Additional Perspectives on Trauma

Andrus Children's Center
The Andrus Children's Center is a private, non-profit community agency that provides assessment, treatment, education and preventive services for children and their families in residential, day and other restorative programs. Andrus has had a long standing commitment to working with some of the most vulnerable children: those who struggle with the effects of psychiatric illness, learning disabilities or who have experienced trauma from stressful life circumstances including loss and abuse. Our programs are grounded in an understanding of the effects of such challenges and of the treatment interventions most likely to bring about positive change. The Sanctuary Model provides our trauma-informed treatment philosophy. We are committed to creating a non-violent, democratic and productive community to restore children's sense of safety, their ability to manage their emotions, acknowledgement of loss, and understanding of and planning for a better future.

The Anna Foundation
The Anna foundation is dedicated to the celebration of Anna Caroline Jennings' life through exhibiting her incredible art work as well as using her life experience to educate others on the epidemic of childhood sexual abuse and its horrific effects on the individual and society. Anna was sexually abused from age 3 to 6, struggled with the lifelong impacts of that abuse, was in the mental health system for 17 years, and took her life at the age of 32. Her story is the story of thousands of adults who suffer the damaging consequences of childhood abuse - who make up the majority of those in substance abuse treatment, mental institutions, prisons and jails, and who are suicidal, self-injuring, homeless, unable to sustain employment, continuously re-victimized, and subject to disease, disability and early death.

New brain research reveals that stress resulting from childhood trauma impacts the chemistry and structure of the child's brain, hindering normal development. These impacts may last over the lifespan. New research is also providing us valuable information on effective strategies for prevention, early intervention, and healing. The Anna Foundation, through its website, art exhibits and multiple presentations, reaches out to the uninformed as well as victims, families, communities, and providers of services. Hopefully together we can first, help to bring the issue of child sexual abuse fully "out of the closet" and into public consciousness, second, separate myth from fact, and third, through research and input from others, communicate ways of preventing such abuse and methods that are effective in treating the anguish of those who are and have been victims.

Bazelon Center for Mental Health Law
The Bazelon Center for Mental Health Law, as the preeminent national legal advocate for people with mental disabilities, recognizes the effects of trauma resulting from accidents, war, disaster, crime and victimization on the mental health of affected individuals. Our concern is broader, however. Even in the absence of such dramatic events, millions of Americans suffer severe trauma, both as a result of their mental illness and of the public mental health system's failure to offer them adequate and appropriate treatment and supportive services. Studies have found that 90% of public mental health clients have been exposed to multiple experiences of trauma through domestic violence, sexual assaults, gang and drug-related violence, homelessness and poverty, coercive interventions, and sexual or physical abuse in inpatient or institutional settings. The impact on the child welfare, criminal justice, health care, mental health care and substance abuse treatment systems is enormous. Our advocacy is directed toward a coordinated approach by public systems to prevent trauma and to deal with its aftermath.

Vincent J. Felitti, MD (physician and researcher, Department of Preventive Medicine, Kaiser Permanente Medical Care Program; lead investigator in the 17,000-person Adverse Childhood Experiences (ACE) Study, which demonstrated links between childhood trauma, illness, and premature death)

Time does not heal childhood traumas; rather, it conceals them. They appear decades later as biomedical disease, chronic depression, and various addictions. The long-term costs are monumental, and concealed because of time, shame, secrecy, and social taboo against discussing certain threatening topics. It is clear that, if we are to promote the health and well-being of our nation's families and children, a significant effort must be undertaken to help all citizens understand the profound role of childhood traumas, be they family-based or due to natural events. Moreover, a plan must be devised to help reduce the prevalence of family-based trauma. Federal funding offers the possibility of weaving the threads of our knowledge into a coherent social fabric.

At present, there is no government supported information system or support network to address disaster and violent crime survivors' long-term trauma needs. The impact of trauma can take months or even years to surface and be recognized, and can have significant human, social, and economic impacts in almost every disaster situation from incest to hurricanes, military combat, and terrorist attacks. Survivors of previous trauma and individuals living with mental illness are among the most vulnerable…I strongly support Federal funding…to conduct a national education and awareness campaign.

The Kent Center for Human & Organizational Development
Psychological trauma is a common factor of mental health and substance abuse issues. Therefore, in order to provide our clients with the best possible services, the Center operates using a "trauma-informed" system of care. This approach manifests itself in many ways. One way is that staff are given ongoing opportunities to attend trainings that increase their understanding of the role that violence, victimization and trauma plays in the lives of many clients … regardless of the reasons a client comes to us, (and typically they do not knowingly come for issues related to trauma or abuse), our clinical staff asks them about their trauma history. This knowledge gives us the ability to treat the client holistically, and not just treat the behaviors that are often the result of the traumatic experiences. Recognizing the debilitating effects trauma has in the lives of many people, The Kent Center seeks grant funding on an ongoing basis to provide counseling and case management services to victims of trauma and victims of crime. The Kent Center is steadfast in its commitment to raising awareness about trauma as it affects individuals and as an important public health concern.

National Center on Family Homelessness
Homelessness is an extremely traumatic experience. The loss of home, community, stability, safety, friends, and routines is outside the realm of everyday experience and is very stressful. Before turning to a shelter, families are likely to have moved many times - from one friend's apartment to another, possibly to a car, and sometimes even to an abandoned building or the streets. For many homeless families, the stress of being homeless is compounded by prior traumatic experiences, including catastrophic illness, abrupt separations, and physical or sexual abuse. As the move to shelter approaches, many parents experience anger, self-blame, and a sense of loss, fear, and hopelessness. Children are keenly aware of the mounting stress and tension, and of the chaos that dominates their lives. In the midst of this turmoil, families are met by a complicated maze of social services, a living situation that offers little privacy, the need to parent in public, and an uncertain future.

The National Center on Family Homelessness (The National Center) was founded in 1988 and is the only national organization devoted to developing a body of knowledge about family homelessness that can be translated into innovative services and responsive policies. The National Center works closely with shelters, homeless families, service providers, researchers, advocates, and policymakers throughout the country. To address family homelessness and related issues of poverty, trauma, substance abuse, and mental illness, The National Center combines applied research and evaluation, program development, and training and technical assistance.

The National Center on Family Homelessness is proud to be a cosponsor of today's congressional briefing on the nature and impact of psychological trauma. While we applaud the federal commitment to end chronic homelessness, we are concerned that children and families have been largely excluded from federal efforts to end homelessness. The impact of this strategy has been devastating to the millions of American families who have no place to call home. We encourage Congress to pursue policy initiatives that not only provide families with affordable housing options, but also supportive services to help them heal from the many traumas they have endured.

National Coalition of Mental Health Consumer/Survivor-Run Organizations
Trauma is a significant determinant of mental illness. The principles of recovery from trauma, such as self-determination, empowerment, and peer support, are equally important in recovery from mental illness. We are striving to facilitate the collaboration of mental health consumers with other advocates to address trauma and disasters.

National Empowerment Center
The National Empowerment Center is engaged in training mental health consumers in Louisiana to provide peer support that will facilitate recovery from hurricanes Katrina and Rita. NEC is involved in a national effort to promote consumers' participation in disaster planning and peer support in every state.

Mental Health America (formerly National Mental HEalth Association)
Mental Health America (MHA) is the nation's oldest and largest mental health organization addressing all aspects of mental health and mental illness. MHA recognizes trauma as one of the most severe threats to the mental and overall wellness of children and adults in the United States. Accordingly, one of the organization's central goals is the prevention, reduction and treatment of trauma and related mental illnesses. In working towards this goal, MHA calls for greater trauma research, full integration of mental health services into disaster/emergency planning, implementation of trauma awareness programs and prevention-based services, and the increased development and use of new treatments and support systems for trauma victims.

Since the organization name has changed, please also move this listing for MHA up so that it’s in alphabetical order, after “The Kent Center for Human and Organizational Development” and before “National Center on Family Homelessness”.

National Sleep Foundation
Sleep disturbance is one of the most common problems victims face following violent or other forms of trauma. It can be very difficult for survivors to relax enough to get to sleep. Typical sleep problems during times of stress and trauma include insomnia and nightmares that often lead to excessive daytime sleepiness and fatigue. Lost sleep robs us of the opportunity to restore ourselves physically, emotionally, and even cognitively. Inadequate sleep and the resulting daytime sleepiness affect our mood, behavior and performance. A night of seven to nine hours of restful, uninterrupted sleep becomes particularly important during times of high stress and anxiety. A lack of sleep can make an already difficult situation worse as it impairs our concentration, decision making, patience, productivity, and ability to get along with others. Furthermore, sleep loss can lead to additional trauma as it increases the risk of making errors and mistakes as well as injuries and fatigue-related motor vehicle crashes.

Addressing sleeping problems early has been shown to help people face the challenges of their waking lives more productively. For instance, early treatment of acute stress disorder often prevents progression to posttraumatic stress disorder.

According to a recent Institute of Medicine report, Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, "The cumulative effects of sleep loss and sleep disorders represent an under-recognized public health problem and have been associated with a wide range of health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke." This report concluded that the nation's health care system is woefully unprepared to appropriately diagnose and treat the 50 to 70 million American that chronically suffer from a sleep disorder. This would include the hundreds of thousands of American's suffering from trauma or stress as victims of violent crimes or natural disasters. Sleep loss is one of the most common problems affecting how a person deals with significant trauma and can lead to compounding public health and safety problems for not only that particular individual, but those around him or her as well.

The National Trauma Consortium
The National Trauma Consortium is proud to support this initiative vital to the nation's health. We have seen and experienced firsthand the devastating effect of violence and abuse on survivor's mental and emotional health. Our work has focused on people receiving services in the nation's behavioral healthcare systems. Extensive research has shown that histories of abuse and violence are at the core of many of the psychiatric and substance abuse disorders addressed in these systems. People with lived experience have informed us that understanding trauma and its effects is vital to recovery from these problems. Our combined years of knowledge and experience have convinced us that preventing violence and abuse and addressing and healing its traumatic effects are primary public health concerns for our times.

Sidran Institute
Sidran Institute, a nonprofit leader in the field of trauma education and advocacy, has been actively teaching about and advocating for the needs of survivors of traumatic stress for over 15 years. We enthusiastically support this initiative to direct the attention of our national leadership to this critical issue. Sidran works with treatment providers, family members and survivors who struggle with the many psychological, physical, and spiritual effects of traumatic experiences such as family violence, childhood maltreatment, street crime, terrorism, war and natural disasters.

Research shows that without treatment, the effects of trauma are cumulative, long lasting, and very expensive. Without intervention, traumatized children face challenges such as social isolation, difficulty concentrating in school, aggressive or self-destructive impulses, and using drugs and/or sex to manage/mask their overwhelming feelings. Adult survivors are at greater risk for numerous serious medical conditions, mental illnesses, addictions, social problems at work and at home, as well as for repeated revictimization. Survivors of adverse childhood experiences are also often among the most vulnerable when later exposed to extreme stresses such as military combat, the 9-11 attacks or Hurricane Katrina.

The good news is that traumatic stress conditions respond well to a variety of established treatments and interventions, including peer and community support. These devastating humanitarian, economic and public health tolls can be reversed. We strongly urge development of effective national policies and programs for trauma awareness, prevention, education and intervention.

The experience of violence and trauma can cause neurological damage and can result in serious negative consequences for an individual's health, mental health, self-esteem, potential for misuse of substances and involvement with the criminal justice system. Indeed, trauma survivors can be among the people least well served by the mental health system … Trauma is an issue that crosses service systems and requires specialized knowledge, staff training and collaboration among policymakers, providers and survivors.

Stop the Silence, Inc.
Child Sexual Abuse (CSA) is not one group's problem; by expert accounts, it is a silent epidemic throughout the United States, and, indeed, the world, creating social havoc - for the children, adult survivors and society. It can be prevented and it can be treated, but a conscious and sustained effort is both missing and essential.

CSA constitutes a broad range of behaviors occurring along a continuum. It is a pandemic according to the currently available international research, and results in grave physical and psychological trauma and social consequences that put children at risk. It is difficult to know the true extent of CSA: most CSA is never reported (due to shame, fear, and other factors); report data is "filtered" by select victims who have disclosed or were found out; reported incidents are then filtered through adults who are willing to then report the abuse; and authorities often minimize or dismiss the abuse reported, blame the victim and/or protect the abuser (Falhberg and Kershnar, 2003). Only one in 10 children in the U.S. tell (Russell, et al., 1986); 42% of women and 33% of men never disclose the experience to anyone (Janssen, 1984).

In the U.S., CSA affects 15% to 33% of females and 13% to 16% of males (DHHS, 1999). Many countries have not yet produced research on prevalence rates (Falhlberg and Kershnar, 2003). From the information available, patterns that have emerged point to the following: prevalence rates range from 7% to 35% for women and 3% to 29% for men (Finkelhor, 1994), with most of the abuse reported in the double and often higher double digits, but with some exceptions: 80% prevalence of CSA for Native Canadian females (LaRocque, 1994); 53.2% for female and 60% for male students living in the Northern Province of South Africa (Madu and Petlzer, 2001); and 2.1% prevalence for male paramedical students in Malaysia (Singh and others, 1996).

CSA has extremely severe consequences, including decreased school performance, delinquency, depression, anxiety, substance abuse, anti-social behaviors, incarceration, promiscuity, teen pregnancy (60% of teens who become pregnant were sexually abused as children - Briere, 1989), prostitution (95% of teen prostitutes were sexually abused - Jennings, 2001) and HIV (Jannsen reported that CSA is the greatest predictor of HIV in women (Jannsen, 1994). CSA costs the nation billions of dollars each year (Dallam, 2001) for medical and psychiatric treatment, special education, and legal/judicial and incarceration costs.

Stop the Silence aims to increase awareness about and conduct programming to address the prevention and treatment of CSA, and the relationships between this issue and broader societal violence. We have identified seven focus areas needed to adequately address the complexity of the situation. We can provide short- and longer-term strategic planning and technical assistance anywhere in the world to address them: (1) individual and group counseling (to heal what has already transpired); (2) community education and outreach; (3) training of service providers; (4) advocacy; (5) policy development and application; (6) research and evaluation; and (7) other prevention measures (e.g., a focus on appropriately dealing with offenders).

Therapeutic Communities of America
Over 150,000 troops were deployed in Iraq and 18,000 to Afghanistan, many of them Reservists and National Guard. This deployment not only affected our troops but their families and their employers as well. Our troops will re-enter their communities at the end of their service and will return to civilian life without the benefit of having the support of being in a military community. These veterans are at risk.

A study released in late March 2005 by the New England Journal of Medicine that "as many as one in four veterans from Iraq and Afghanistan that were treated at VA hospitals in the past 16 months were diagnosed with mental disorders". The article continues, "Post Traumatic Stress Disorder was most common at 10% of the patients, followed by 9% for substance abuse, 7% with depression and 6% for anxiety disorders". Clearly, there is a rising need to prepare for these veterans. Public policy should anticipate the increase of newly returning at-risk veterans to their communities, many of who will seek out or need substance abuse and/or co-occurring mental health treatment within their communities in addition to the traditional services of DOD and VA.

Treatment centers and treatment organizations need to recognize the changing responsibilities of their members and staffs in light of extreme circumstances within our communities. Treatment providers and national organizations need to restructure their missions and develop plans that allow their expertise to appropriately and immediately fit into disaster responses. In turn federal policy needs to also recognize the need for substance abuse and mental health services within communities as part of response to treating individuals with trauma. Federal policy should also recognize the need to provide training to current providers specific to working with trauma clients.

Treatment providers and communities need to be prepared to assess and intervene earlier with individuals with trauma. Client -based early intervention with trauma related disorders will be an emerging and significant need in the coming years. Therapeutic communities traditionally have provided mental health and addiction treatment to individuals with multiple barriers to recovery and trauma affected clients but earlier intervention and prevention are also needed. We are committed to our communities, our neighbors and the mission of our organization. Through our mission, TCA and its members will help individuals and families identify sources of support, develop personal recovery plans, acquire access to services and take appropriate actions to become resilient and self-sufficient once again.

Witness Justice
Witness Justice is a national nonprofit organization providing technical assistance and direct assistance to survivors of violence and their allies, with a particular emphasis on addressing gaps in services or unmet needs. Trauma support is arguably the single most urgent need of survivors of violent crime, because it impacts every survivor at some level and can have devastating consequences on individuals, communities, our nation, and the world. Trauma is largely overlooked or ignored across a wide range of human service systems.

More than one in three adults and nearly 70 percent of adolescents are estimated to fall victim to violent crime in the United States. Since only about half, at most, of all violent victimizations are ever reported to the police, and because survivors must report crimes to become eligible for state-administered victim compensation and other services, an alarming number of survivors go without the help and support they need. Even when survivors can access services, they are faced with the fact that the nature and scope of services can vary drastically from one community to another, with sufficiently "trauma-informed" services being rare even in the best scenario.

Hurricanes Katrina and Rita illustrated the urgent and growing need for trauma education, awareness, and support. Witness Justice has been working to inform federal legislators about the nature and impact of trauma as a growing public health concern and the need for related programs and services for survivors. It is for this reason that Witness Justice has sponsored and organized today's issue briefing. We are committed to facilitating change within systems of service so that trauma is understood, factored into and addressed in programs for survivors of violence, abuse, disaster, terrorism, and war.