Dr. Wayne Carson, CEOACH Child and Family Services

Lena Zettler, MA, LPA, DirectorCook Children’s Medical Center, Psychology

Fort Worth, Texas

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 tolocal mental health providers, requestinga plan for improving access to qualitymental health services for all residents ofTarrant County.

Memorial at Wedgewood Church

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.

2007- 2011: Bridging the Gap Mental Health Connection

5 Year InitiativeAnnual SymposiaEvidence Based PracticeCreate Learning

Communities in 6 areas Met for 6 months Reviewed research Identified policy issues and

barriersPilot/Implementation in 5

areas based on EBP’s

2008: Trauma Implementation Team Trauma/PTSD Pilot programObstacles:

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

2008 CCHAPS Survey5.5 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.

2008:TF-CBT in Tarrant CountyTF-CBT model proposed (Cohen, Mannarino, and Deblinger,

2006) EBP sponsored by NCTSNCultural AdaptationsProfessional Facilitation/supervisionCollaboration 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 componentEducation/training

2009: Trauma ImplementationTrauma 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)

2009 Bridging The Gap SymposiumAround 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

Trauma/EBP Lessons Learned

Therapist/Agency attitude towards EBP’s was positiveNeed for ongoing supervision/fidelityHighlight the overall problem of access to services in

Tarrant CountyNeed policy changes to support ongoing workRealize Implementation is a SCIENCE; real change

involves more than technical solutions to obstacles

2010: Pediatric Trauma in the Medical SettingGrand Rounds at Cook Children’s Medical Center by

Nancy Kassam-Adams, PhDHealthcare 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

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 MembershipLarge 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?”

MHC: Trauma Informed CommitteeDefinition:

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.

MHC: Trauma Informed CommitteeBroaden stakeholder base to reflect vision of “community”

TeachersFirst respondersJuvenile JusticeIntake staff who may not be clinically trainedUniversities

Explore NCTSN resourcesLocal networking and resource sharingDevelop webpage for information sharingDiscussions were relevant, respectful, and synergistic

Following intensive Implementation Leadership training by Ellen Kagan, MSW Georgetown Leadership Program

2012: MHC Trauma-Informed CommitteeComplex Trauma

Treatment Network (CTTN) Midwest Region Learning Community

Brad Stolbach, PhDTechnical assistanceFunded by the US

Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA)

National Child Traumatic Stress Network

CTTN Trainings and AssistanceComplex Trauma Training by

Brad Stolbach, PhD:Arlington, Euless, &

Watauga Police Departments

CPS supervisorsMHC membership and

community (around 90 individuals)

Cook Children’s Medical Center CARE Team

MHC Site visitCook Children’s Medical

CenterMHC Board of DirectorsJuvenile ServicesUT- Arlington faculty and

studentsTCU faculty

CTTN Southern and Gulf Coast Regional Conference in Houston15 attendees from MHC,

including parent/family partners

2012 Other Trauma Work:TarrantCares.org to include Trauma-informed servicesResource library for professional trainings offered by

agenciesAgency/organizational assessment project with UTA

graduate students in Mental Health and Social PolicyExplore universal screening and assessmentContinue First responder training:

Arlington PDMHMR Law Liaison programMental Health Assn. (MHA) trainings for police officers

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

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 resilienceHow do we retain clinical workforce?Support for non-clinical staff

2013 MHC Forum on Trauma

Where are we now?Pilot with Crossover Children

(Juvenile Justice and Child Welfare)Birth to age 6Judge Boyd advocate; Tonya Green of

CASA; Aaryn Lamb, AttorneyTRBI 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

Mental Health Connection of Tarrant County www.mentalhealthconnection.org

Dr. Wayne Carson wcarson@achservices.org

Lena Zettler Lena.zettler@cookchildrens.org