MARYLAND WOMEN AND VIOLENCE
The Sidran Institute, in collaboration with the Maryland Mental Health Administration and the University of Maryland Center for Mental Health Services Research, was awarded a $600,000, multi-year grant from the Substance Abuse, Mental Heath Services Administration (SAMHSA), Center for Mental Health Services, a division of the U.S. Department of Health and Human Services. The grant began October 1, 1998, and continued for two years.
Known as the “Women, Co-occurring Disorders, and Violence Study”, the purpose was to develop, deliver, and evaluate specialized services for women who had histories of traumatic abuse as well as co-occurring mental health and substance abuse disorders. The grant also provided for trauma assessment and services for the children of the women in the study.
The Maryland group’s TAMAR Project was one of fourteen programs around the U.S. selected for this multi-site federal study, and the only one based in the criminal justice system. This project served identified trauma survivors in three Maryland county detention centers, beginning while the women were incarcerated and continuing after their release into the community.
The project was named for Tamar, daughter of the biblical King David, who was raped by her half-brother Amnon. Afterwards, she tore her clothing in an act of mortification and lived in disgrace in the home of her brother Absalom. However, the word “tamar” (in Hebrew) means “palm tree,” symbolizing both strength and flexibility. The Maryland Women and Violence project offered the Tamars of today a different ending to their stories, building on the themes of strength and resilience. The name was adapted to stand for Trauma, Addiction, Mental Health, And Recovery.
Sidran’s role in the Maryland project was to conceptualize, develop, and deliver training to the staff of all the agencies working with the women participants in the project, both in the jails and in the community after their release. This included departments of corrections, parole and probation, substance abuse, mental health, domestic violence, and social services in each of the three counties. The idea was to create a truly “trauma informed” support system for the women, at all stages of their recovery.
Over two years, the following were implemented:
- Intensive Risking Connection training and implementation consultation for mental health treatment staff specialists in the jails and in community services of the three counties.
- Basic Risking Connection framework and crisis intervention training for all staff of all agencies at all levels.
- Training on the Long-term Effects of Traumatic Abuse for frontline staff in all the service providing agencies.
- Self-care for the Helper: Secondary Trauma Reactions, Making Meaning, and Sustaining Enthusiasm was taught to all clinical and research staff and peer advocates.
- Growing Beyond Survival: Tools for Symptom Management was taught to all clinical staff.
- The Essence of Being Real: Peer Support for individuals who have experienced trauma was developed by Sidran and a team of peer advocates who represented and worked with the women in the jails and upon their release in the three county communities.
THE PTSD ALLIANCE
Active from 2000 to 2006, the Posttraumatic Stress Disorder (PTSD) Alliance was a multi-disciplinary group of professional and advocacy organizations that joined forces to provide educational resources to
• medical and healthcare professionals
• individuals diagnosed with PTSD and their loved ones
• the general public
• the media.
The mission of the PTSD Alliance was to increase awareness and promote a better understanding of the prevalence, diagnosis, and treatment of PTSD.
The four national organizations that comprised the PTSD Alliance represent a spectrum of healthcare issues related to PTSD. Alliance members included
• Sidran Institute
• Anxiety Disorders Association of America (ADAA)
• International Society for Traumatic Stress Studies (ISTSS)
• American College of Obstetricians and Gynecologists (ACOG).
Supported by an unrestricted education grant from Pfizer, Inc., the PTSD Alliance provided educational resources to
• medical and healthcare professionals
• at-risk individuals and their families
• individuals diagnosed with PTSD
• the general public
• general consumers
• medical and healthcare trade media
Public Education Campaign
The PTSD Alliance Public Education Campaign was developed to raise awareness of PTSD to de-stigmatize the disorder and help people understand that recovery is possible through proper diagnosis and treatment.
• Key Messages of the Campaign
PTSD is a prevalent and serious health problem
PTSD is treatable
Education is key to understanding and effectively treating PTSD.
The Alliance mounted a website, which provided basic information, took requests for educational literature, and directed requests for resources to Sidran’s Help Desk. Central to the campaign was The PTSD Alliance Resource Center, which was accessible via toll free phone or web site. Consumers and professionals who called the automated toll-free number received a PTSD Alliance booklet free of charge and information on how to order consumer education materials, professional development programs, and other resources currently available from the four member organizations.
Two booklets were developed for distribution, and are available here for download:
• Hope for Recovery: Understanding Posttraumatic Stress Disorder for survivors and family members
• Posttraumatic Stress Disorder: A Guide for the Frontline for professionals.
The PTSD Frontline
A wide range of professionals interact with people at risk for developing PTSD or who already have PTSD—diagnosed or not:
• Psychiatrists, psychologists, social workers and other mental health professionals in various settings, including private practice, community hospitals and clinics, or public health agencies
• Primary care providers such as family and general practitioners, obstetrician/gynecologists and internists
• Nurses and physician assistants in private practice, clinics, public health agencies or emergency room settings
• Counselors who work in domestic violence shelters, rape crisis outreach, substance abuse programs or family service agencies
• Staff with advocacy and support groups for survivors of specific traumas
• Others in contact with people at risk such as:
• Emergency service personnel, such as police, firefighters or emergency management technicians, or disaster relief workers who generally are the first to deal with those in life-threatening situations
• Clergy who counsel people in distress
Those on the frontline can facilitate the recovery process if they integrate the following as part of their routine practice:
• Learn to recognize and identify PTSD symptoms.
• Screen for signs of PTSD or past trauma through routine history-taking as part of a general health assessment.
• Explore the possibility of PTSD as an underlying problem when appropriate.
• Be familiar with local referral options for treatment and direct patients to appropriate referrals when merited.
• Offer support to patients and their families.
Special Role of Primary Care
The healthcare provider’s role in a primary care setting is important because people with PTSD often seek medical care for a range of healthcare problems for which past trauma may be the underlying cause. In many cases, the traumatic cause has not been recognized or associated with the aftereffects.
In addition, the prevalence of physical and sexual abuse among the general patient population seen in primary care and emergency room settings justifies a universal screening for trauma and PTSD as part of the history-taking process. Because PTSD often manifests with physiological as well as psychological symptoms, it is important that treatment be coordinated between the mental health and medical healthcare providers.
Family and friends of those living with PTSD
It can be very difficult to watch a loved one or good friend deal with the aftereffects of a traumatic event. Not only do family and friends worry, but their offers of help may be rejected. The affected person may seem distant or emotionally numb or may be struggling with other symptoms that are characteristic of PTSD. The PTSD Alliance encouraged family and friends to:
• Provide emotional support and listen.
• Be patient and have realistic expectations for recovery
• Take care of themselves
• Learn about PTSD
• Encourage the person to seek and continue treatment
NYC PUBLIC SCHOOLS 9-11 PROJECT
“This is groundbreaking training for our school counselors, social workers, and psychologists. It is the first complete protocol for the assessment and treatment of posttraumatic stress in our students and the very best program I have attended in my 30 years of work in mental health at the Department of Education. The participants feel the same.”
— Cristina Casanova
NYC school’s citywide coordinator for professional staff development
New York City school administrators turned to the Sidran Institute to prepare the Department’s psychologists, social workers, and guidance counselors to respond to the growing number of traumatic stress cases among school children as a result of the September 11 tragedy.
Through a grant from the Philip Morris Companies, Sidran provided training to New York City–based mental health professionals in the neighborhoods most affected by the World Trade Center tragedy. Using Sidran’s curriculum Risking Connection as a core, Ricky Greenwald, Psy.D. taught all NYC Board of Education mental health staff to recognize and treat PTSD symptoms in children.
The Risking Connection model armed the department with the tools and skills necessary to provide and sustain services to thousands of affected children—many of whom were already exhibiting signs of posttraumatic stress disorder (PTSD) and a wide range of trauma-related emotional and behavioral problems, such as
• acting out
• behavior changes
• hands-on skills
• how to take better care of themselves
• how to avoid burnout
Avoiding and transforming vicarious (secondary) trauma is particularly crucial in a case like this where the providers experienced the same traumatic event as their clients. Attending to self-awareness and self care is a unique aspect and critical feature of the Risking Connection curriculum, which incorporates tools to help clinicians maintain their strength, objectivity, and effectiveness and to reduce the inevitable vicarious trauma they are likely to experience as a result of working closely with many traumatized children.
This program brought Sidran into the forefront of developing and teaching treatment models for traumatized children. Using the practical, relational approach of building RICH (respect, information, connection and hope) relationships between the caregivers and the students, we are able to help reduce the impact of trauma on the children.
The New York City school system is now better prepared to handle trauma cases, and the resulting benefits to the children and their families are immeasurable.
MONTGOMERY STANDS TOGETHER
A Collaborative Response to the Beltway Sniper Attacks
Launched: October 2003, on the one-year anniversary
• The government of Montgomery County,
• The Maryland Department of Health and Mental Hygiene
• The U.S. Substance Abuse and Mental Health Administration (SAMHSA), and
• The U.S. Department of Homeland Security
Sidran Institute developed a new public education campaign to provide support, resources, and information on posttraumatic stress disorder (PTSD) for Montgomery County residents. The Campaign, aptly dubbed “The Healing Project: Montgomery Stands Together,” promoted community healing and created greater awareness of PTSD and its symptoms.
The Montgomery Healing campaign helped physicians and the general public correctly identify PTSD (which is often misdiagnosed) and helped victims get treatment, which has a high success rate.
The cornerstone of the Campaign was “Why Don’t I Feel Safe Anymore?” a brochure produced in both English and Spanish that described PTSD and its symptoms, encouraged people to get help when they needed it, and offered hope for recovery. The brochure also included a tear-off checklist that citizens could use to identify their symptoms and take to their family physician. The Campaign also included:
• A healing weekend – Montgomery County clergy of all faiths promoted community healing, discussed PTSD and the importance of seeking professional help when needed, and distributed Campaign brochures,
• Public service announcements and local radio and television interviews to build awareness and provide information,
• A fact sheet for doctors, PTSD in Primary Care, including diagnostic criteria, risk factors, and treatment guidelines.
• A new website featuring consumer and professional (physician and clergy) resources and information, and
• Three professional briefings – one each for physicians, clergy, and county officials.
The Campaign was intended to make people aware of the scope and nature of the problem and encourage community residents to get help if they needed it.