The East Bay Agency for Children is addressing the challenge of support systems following patients
By Evan Bleier
Think of trauma as a wound. Like a wound, with proper treatment and time, it can heal. Also, like a wound, without appropriate treatment and care, trauma can spread to epidemic proportions, especially when victims’ support systems fall apart.
In northern California, the East Bay Agency for Children (EBAC), has found a way to prevent the systematic traumatization of individuals and families who’ve received care from a public institution but sometimes lose that care because they may move to another part of the city, or into another county. The key to their success was getting five partner agencies and seven counties (Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, and Santa Cruz) to promote a trauma-informed system of collaboration. The nonprofit organization, Trauma Transformed (or T2), began in 2015 to take on the challenge of making sure youth and families battling any form of trauma continue to get the care they receive or are assigned, no matter where they live.
One of the organization’s most significant achievements is bringing people together to raise awareness and create tangible connections and providing activities that can support policies and practices that reduce trauma and inequities in the system. Jen Leland, a center director for Trauma Transformed, says, “Our system is broke. We can keep adding money, but we have this metaphor we use, we call it ‘The Broken Syringe.'” She says. “We can keep putting medicine into this broken syringe, but that patient, or person, who needs the medication, is not getting that medicine through a broken needle.”
Leland’s mission is to fix the system and find a solution to the impact trauma has on communities in areas like Alameda County. To her, it’s no coincidence the areas most impacted are minority and poor. But poverty and race should not determine an individual’s access to proper healthcare. A child, or family, living in dire circumstances requires more help, not less. Research has shown that children living in a major metropolitan city like Oakland are more likely to suffer from conditions like Post Traumatic Stress Disorder than a soldier returning from duty in Iraq or Afghanistan. The staff at Trauma Transformed believes the impact of living in low-income areas can be devastating. It’s the crux of Leland’s argument. A child or family living in Oakland receives care for their issues through the local public health system. They could be dealing with substance abuse, child abuse, foster care, or the criminal justice system. If that youth or family is displaced or moves to another city like Richmond, which is just 10 miles away from Oakland, often they lose access to their care.
“Just because they moved across county lines, or to a different city, they could lose access to dental care, they lose access to the substance abuse counselor, they lose access to psychiatric care,” Leland says. “They can lose access to the therapist who was treating them for trauma.” Trauma Transformed is working to fix “the syringe” she mentioned earlier so people can get what they need when they need it, where they need it. Whether it’s medical care or mental health support, T2 officials are cautious in how they approach the epidemic. Their biggest obstacle is not having the capacity to keep up with the number of people who need help.
Being able to hire enough counselors, therapists, and doctors is a tough task to solve. But she says local leaders were smart enough to recognize the natural bureaucracy inherent in government actions would only hold up the work EBAC assigned Trauma Transformed. She credits the San Francisco Department of Health for conceding the need to outsource this program to an agency like EBAC. Trauma Transformed is supported by a four-year, $4 million grant the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded the San Francisco Department of Public Health. SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities. When San Francisco’s Department of Public Health received the grant, it contracted the services required to fulfill the funding to EBAC, which used the funds to support Trauma Transformed. That money pays for the staffing, programs and, care the organization provides to more than 18,000 individuals.
“We have moved the needle,” says Leland, who is also a senior director for EBAC. “Historically, county and city’s public health systems are very silo sectors. We have changed that toward greater coordination and care through collaboration.”
Leland points to the work of Matthew Reddam as further evidence of the organization’s work. Reddam is a licensed MFT (Marriage and Family Therapy), who specializes in complex trauma in children and adolescents. He has been working with sufferers of trauma for more than 15 years and has seen the toll it can take on victims. He knows trauma work, no matter how well done, can easily be undone by a public system that is still rough around the edges. “There’s a lot of disparity among the different agencies,” he says. “If I’m doing great work as a therapist with a kid and he’s in a system that’s going to traumatize him because the next adult he has contact with is a probation officer who thinks he’s a monster, it’s all undone in the blink of an eye.”
“If we look at a system as an individual, we know that when an individual experiences trauma, they either get hyper-aroused (really amped up) or they disassociate (check out),” Reddam says. “Systems do the same thing. When they get too stressed, they either get too rigid and inflexible, or they just get jaded.” To do that, trainers at T2 use six principles (understanding trauma and stress; cultural humility and responsiveness; safety and stability; compassion and dependability; recovery and resilience; and collaboration and empowerment) upon the other 9,000 or so workers in the San Francisco public health department to make them as trauma-informed as possible. “It’s like a janitor-to-judge training,” Reddam explains. “I will train a cohort of 12 people all from different agencies—nonprofits, county systems, probation—and then they go and train their people. It’s not a deep dive into the biology of trauma or cultural humility, etc. It just touches on everything and explains what we’re doing.”
A lot is being done geared towards the idea individual interventions don’t matter unless the system changes. That’s the only way this idea of trauma-informed care doesn’t die on the vine.