Addressing Trauma through A Public Health Approach to Behavioral Health

National Network of Hospital‐Based Violence Intervention Programs (NNHVIP)September 2013

Arthur C. Evans, Ph.D.Commissioner, DBHIDSFaculty, University of Pennsylvania www.DBHIDS.org

Challenges Facing Philadelphians

The CurrentService System

4 THINGS WE KNOW about trauma that inform the Public Health approach we’re taking in Philadelphia

Overview

1: TYPES AND EXPOSURE TO TRAUMATIC EXPERIENCES ARE BOTH DIVERSE & WIDESPREAD 

A. Can occur across lifespan

B. Can be a critical incident, chronic,     and /or cumulative experience

Woll, P. et al., 2013

2: WIDE RANGE OF EFFECTS AND SEVERITY

Woll, P. et al., 2013

3: THERE ARE MULTIPLE POINTS  & TYPES OF INTERVENTION

Effective promotion, prevention, early interventions, and treatments are available along this  continuum

Woll, P. et al., 2013

4: COMMUNITIES AND SYSTEMS CAN PREVENT, CONTRIBUTE TO AND MITIGATE THE IMPACT OF TRAUMATIC EVENTS

Woll, P. et al., 2013

This calls for a comprehensive approach that can have a broad impact with multiple strategies

HOW CAN A BEHAVIORAL HEALTH SYSTEM TAKE A PUBLIC HEALTH APPROACH?4 AREAS:

#1: Broad Understanding of Trauma Beyond an Acute Stress Experience & Individual Treatment for PTSD

Traumatic events exist at many ecological levels – individual trauma like loss of a job, to family trauma like loss of employment/housing, to community trauma like a violent event or concentrated rates of violence, to societal trauma like 9/11 We need to redefine trauma beyond the individual level (treatment level) and intervene early and at various levels from individual to family to community to society

Hub of HopeHomeless outreach in a major transportation concourse

Trauma informed and trauma

specific approaches

1 of the 10 core values of

system transformation

2: Effective Behavioral Health Services

Effective Specialized TreatmentSupporting Trauma‐Informed and Trauma Specific Approaches• Child and Family Traumatic Stress Intervention 

(CFTSI)• Trauma Focused Cognitive Behavioral Therapy (TF‐

CBT)• Prolonged Exposure• Dialectical Behavior Therapy (DBT)

Requires Intervening with Systems, Not Just Individual Clinicians

Sanctuary Model

Philadelphia Alliance for Child Trauma Services (PACTS)

A consortium of pediatric and other child serving agencies and behavioral health providers that see young people who may be traumatized

3: Strategic Cross System Partnerships

Court SystemFirst RespondersPolice – Crisis Intervention TrainingChild Welfare ‐ Department of Human ServicesHealth Care ProvidersEmergency Room Departments

“The training actually empowers our officers to respond to any call with more understanding, empathy and respect for the person on the other end.”

Charles H. RamseyCommissioner, Philadelphia Police Department

FIRST RESPONDERS/POLICETrained in Crisis Intervention & Mental Health First Aid to better address individuals with behavioral health challenges

HEALING HURT PEOPLE• Hospital‐based intervention• Critical incident• Opportunity for early intervention, prevention, and access to 

services and supports

4: Community Interventions, Strengthen Community Skills & CapacityCommunity Response TeamsMental Health First AidOnline and In‐Person ScreeningFaith‐Based CommunityCommunity CoalitionsMural Arts – Porch Light ProgramYouth Move

“It provided me with the confidence to extend a warm hand to anyone who needs assistance.”

Community-based and Online Mental Health Screening:

HealthyMindsPhilly.orgHelpYourselfHelpOthers.org

CommunityCoalitions

A partnership between Mural Arts and the City of Philadelphia Department of Behavioral

Health & Intellectual disAbility Services situates art and human connection to promote

resilience, recovery, healing, and wellness

© 2012 City of Philadelphia Mural Arts Program/ Phillip Adams and Willis Humphrey4129 Woodland Ave  Photo By Lovella Calica

Communion between a rock and a hard place 

#1: Enhancing Physical and Social Environments

Personal Renaissance © 2010 James BurnsJEVS ACT II –1745 N. 4th Street

#1: Enhancing Physical and Social Environments

Personal Renaissance © 2010 James BurnsJEVS ACT II –1745 N. 4th Street

Photo by Mustafah Abdulaziz

#1: Enhancing Physical and Social Environments

Finding The Light Within© 2012 James Bur119 S. 31st Street

Behavioral Health Murals in Philadelphia

YOUTH MOVEYouth advocates for children’s behavioral health and resilience

"It helped me be a stronger person. Now I feel like I can say anything I want. I'd say I feel free.

YOUTH MOVECintraYouth M.O.V.E. participant and youth advocate

YOUTH MOVE

SUMMARY

Trauma is a big issue, we need to take a wide view and have a broad impact, where we don’t wait for challenges to occur and we don’t rely only on professionally driven interventions

This calls for a public health approach where everyone plays a role

IMPLICATIONS FOR HOSPITAL‐BASED VIOLENCE INTERVENTION PROGRAMS

• Recognize broader experience and potential impact of trauma

• Identify other resources and supports available to meet diverse needs of individuals

• Partner with other systems• Connect to community resources• Think outside the box

Arthur C. Evans, Ph.D.Arthur.C.Evans@phila.gov

@ArthurCEvans@PhillyRecovery

www.dbhids.orgHealthymindsphilly.com