Trauma, treating it become issues in campaigns

Politicians split on programs addressing it

From 2012 to 2014, the administration of Republican Gov. Scott Walker tested a promising new program at Lincoln Hills School for Boys, the state’s main prison for young offenders, located in rural northern Wisconsin.

Walker’s state Department of Corrections sponsored 26 workshops for 135 guards and other prison staff on a concept called “trauma-informed care” — practices meant to sensitize government workers and social agencies to the prevalence of neurological trauma that stems from childhood exposure to neglect, abuse, violence, sexual assault, addiction or chronic stress.

Data collected in the last decade show an epidemic of psychological trauma all across the American population — rural, urban and suburban. In the case of U.S. prisons, though, the research reveals a population made up almost entirely of people with histories of childhood trauma.

Then came a series of dramatic events, one after another: In late 2014, allegations surfaced of abuse of minors by staff and allegations of the destruction of records, then a raid by state investigators, followed by a federal criminal probe into child neglect, prisoner abuse and a nearly $19 million settlement to end a lawsuit by a former inmate who was severely brain damaged in a suicide attempt.

Some guards afterward said they considered the trauma-informed approach ineffective and poorly executed, with one of them dismissing it as a “hug-a-thug” mentality.

If trauma-informed care amounted to a mere political fad, an embarrassment like Lincoln Hills likely would be enough to discredit it for good.

If anything, the scandal has had the opposite effect. In Wisconsin, the trauma-informed concept has never had more adherents and traction.

In a bitterly fought election year, both candidates on the ballot for governor built some form of trauma-informed policies into their agendas, even sparring this year over spending on programs billed as “trauma informed.”

Democratic nominee Tony Evers, the

state schools superintendent, has been pushing “trauma sensitive” programs into state-funded schools since 2015, with training sessions carried out in 128 school districts or schools.

Evers’ agency, the state Department of Public Instruction, argues that schools are an ideal venue for trauma-responsive work because young people are mandated to be in school and that’s often where counselors, therapists and social workers already are on staff. In Wisconsin, where 48 of the state’s 72 counties lack even one practicing child psychiatrist, that can be decisive.

“Schools are at the forefront of addressing the mental health needs of kids,” Evers said. “Trauma-sensitive schools training prepares school staff for the role they can play in mitigating trauma’s impact and helping students succeed socially and academically.”

Leading the movement on the Republican side is first lady Tonette Walker, who has been on the trail all year talking about her signature initiative, Fostering Futures, an advocacy group that runs training programs. In the current election year, the first lady has issued 14 news releases on her trauma-informed activism, compared to one last year.

At his wife’s urging, the governor required major state agencies to allow Fostering Futures to carry out its version of trauma-informed care training. That training, conducted as a separate Walker initiative from the initial workshops at Lincoln Hills, began in 2016. Fostering Futures has worked with health and human service agencies in eight counties as well as seven state agencies, including a new round of training with the Department of Corrections, which runs Lincoln Hills.

Walker’s administration this year has doubled down on the idea. Attending a three-hour “trauma-informed care” workshop, in fact, is listed as the top prerequisite for schools to apply for funds that Walker and his GOP allies released earlier this year meant to secure school buildings against gunfire violence and offer training to school administrators in adolescent mental health issues.

In Madison, the trauma-informed idea remains so new that it still means different things to different people. Broadly speaking, however, it’s meant to transform thinking within bureaucracies away from conventional blame and punishment and more toward understanding, support and post-traumatic recovery. Trauma care practitioners avoid conventional questions such as: “What’s wrong with you?” Instead, they ask, “What happened to you?”

Both Fostering Futures and Trauma-Sensitive Schools pull in the same direction. Both have advanced on roughly the same timeline. Both widely are credited with raising awareness for the idea of trauma-informed care. Both aspire to transform the internal cultures of the state-run agencies or schools where they train.

Neither regards workshops by themselves as a panacea. Nor does either side claim to have a specific blueprint for change. Each says they offer a new “lens” or “prism” on how to view the delivery of government services, leaving it to each school or agency to develop and adapt its own ideas.

And both sides appear aware of the pitfalls and delicacies of trying to change state-run bureaucracies.

“People love to go fast but this is a multiyear constant change process,” said Elizabeth Cook, a career school psychologist who oversees the trauma-sensitive schools training programs at the Department of Public Instruction. “We are walking people through a transformative process.”

Fostering Futures co-founder Laurene Lambach, an adviser to Tonette Walker, said trauma training is neither simple nor easy. “It’s a seven-year minimum process and we’ve done it for two years,” Lambach said.

As scandals erupted at Lincoln Hills, for instance, some guards said they thought Lincoln Hills’ version of trauma-informed care led to a less-punitive approach, which they believed emboldened teen inmates to act out and fueled more problems. Reports at the time indicated confusion over trauma-informed policies. Earlier this year, Gov. Walker agreed to close Lincoln Hills and replace it by 2020 with smaller, regional facilities. The criminal probe of Lincoln Hills is ongoing and two former guards have been notified they could be charged.

To create meaningful change within organizations, Lambach said, Fostering Futures begins with the top tiers of an agency’s appointed managers, winning them over, and then working down through layers of managers and finally percolating down to practices that help individuals or communities. “It’s a system of coaching state employees to deliver human services differently,” Lambach said.

Across Wisconsin, there’s little doubt about the breadth of the trauma epidemic.

“A Time to Heal,” a series of stories last year in the Milwaukee Journal Sentinel, explored entire neighborhoods within Milwaukee where exposure to traumatic experiences is an everyday fact of life. The Journal Sentinel used the same metrics to examine rural communities in Wisconsin, which also have stagnant economies, revealing a growing rural underclass with nearidentical dysfunctional demographic profiles as poor families in Milwaukee.

Public health researchers increasingly see the trauma epidemic as the root cause of such social ills as depression, addiction, unemployment, imprisonment, even suicide and homelessness.

What’s worse, data consistently show that psychological trauma frequently is passed from parent to child, creating a generational cycle that’s avoided only when a resilient person or successful intervention breaks the downward generational spiral.

“The scope of the problem is broad and myriad,” said Cook at the state schools agency.

Even as Fostering Futures and the state-run schools get started on the basics, both programs are playing catch up to the progress in Milwaukee, where clinics, social agencies and university researchers have advanced well beyond theory and basic training.

For over 10 years, trauma-responsive practitioners in Milwaukee have been fine-tuning therapeutic practices that focus on one-on-one healing of invisible post-traumatic wounds. While shades of ambiguity exist in Madison about the definition of trauma-informed care, the meaning in Milwaukee is straightforward: Practices meant to break the generational cycle; programs that assist the developing child as well as the struggling adult.

Both Fostering Futures and the state schools have turned to experts at Milwaukee social agencies. Even so, some practitioners in Milwaukee bristle when they hear an organization claims to be “trauma-informed” because its staffers sat through a workshop. “Talk is cheap,” said Josh Mersky, a professor at the University of Wisconsin-Milwaukee and one of the state’s leading trauma researchers.

Trauma-informed practices never previously made their way into state elections, even though the issue directly impacts bread-and-butter political issues like jobs, schools and poverty. And as a new issue, trauma care doesn’t fit conventional political labels or categories. Unlike roadwork, bridges or funding for the arts, there is no single program or policy that defines “trauma-focused” work.

But the issue already has shaken out in several key areas:

Schools: Educators believe trauma awareness is critical in school, where neurological afflictions are often misdiagnosed and mistreated as attention disorder or disruptive behavior.

In the world of trauma care and resilience, schools have a built-in advantage, at least in theory. Many staterun schools have onsite counselors or therapists, but also teachers and coaches who often play pivotal roles in motivating and guiding students. “Teachers who are trained to recognize the signs and symptoms of trauma will be better equipped to understand the needs of trauma-exposed students,” Mersky wrote.

Schools are also where Evers and Walker have sparred most frequently over spending.

Under nationally recognized norms, also adopted in Wisconsin, 10 percent to 20 percent of students in grade school and high school are expected to need some sort of counseling, therapy or specially trained social workers, according to Cook, who runs the Trauma Sensitive Schools programs.

In 2011, when Walker and his GOP allies pushed for a 5.5 percent across-the-board cut at every public school in the state, many schools chose to cut psychologists and social workers before they cut teachers, according to DPI spokesman Thomas McCarthy. Walker argued that schools could compensate for the cuts by making teachers and school staff pay more for their benefits, to bring them more in line with private sector practices.

Wisconsin already lags behind national standards for its ratios of school-based counselors, therapists and social workers, according to National Association of School Nurses. (Wisconsin schools have an average of one social worker for 1,468 students, compared to a recommended ratio of one to 400; similar figures exist for separate categories of school counselors and school psychologists).

To help remedy the ratios, Evers last year pushed for $7.2 million in additional funding for school mental health services and Walker included it in the budget approved by the Legislature.

In the current election year, however, Walker opened the spending spigots so aggressively that his allies have had difficulty spending all the money. After a gunman with a semiautomatic rifle killed 17 at a high school in Florida in March, Walker unveiled legislation to create a new schools safety agency tasked to disperse $100 million in funds to upgrade physical security in schools and offer mental health training for school staffers.

Rather than allow Evers’ agency to allocate the $100 million in funds — all are earmarked for schools — that task went to a newly created bureaucracy run by the state Department of Justice, where Walker’s fellow Republican, Attorney General Brad Schimel also faces reelection.

To apply, the top-listed prerequisite was that school staff must have a minimum of three hours in “Trauma Informed Care/Trauma Sensitive Schools “training. As he campaigns for re-election, Schimel has been touting his inclusion of trauma-informed requirements in the grants.

When only half the $100 million was disbursed, Evers spoke out, requesting a portion for other mental health needs in state schools. He was turned down.

The budget: Scott Walker helped win approval for $10 Million for the new Sojourner Family Center — a national exemplar of social services concentrated under one roof, meant to heal survivors of domestic abuse and break the generational cycle of violence. The governor’s administration also takes credit for a $29 million increase in mental health spending in the 2013-’15 state budget.

However, other budget practices are criticized by officials in the counties, which are responsible for administering the bulk of Wisconsin’s child welfare, mental health and substance abuse services. The state’s share of funding to county-administered programs come primarily from two sources.

The first is known as community aids and is earmarked specifically for human services. It’s mainly held constant — up some years, down others, according to data from the state Legislative Fiscal Bureau.

The other is called shared revenue and counties have discretion how it’s spent. That slice of the budget pie has shrunk in the years Walker has been in office — collectively for the all counties in the state (down 19 percent from 2011 to 2018) and in Milwaukee County (down 15 percent), according to the Legislative Fiscal Bureau.

But costs to provide services have risen. For years, Milwaukee County’s human services have been streamlining and belt-tightening, according to county budget director Joe Lamers. “Going forward, the amount of efficiencies you can squeeze out gets more challenging every year,” Lamers said.

Evers complains that the tax burden has just been shifted from the state to local communities.

Criminal justice: Nowhere have the discussions over trauma upended the social debate like incarceration.

Trauma data, based on surveys called “adverse childhood experience” questionnaires, are unambiguous — nationally, the criminal justice population is made up almost entirely of people with childhood histories of traumatic violence, neglect and abuse. That makes the prison population Exhibit A for a phenomenon of generational trauma that spreads from parents to children to grandchildren.

Those data go to the heart of one of the great unresolved issues in criminal justice: In order to break the generational cycle, how aggressively should the state pursue alternatives to incarceration? The question continues to split politicians.

Although it’s common among Milwaukee social agencies and clinics to screen clients for trauma exposure, the state doesn’t conduct intake screenings for inmates, meaning it lacks data on its prison population. But a few isolated samples show that 81 percent of women in Wisconsin prisons have mental health problems, the agency said.