My name is Rebekah Couch and I am a former teen mother of five children, the youngest child being my only clean and sober pregnancy allowed to remain in my care. I am a survivor of multiple sexual assaults and was afflicted with untreated mental health issues as an adolescent. My destructive journey began with self-medicating and illegal activities in junior high and a daily cocaine addiction by the age of 15 that eventually advanced to methamphetamine abuse. My addiction and criminal activity persisted for 18 years, until finally embracing sobriety in December 2007.
I have first-hand experience as a dual-diagnosis, un-cooperative and contentious client of Sacramento health care systems, CPS Family Court, DHS office and Sacramento County Probation Department.
Over the past nine years, I have re-established healthy relationships with my first four children, continuously participated in the rearing of my eight-year-old, created a solid foundation of recovery, received training and experience working with high-risk mothers. Currently I am the case manager of Bishop Gallegos Maternity Home (a homeless shelter for pregnant women in Sacramento), a contract speaker for Yolo County Foster Kinship Care Education, a volunteer liaison for Family HUI Mainland, and the most recent member of the California Child Welfare Council Prevention and Early Intervention Committee.
It has been my pleasure to serve and effect change in different capacities throughout the community. I am humbled and honored to provide my perspective to anyone interested. I have compiled some basic client related barriers to trauma informed care as well as barriers I feel are more systematic related.
Barriers to Trauma Informed Care: From a Client’s Perspective
Barriers With Fairly Simple Solutions:
- Clients are not forthright or willing / lack of trust with professionals/ cultural barriers:
Solution: Remain respectful, learn to communicate in the style your client understands. Regardless of personal opinion, do not indicate judgement. Adapt simple intake interview questions at initial meeting: Have you been a victim of domestic violence in the last 60 days? Any history of substance abuse in your lifetime? Have you ever been in the foster system? Any history of sexual assault? These questions lack judgement and reveal tremendous insight.
- Lack of social support AND lack of trauma-informed parenting skills for birth families. During the arduous task of detoxing from methamphetamine addiction, neurotransmitters within the brain require 12-18 months of substance-related abstinence to re-establish A & B cell communication. Generally, in the state of California, CPS Family Court Reunification services max out at 18 months. Assuming a parent has been successful at completing reunification requirements (parenting classes/counseling/etc.), most of the information will not be fully retained. When familial reunification happens and the children begin to dysregulate as they heal, parents misinterpret the behavior, have no healthy peer or family support and become overwhelmed, adding to the percentages of repeated cases.
Solution: Execute parent peer groups within high risk communities. Implementing Family HUI curriculum would be incredibly successful among our target populations, and enables parents to create a new network of like-minded friends.
- Lack of income, literacy, transportation:
Solution: providing resources for and funding, or adding case plan requirements to eligible clients for participation in work programs that prepare them to succeed personally, professionally and ultimately obtain financial independence. Women’s Empowerment, Sacramento, CA, is a great model
- Lack of empathy or “relate-ability” from social workers, stereotypes and lack of personal experience with the client’s “recovery” process:
Solution: Professionals who have not healed from personal adversity will be ineffective working with traumatized clients. Anyone working directly with high-risk or traumatized persons should complete a 12-step process, attend several sex-traffic victim group meetings, spend a couple of days using only public transportation, present yourself professionally or publicly without bathing for two to three days, have an eight-year-old fill out a mock Cal Works application and get a feel for how difficult it is to do paperwork (or navigate online) with an elementary school education, sit through a four-hour class or presentation with flu-like symptoms, visit a VA hospital and understand how PTSD presents, go through an entire month using only $339 for expenses and $196 for food. FIND A WAY TO RELATE TO YOUR CLIENT! (Over-achievers should do all of the above at the same time!)
Systematic Barriers: More Difficult Solutions
- Medicaid coverage limitations and delayed benefits (county transfers, referrals):
Solution: A specific contact (perhaps office of ombudsman?) with the sole purpose and authority to expedite county transfers for clients with pre-existing, chronic health conditions or pregnancies without previous prenatal care.
- No existing in-patient rehabilitation facilities inclusive of families. All rehabs are gender- or age-specific and families are divided, parent receives treatment individually:
Solution: Start dialog and petitions at the state level. (There are unused state funds that could potentially cover a project like this.)
Other Noted Barriers
- Lack of inter-agency communication to refer and expedite services for high-risk families (i.e. paper referrals are faxed with questionnaire completed, no follow up phone contact to elaborate on emergency need or familiarizing receiving agency of important case information)
- Overloaded workers (medical, county, etc.):
- Six- to eight-week delay for GMC Access Mental Health services:
- Barriers for developmental/behavioral disability assessments:
- Lack of licensed marriage and family therapists (LMFT) willing to accept Medicaid for long-term family counseling during and after the re-unification process:
I am fully aware that there are other unresolved barriers and am grateful for any opportunity to discuss solutions or contribute my insight for problem-solving. As a former high-risk client, I am excited that trauma-informed care best practices is now a topic on the table of policy makers and state legislatures. We cannot effect positive change without those in power acknowledging that change needs to occur.
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