A young man named Manny looks very tense and unhappy. His parole officer says, “I’ve known you for a while, and I believe you’re a good kid, but your anger is going to be your undoing, and you’ve got to do something about that.” A quick flashback shows a chaotic close-up of a violent beating.
So begins “Remembering Trauma: Connecting the Dots between Complex Trauma and Misdiagnosis,” the 16-minute video that vividly portrays how past trauma impacts the present lives of many youth caught up in the criminal justice system.
In another flashback, Manny walks in the park with a friend. A young couple is arguing, and the man starts to grab his girlfriend. As the woman yells out in protest, Manny quickly approaches the couple. He intervenes and fights the boyfriend, then hits him too hard, too many times.
Next, a deeper flashback. Five-year-old Manny brings a cup of water to his father who is yelling, hitting and berating him for not bringing it fast enough. The father approaches the mother, who cowers, bracing herself against his blows. Next, young Manny is walking home from school with his sister in a deserted area. Suddenly two men attack and sexually assault her, while Manny’s sister yells to her terrified little brother to run away.
Based on a true story, the video illustrates the experience of complex trauma. When people undergo multiple traumatic events, the brain becomes programmed in the heightened fight or flight state. After that, behavior that was adaptive under attack becomes problematic.
“It’s a powerful vignette of one young man’s story about the trauma he experienced as a child…and very simply explains our work to educate all the players in the criminal justice system,” said Patrick Keenan-Devlin, Executive Director and Juvenile Justice Attorney for the Moran Center in Evanston.
The Moran Center’s clients are Evanstonians from middle-school age through age 22 who are in trouble at school or with the law. Many of the youth have experienced complex trauma as children. “Childhood trauma plays a great part in driving people into our criminal justice system,” said Mr. Keenan-Devlin.
Using an integrative approach, social workers and attorneys work together to help young people find their way out of the school-to-prison pipeline and onto a path of healing, greater self-esteem, and academic or vocational achievement.
Social workers provide therapy to help youth heal from past trauma and understand how to modify their behavior going forward. Attorneys offer legal representation, to give those charged with crimes a chance at a clean slate and set them on a new path. And special education attorneys advocate for clients in school, to provide the support needed to see them through to graduation.
During the first six months of this year, thanks to a grant from the Evanston Community Foundation, the social workers, attorneys, staff, and board members of the Moran Center attended workshops on providing trauma-informed services. The staff at the Moran Center are “dealing with people who have experienced immense trauma,” said Mr. Keenan-Devlin. “We needed to make sure that everyone knows what trauma looks like and sounds like, and how to do basic triage.”
“These workshops provided a framework for us to apply to every aspect of our work – from our phone interactions, to our intake processes, to how we present cases in court, to how we counsel children and advise parents, and even to our physical office space,” he said.
The trauma training was conducted by Colleen Cicchetti, Executive Director for the Center for Childhood Resilience at Lurie Children’s Hospital, and Marjorie Fujara, M.D., who specializes in Child Abuse Pediatrics at John H. Stroger, Jr. Hospital. Tom Lenz, the Coordinator for the Partnership4Resilience, facilitated the event.
“Our organization has always been an organization to look at the whole child and for so many of our kids trauma is part of their reality and their experience of those traumas has become part of them – something they have to learn how to manage all the time in their lives,” said Betsy Lehman, Chair of the Moran Center Board of Directors. “It’s a part of who they are, and how they perceive the world, and we can’t advocate for them on a path for change…if we don’t understand that vitally important context.”
Terrible things happen to a child who has undergone chronic, repeated traumatic events. “Fight or flight as a reaction to danger is supposed to go up and then down, but if it stays turned on – you can’t slow down, you can’t think, it even has an impact on the immune system,” said Dr. Cicchetti. You have trouble self-regulating, and the stress hormones “turn on so quickly, even when danger doesn’t exist, you need to know how to manage that. You can’t be so dysregulated that your boss raises his voice and you go off on him,” she said.
Dr. Cicchetti said, “If people hurt you who are supposed to protect you – your parents – you end up with core beliefs that the world is not a safe place, you can’t trust anyone, and you don’t get along with other people. Many of the people in this category end up in detention.” They are also often misdiagnosed as suffering from mental health disorders, such as bipolar disorder, when they’re really reacting to trauma.
A deeper understanding of childhood trauma started with The Adverse Childhood Experiences (ACEs) Study in 1995. Kaiser Permanente and the CDC compiled data from 17,337 participants and followed them for 15 years. Participants were asked if they had experienced any of ten adverse childhood experiences, including sexual, emotional or physical abuse; domestic violence against the mother; incarceration of a family member; substance abuse in the family; divorce or abandonment by a parent; or emotional or physical neglect.
The study’s findings revealed that many more people had suffered from ACEs than had been understood previously. Up to two-thirds of the participants had had at least one adverse childhood experience, and nearly 40% had experienced two or more. The higher the ACEs score a person had, the more likely they were to suffer from obesity, substance abuse, heart disease, cancer, stroke, pulmonary disease, depression, anxiety, suicide, and incarceration. The original study was conducted among a predominantly middle class, white population in San Diego, Cal. Subsequent studies show higher ACEs scores in more densely urban settings.
Dr. Fujara expressed surprise that more people are not aware of the ACEs Study. “I don’t know why this landmark study is not more well known,” she said. “In the original study, it explains that [having been exposed to] six of ten factors reduces your life span by 20 years. It really changed the way I practice medicine. Trauma changes the way we’re wired; it changes the brain.”
The ACEs Study led to an explosion of research on the effects of childhood trauma on the brain and on behavior. “The more ACEs you’ve had, the more your brain is affected, the more you develop adaptive behaviors,” said Kristen Kennard, Deputy Director and Director of Social Work Services at the Moran Center. “Resiliency factors can make a difference in outcomes, but a lot of our clients don’t have a lot of support at home – they get it from the Moran Center and other community support. The Moran Center ends up being a safe haven … When something is bothering our clients or comes up for them, they see this as home.”
This is a place where “things are pretty crisis-driven,” said Ms. Kennard. “We needed to make sure the non-clinical staff and lawyers know how to work with, talk to and handle clients in crisis.”
The trauma-informed trainings included techniques in building trust and creating a feeling of safety for clients. Staff learned how to help de-escalate situations for clients in crisis. They learned how to reframe conversations to ensure that each client’s version of events and point-of-view are understood. And they learned how to validate their clients’ individual experiences and perceptions. Even something as simple as an uncluttered, warm and welcoming reception area is important.
Mr. Keenan-Devlin said the trainings showed him how to conduct trauma-informed interviews with clients at the courthouse or in detention. “Often attorneys just want to get to the guts of a story and close with the client and get to the next thing,” he said. “But I learned to recognize the importance of incorporating a closing ritual that allows the client to process that he or she is about to leave me and go back to the world … to make sure he felt calm and centered before he walked away and returned to jail … that when the kid left my side he was ready to leave me.”
Vicarious trauma was another important component of the training. To avoid burnout and maintain their own resilience, social workers and attorneys also need to know how to take care of themselves. Ms. Kennard said, “We’re not good to anyone else if we’re completely burned out.” She said, “Many kids are killed. We spend a lot of time in ER. We’re on the front lines of things here … We have a passion for these young people and we’ve lost quite a few clients” to gun violence. “We see them go off to Cook County jail and the DOC.” Even the staff in the reception area are affected, because they deal with “clients who are in a tough space.”
Another flashback. Manny comes home with blood on his shirt. His girlfriend, holding their baby, yells at him for “not keeping his promise” and tells him he cannot hold the baby. Manny pleads with her to forgive him, to believe him when he says he will do better. She tells him to wash the blood off his hands first.
Back in the present. Manny tells his parole officer, “Maybe they’re better off without me. I’m just a screw-up.” Next, a social worker explains to Manny the connection between his childhood experiences and his violent behavior. They will work together to “see what they’re going to do about this.”
Dr. Cicchetti said being trauma-informed means “changing the focus from ‘What’s wrong with you?’ to ‘What happened to you?’”
Ms. Kennard said, “When clients understand they’re not ‘bad’, there is not something ‘wrong’ with them – that they are more than their worst decision – that’s when you’re going to see them start to change.”
Mr. Keenan-Devlin attends every Evanston Township High School graduation ceremony, and checks off each client’s name in the program. This June there were 14.
Coming Soon: Diversity Trainings in Evanston, including the diversity training for the Moran Center that was conducted by Elisabeth Lindsay-Ryan, a Diversity and Inclusion Professor at DePaul University and a diversity training facilitator and consultant.