City council reviews effort to offer trauma treatment closer to home
With many who work with trauma saying it too often goes unrecognized and untreated, some elected officials and organizations are seeking ways to make care more accessible to those affected. One such effort by the Boston Public Health Commission came under review last week at a hearing convened by City Councilor Ayanna Pressley.
At the hearing, BPHC representatives reported on a two-year-old initiative to prepare community health clinics to respond to psychological trauma among residents in those neighborhoods with the highest rates of violence. With support from city funding, the BPHC established Trauma Recovery Centers at eight clinics in Roxbury, Dorchester and Mattapan. Each recovery center received a trauma-trained clinician and community health worker to provide prevention and care, facilitate support groups and be a resource at community meetings, said BPHC executive director Monica Valdes Lupi.
Results thus far seemed mixed: The recovery centers were utilized by residents, with trauma-impacted individuals completing more than 5,500 visits at the centers between March last year and March this year. However, most of those visits were made by women and children, suggesting that more needs to be done to reach everyone.
The impact of violence and trauma is not equally distributed across Boston.
Among the major details that emerged from BPHC’s case review of the community clinic-based recovery centers is that, in many cases, the traumatizing experiences reported by residents were not one-time incidents.
According to information gathered from a sampling of 480 clients seen between March 1 and August 1, 2015, the vast majority of them — 70 percent — said they were driven to seek care because of chronic exposure to violence. Forty percent listed the type of trauma they were exposed to as “community violence,” Valdes Lupi said. She termed the community violence statistic “really troubling.”
The latest BPHC data found that 26 percent of parents of Boston children ages zero to 17 years reported feeling that their child is unsafe in their neighborhood. When narrowing the focus to parents of teens ages 15 to 17, the percent of parents who felt their child was unsafe rose to 34.3 percent.
The BPHC had a sense that violence was unequally evident in the city before commencing the study, which informed decisions about which neighborhoods received Trauma Recovery Centers.
“We know that violence occurs in all our neighborhoods. We also know this burden is not distributed equally,” Valdes Lupi said.
On the web
Directory of trauma resources: http://www.bphc.org/whatwedo/mental-emotional-health/trauma-response-and-recovery/Documents/Trauma_Resource_Directory.pdf
Clinics with Trauma Recovery Centers: http://www.bphc.org/whatwedo/violence-prevention/Violence-Intervention-and-Prevention/Our-Mattapan/Mattapan-VIP/emotional-heath-wellness/Pages/Trauma-Centers.aspx
Community clinic approach
Locating treatment providers at health clinics was a way to bring services closer to residents of “hot-spot” neighborhoods, Valdes Lupi said.
“Over the last two years we invested in a strategy that places community health centers at the heart of response to trauma,” she said. “We know that community health centers are an anchor in the community. They are a resource, a refuge.”
Catherine Fine, BPHC director of the Division of Violence Protection, said that she recognized a health center model is not the answer for all impacted people, and that the ultimate vision is to eliminate the need to call upon trauma-specialized responders. Instead, BPHC’s goal is to train the staff in places where people already go — such as early education centers and care centers — to recognize and respond to the trauma in all its various forms.
Most of those who visited the participating community health clinics for trauma treatment were women (54 percent) and children (53 percent were under 18 years old). Fifty-eight percent were black, 24 percent Latino and 5 percent white.
Several speakers at the hearing said the lower presence of men at the recovery centers may not be an indicator that men are less affected by trauma, but that they do not choose to turn to clinics.
James Hills is a community member who lost a brother to homicide and for three years served in former Mayor Thomas Menino’s office as a direct responder to homicide and trauma. He and Councilor Jackson said that black men notoriously are unlikely to seek care for prostate cancer, a pattern of behavior that may apply to trauma care as well.
“I can guarantee you there’s a lot of brothers out there who are hurting, and many of the young men who are hurting the most are not going to walk into that building,” Jackson said. “For men in general, we need to really break out of our mentality that folks are going to come to us.”
For black men, an often-frequented place may be the barbershop, Jackson said. Hills also recommend the BPHC to proactively recruit male treatment providers.
According to Valdes Lupi, youth are especially impacted by violence and trauma. Violence is the leading cause of death for black and Latino children in Boston and 48 percent of the city’s high school students know someone who’s been shot or killed, she said.
An initiative announced Monday would enhance efforts to provide trauma care within schools. Boston Public Schools received at $1.6 million federal grant to support initiatives to identify and treat early signs of trauma in students, faculty and families, including placement of trauma specialists in ten schools.
A persistent city problem is a lack of coordination among existing trauma treatment groups, along with challenges associated with making the public aware of the variety of services available to them, many testified.
Responding to trauma is complex, and people’s needs are varied. Immediately after a homicide, families may require assistance with funeral preparation and filing for victim compensation. A few weeks later, families may need to be alerted to the kinds of trauma treatment services available to them, if and when they are ready, and given help attaining insurance coverage for such services. Treatment needs to be available on a long-term basis to members of the wider community, as well as immediate friends and family, speakers said. And there are many organizations across the city that handle specific aspects of these services. For instance, Charlene Luma is the director of SMART Team Boston, an organization whose trauma work focuses especially on providing temporary post-funeral support to homicide-affected teens in Roxbury, Mattapan, Dorchester and Jamaica Plain.
Luma said at the hearing that, for the most part, Boston has the trauma treatment providers it needs, but lacks the coordination to make full use of them.
“We don’t [as much] need additional resources. We need to know how to access those resources,” Luma said.
In 2010, Pressley sat city officials down to hear from individuals who had lost loved ones to homicide. Among the testifiers’ recommendations was to create a standard protocol for coordinating the various groups offering treatment and ensuring all needed stages of treatment are provided. Six years later, such an official response protocol is still lacking, noted Rachel Rodrigues, director of programs for the Louis D. Brown Peace Institute.
“The solution … is not simply more resources but rather a shared understanding of the many city departments and agencies involved in trauma response,” Rodrigues testified at the hearing. “Maximizing the impact of any shared resources requires clear and consistent communications [across organizations].”
At the hearing, James Hills urged the city to move as quickly as possible, noting that violence in the city tends to spike during the summer.
“This is April. We’re not ready. Once again we’re not ready,” Hills said. “We can’t be here next year.”