conference is being recorded. If you have any objections you may disconnect at this time.

I would now like to turn the call over to Mary Pat King. Thank you. You may begin.

Mary Pat King: Thank you‚ hello and welcome to Demystifying Trauma‚ Sharing Pathways to Healing and Wellness. Today’s Webinar is sponsored by the Substance Abuse and Mental Health Service Administration’s Resource Center to Promote Acceptance‚ Dignity and Social Inclusion Associated with Mental Health‚ also known as the ADS Center.

SAMHSA is the lead federal agency on mental health and substance abuse. And is located in the US Department of Health and Human Services. Please join the AD Center listserv to learn more about social inclusion‚ including upcoming webinars‚ new resources and events.

This Webinar will be recorded. The presentation‚ audio recording and a written transcript will be posted to SAMHSA’s ADS Center Website at promoteacceptance.samhsa.gov in October.

The views expressed in this training event do not necessarily represent the views‚ policies and positions of the Center for Mental Health Services‚ the Substance Abuse and Mental Health Services Administration or the US Department of Health and Human Services.

Our presentation today will take place during the first hour. And will be followed by a 30-minute question and answer session. During that time please press star 1 on your telephone to ask a question.

You will enter a queue. And you will be invited to ask your question in the order in which it is received. Upon hearing the conference operator announce your first name‚ then please proceed with your question.

Due to limited time‚ we may not get to all questions. If your question isn’t answered or you wish further information‚ we’ve included the presenter’s contact information at the end of the presentation so you can contact us directly.

Today we will learn about the impact of trauma and how all of us can support people in moving toward healing and wellness.

Trauma and violence have a significant impact across all human service sectors‚ including the Justice System. Most providers‚ if not all‚ have come in contact with someone who has experienced trauma‚ such as child abuse‚ domestic violence‚ refugee trauma‚ natural disasters‚ war and more.

As we begin to adapt the trauma informed orientation to services and support‚ it is critical that we also re-examine current conceptualizations about trauma‚ the tenacity of survivors and how we can all support people to help from the damage trauma inflicts.

Our speakers today will examine the issue of resilience and the role of self-healing as a natural response to traumatic events. They will present ways to replace the notion of the survivor as fragile with a new understanding of the survivor as teacher.

We can all play a part in supporting the natural healing response. And we’ll benefit when we listen to what the survivor has to say about overcoming extreme life events.

This knowledge can and must inform our communities‚ our society‚ our organizational policies and our practices.

Our first presenter is Doctor Richard Mollica‚ who is a national expert in the care of trauma survivors. Richard directs the Harvard Program in refugee trauma of Massachusetts General Hospital and Harvard Medical School.

Richard has written over 160‚ 70–160 scientific articles‚ as well as the book‚ Healing Invisible Wounds‚ Path to Hope and Recovery in a Violent World. Richard is recognized as a leader in treatment and rehabilitation following trauma.

Richard will tell us about the nature of trauma. How it affects physical and mental wellness‚ and how we can start the self-healing process now. Thanks for joining us Richard. You may begin.

Richard Mollica: Well thank you very much. It’s a great honor and a privilege for me to be speaking to this national audience on such an important topic. Little did I know that when I began this work in 1981 that I would still be doing it 30 years later. But it’s been really an honor for me to work with the thousands of people all over the world who have been through extreme violence.

Now one of the things that I learned over the past 30 years is that the extreme situation teaches us about everyday life. The traumatic life experience is a universal experience. Every human being experiences tragedy in their own lifetime. This is an inescapable.

And of course‚ we all know that a profound pain and fear enters us when we realize that one human being has intentionally hurt another. This is the important part of the human relationship that when one human being hurts another human being‚ it’s extremely‚ extremely disturbing.

Now it’s been my understanding and experience doing many oral histories and listening to people‚ both patients‚ clients‚ non-patients‚ citizens‚ people that one of the major instruments of violence is humiliation.

In other words‚ humiliation is used to hurt people. And humiliation is used to create the outcome called humiliation. And humiliation is a very‚ very powerful tool because humiliation is really based on what I call empathic failure‚ in other words when people I work with who have been torture survivors and been through extreme situations‚ what they’ll always tell you is that it’s the deep humiliation‚ the lack of empathy‚ the total lack of empathy that is the most painful‚ not the physical pain itself. Whether it’s domestic violence‚ torture‚ sexual abuse‚ gender-based violence‚ etcetera‚ it’s the lack of empathy that is very disturbing to human beings. And they find it extremely hard to cope with.

Now unfortunately we have a common situation where even though tragic events are common in everyday life‚ there’s a will to deny. And this will to deny we all know that friends‚ family members‚ society at large‚ they find it difficult to acknowledge the traumatic life experiences of other human beings.

And Sophocles‚ 2005 years ago in his famous Greek tragedy called Philoctetes talked about a Greek hero who was injured by a magical snake sent by a God so he wouldn’t participate in the Trojan War. And he was sent on an island in mortal agony.

And he was in such terrible pain that ships would avoid the island in which he was sent away as an outcast. And this isolation‚ as we all know‚ in trauma survivors is very common. We’re sent away. We’re sent that outcast. We even may be stigmatized.

And when the Greek course comes back to meet Philoctetes‚ they sing‚ I’m a Stranger in a Strange Land. This is where that beautiful and wonderful expression comes from‚ I’m a stranger in a strange and‚ because Philoctetes has lost his world‚ the normal world. And he has to re-find it and re-create it.

Now we know that from all our scientific research that the traumatic life experience can be found in the events‚ the symptoms‚ the limitation‚ the disability and the resiliency because not everybody is traumatized. Most people who are traumatized actually are extremely resilient.

So the trauma story can be found medically in the symptoms‚ in limitations‚ but also can be found in the disability and the resiliency. So this is the way I work with patients is I look for the trauma story and its impact on the body‚ mind and the spirit because the spirit is also very deeply impacted by violence.

Now the - we have tremendous amount of research now demonstrating that the traumatic life experiences in the short-term and in the long-term are associated with chronic disease.

So no longer can one say I’ve had a traumatic life experience. I’m going to get over it because the seed of the chronic disease is already planted. In other words we’re finding in our communities like Cambodian community‚ other communities that have been highly traumatized‚ we’re finding now diabetes‚ hypertension‚ heart disease‚ stroke‚ metabolic syndrome which is high cholesterol‚ etcetera.

And not only long-term impact of post-traumatic stress disorder and depression. We’re also finding chronic insomnia and unremitting grief. So it must be remembered now that trauma has long-term medical consequences. And the seed‚ you may look healthy now‚ but you have to really work on your health promotion and your resiliency‚ physical resiliency to prevent these problems from developing in the future.

And this is research that’s come out of three major national studies‚ which is in my resource list. And you’re willing - you’ll be able to look at that and look at these very important studies‚ including ACE study.

Now let’s talk about the centrality of the trauma story. This is interesting that I’m trained as a physician‚ as a psychiatrist‚ as epidemiologist. And it took me 20 years working with traumatized people from around the world to put the trauma story at the top of the list of the medical information I need to obtain from a patient.

Now there are many reasons for this. Not just the fact that listening to the trauma story is therapeutic. We know that for instance the trauma story‚ as I’ve already pointed out‚ leads to medical and psychological diagnosis.

The trauma story teaches us about survival and healing. The trauma story promotes trust. I don’t know how you can work with a patient or a client if you don’t know their life history‚ especially if it’s a traumatic life history. And this builds a strong therapeutic alliance.

It also is well known now through literature that it facilitates physical‚ emotional and spiritual recovery. And most importantly‚ this is one of the unique areas in medicine where the trauma story is directly related to social justice.

All traumatized people want justice. The justice is at the heart of the trauma story. And becomes essential to the healing relationship. And I think that this is something that’s often‚ you know‚ overlooked. Now we may not be able to guarantee justice in our work. But we can at least address it in our discussions and our dialogue.

Now it’s very important to know that all of the scientific evidence on emotional disclosure strongly recommends that there must be or should be a dialogue between the listener and the survivor.

And this maximizes the benefit of emotional disclosure. So there’s a lot of research where it’s arthritis‚ pain‚ etcetera where people will write diaries‚ etcetera. But it’s always been shown over and over again that it’s in the relationship with the therapist‚ with the psychologist‚ the family‚ etcetera that they needs to be a listener.

That dialogue is essential to the healing relationship‚ the therapeutic relationship. And sometimes we forget this‚ the importance of an empathic dialogue.

Now the elements of the trauma story is based on my 30 years of work. I call it the TSAT. And this you’ll be able to get from either emailing us or looking at our Website or looking at Lulu because basically in my book‚ Healing Invisible Wounds‚ I talk about the main architecture of the trauma story. The main foundations of the trauma story. And these four points seem to be universal.

The factual accounting of the events‚ the brutal facts‚ the cultural meaning of trauma‚ in other words how trauma - what is traumatic in that person’s unique culture and its special cultural relationships.

Looking behind the curtain based on Thomas Martin’s work‚ which has to do with revelations because within all trauma there is revelation. And I think that this is very‚ very important‚ the whole issue of revelation.

And finally the listener‚ storyteller relationship because there is relationship between the listener and the storyteller. Now one thing should be pointed out here is that as we look at this‚ the - a new model emerges. The trauma - traumatic person‚ the person with the traumatic life experience becomes the teacher.

Becomes the teacher because they are teaching us about their life experiences‚ the cultural meaning of trauma and their revelation and also their relationship to it. So I moved away from the looking at the patient as someone I’m doing something too.

And looking at more in a more dynamic way as looking at the storyteller as the teacher‚ my teacher.

Now the concept of self-healing is there’s an extensive amount of research in this. In the resiliency literature it begins with everything at the molecular level. You know‚ my belief is that‚ and there’s a lot of science that backs this up‚ at the moment trauma hits somebody‚ there’s an immediate healing response.

And this is often overlooked by doctors‚ by social workers but that the patient or the client‚ the person with the trauma is already beginning a program of self-recovery.

Now they may not be aware of this. In other words‚ they may not say oh‚ I have this program of self-recovery. But it’s important in the relationship with the traumatic - with the trauma survivor to recognize this. To say wow‚ you’re building on this and you’re doing this and isn’t this wonderful that you’re doing this. That you’re‚ you know‚ you haven’t talked to your mother in years and now you’re speaking to your mother every night.

Or you’re going to the temple and you haven’t been there in years. You know‚ so this is really important. Now we know that there are three areas that are essential for the social instruments of healing‚ altruism‚ work and spirituality.

The research shows over and over and over again the major elements of social healing or altruism‚ work and spirituality. I just want to go now‚ as I’m coming to the end‚ is talk about the self-healing response.

I ask every patient‚ every client‚ and you can do this yourself in your own setting‚ these four questions. The simple rubric is very‚ very helpful. And I think you’ll find it very useful.

One‚ all trauma - in this slide here I’ve already reviewed. I’m not going to - I’m going to go on to the next one with the basic rubric like what traumatic events have happened? How are you and your body and mind repairing the injuries sustained from these events? What have you done in your daily life to help yourself recover? And finally‚ what justice do you require from society to support your personal healing?

These four questions I ask all of my patents. And it’s fantastic to listen to them. And to really hear what they have to say about their own self-healing response.

And so these are the resources. And I think at this point I’ve come to the end of my brief discussion. Thank you very much for listening.

Mary Pat King: Well thank you Richard. Thank you so much for helping us to better understand trauma. And specifically the elements of the trauma story and the important role that self-healing plays in trauma survivor’s lives.

Now we’re going to hear from Beth Filson‚ a nationally recognized trainer and curriculum developer in trauma informed peer support and peer workforce training and development.

Beth is a consultant for the Self-Inflicted Violence and Healing Project‚ an initiative of the Massachusetts Department of Mental Health and the Transformation Center.

She co-authored‚ Engaging Women Trauma Survivors in Peer Support‚ a Guidebook and also co-facilitates Intentional Peer Support with Shery Mead and Chris Hanson.

Beth will provide an overview of trauma informed peer support. And will tell us why these relationships and stories are so important to all individuals involved. Beth thanks for joining us. You may begin.

Beth Filson: Hi‚ thank you very much. I’m really excited about being here‚ especially to talk about trauma in the context of peer support relationships.

When I first started this work in 2002 I was training folks who had a mental health diagnosis to become peer specialists. And we were all very excited about the concept of recovery.

But what some of us recognized very soon was that we didn’t have a language for trauma and violence and its impact in our current distress. And that if we were really going to be able to claim the power of peer support and recovery‚ then we were going to have to find a way to talk about trauma. We could not exclude trauma from the discussion about healing.

So before we really get started‚ just for audience members that may not be in the know‚ let’s talk a little bit about what peer support is. I want to - when we talk about peer support‚ we’re talking about a non-professional and non-therapeutic kind of relationship that’s created around a common or shared experience.

So let’s say in the arena of mental health‚ that may be the shared experience of living with a psychiatric diagnosis. The important thing is that people involved in the relationship are themselves defining what it is they share. For the value of peer support is that the shared experience provides insight that really benefits both people.

It’s really important to understand that we heal in relationships. Pat Deegan a long time ago said we don’t recover and then go live our lives. We don’t recover and then go to work. We don’t recover and then have instant relationships. We recover in the process of all of these things.

But trauma so often creates disconnection‚ not just ourselves‚ a disconnection of mind and body‚ but also a profound disconnection from others. Susan Salas once said that trauma renders everything about human connections suspect. What loves means. What trust means. What justice and safety means.

Peer research and writer Shery Mead tells us that peer support by its very nature is about reconnection. And I just point to the tattoo above. A friend and colleague of mine from Kansas is a peer specialists and used this tattoo to keep always forefront the vital importance of relationships when it comes to who we are and how we participate in the world.

So what are the characteristics of peer support? In Shery Mead’s work in intentional peer support tells us that mutuality is really about creating two relationships that reflect the type of relations we have in our community and not the type of relationship we have with care providers.

So when we talk about mutuality‚ we are talking about engaging with each other in a way that the focus is not on what one of us in the relationship needs‚ but is actually on what the relationship itself needs in order to stay healthy.

This is important. Let me give you an example of what can happen when we’re talking about trauma and peer support. But only focused on what one of us in the relationship needs.

I might say‚ you know‚ I - to someone‚ I need to tell you more and more and more about what’s happened to me in my life. And it’s really intense. The other person could say yes well I need you not to tell me about what happened to you. It’s just too much for me.

So what happens? Where does that take us? We’re not going to get anywhere. Instead what if we started looking at what it takes to stay connected in our relationships so the conversation instead might sound like this.

I hear that you really want to talk more to me about what’s happened to you. And I hear how much pain you’re in. And I am so honored that you feel comfortable talking to me. But I guess I need to be honest with you. I’m feeling really overwhelmed. And I’m beginning to react to my own feelings. I’m just wondering could we maybe take a walk‚ take a breather. And then come back together.

That’s whole different kind of conversation. Now peer support is also about a non-clinical focus on what’s taking place. When we meet at the non-clinical end‚ we can begin to name our experiences rather than‚ you know‚ like our symptoms.

And this is how we’re really able to - I think when we start talking about our experiences‚ we’re revealing the multiple ways that we’re actually connected to each other. And not just to each other‚ but to our larger community.

So this non-clinical way of communicating means we’re going to be using the language of human experience. If you say you’re depressed. I might ask you what that means for you.

You know‚ so many of us have learned to translate our human experience into clinical descriptions of illness. And that’s just keeping us really stuck. We stop having any feelings. And instead‚ just have many symptoms.

I think what we are really trying to do here‚ what we’re trying to talk about is wanting to connect on the basis of our suffering and through relationship‚ transform that suffering into something that is finally meaningful.

So peer support in the arena of trauma really becomes a dialogue about what most people need in order to stay connected.

Doctor Mollica said that it took him 20 years a clinician to really understand the importance of the story in healing. And so the question that we have to ask is why? Why are our stories so important?

You know‚ a personal account‚ what we survived and how - what these experiences mean to us and what we know now that we did not know before are what I mean by story.

The creation of the story I think happens as a kind of natural response to trauma. In fact I think that when we’re talking about natural healing response that occurs immediately after a trauma event. For me that means I’m immediately creating a story to make sense out of what has just occurred.

So the story is the trauma event transforms into meaning. It’s the natural response to traumatic or overwhelming life events. You know‚ who among has not shouted‚ "Why me? Why did this happen to me?"

And what we’re doing is immediately beginning to formulate a story to try to make sense out of what happened. And then that way it becomes manageable. It becomes doable.

And because a story needs an audience‚ because we tell our stories to someone‚ it creates a connection with our listener‚ with our audience. We tell our stories in all different kinds of ways. I mean I’m using some of my etchings because one of the very important ways that I have told my story is through these etchings.

Many of us use dance. We use poetry. We use theater. And‚ you know‚ even if it’s - if we’re our only audience‚ we still begin to acknowledge the capacity within ourselves to create. And that’s incredibly transformative.

When our audience bears witness to what we created‚ they see us more than - they see us more than a mental health diagnosis.

So what does it mean to be trauma informed? It’s about - it’s an understanding that begins when we shift the question that we’re asking each other from what’s wrong with you to what happened to you?

It’s when the shift occurs where we begin to understand all of the ways that people are surviving and living and making meaning out of their experience with violence and abuse and natural disaster and war.

This etching at the top says what grief becomes. And the words around the figure’s collar are some of the labels I think people with trauma histories get. Borderline personality disorder‚ schizophrenic process that’s an incredibly limiting description of what our experiences have been and how we figured out to survive.

In Demystifying Trauma‚ I’d like to respectfully challenge some of the current thinking about who trauma survivors are and how we heal. We’ve already survived the stories we’re trying to tell.

So I think we can expect profound strength and resiliency rather than fragility. If we’re going to talk about trauma in the context of peer support‚ we also need to expect struggle.

And that is largeness of feeling and emotion. I don’t think these things need to create disconnections in our relationships but that they can really enlarge the landscape of peer support.

By speaking our stories and by listening to each other‚ we’re finally shattering the isolation that trauma imposes. And we can begin to forge relationships with each other. But what we’re really doing is returning to community from exile.

There are three dimensions of trauma. So there are three dimensions to the trauma narrative as well. The factual events that took place‚ and I think we as peer supporters often times get really hung up here because we’re not considering the other dimensions of the trauma story‚ which were its impacts. What are the results of this trauma in my life? And what meaning does it hold for me?

For many of us the greatest impact was not what happened‚ but the meaning we make as a result of what has taken place. It’s how we interpret what our lives have been about that makes us who we are‚ not the trauma events themselves.

And knowing this we can begin to explore all of the dimensions of who we are. And Doctor Mollica suggests that there’s a vital‚ a mutual reciprocal relationship between storyteller and listener when the survivor is new to the teacher‚ especially if someone who knows something about coping with community violence or surviving Katrina‚ Rita or whatever.

This idea of survivor as teacher really lends itself well to the role of peer supporter. Not only is someone benefiting from the survivor’s knowledge about how to cope and live beyond the extremes of human suffering but also as co-learners.

You know‚ like exploring with the survivor the other dimensions of the trauma narrative. We really want to look at meaning and impact in the cultural context.

It’s in the meaning of impact that there’s been incredible opportunity to explore who we are and how we make sense out of our lives. As we use our relationships to transform that meaning and try out new ways of being in our world.

When we understand what it is that people go through‚ I think we as a society benefit as we‚ you know‚ Doctor Mollica really said this. And this really comes out of Healing Invisible Wounds but‚ you know‚ we as a society benefit as we learn the necessary ingredients‚ you know‚ for overcoming adversity.

The question how did you survive becomes teach me how to survive too. Dealing with includes the cultural context. How does the culture I live in relate to fail and succeeding‚ evaluate meaning relation to the trauma experience?

This is where often change‚ humiliation and other intense experiences of marginalization are revealed. But it’s also the place where healing has got to take place. And I think we need to do more about becoming culturally aware‚ culturally competent.

But the story also offers up revelations. This is the most important thing to me. And I think what’s really going to excite other peer supporters. What do I know that I did not know before? Think of the power in peer support if we were asking each other.

If we were not just‚ you know‚ focused on the what happened to you. But we’re also really asking each other what does it mean to be alive as you? Why are you alive? What did you do to hold on to life? What do you know now that you did not know before? What is important to you now? What sense do you have about why these things took place?

We all need to figure out how to ask those questions. I mean to get over fears. To simply get over our fears about asking each other those questions because the answers are essential to our community and to our families and to our world.

So I think there are many of us with stories to tell. And I really want to thank you for letting me tell you a little of what I have come to know because of where I have been. We really are all teachers. So thank you.

Mary Pat King: Beth thank you so much. Thank you so much for shedding light on the characteristic of peer support. The listener’s story‚ relationship and revelations that come from the experience. I love your artwork. It’s amazing.

Our final speaker today is Elizabeth Hudson. Elizabeth’s partners with the Wisconsin Department of Health Services to integrate trauma-informed care into mental health and substance abuse systems‚ child welfare settings‚ school settings‚ homelessness services and correctional settings.

Her department has been recognized for its work in promoting trauma-informed care and the reduction of seclusion and restraint. Elizabeth is a founding member of the National Organization Coalition Addressing Trauma.

Elizabeth will share with us how Wisconsin has implemented trauma informed care. She’ll share the results of engaging diverse stakeholders to promote trauma-informed care and its benefits‚ philosophy and practices. Elizabeth thanks for joining us. You may begin.

Elizabeth Hudson: Thanks for having me and what an honor to follow Richard and Beth. Thank you. Well I’m going to start by bragging about Wisconsin’s colorful and as you will probably agree‚ eye-catching trauma-informed care logo that you see on the screen in front of you.

In 2008 Wisconsin received a transformation grant through the National Association of State Mental Health Program Directors. So in addition to a lot of other activities that we were able to fund‚ we teamed with Wisconsin - Witness Justice’s creative team to create this image‚ as well as some other educational material.

And we really felt like this highlighting shift was really where we wanted to land. Just to name a few of the shifts that we’re focusing on‚ one is viewing people. It is shifting from viewing people as diseased to understanding that a mental injury has occurred. And that symptoms should be understood as ways to cope with this injury.

Viewing clinicians as the ones with the answers and then shifting to viewing people with trauma histories as the experts on their lives‚ much like Doctor Mollica mentioned as the person as teacher.

We’re wanting to see a shift from punitive punishment-based systems of accountability to more collaborative problem-solving and restorative approaches.

And then finally that just these are just naming a few. But I think this will be of attention to all of you beleaguered care providers and peer specialists out there.

We’re really hoping that we shift from viewing you all as impervious really to work stress. And that organizations recognize the need for support to promote an emotionally health workplace. And employees that have a capacity to have healing relationships with the people they work with.

All right so I’m continuing to brag a little bit. This is showing off the poster that was created in addition to a brochure and our logo. So essentially you can go all over Wisconsin‚ and you can find these hanging in institutions‚ organizations‚ consumer run organizations.

And a lot of folks are using this as a reminder tool of when they start the transformation within their system of care that this is one of the commitments that they’re making.

So here we have the lovely State of Wisconsin. And I’ve identified three real essential elements that need attention in describing what we’re doing in Wisconsin.

In this slide I’m just going to focus on the last element‚ culture change versus interventions. So I’m focusing on this because I’ve seen a lot of organizations and other systems do a high level of promotion for trauma specific treatments. And they call it trauma-informed care.

So they’re really promoting things like trauma focused cognitive behavioral therapy‚ psychodynamic therapy with a trauma focus‚ eye movement desensitization and reprocessing.

All of the - there’s many specific interventions we could name. And they’re all really important. And they’ve been quite effective for a lot of people. But this transformation we’re looking for‚ that is one small aspect.

Instead‚ we’re really looking at culture change. And personally the importance of culture change in an environmental focus was really clear when I worked as a therapist with really young traumatized kids.

What I realized‚ with this population you’re not able to work within the context of one on one therapy and expect any kind of significant change to occur.

The kids are developing across multiple environments. And each of these environments really offering the potential for healing relationships and therapeutic contacts.

So it meant as a therapist that I really needed to engage everyone in this trauma sensitive mindset‚ whether it was daycare‚ the school‚ foster parents‚ parents‚ relatives.

Well in doing this work now‚ I believe that this reality exists for adults too. But what I think I’ve seen is a mental health system that loses sight of this. And expects really extraordinary change from individuals without a focus on the larger social context.

And what we end up doing is asking people to develop their capacity to trust. But through services where policies and practices undermine the individuals trust in the system and in the services.

One example‚ and we have done some limited‚ but it’s moving quickly‚ work with the correctional system. But we talk too‚ you know‚ the people who are incarcerated as well as the folks who are running the correctional services about recognizing how our nervous systems become dis-regulated by frequent exposures to violence.

And how that can happen when we’re young. And it happens in our homes and in our communities. But then what happen when people enter a correctional system that recapitulates all of these dynamics through punishments and punitive reactions.

So it’s this exposure to our social context. And how we are or aren’t really promoting healing. So‚ you know‚ to truly facilitate the change for people who have established these habitual ways of adapting to adversity. The one-hour with a therapist every two weeks just isn’t going to cut it for most of the folks who have this long history of exposure to toxic stress and trauma.

One of the analogies that I often use is learning a new language. And I’d as you to imagine taking a French class once a week‚ sort of how that makes you feel to think about that.

And then imagining a trip to Paris. But not for too long because I want to have you stay here for the teleconference. But when you’re imagining your stay in Paris you’ll note that every interaction reinforces the use of the new language.

And we know that this type of immersion has a larger and longer-lasting effect. A language class‚ much like a therapy session‚ is really hard pressed to create this real fluency in the way we engage in the world.

So our TIC efforts are really focused on this culture change that will allow people an immersion process into what it is to be in a healing environment.

So in Wisconsin we’ve used every opportunity possible to educate people about what Doctor Mollica mentioned as the adverse childhood experience study.

And I highlight this particular slide with this piece of information because we really found that stakeholders resonate with the research that has originally been done‚ you know‚ in the mid-1990s. But continues to be done across the country.

So it highlights the prevalence and impact of trauma. And it’s really served to catch people’s attention. And then once we talk about the prevalence and impact‚ the schools‚ corrections‚ child welfare‚ mental health‚ they all start to see this link between a person’s history and his or her current engagement with a variety of social services.

So once we have this interconnectedness‚ there becomes this passion and a sense of common purpose. Issues that seem inexplicable can take on new meaning and bring a sense of resolu- attention. And promise for a more hopeful future.

We offer Wisconsin trauma informed care values. And I’ll introduce those in a later slide. But the values are applicable across the system. So they weren’t created necessarily to only hold water in one system.

They’re often merely tweaked based on a particular population that needs to engage with services. So we have this common set of values that’s very important in unifying and a movement that people are creating together.

And I mentioned cost effectiveness. There’s certainly cost in training and having staff attend to a continuous process of culture change. But I think measured against the cost benefits of‚ you know‚ losing staff‚ reducing injury‚ reducing sick days and more effective services‚ it pays itself off in the end.

So what’s worked? I - there’s no way that I could really pull out one of these checked indicators and say this was the one because I think it’s been a synergy of all of these combined that has led to some of the momentum we see right now.

I’m going to go through just a few of them to highlight to give a little bit more information for those of you who might have questions. My position is the designated staff person. And it is funded by our mental health block grant.

And I think having a point person who is accountable for pushing this for - this transformation forward has been really essential. We continue to develop our core group of trauma-informed care consumer champions.

So they are a group that have been with us from‚ you know‚ the see 2008 grant funding that we received. And they are amazing. They’re providing trainings and consultations all over the state to a wide variety of groups. And they’ve really been tireless in promoting statewide awareness.

They’re hoping to really make this about a grass roots movement that pushes our providers into a better way of practicing versus providers imposing something onto the people who come for services.

It’s the people who come for services are going to be asking‚ you know‚ are you trauma informed because it’s important to us.

The listserv has something I’ll also highlight. We‚ in Wisconsin we have 950 members now. And it’s been a good example of how you can even the playing field. I’ve often been asked how our listserv operates.

And there’s an assumption that it’s provider only. That people have to have a certain degree or a certain certificate to become members. And it’s absolutely the opposite. It’s anyone‚ it’s typically anyone who’s viewed any of the presentations across the state and wants to stay engaged in the conversation. Wants to continue to help and move this initiative forward.

So there’s a training‚ advertised research‚ help in locating therapists. And it’s a forum for people to brainstorm barriers to their implementation of trauma-informed care.

Lastly I’m going to note by the Wisconsin Department of Health Services‚ and in particular my division‚ the Division of Mental Health Substance Abuse Services is being incredibly supportive in the effort to enlarge the focus from mental health and substance abuse to the many interconnected areas. As I’ve mentioned before‚ corrections‚ schools‚ child welfare‚ public health‚ disability‚ homelessness services.

It’s really been a recognition that the collective power in including the other state departments will have this grow exponentially. And it’s not as easy as it sounds because there’s a reflective process that typically takes place when we’re dealing with limited resources.

We want to keep focused on our piece of the pie. But one of the good things about trauma is it just doesn’t work that way. We are forced to recognize our interconnections. And recognize the power of those interconnections.

So now I’m going to move you to the values that I had made mention of before. So these were created by a hardworking sub-committee from our statewide trauma informed care advisory committee.

What we’ve done is created these values. And hope of not having a prescriptive approach to integrating trauma informed care across environments.

But asking organizations and communities and individuals to think about these values and then to evaluate their policies and practices through this lens.

So if the goal is to empower people to be creative in identifying what they need to change based on this is their grounded value system. We will offer organizational assessments and ideas based on other group’s work.

But really at the heart of this is an engagement and a continuous reflection from all the stakeholders that get together. And that’s what’s going to lead to the culture change.

The notion of prescribing‚ regulating‚ certifying‚ you know‚ it can lead people to feel put upon and dis-empowered and dis-engaged which the antithesis of what we’re trying to do with changing a culture to one that is the opposite of those descriptors.

So we’re really wanted a meaningful process‚ internally motivated versus externally required. Hopefully what we’re going to move to is at least having a list of outcomes and monitoring tools that will allow people to measure their success and their innovations. And‚ you know‚ an opportunity to reflect on accomplishments.

So for those of you who do trauma presentations out there‚ this image is likely to be quite familiar. We often use this to talk about the tip of the iceberg being symptoms and behavioral problems that either adults or children present within our many human service systems.

And then within the trauma presentations we talk about that underneath‚ underneath what is so obvious when you’re above the water line is this immense‚ expansive history that contributes to this positioning off of this very small piece of a much larger existence.

So in this context‚ I’m using it to show that we are just the tip of our iceberg in Wisconsin. We’re really just beginning. But we have a lot of exciting momentum and connections in place.

Our plans at this point will be we’ve got set meetings with top leadership in the state. And then we’re going to have coming up just in a few weeks a full day of our advisory committee meeting to put together a strategic plan through the use of a logic model to guide our next steps for the next few years.

And then I think you have a list of resources that have been incredibly helpful as we move forward. The Anna Institute I’ll highlight as being a super resource for a lot assessments. And focused on the trauma-informed culture change aspect of trauma-informed care. Thank you.

Mary Pat King: Thank you so much Elizabeth. What you’re doing in Wisconsin really is a great model for the rest of the country. I appreciate you sharing that with us.

Before we open up the lines‚ we really wanted to ask our speakers a question. Richard‚ Beth and Elizabeth‚ what is your vision? We’ll start with Doctor Mollica.

Richard Mollica: Well I tried to summarize my - the nature of my talk. And I think I’ll read it. I’ll say every human being suffers tragedy in their lives. This is inevitable. We can’t avoid this.

The paradox is that while collectively we have an active will to deny‚ when I say active‚ people actively deny the life experiences of others. Trauma survivors our greatest teachers.

In other words‚ it’s been - it’s my deepest feeling that we - traumatic life experiences that people have experienced teach us‚ the individual and the society about survival and healing.

Listening‚ understanding and deeply appreciating‚ which one of my professors in Italy calls LUDA. The trauma story is the foundation of all recovery. Building upon the inner self-healing forces activated within all traumatized persons is an essential part of the healing process.

I begin with this. For every person who has lived through a traumatic and tragic life experience‚ they are in the process of self-healing whether they realize it or not. And it’s our obligation‚ our responsibility to build upon that. Thank you.

Mary Pat King: Thank you‚ how about you Beth?

Beth Filson: Trauma is acknowledged as just simply part of the human condition. And each one of us gets to name what our experience means to us. This naming of our stories I would say is the real beginning of the healing journey.

And so my hope and my vision is that the peer community is a place of intentional healing where we are all storytellers and we are all listeners. And we use our shared knowledge to strengthen our relationships with ourselves‚ with others‚ with the world.

And we recognize that stories is a glue that is holding us together. And it’s a place from which personal and community transformation really takes place. So thanks.

Mary Pat King: Thank you‚ Elizabeth?

Elizabeth Hudson: Yes‚ well Wisconsin‚ there’s the name again. Well this is the focus right now for us as we engage with the top leadership and talk about what this is all about.

We’re really‚ you know‚ putting our eyes to the prize of what would it be like to live in communities that understood the impact of toxic stress. And understood how people’s coping skills are the best that they can do right now. And reducing the judgment‚ the shame‚ the humiliation.

So that this kind of mantra that we have‚ healing happens in healthy relationships‚ is just something that’s contagious. So that’s my vision.

Mary Pat King: Great thank you all so much. Our speakers provided some great resources at the end of their slides. And on Slides 41 and 42‚ there are a few additional resources for you to learn more perspectives on trauma and wellness.

We will now take questions from callers. To ask a question‚ please dial star 1 on your telephone to be placed in the queue. Be sure to tell the operator your name.

If you do not wish to your full name to be announced‚ then please only state your first name. Because time is limited‚ please limit yourself to only one question.

After the conference operator announces your name‚ ask your question. And once you’ve asked it‚ your line will be muted so the presenters may respond. Operator the first question please.

Coordinator: Our first question comes from Elizabeth. Your line is open.

Elizabeth: Yes thank you so much for bringing trauma survivors to the forefront. My credentials are that I’m a survivor of 15 years of torture level abuse. I’ve done lots of healing and I’m in graduate school now.

And my question is this. Given that my torture did not happen in Abu Ghraib‚ but in a family dynamic‚ as did most of the ACE participants‚ what is your vision of prevention? You know‚ what do you consider the importance or possibility of providing parenting classes after all‚ we’re the only animal in the animal kingdom that doesn’t instinctively raise its young well?

Mary Pat King: Richard could you answer this? Richard can you un-mute?

Richard Mollica: Yes thank you. Thank you for that important question. I work with mostly political and extreme violence. And I’ve come to the opinion that domestic violence is the number one scourge of the planet‚ not torture‚ not war‚ but domestic violence.

And it took me a long time to try to understand why people would hurt their own family members. Why people would hurt their own family members. And I tried to talk to the President of Peru about this who was a colleague of ours. He’s a Harvard graduate‚ the former President.

And he‚ this is a very political thing. I mean we must have a campaign at the social level against domestic violence‚ a serious campaign that domestic violence is not acceptable. And it cannot be tolerated.

And I think that this also goes along with what I call empathic teaching. We really have to get at the school level‚ elementary school and high school‚ the whole issue of empathic learning‚ empathic relationships.

And because people really are not understanding this that the main problem of the domestic violence is a breakdown in empathy related to power‚ poverty. It doesn’t matter. But it’s a tremendous horrible breakdown in empathy.

Mary Pat King: Thanks Richard. Elizabeth or Beth do you have anything to add?

Elizabeth Hudson: Well this is Elizabeth. And it’s such an important question. And I think that with the introduction of at least‚ you know‚ within the realm that I’m working in‚ the adverse childhood experience study.

I have this dream that‚ you know‚ for so many years people thought that regulating tobacco and eliminating smoking was an impossibility. That there was just no way that that could be done.

But through hard work and a lot of consciousness raising and research and financial constraints‚ we’ve seen this amazing reduction in smoking. And so I know it’s a bad - it’s really not a great analogy.

But it’s the analogy of something that seemed impossible that we found a way to drastically reduce‚ and someday eliminate. So I like to think about those kinds of public health approaches‚ those large population-based approaches that will make child abuse just intolerable.

Mary Pat King: Thank you so much. You know‚ we received a question from Margaret online. And it’s an expansion a bit on that question. If several family members have gone through the same trauma‚ can they be peer supports to one another? Or do they need to be with others outside of their family who have had similar trauma? Speakers?

Beth Filson: This is Beth. Let me take a stab at this. It’s sort of a joke among some of my friends who are peer supporters that we can’t do peer support in our families. It just gets screwy.

I think what you’re talking though - what you’re talking about though is having a dialogue. And yes‚ we can have a dialogue with our family members. I can’t tell you how critical in my own family the dialogue between sisters and brothers‚ my parents was in our family’s healing.

And it takes tremendous amount of courage to begin that conversation. I will tell you now. But if you can begin to try to reach out to your family members and begin to speak the truth.

Mary Pat King: Thank you so much‚ operator next call.

Coordinator: Our next question comes from Beero. Your line is open.

Beero: Yes thank you for a great and wonderful presentation. My question is kind of different. I am an African American male practitioner also living with schizoaffective disorder.

So my question is how is racism and sigma enhance the traumatic shared experience of being both African American and someone living with a severe and mental illness?

Mary Pat King: Thank you so much for your question. Richard can you answer?

Richard Mollica: Well yes. I mean I think we have a 50-year scientific history of the negative impact of poverty and race. And they’re not the same‚ poverty and race in terms of the prevalence of mental health problems and also in terms of the services that we call health disparities today.

But in the old days we called this a social class and mental illness. I mean the disparities in what people receive. And so‚ you know‚ I think that it’s at every level. And that‚ you know‚ we see it in our professions. We see it in a delivery of services. And we see it in the community.

And it obviously needs to be addressed at all of those levels‚ at the public health level and at the clinical level and at the personal level.

I don’t know if this is an answer to your question. But clearly this is a well-recognized phenomenon. And most I think mental health practitioners are aware of this‚ you know‚ and doctors as well‚ medical doctors as well.

Elizabeth Hudson: And this is Elizabeth. I’d just like to respond because as part of our general kind of spreading concepts throughout our communities‚ we talk about something called historical trauma which in many ways is another kind of less inflammatory way to say racism.

But it has helped to start the conversation around‚ you know‚ what does it mean to have an unresolved social situation looming in our history? Whether it’s looking at‚ you know‚ people from tribal communities here in the United States or African Americans and the unresolved issue of slavery.

So it’s definitely on our radar as one of the important elements of when we talk about trauma‚ it’s - there are so many aspects. And historical trauma is very relevant‚ particularly when we’re talking‚ yes‚ to any audience.

Richard Mollica: And can I say one quick thing? In primary healthcare we’re well aware of the fact that in the primary healthcare setting we do not ask people their traumatic life experiences‚ particularly people who might have experienced this kind of historical violence or current racism.

And I think that this is something that we’re trying to‚ in our state‚ in our clinic to correct in the primary healthcare setting. This is really neglected area.

Mary Pat King: Thank you all so much. Okay operator next call please.

Coordinator: Our next question comes from Mark. Your line is open.

Mark: Thank you very much for the presentation. There’s wide interest of course in the adverse child experience questionnaire as a springboard. Perhaps in primary healthcare for storytelling about what does and doesn’t still bother a person.

And how they’ve been able to move from being bothered to not bothered. And almost to say more about their experience that they know of or have used with the questionnaire.

Mary Pat King: Beth have you used that?

Beth Filson: Let me just make sure - I’m not sure I heard you right. But my response to you - to what I heard was that what is essential is the transformation of the narrative that occurs through the storytelling process as we begin to ask people about the dimensions of their experience‚ as well as the meaning that they’ve made out event. Does that answer what you were asking?

Mary Pat King: I think that ACE questionnaire is the tool that helps to screen for traumatic experience. I wonder‚ Elizabeth do you use that as part of across Wisconsin?

Elizabeth Hudson: Well one of the interesting things‚ yes‚ there’s lots of way we’re using it. But one of the interesting ways that states can become engaged in is through their surveillance system‚ through the Center for Disease Control.

All states are required to survey citizens. And it’s a small pool based on your population base. And you ask a series of questions to establish the relative health across the country of your state.

And you can purchase as a state additional modules to ask your citizens. So we put together through a group‚ funds to purchase that ACE module. So that now when our citizens are surveyed on their health and their history and they are now asked the ACE questionnaire.

So we are hoping to collect data over the next several years that will give us a sense of what Wisconsin looks like in relation to the ACE screening. So this just points out that it can be used individually to help guide the development of a therapeutic relationship.

And it can also be used in a more epidemiological way to look at the state of health of a state or the country.

Richard Mollica: I wanted to say quickly‚ we use the Harvard trauma questionnaire which we developed in the 1980s. It’s in over 30 languages now. And it has the traumatic life events that has to be culturally adapted.

This would be our part to it. That traumatic life experiences have to be culturally adapted. That you cannot apply in one culture to another culture traumatic life experiences.

You have to go into the culture and find out‚ you know‚ what does domestic violence look like in this culture versus that culture? You know‚ what does sexual abuse look like in this culture.

And I’m not talking about culture relativism here. I’m talking about very close ethnographic understanding at the cultural level of the meaning of trauma. And so we - you might want to look at the Harvard trauma questionnaire as well because it’s really widely used in primarily healthcare and other medical settings throughout the world working with traumatized communities.

Mary Pat King: Thank you all so much. Great answers. Operator next question please.

Coordinator: Our next question comes from Glen Lucas. Your line is open.

Glen Lucas: Yes thank you very much. I’m getting a lot of information from this presentation. One of the issues I have in in-patient work is that the staff‚ I think over the years‚ have been almost instructed to avoid‚ tiptoe around or not even acknowledge trauma issues. Because in-patient is not considered the appropriate setting that a long-term outpatient‚ or in this present age‚ peer support work is probably more effective.

There’s some truth to that. But we have invited therapists in when we have patients in and kept up phone contact. But what else could be done to sensitize the staff more and empower them more to deal more directly with trauma issues?

Richard Mollica: Well let me take this on. I mean the trauma story at a pharmacological level‚ or the symptom level‚ is embedded in all psychiatric and physical symptoms‚ as well as in disability‚ as well as in limitations‚ as well as re...

So I can’t understand as a medical doctor and psychiatrist how in an in-patient unit you can understand the diagnosis of the patient without understanding the impact of the traumatic life experiences on the physical side‚ the mental side. You know‚ what they call the biopsychic‚ social‚ spiritual approach.

So I think that also if you say you have a depressed diabetic. And you don’t know that they’re living in a family of domestic violence or extreme poverty‚ whatever.

I don’t know how you can imagine that they’re going to return home to that setting and have a proper follow through. So on every level it seems to me that you have to know the context of traumatic life events to not only make the diagnosis but also carry through with the treatment and treatment recommendations on the in-patient setting.

Now I have to tell you‚ we’re still practicing‚ still seeing 25‚ 30 patients a week. That this is the biggest failure on the in-patient service is the lack of connection between the patient and the community.

That patients are sent home not properly prepared to re-enter their family life and their community life. And often go home to the same traumatic life experience that they came out of too much to the detriment of the patient‚ you know.

So that would be my response. Look at what’s needed and look at the outcomes.

Elizabeth Hudson: And the other thing‚ this is Elizabeth that I would mention in promoting this culture change across a lot of different environments. It seems like a two-pronged approach can be really helpful.

One is talking with staff about their - it’s a gentle way to introduce the conversation about how they have experienced toxic stress and trauma in the workplace because it starts that empathic connection.

And once you say we care about how you’re functioning. And we know that you will be better in establishing relationships if you’re taken care of. And if your toxic stress and traumas are addressed.

That leads them to be more receptive to then altering the culture of the environment. But at the same time leadership has to make a commitment and say we’re doing this. We’re moving in this direction.

And we’re going to be a culture that does as much of what Beth has talked about and Richard that knows that there are trauma histories behind every person we see. We may not learn about each of those.

But we’re just implicitly going to assume that they’re there. And we’re going to create a culture here that allows people an immersion into health and healing. So that two-pronged approach has been most effective in my experience.

Mary Pat King: Great Beth do you have anything to add? Beth un-mute. Okay so we had a great follow-up question from Michael online.

How do clinicians feel about peer support? And how likely are they to refer people? Richard or Beth.

Richard Mollica: I think this is Beth’s area. I mean I would just say that how to clinicians feel about peer support? I think that clinicians are deeply ambivalent - I hate to say this but deeply ambivalent about their own peer support‚ what we call Balint groups‚ you know‚ meeting in Balint groups or meeting with our own peers to discuss our problem cases.

And so if we have a hard time talking to our own colleagues in ways that have been proven‚ you know‚ very beneficial‚ and we avoid it. I think that we also would probably avoid thinking that the peers in the community are going to be helpful because we avoid our own peers.

So I‚ Beth I’ll let you take this up.

Beth Filson: Can you all hear me?

Mary Pat King: Beth‚ we can Beth. I’m glad to have you back.

Beth Filson: I’m so sorry. I’m afraid that I did not hear the question. I was being reconnected to by the operator.

Mary Pat King: No problem‚ I can answer the question. We heard from Michael‚ how do clinicians feel about peer support? And how likely are they to refer people?

Beth Filson: Well I don’t think - I think it’s very different from state to state. And there is an excellent report that can give you more information called the http://www.thepillarsofpeersupport.org.

But we have really got to begin to understand that when we’re utilizing these community-type relationships which define peer support‚ that we are beginning community integration.

That we have really got to understand the profound value in this two-way relationship that is based on both people as people who have profound insight.

Mary Pat King: Thanks Beth. One question that came in for Beth‚ Beth when is your book going to be available?

Beth Filson: We’re not sure. But it’s going through the SAMHSA review now. I hope within this year. But if that person wants to email me‚ I can find out if we’ve got any better information about it.

Mary Pat King: Okay great. And certainly you can contact Beth directly. Her contact information is at the end of this presentation. And Beth can give you more information if you’re interested in that book. Thank you‚ operator next call.

Coordinator: Our next question comes from Diane. Your line is open.

Diane: Thank you for taking my question. I have a question for Beth. It seems to me that the idea of telling my story to employers or co-workers or‚ you know‚ in the interest of generating this community of support‚ is just kind of politically suicidal.

I’ve had‚ an only minute amount disastrous effects - disastrous experiences with revealing the fact that I am a trauma survivor. Not to mention what any of the details are. I think that it’s just‚ I can’t see an application of that for me at all.

And I am now disabled because I can’t work in an environment where anybody knows anything about me at all. And I find your suggestion that telling my story is going to somehow enrich my social interaction with people just kind of ludicrous.

And I’m wondering what experience it is that you have where this worked for you. How did you find a workplace where anybody was interested in what had happened to you‚ let alone the details of your experience‚ you know‚ much less viewing your artwork about it?

Beth Filson: I’m so sorry that that’s been your experience. And I’m tragically—that’s the experience of many peers supporters working within the mental health system currently. Now was your job title peer support? I’m sorry; you’re not able to answer.

But listen‚ in order for us to be in relationship‚ we have got to feel safe. And we have got to feel like that relationship is meaningful. And we have got to feel profound trust.

If those things are not there‚ absolutely no‚ you cannot tell your story. You’re opening yourself up to incredible hurt and incredible pain. I chose to become a private consultant to have a better—to be able to direct my life and my work because I did see the limits of what I could do within the organization.

So the other important thing here is that there are many ways we can participate as trauma survivors. And you may do that through art. Or you may do that through meditation. Or you may do that through the relationship you have with somebody that comes into your home to just say hello to you.

I really want you to hear again that the relationships have got to be meaningful first before we can really do this work.

Mary Pat King: Thanks so much Beth. We have a question from Chris Hanson over email. This is for Elizabeth. Can you explain what the role of your consumer champion is?

Elizabeth Hudson: Sure. We—what we did when we began to really push this forward in 2008 is we—I put a call out to people who had had some kind of leadership role within mental health consumer activities across the state.

And we got about 16 applications. And ended up at the time with about nine people who went through a pretty extensive training over the course of probably a week to identify trauma. And be able to articulate comfortably to others how trauma has impact - without telling their story‚ just how trauma impacted them.

And what it meant to be involved in a mental health system that was recovery-based versus was traditional‚ a traditional medical model. So they were able to bring lived experience to both consumer groups across the state‚ as well as to providers about here’s the difference that trauma-informed care can make.

Here’s the difference it would have made for me. Here are things that happened within the system that I’m still struggling with that are yet to be resolved because of the way I was treated within the system.

So they have just‚ you know‚ been amazing. Many have served on different committees. And we have folks on our advisory committee. And I’ve looked at them as‚ you know‚ not only my good friends now‚ but also the focus - instead of focusing on a cadre of professionals who could go out and talk about trauma-specific interventions.

Our focus was on no‚ let’s focus on a cadre of consumers who can talk about their lived experience because we think that that’s going to make a tremendous impact where there isn’t a lot of attention being devoted.

Mary Pat King: Thanks so much Elizabeth‚ operator next call.

Coordinator: Our next question comes from Susie. Your line is open.

Mary Pat King: Hi Susie. Operator.

Coordinator: Susie please check your mute button. Your line is open. Our next question comes from Kim. Your line is open.

Mary Pat King: Hi Kim.

Kim: Hi. Can you hear me?

Mary Pat King: Yes we can.

Kim: Okay. I have a question probably for Beth and maybe also some of the other panelists. Could you give some examples of how the traditional mental health systems and services for people who have serious mental illnesses may pose barriers to recovery from trauma?

And what some of the—some examples of some of the changes in the system that could address or remove some of those barriers?

Beth Filson: Okay I’ll probably get in trouble. But let me just say this‚ I think a medical model focused on experience is often times creating some barriers to addressing the impact of trauma.

Now here in Massachusetts‚ we have invited trauma survivors‚ specifically people who use self-inflicted violence‚ to tell us what they need at some services. Sort of using folks - seeing folks as teachers. Does that answer?

Mary Pat King: Yes I think that’s really good‚ Elizabeth or Richard?

Elizabeth Hudson: Well I’d love to talk about…

Richard Mollica: I’d like to say something about this is that the - on the medical side‚ you know‚ we—in the refugee community we never had mental health services for obvious reasons that they were not available and also they were discriminated against.

And so we had to take care of the very‚ very sickest‚ most disturbed people‚ you know‚ in the home‚ in the family community. And it worked out very well.

So this new idea in primary health care of the medical home makes a lot of sense in the sense that a human being who has any mental health problem should be in a normal medical setting‚ treated like a normal person‚ without stigma‚ without prejudice.

And with a continuity of care that can last a lifetime. I’ve been seeing the same patients‚ you know‚ at different levels for 30 years in a primary healthcare setting. This is normal.

And I think when a young kid comes in who is psychotic or who has been‚ you know‚ psychotic and has domestic abuse or whatever‚ that young person can be in a normal‚ non-stigmatizing healthcare setting for a long period of time.

You have to guarantee to the person as a medical doctor that they’re going to be able to live quote‚ “a normal life with a chronic problem” if that’s what it is. And this doesn’t happen.

The system breaks up the people‚ sends them around. They have a million different therapists. They go in and out of the mental hospital. They get all kinds of drugs they don’t need.

It goes on and on because there’s no long-term consistent commitment to the individual over time to live a normal life. And I feel very strongly about this as you can tell.

Kim: Thank you Richard. I really appreciate your work on that.

Mary Pat King: All right‚ we have a question that just came in from Rosa. It’s a question that the speakers have talked about before together.

After years of working with trauma victims‚ I’ve seen many service providers become traumatized from their work. Does Wisconsin have a method of helping this group of people so that these professionals gain resiliency and ensure that their symptoms do not cause more trauma?

I worked for over ten years in the child protection field with parents and children‚ thanks Rosa.

Elizabeth Hudson: Sure‚ this is Elizabeth. It’s funny‚ last week we just had Laurie Anne Pearlman in who is‚ you know‚ just an amazing thinker and writer on the area of secondary trauma and vicarious trauma. And has helped to author things like Risking Connection and a lot of good work that helps people in this field do day to day trauma exposure jobs.

So we try and look for opportunities for that. And one of the things that’s unique I think is we open it up beyond mental health professionals. So we had people from juvenile justice‚ child welfare‚ the mental health services‚ in-patient institutions.

A correctional group came and people who work in the correctional facility. So it’s definitely on our radar. And I think when we go in and we talk to organizations about the transformation‚ increasing caregiver capacity‚ making sure that the organization is doing what it needs to do to provide the care and support to the employees is one of the elements.

So if they’re going to be trauma-informed that has to be part of their action plan.

Mary Pat King: Thanks Elizabeth‚ Richard or Beth.

Richard Mollica: Yes self-care protocols‚ in every setting I go I ask people‚ sometimes in the most extreme settings and the most traumatic places I ask‚ you know‚ do you have a self-care protocol? And most people say no.

That in their system‚ they do not have a self-care protocol‚ and I think this is basic. I think you need to ask your managers‚ your employers‚ people running the organization‚ what is the self-care protocol?

And if there isn’t one‚ in a very benign way advocate for one because it really should be mandated and required because of burnout or whatever you want to call it‚ stress of working with traumatized people is an occupational hazard that’s well known.

And every organization‚ including my own here in Boston has had - has really fallen behind on having a self-care protocol.

Mary Pat King: Thank you. All right‚ we have come to the end of the question and answer portion of our call today. Thank you for such thoughtful questions and answers.

If we were unable to take your question‚ you can reach out to the speakers directly or contact the ADS Center at promoteacceptance@samhsa.hhs.gov.

Contact information for each speaker is available on Slide 44. And you can read more about each speaker on Slides 45‚ 46 and 47.

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To learn more about SAMHSA’s wellness efforts‚ go to http://www.samhsa.gov/wellness.

We’ve come to the end of our time today. If you have more questions or would like to follow up‚ please contact the SAMHSA ADS Center by phone‚ fax or email.

The Website is http://www.promoteacceptance.samhsa.gov. For future reference‚ ADS Center contact information is available on Slide 51.

On behalf of all of us at SAMHSA’s ADS Center‚ I want to extend our sincere appreciation to Richard‚ Beth and Elizabeth who donated their time to help us learn more about trauma‚ wellness and healing.

Also thanks to you‚ all of our listeners‚ for taking time out of your afternoon to join us. And thanks in advance for completing our survey. Good bye.

Coordinator: Thank you. And thank you for joining today’s conference. You may disconnect at this time.