“Ask the Expert” features an interview with a leading expert on homelessness or co-occurring mental and substance use disorders. The following is an interview with Dr. Joan Gillece, Project Director for two SAMHSA Centers: The National Center for Trauma Informed Care and the SAMHSA National Technical Assistance Center for the Promotion of Trauma Informed Practice and Prevention of Seclusion and Restraint.
We are pleased to welcome Dr. Gillece, who has 30 years of experience working in the behavioral health field with 15 dedicated to trauma and six in prevention of seclusion and restraint. Working across agencies, Dr. Gillece has provided technical assistance and support to publicly funded systems in a variety of settings. Relevant interagency training, technical assistance and collaboration include agencies serving individuals with HIV/AIDS, substance abuse, specialty courts, homelessness, older persons, juvenile and adult justice, and developmental disabilities. Prior to joining the NASMHPD six years ago, Dr. Gillece served as Director of Special Populations for Maryland’s Mental Hygiene Administration where her responsibilities included all aspects of State mental health planning and delivery of services as well as development of collaboration across agencies serving individuals with psychiatric diagnosis. As Project Director for two SAMHSA Trauma Centers, Dr. Gillece has championed the cause of full consumer integration and development of culturally competent programs. Commitment to strength-based support by implementing trauma informed values with the overreaching theme of recovery has been her focus.
Question: Please discuss how your work with NASMHPD ties into your work with SAMHSA.
Answer: All of my work is with SAMHSA. The SAMHSA centers I direct are in trauma and prevention of restraint and seclusion, so I see my role as carrying out the mission of SAMHSA. I’m particularly happy with the strategic initiatives, especially the trauma and justice. These are a real passion of mine and it’s very exciting to me that SAMHSA is taking the lead on moving the trauma-informed initiative forward. Although I am located in, and a member of NASMHPD, all of my work is with the trauma centers at SAMHSA.
Question: In what ways has trauma-informed technical assistance (TA) changed during the past decade? Both physically (in terms of TA) and psychologically (in terms of a cultural shift).
Answer: There has been a huge shift. I was the recipient of several SAMHSA grants on trauma back in the mid- to late-1990s and trauma was not really recognized. Since that time, I think under some of the SAMHSA leadership, the trauma message has grown exponentially. We now see it in all of the requests for proposals, grants and contracts across centers. To see trauma and justice as a strategic initiative exemplifies SAMHSA’s commitment to promote services that don’t just treat the symptoms, but also address the causes. That’s what trauma-informed care if really about. I think the cultural shift is from being prescribers of medication to lessen symptoms to where we are now; looking at treating what causes the symptoms in the first place. We’re teaching and training and promoting the understanding of how trauma affects the developing child and what we do to protect ourselves from future traumas. There are so many symptoms and the symptoms are adaptations to trauma. So this shift helps consumers connect the dots between what happened to them and their response. It helps providers not blame their clients and understand why they are doing the things they are doing in the first place.
Question: What adaptations have grantees been making to provide effective trauma care to their clients? Please describe some innovative activities you’ve seen in the field.
Answer: We work across systems and there are innovations going on in multiple systems. We’re working with States and the military correction facilities, training the staff on trauma and teaching them how to use psycho-educational trauma interventions. This helps consumers self regulate. In juvenile justice we’ve seen some exciting things such as watching people begin to understand that there is a reason behind these behaviors. And clinicians are beginning to ask, “What happened to you” as opposed to, “What’s wrong with you.” The field is now looking for the strengths in consumers instead of just looking at their deficits. Peer support is huge in trauma-informed care. Another important innovation is working with peers to provide support. In Framingham Women’s Prison, the superintendent of that facility just brought us in to train 25 women in custody to become peer supporters in that facility. That’s a huge culture shift. Mark Patterson, Warden in Hawaii’s Women’s Correctional Center, which is the only women’s prison and detention facility in Hawaii, has completely incorporated trauma-informed services. He says that his facility is a place of forgiveness. What an incredible concept that doesn’t cost money. It’s a change in attitude and that is not a new technique, it’s a shift in our understanding and it works.
We are working with a lot of drug courts across the county. SAMHSA, through its new national centers (National TA Center to Promote Trauma-Informed Practices and Alternatives to Seclusion and Restraint and the National Center for Trauma-Informed Care), just hosted a meeting that brought together judges, and consumers who have experienced multiple court proceedings, to have a conversation about what a trauma-informed court would look like. It was a phenomenal meeting. At the judge’s request, we are developing a guide book for the judges. Within a few months we’ll be moving this forward. So many judges are asking us to come to their courts. We are doing quite a bit of TA for grantees throughout SAMHSA. We are committed to providing the expertise we have on trauma to all of SAMHSA. We are also providing this assistance to the Bureau of Justice and we assist them with the mental health and criminal justice grantees around trauma.
Question: What affect (if any) has the current healthcare reform bill caused with how or how much trauma- informed care is provided?
Answer: This is a difficult question. However, what I would like to see is the Adverse Childhood Events (ACE) Study that looks at the somatic effects of trauma, used on a wide basis. According to its Web site, The ACE Study is, “…an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente. Led by Co-principal Investigators Robert F. Anda, MD, MS, and Vincent J. Felitti, MD, the ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma, and health and behavioral outcomes later in life.” Dr. Felitti and Dr. Anda’s findings of untreated early childhood trauma and their healthcare costs is an important message.
Question: What challenges are the vets returning with PTSD facing?
Answer: What they’re facing is our need to make trauma-informed treatment services available. We are thrilled to be able to work with, for example, the Naval Consolidated Brig at Miramar at Marine Corps Air Station Miramar. The Brig is the correctional facility for the military. We have been working with them to train the staff to help them develop peer support and how to conduct a trauma intervention called TAMAR (Trauma Addiction Mental health And Recovery). Our work with them has been incredible. People now understand the trauma message and it is certainly front and center in the military. There is a real willingness to address it. I have not felt a stigma regarding mental illness in the military. I really have not felt or heard that message. I only hear compassion.
As we’re working with the military, the women we work with is something quite different. I’m not sure how many women end up, after combat, with PTSD. This is a rather new phenomenon with so many women now in the service. They have different issues with trauma, issues with their children….Mental Health America, which is a nonprofit dedicated to helping people live mentally healthier lives, has been exploring new ways to enhance communities’ capacity for handling trauma with returning vets. This is an exciting development and very important. I think SAMSHA’s military family’s initiative is so very critical to this endeavor.
Question: Please describe some of your partnerships/collaborations (e.g. SAMHSA/Iraqi physicians/criminal justice facilities).
Answer: Most of my work is about creating partnerships. Working with the SAMSHA SAMHSA sponsored Iraqi medical professional visit in the fall providing training and site visits to trauma informed programs, our visitors took the trauma training back to Iraq and are starting to train others. Then there’s the collaboration with the National Institute of Corrections. We authored a Web-based curriculum section on trauma that is expected to be released this summer. I’ve never done anything like that with avatars and the like, very intriguing. We’re also working with the Bureau of Justice Assistance (BJA); they funded a couple of centers we’re working with, and the National Resource Center on Justice Involved Women and the Council of State Governments Justice Center. I partner with them on these centers that will take the lead of moving the trauma message forward in the criminal justice system. We provide TA for BJA funded grantees.
We speak at national conferences, addressing everyone from the National Association of Drug Court Professionals to the National Association of State Directors of Developmental Disabilities. We work with victims of crime. I’ve conducted TA for Federal parole and probation agencies, State departments of corrections and juvenile justice, local health departments, homeless programs…the list goes on. This week alone, I am conducting two webinars and a training for a college/community/graduate school. I honestly believe that SAMHSA has taken the lead on all this happening and it is very exciting.
Question: How is NASMHPD in sync with SAMHSA’s strategic initiatives?
Answer: I think there is a lot of support. NASMHPD is absolutely supportive of carrying out the mission of SAMSHA while providing support to State directors of mental health.