Dr. Wayne Carson, CEO
ACH Child and Family Services
Lena Zettler, MA, LPA, Director
Cook Children’s Medical Center, Psychology
Fort Worth, Texas
1999: Trauma in Tarrant County:
Catalyst for Change
 In September 1999, a man suffering from untreated mental illness entered a local church,
armed with a semi-automatic gun and a pipe bomb, during a youth rally. There were around
150 individuals present. Eight people were killed, including the gunman and 4 teenagers.
Seven others were injured. He had no previous criminal record.
 Fort Worth Mayor Kenneth Barr turned to
local mental health providers, requesting
a plan for improving access to quality
mental health services for all residents of
Tarrant County.
Memorial at
Wedgewood Church
2000: Mental Health Connection
 Initial collaboration of pediatric service providers and community
agencies provided leadership, planning, and financial resources to
develop infrastructure and goals:
• Cook Children’s Medical Center
• Lena Pope Home Inc.
• MHMR of Tarrant County
• City of Fort Worth
• Fort Worth ISD
• Child Study Center
in 2000 and today has over 70 participating agencies and numerous
private practitioners, advocates, consumers, and family members.
2007- 2011: Bridging the Gap
 Mental Health Connection
5 Year Initiative
 Annual Symposia
 Evidence Based Practice
 Create Learning
Communities in 6 areas
Met for 6 months
Reviewed research
Identified policy issues and
 Pilot/Implementation in 5
areas based on EBP’s
2008: Trauma Implementation Team
 Trauma/PTSD Pilot program
 Obstacles:
 Identification and diagnosis
of trauma in children and
 Increased trauma
experiences for children/
adolescents in Tarrant
2007 Texas DFPS - alleged
child abuse and neglect (up
2005 United Way survey
shows increased perception
of violence in home/
community/school (18-51%)
2006 Texas DHHS Hurricane
Katrina evacuees remaining in
Texas under age 18 = 25,740
2008 CCHAPS Survey
 5.5 percent of CCHAPS respondents say their child has been abused
or neglected, including physically, psychologically, sexually or has
been a victim of gang threat. This equates to almost 34,000 children
across 6 North Texas counties.
 6.48 percent of CCHAPS respondents say their child has experienced
something traumatic such as a natural disaster, accident, violence,
neglect, or abuse. This equates to over 40,000 children across 6
North Texas counties
 15.24 percent of CCHAPS respondents say that their child had
accidental injury that needed medical attention in the past 12
months. This equates to over 94,000 children across 6 North Texas
2008:TF-CBT in Tarrant County
 TF-CBT model proposed (Cohen, Mannarino, and Deblinger,
 EBP sponsored by NCTSN
 Cultural Adaptations
 Professional Facilitation/supervision
 Collaboration of 22 agencies, including pediatric mental
health service providers, hospitals, CPS, FWPD, and
domestic violence service providers
 T.A.R.P. (Trauma Assessment and Referral Process)
Screening tool
 Social marketing component
 Education/training
2009: Trauma Implementation
 Trauma Focused CBT:
 54 providers or
administrators trained
across 15 agencies
 Bi-weekly consultation for
9 months
 Partner with UT – Austin
 85 youth/families
enrolled; 65 participated
in 12 month follow up
 Obstacles:
 Intake/referral navigation
different across agencies
 For example, some agencies
require CPS or police referral or
child may be triaged to a higher
level of care (inpatient
psychiatric unit)
 Access
 For example, some agencies
serve identified children in
specialized settings (group
2009 Bridging The Gap Symposium
 Around 180 participants received Trauma training
Trauma and the Brain: Bruce Perry, PhD
Trauma Informed Policy: Janice L. Cooper PhD
The Science of Implementation: Allison Metz PhD
Trauma/EBP Lessons Learned
 Therapist/Agency attitude towards EBP’s was positive
 Need for ongoing supervision/fidelity
 Highlight the overall problem of access to services in
Tarrant County
 Need policy changes to support ongoing work
 Realize Implementation is a SCIENCE; real change involves
more than technical solutions to obstacles
2010: Pediatric Trauma in the Medical
 Grand Rounds at Cook Children’s Medical Center by
Nancy Kassam-Adams, PhD
 Healthcare Toolbox (NCTSN, Children’s Hospital of
 “Supporting the Traumatized Child” School Nurse
Symposium and video conferences for school nurses
provided by Cook Children’s Child Life, Trauma Dept, and
CISD trained staff
2011 Trauma Committee
 Grant Submission:
Integrating Traumainformed and Traumafocused Practice in CPS
Delivery; application
 MHC Trauma Informed
Committee evolved/
 MHC: Table Discussions
with Membership
 Large and varied interest
in spite of grant denial
 “What does a traumainformed community look
 “What resources do we
have now and what do
we need to develop?”
MHC: Trauma Informed Committee
 Definition:
Trauma is defined as the
experience of an event by a
person that is emotionally
painful or distressful which
can result in lasting mental
and physical effects. Trauma
is defined by the experience
of the survivor. What is
traumatic to one person may
or may not be traumatic to
another. Trauma can affect
 Vision:
A community that
understands and acts
quickly with sensitivity to
the needs of those who
have experienced any form
of trauma.
MHC: Trauma Informed Committee
 Broaden stakeholder base to reflect vision of “community”
 Teachers
 First responders
 Juvenile Justice
 Intake staff who may not be clinically trained
 Universities
 Explore NCTSN resources
 Local networking and resource sharing
 Develop webpage for information sharing
 Discussions were relevant, respectful, and synergistic
 Following intensive Implementation Leadership training by Ellen
Kagan, MSW Georgetown Leadership Program
2012: MHC Trauma-Informed Committee
 Complex Trauma
Treatment Network
(CTTN) Midwest Region
Learning Community
 Brad Stolbach, PhD
 Technical assistance
 Funded by the US
Department of Health
and Human Services,
Substance Abuse and
Mental Health Services
Administration (SAMHSA)
 National Child Traumatic
Stress Network
CTTN Trainings and Assistance
 Complex Trauma Training by
Brad Stolbach, PhD:
 Arlington, Euless, &
Watauga Police
 CPS supervisors
 MHC membership and
community (around 90
 Cook Children’s Medical
Center CARE Team
 MHC Site visit
 Cook Children’s Medical
 MHC Board of Directors
 Juvenile Services
 UT- Arlington faculty and
 TCU faculty
 CTTN Southern and Gulf
Coast Regional Conference
in Houston
 15 attendees from MHC,
including parent/family
2012 Other Trauma Work:
 TarrantCares.org to include Trauma-informed services
 Resource library for professional trainings offered by
 Agency/organizational assessment project with UTA
graduate students in Mental Health and Social Policy
 Explore universal screening and assessment
 Continue First responder training:
 Arlington PD
 MHMR Law Liaison program
 Mental Health Assn. (MHA) trainings for police officers
2012: Other Trauma work:
 Cook Children’s Medical Center Trauma Department and
Trauma Support Services of N. Texas (TSSNT)collaborative
 Provides education, group counseling, and individual or family counseling to
families who have experienced medical trauma at Cook Children’s
Emergency Department; LPC from TSSNT collaborates with family, and
Home Health/Child Life staff
 Cook Children’s Trauma Conference (110 participants)
 TF-CBT competency required for all Lena Pope Home and Cook
Children’s Psychology clinicians
 NCTSN grant submission/declined
Where are we now?
 Cook Children’s grant pending to provide Trauma informed
Organizational Assessment and Trauma informed training in 2
local homeless shelters
 2013 Cook Children’s to provide Trauma-informed training to
Cook clinical and non-clinical staff ,and Executives, who
serve/support collaboration in 3 homeless shelters (include
MD’s, RN’s, van driver, VP’s, etc)
 Trauma and compassion resilience
 How do we retain clinical workforce?
 Support for non-clinical staff
 2013 MHC Forum on Trauma
Where are we now?
 Pilot with Crossover Children
(Juvenile Justice and Child Welfare)
 Birth to age 6
 Judge Boyd advocate; Tonya Green of
CASA; Aaryn Lamb, Attorney
 TRBI and partnership with Dr. Karen
Purvis at TCU Child Development
Treatment implementation
Trauma-informed education for CPS
workers and attorneys
 Ms. Lamb to speak at Texas Juvenile
Law Conference in 2013
Mental Health Connection of Tarrant County
Dr. Wayne Carson [email protected]
Lena Zettler [email protected]

Presentation slides – Lena Zettler