Rising from the Ashes: How Trauma-Informed Care Nurtures Healing in Rural America [The Rural Monitor]


By Jenn Lukens
April 17, 2019

It was late July 2018 when the Mendocino Complex wildfire broke out in rural Lake County, California. It burned more than 450,000 acres and destroyed 280 structures before it was contained. Ana Santana managed to fill some storage bins with sentimental items – her kids’ blankets, pictures, and art projects – before fleeing her home.

Santana is the facilitator of the Lake County Children’s Council and Program Director for Healthy Start Youth and Family Services, where she and her team provide home visits, parenting classes, and resource connection. Her evacuation experience gave Santana more empathy for her clients’ desperate situations.

“Working in the shelters and with families afterwards, I think that was worse than if I had lost my home. Hearing the pain, the desperation in people’s voices…you can never be prepared for that,” relayed Santana.

A lot of times, we think that because a child is going to school or playing at recess, he’s back to normal and has forgotten everything that’s happened. But that’s not true.

Since 2012, wildfires have burned more than half of Lake County. Though the county is recovering, the wildfires have left ongoing effects on residents. “Children have anxiety about being separated from their parents while the adults are still working out the logistics of rebuilding their lives,” explained Santana. “A lot of times, we think that because a child is going to school or playing at recess, he’s back to normal and has forgotten everything that’s happened. But that’s not true. Same with teachers: just because you’re back in the classroom doesn’t mean you are okay.”

Thanks to some countywide efforts, Santana and her team have been using a trauma-informed care approach to help families recover from this and other negative experiences. Trauma-informed care (TIC) is understanding and responding to trauma by using principles that cultivate safety, empowerment, and healing.

Making a Case for Community-Wide Action

The National Child Traumatic Stress Network identifies natural disasters as one of 12 types of trauma that most commonly affect children and adolescents. Although natural disasters are considered “tolerable stress,” other types of trauma can create a cycle of toxic stress that is harder to break. Studies show that toxic stress can disrupt not only mental health over the long term, but also physical health.

In Lake County, Susan Jen is the director of the Health Leadership Network. She acknowledged that, over the past decade, high rates of poverty and domestic abuse, along with drugs and alcohol misuse, have contributed to Lake County’s poor health rankings. “We could statistically make a case for needing cross-sector, collective wisdom on how to address these issues we were dealing with,” said Jen. Visits from professionals like Dr. Vincent J. Felitti, one of the world’s experts on adverse childhood experiences (ACEs), were instrumental to organizations like Jen’s regarding their approach to community health.

One of the actions the Health Leadership Network took was creating the Lake County Wellness Roadmap, a project funded by the Health Resources and Services Administration (HRSA), which included addressing exposure to trauma and resiliency-building through countywide collaboration.

The Network also formed a Trauma Guide Team to help organizations work together through a common lens. Santana was appointed as the Guide Team’s facilitator. She helped bring in Strategies 2.0, a statewide family support entity, as a resource to train the team on the effective use of TIC. “We’re in an isolated place, so it’s very hard to get our people trained in an effective way,” explained Santana.

Ana Santana, Facilitator of the Lake County Trauma Guide Team

[Ana Santana, Facilitator of the Lake County Trauma Guide Team. Photo Credit: Carolyn Jones, EdSource.]

Next, the Guide Team created a multidisciplinary approach to carry out trauma-informed care throughout the community. By engaging healthcare, social services, and other agencies across the county, the Health Leadership Network made sure entities with the potential of treating trauma victims were on the same page.

In addition, healthcare facilities across the county have adopted the use of evidence-based screening tools and other TIC approaches. Some came up with their own strategies: the Lake Family Resource Center developed California Hope to provide ongoing emotional, mental, and day-to-day support for wildfire victims. Adventist Health Clear Lake established Project Restoration to serve patients with housing needs. Lake County Tribal Health uses the Circle of Security to help Native American families and children who have suffered trauma.

“I don’t know any place in our country that isn’t tackling [trauma] in some way, shape, or form, whether it’s someone who is dealing with the trauma of the fire, or someone who has experienced domestic violence, or someone who has been incarcerated,” said Jen. “But in a small, rural community like ours, when you do something, it has the potential to impact the entire community.”

Engaging Law Enforcement in Trauma-Informed Care

Another example of a statewide effort that helps rural communities become trauma-informed across all sectors is Elevate Montana, initiated by ChildWise Institute. One of their initiatives is Handle With Care, a partnership between local law enforcement and schools. Here’s how it works: If a child is found on the scene of a disturbance or crime, police notify the school and report only the child’s name and the words “handle with care.” The code respects the child’s privacy while alerting school staff to take action, whether allowing additional time on homework, referring them to the school counselor, or simply being extra sensitive to the child’s emotional state.  

As Tina Eblen, director of ChildWise Institute and Elevate Montana, explained: “It’s understanding that, when [the students] go home, they are dealing with a lot. So making the school an environment that provides compassion and care for these kids versus being punitive is important.” By applying this trauma-informed approach, schools in rural towns like Libby and counties like Pondera are creating safe spaces for children to build resiliency in the face of adversity.

Elevate Montana was one of 14 communities selected by Mobilizing Action for Resilient Communities (MARC) to participate in a learning collaborative that builds policies and practices to improve resilience.

From the Front Desk to the Operating Table

Trauma-informed care has become increasingly recognized as a response to trauma within and outside of the medical setting. Since knowledge of the widespread impact of trauma has increased, more classroomsworkplaces, and even media are using TIC approaches. Some experts even suggest that trauma should be considered a public health concern because of its link not only to mental and emotional health, but also long-term physical health.

Dr. Bird Gilmartin is a pediatrician at Evanston Regional Hospital in Wyoming who uses a trauma-informed approach when treating patients. She explained that trauma due to adverse childhood experiences can manifest itself in different ways: “It affects everything and goes throughout an entire family and masquerades as all kinds of things. It looks like poor sleep, failing grades, bad moods, and health problems,” explained Gilmartin.


Read the entire article from The Rural Monitor here:  https://www.ruralhealthinfo.or...rauma-informed-care/

Title image: Dr. Bird Gilmartin uses a trauma-informed approach when treating her patients. 

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