The Trauma & Gender (TAG) Project at Connecticut Mental Health Center (CMHC) completed its final “report-out” this month at the Connecticut Women’s Consortium in Hamden, Connecticut. CMHC, along with several mental health organizations throughout the state, has been working for the last two years to further develop its culture of trauma-informed, gender-responsive care.
TAG is a Learning Collaborative project sponsored by the Department of Mental Health & Addiction Services (DMHAS) and the Women’s Consortium.
TAG is considered best practice, but mental health systems in general were not designed with trauma and gender sensitivity in mind. The Learning Collaborative program helped agencies increase their capacity to work effectively across five domains: safety, choice, trustworthiness, collaboration, and empowerment. (Read an earlier article on CMHC’s trauma-informed care efforts.)
Ed Renaud, PhD, CMHC’s associate director of clinical services and co-chair of the TAG Committee, led the report-out in collaboration with co-chair Jessica Pollard, PhD and other committee members.
Communication Tools
Culture development, central to the TAG initiative, takes many forms. At CMHC, communication was a major focus. Accomplishments include “TAG Tags,” which identify the values of safety, empowerment, choice, collaboration and trust on small cards for staff to wear along with their ID’s; “Safe Zone” stickers for desks and bulletin boards, indicating an LGBTQ-safe environment; and a “TAG 101” reference card capturing the basics: what trauma is, how it manifests itself in people’s lives and relationships, and strategies for fostering recovery and resilience in ourselves and others.
“Our Promise to You” posters were hung in all acute services triage rooms, Wellness Center primary care exam rooms, and outpatient waiting areas. The posters outline the basics of trauma and let people know that healing is possible. The Substance Abuse Mental Health Services Administration (SAMHSA) created these posters in collaboration with integrated care grantees (PBHCI) across the country, including committee member Rebecca A. Miller, PhD, director of peer services at CMHC.
Also within the building, corner mirrors were mounted in hallways and new directional signage installed. A “safe corner” on the outpatient floor now provides a semi-private, quiet space for clients and staff to meet outside of offices.
TAG Talks
One of the most visible aspects of the TAG Project at CMHC has been the monthly “TAG Talks,” presentations about aspects of trauma, gender, and clinical care. TAG Talks, open to clients, staff, and the general public, began over one year ago and will continue throughout 2016. Dr. Pollard, TAG Talk organizer, said the talks are given by invited guests from within and outside of CMHC and always include plenty of time for audience questions and discussions.
At the report-out, a social worker from Columbus House enthusiastically described attending a TAG Talk at CMHC, “Introduction to Serving the Transgender Community,” with his fellow staff members. Columbus House, a New Haven-based shelter and housing agency within the Community Services Network, has its own TAG initiative that includes developing policies on “how to best serve transgender individuals with their safety in mind.”
Sharing Stories
TAG principles have been incorporated into orientations for all new staff, including medical residents and pre-doctoral psychology fellows who come to CMHC to complete their graduate and post-graduate training.
In addition, “Recovery Talks” began on the inpatient unit, with recovery support specialists and other staff members sharing stories about their own recovery.
“We found there was a need for additional involvement of peer staff on the inpatient unit,” said Dr. Rebecca Miller. “Often, it’s helpful to hear a personal story of recovery. Our team has also learned a lot from staff members’ questions about recovery.”
Another TAG innovation: the regularly scheduled “Peer Panel” in which clients and peer support specialists share their perspectives on care in front of an audience of staff members and trainees during new staff orientation. Brought to CMHC by consultant David Howe, LCSW who initiated the program at Connecticut Valley Hospital, the panels have been a great addition to the orientation program.
“They talk about what has been helpful to them and what has not been helpful,” says Dr. Miller. “It’s been a huge success.” She and Howe presented about peer panels at the recent IPS: Mental Health Services Conference (read more about that here).
Gender
TAG will continue to transform our culture in a meaningful, enduring way.
Michael J. Sernyak, MD
“Gender has been more difficult for us than trauma,” said Dr. Renaud, “partly because it’s a lived experience and different for everyone.”
“Your experience is very common,” noted Stephanie Covington, PhD, LCSW at the report-out. Dr. Covington, senior consultant to the TAG initiative, leads trainings in trauma and gender practices throughout the United States. “Most people can pick up trauma fairly quickly," she said, "but gender is more difficult, in part because it’s so embedded in our culture that we can’t see it.”
CMHC experimented with a few innovations in the area of gender responsiveness, including a six-week Men’s Trauma group offered in the fall of 2015 using Dr. Covington’s curriculum.
“The guys really opened up,” observed Ed Smith, peer support specialist who co-led the group with David Howe and spoke at the report-out. “I had trauma myself, and I know that it’s hard for men to speak their minds. The guys feel safe. They feel comfortable talking about their problems. It’s a great program and I think we need to keep it going.”
Beginning this winter: a new Women’s Dialectical Behavior Therapy (DBT) Group.
Survey Data
The TAG committee conducted staff and client surveys in 2014 and 2015. The most recent staff survey results showed small improvements across all TAG domains, statistically significant when compared to 2014 survey results. “We’re making a difference,” said Dr. Renaud. “This kind of culture development is at least a five-year process. We still have work to do, but I think the data shows we are moving in the right direction.”
The latest client survey data showed no statistical change from 2014, pointing out a future area of focus.
Trust and Empowerment
CMHC is also working to improve levels of transparency and trust across various employee groups—senior leadership, clinical, and other staff. Committee members wrote draft organizational policies around trauma and gender, to be reviewed by senior leadership. Dr. Renaud said that in response to staff survey data, the committee continues to explore how to improve staff clinical supervision.
They have provided staff training and education including “The Good Psychiatric Management of Borderline Personality Disorder” with John Gunderson, MD and workshops for CMHC Wellness Center staff on recovery, person-centered care, and TAG.
In response to clients’ call for more skill-based groups, several new offerings have emerged: Hard of Hearing Movie Group, Better Eater’s Club, Emotional Eating, and a Women’s Fitness Group.
Conclusion
While the formal two-year TAG initiative has ended, the work and excitement continue. At the report-out, Dr. Renaud thanked the consultants at the Women’s Consortium as well as the people of CMHC for their support in making TAG “a living, breathing, continuing enterprise within our organization.”
Michael Sernyak, MD, CEO of CMHC, attended the report-out. He said the TAG Project has given the CMHC community an important opportunity to think deeply about many of its practices, values, and ideals.
“We’re now undergoing a redesign of our outpatient services, and many of our TAG action items will become part of that process,” he noted. “TAG will continue to transform our culture in a meaningful, enduring way.”