Here in California, many people think that it’s only liberal Democrats who have a corner on championing the science of adverse childhood experiences (ACEs) and putting it into practice. That might be because people who use ACEs science don’t expel or suspend students, even if they’re throwing chairs and hurling expletives at the teacher. They ask "What happened to you?" rather than "What's wrong with you?" as a frame when they create juvenile detention centers where kids don’t fight, reduce visits to emergency departments and shrink teen pregnancy rates….among many other things.

Because they do all this and more by abandoning the notion of trying to change people’s behavior by punishing, blaming or shaming them, and instead using understanding, nurturing and healing, some people might think this approach belongs to the purview of one political party.

Mmmmmm….Not so fast.

To paraphrase Tonette Walker, the First Lady of Wisconsin, married to Republican Governor Scott Walker, who was a GOP presidential candidate in 2016:

That’s ridiculous.

Her exact words were: “It’s ridiculous that people say this is a Democratic or Republican issue. We all care about issues concerning families and children. We all care about the outcome of people’s lives, no matter who you are.”

In fact, many residents of Wisconsin might think that it’s only conservative Republicans who have a corner on championing ACEs science. That’s because the state — and Tonette Walker — have some serious bragging rights about how they’ve implemented trauma-informed practices based on ACEs science. Since 2012, 43 counties and three tribes have participated in the Wisconsin Trauma Project, as shown in this project map, list of project sites, and an interactive map. Here are some examples of the results: 

• The Menominee Indian Tribe of Wisconsin has become the “poster tribe,” according to U.S. Senator Heidi Heitkamp (D-ND), in educating and integrating practices based on ACEs science. Hundreds of tribal members have been educated about ACEs science, starting with historical trauma. The schools have integrated trauma-informed practices with the result that graduation rates soared from 60 to 99 percent.
  
  
• After all staff members of the Waupaca County Department of Health and Human Services learned about ACEs science and the Child Welfare department started becoming trauma-informed, workers’ burnout rates dropped 23 percent and secondary traumatic stress rates dropped 42 percent over three years. In addition, the number of children placed outside the home dropped 15%, and kinship placements increased.
  
  
• In January 2014 the Wisconsin legislature was the first in the U.S. to pass a joint resolution addressing early adversity and noted the “role of early intervention and investment in early childhood years as important strategies to achieve a lasting foundation for a more prosperous and sustainable state through investing in human capital.”
  
  

There are other states where Republican governors are helping lead or are supporting ACEs initiatives —Tennessee, Utah, and Vermont come to mind. And there are states with Democratic governors that have robust ACEs initiatives in their cities, counties, regions and sectors such as education: California, Washington, Oregon, Montana, New York, Massachusetts.

But the focus of this article is on what no other state is doing: In 2016, Wisconsin Gov. Walker directed seven state agencies to learn about ACEs science and to implement practices based on that science for their own workforces. His and his wife’s goal: To make Wisconsin the first trauma-informed state in the U.S.

To people who don’t know much about ACEs science, jargon such as “trauma-informed” or “resilience-building” sounds like so much gobbledygook…a waste of time. But there’s enough evidence from the early adopters to show that people ignore this at their peril. There’s the 50% plus drop in births to teen mothers. The 98% drop in youth suicide and suicide attempts. A 90% drop in school suspensions, and the elimination of school expulsions. Over one year, zero violent incidents in a juvenile detention facility. After a year involvement in Safe Babies Courts, 99% of kids no longer suffer abuse. A 30% drop in emergency department visits. At an organization that implemented trauma-informed practices throughout its workforce, a 5% drop in health insurance rates. Radical cost savings for state and local governments.

To fuel what now seems like an unstoppable ACEs movement In Wisconsin, it took a combination of the right people in the right place at the right time, their indefatigable determination and unstinting optimism that they could use this new knowledge of human behavior to solve their most intractable problems, and, well…perhaps a little pillow talk.

Why are we here? Why are we doing this?

On April 5, 2016, when about 60 people from seven state agencies sat down and heard that they were joining a two-year trauma-informed learning community, their first reaction was: What in the world does this have to do with us?

Most knew nothing about the science of adverse childhood experiences. But they were intrigued about how they might become part of the organized ACEs movement that had been spreading rapidly across Wisconsin since 2007, when people first started talking about this new knowledge of human behavior that could, well, change everything.

ACEs, or adverse childhood experiences, was a phrase coined during the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), whose first results were published in 1998. The study looked at how 10 types of childhood trauma affect long-term health. They include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused.

Subsequent ACE surveys include racism, witnessing violence outside the home, bullying, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver or extended family member being abused, involvement with the criminal justice system, attending a school that enforces a zero-tolerance discipline policy, etc.

The ACE Study is one of five parts of ACEs science, which also includes how toxic stress from ACEs damage children’s developing brains; how toxic stress from ACEs affects health; and how it can affect our genes and be passed from one generation to another (epigenetics); and resilience research, which shows the brain is plastic and the body wants to heal. Resilience research focuses on what happens when individuals, organizations and systems integrate trauma-informed and resilience-building practices, for example in education and in the family court system.

The ACE Study found that the higher someone’s ACE score – the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and a bunch of other consequences. The study found that most people (64%) have at least one ACE; 12% of the population has an ACE score of 4. Having an ACE score of 4 nearly doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1200 percent. (For more information, go to ACEs Science 101. To calculate your ACE and resilience scores, go to: Got Your ACE Score?)

Wisconsin did its first ACE survey in 2010, followed by three more in 2011, 2012, and 2013. The surveys found that 58 percent of Wisconsin adults have at least one ACE; 14% have four or more.

Pioneers in the ACEs movement, such as Elizabeth Hudson, now director of the Wisconsin Office of Children’s Mental Health, learned about ACEs in early 2000 while working at a Wisconsin sexual assault service agency. 

“I had been using the science of trauma to train law enforcement on how to be more effective in interviewing and interacting with survivors,” she recalls. “During this time, a sexual assault nurse examiner forwarded me the Kaiser Permanente newsletter with the ACE Study and I realized the extraordinary shift in consciousness that would be possible – that people would no longer be able to relegate trauma to an emotional response that people expected survivors to ‘just get over it’. Introducing the biological impact would lead people to better understand the potential life-long impact of events.” 

When the opportunity to share this information across Wisconsin as the state’s first trauma-informed care consultant became available in 2007, she jumped at the chance. And she told everyone she talked with about how this new understanding of human behavior could change everything.  

And, now the state seems to be at a turning point, if not a tipping point. And that's mostly due to Tonette Walker.

After Scott Walker’s gubernatorial inauguration in January 2011, Laurie Gramling Lambach, president and CEO of SET (serve, empower, transform) Ministry, a human services organization in Milwaukee, WI, and who has been friends with Tonette Walker for decades, asked her: “What’s your initiative going to be?” Every First Lady has one. Although Walker was deeply interested in the needs of Wisconsin’s foster children, she hadn’t decided.

Lambach introduced her to Dr. Angela Carron, a pediatrician and executive director of the Fostering Hope Foundation. Carron introduced Walker to ACEs, says Lambach.

“Just seeing the brain science of ACEs was all new to me,” says Walker. “When I heard about it for the first time, I thought: Is this true? Is this right? Could this be why children have problems in school, why adults can’t hold jobs, why some people are stuck in the cycle of welfare their entire lives? It’s trite to say, but the light bulb went on….it was just at that moment.”

In April 2011 Walker founded Fostering Futures with Lambach and Carron. Her initiative was to educate everyone and every organization in Wisconsin about ACEs science and encourage and support them to translate that science into practice to reduce the impact of childhood adversity and improve the well-being of Wisconsin's children, parents and families. Specifically to:

• Form a trauma-informed coalition to advance a movement in Wisconsin;
• Increase awareness of health literacy about ACEs, the effects of toxic stress, trauma-informed care, and resiliency;
• Offer methods of best practice for communities to use;
• Stimulate the creation of policies that advance trauma-informed care in Wisconsin.

In phase one of the initiative, three pilot communities were chosen to teach people across sectors about ACEs science and to support them to start developing approaches to integrate trauma-informed and resilience-building practices. The three communities were: one urban (Milwaukee’s Harambee neighborhood), one rural (Douglas County), and one tribal community, the Menominee Nation. The Menominee Nation was by far the most successful in integrating ACEs science, and the experiences in the other communities provided useful information about how to engage – and how not to engage communities.

At the same time, the Wisconsin Department of Children and Families (WDCF) set up the Wisconsin Trauma Project, in which 43 counties and three tribes have participated. The project provides training for caregivers in trauma-informed parenting, for mental health clinicians in trauma-focused cognitive behavioral therapy for children, and for county and tribal systems change. Last year, the Wisconsin Trauma Project and Fostering Futures formed a collaborative.

Although the phase one pilot revealed encouraging results, the Fostering Futures team also recognized something significant about ACEs science: that “this was a nonpartisan issue in politically challenging times,” said Elizabeth Hudson.

Referring to an effort to recall Scott Walker in 2012....after he signed an anti-union law in 2011....that had furious union workers occupying the state capitol for weeks....as “challenging times” is a pretty good example of the word “understatement”. Nevertheless, that people from different political persuasions have continued to work together on integrating ACEs science in Wisconsin is a pretty clear indication that ACEs science is apolitical and acultural. How it’s implemented might become political; but, in itself, ACEs science is about how toxic stress harms humans and affects their behavior. And no matter where they live on the planet, humans suffer the same consequences when they experience ACEs: Toxic stress from ACEs damages children’s developing brains and puts such stress on a person's immune system that, without intervention, it leads to a cascade of health problems that appear decades later.

The Fostering Futures team forged ahead with phase two. In January 2016, Tonette Walker addressed the governor’s Cabinet to personally deliver an invitation to state agencies to join a two-year Fostering Futures learning collaborative guided by the National Council for Behavioral Health, which had been running trauma-informed learning communities across the U.S. for six years. Walker’s husband surprised everyone when he directed several agencies to participate and announced that Wisconsin was going to become the first trauma-informed state in the nation.

One interesting aspect about the way the governor directed the agencies to participate is that there was nothing in writing, says Lambach. After the Cabinet meeting, the Fostering Futures team met with each of the agency secretaries, who "were delighted to have been chosen," to participate in the project, says Lambach. "We were welcomed everywhere with kind words, photographers, small gifts and refreshments. So essentially it was handled within the context of relationships, as is the best trauma-informed work."

(As part of phase two, 14 county human service organizations in the Fostering Futures-Wisconsin Trauma Project collaborative also started a two-year learning community, and met as a separate cohort with a slightly different approach. I’ll be doing a separate story about them later.)

So, that’s why, at 8:30 a.m. on April 5, 2016, teams from the Department of Health Services Division of Public Health, the Department of Health Services Children’s Long-Term Supports, the Wisconsin Economic Development Corporation, the Department of Corrections, the Department of Children and Families, the Department of Veterans Affairs, and the Department of Workforce Development sat down to learn about ACEs science and how they could use it to build a trauma-informed workforce. The Department of Public Instruction, whose superintendent is elected and not under the governor’s jurisdiction, was invited, but declined to participate because it has its own trauma-sensitive schools initiative underway.

“Many of these people were hearing this ACEs and trauma information for the first time,” Lambach said a few days after the first meeting. “They were able to connect dots more deeply and more quickly than we had hoped.”

Although it was much easier for the meeting participants to project the need for using ACEs science onto the people they supervise or oversee, she explained, the Fostering Futures leaders impressed upon the participants that this project was not about the agencies trying to transform counties or nursing homes or jails.

“These state departments are looking at themselves. This is a transformation of the system itself,” she said.

But it was a transformation that none of them understood.

Stumbling along, finding their way, with some early surprising outcomes

Indeed, none of the teams had a clue about how to proceed.

They did know they had to meet regularly. They knew that they had homework assignments and coaching calls with their advisors from the National Council, and that they would all get together again in six months to report on their progress, or lack of it. They knew what their first chore was: to establish a vision for the outcomes of their work.

Here are the stories of four state agencies’ experiences:

Wisconsin Economic Development Corporation (WEDC), 113 employees

For Anne Jesko, WEDC vice president of human resources, ACEs science was “eye-opening”. Before joining WEDC, she’d worked at Home Depot, which “has a strong focus on servant leadership,” she explains. “The CEO is at the bottom of the organizational pyramid; customers and employees are at the top.”

She learned that the practices that she’d used at Home Depot weren’t just “a nice thing to do — there was science that supported them.” Still, she realized that some of the experiences the employees had with customers would have played out better if they’d known about ACEs science.

“Some of us were causing our own problems,” she recalls. In addition, knowing how to integrate trauma-informed practices based on ACEs science “would have been more beneficial in our recruiting and retention efforts.”

Nevertheless, it took Jesko and her trauma team a while to figure out “how make this something that our people care about,” she says. “We immediately got that this was great for direct service organizations, like the Department of Children and Families, who are dealing with families going through traumatic experiences. For us, we’re not dealing with that population. Our customers are not experiencing those things, and they weren’t going to tell us if they are because that’s not what they’re here for.”

After training their entire staff on ACEs science and trauma-informed practices, they decided to provide their employees with information every month on different aspects of trauma-informed practices. One month, they addressed work-life balance; another month, they looked at how organizations create a physically and emotionally safe place for employees; earlier this summer, they looked at the topics of human rights and child abuse prevention. For each topic, they post articles in their newsletter, and tips and tricks on posters in their lunchroom and posts in their internal social network.

“We’ve really gotten great feedback from staff,” says Jesko. “We’re seeing a difference in our day-to-day interactions,” including managers asking their employees “What happened to you?” instead of “What’s wrong with you?” when it’s clear they’re having difficulty doing their work. Managers help their staff with rehabilitation services, leaves-of-absences or whatever they need to heal and return to their jobs.

In one example, a staff member who evaluates requests for grants to new businesses had a person call him about getting funding for an environmental business. Now, Wisconsin happens to be saturated with that type of company, and the staff member knew that. But in talking with the person, he realized that he probably had a high ACE score. Instead of delivering an abrupt “No”, the staff member helped the person think through how to approach his ideas for a business from another angle.

As he told Jesko later: “I helped him in a different way. There was an opportunity to connect, and be that ear for this individual.” He didn't give him a grant, but he still helped him, and the staff member said he took that approach because of the ACEs science training.

Jesko and her team are also looking at their policies through a trauma-informed lens. For example, the bereavement policy required documentation if an employee attended a funeral.

“That’s awful,” says Jesko. “What are they supposed to bring back? That language just feels yucky. It creates an adversarial relationship, and it’s just not needed.”

This approach of “leading with empathy” has resulted in a drastic reduction in the number of people quitting their jobs. WEDC’s voluntary attrition rate dropped from 21 percent in 2015 to just 3 percent in 2016. Jesko attributes the drastic reduction to trauma-informed practices and to the support of Mark Hogan, WEDC’s CEO. He’d also come from an environment that used servant leadership, says Jesko, and made it clear that it’s just good business to treat people in a way in which they feel respected.

Still, Jesko says what they’ve done is only a start.

“Although our staff are familiar with ACEs and trauma-informed practices, and can see and feel the difference,” she says, “in no way do we think that we have this figured out.” 

Department of Children and Families (DCF), about 800 employees

“What hit me right away was how powerful the science is,” says Fredi-Ellen Bove, administrator of the DCF Division of Safety and Performance, who leads the DCF trauma team. “A lot of the concepts are of sort of intuitive if you’ve had hardships.”

Still there was a learning curve, she says. “Most of our agency does not do direct service. So, it was challenging for all of us to think about how it related to us,” she explains. “But once we emphasized that this applies to how staff relate to staff, the light bulb clicked on a little bit more. For example, people in accounting said, ‘Now I get it.’”

And since the Wisconsin ACE surveys show that most of the state’s residents have at least one ACE, and 14% have four or more, “it started people thinking that there was some relevance here — we’re a community and we want to interact with each other with trauma-informed principles,” she says.

The team that Bove leads comprises 12 people from different positions — staff and management — from DCF’s five divisions. The first decision they made was to give the entire DCF staff a half-day training about ACEs science and trauma-informed practices. They also invited anyone who was interested to become a trauma guide to be actively involved in advancing the department’s trauma-informed efforts. About 45 people signed up from across DCF.

The team distributed a department-wide survey for employees to rate how the DCF work environment stacked up against trauma-informed principles such as empower staff and clients, and transparency in communications. (For more information about trauma-informed practices, see Concept of Trauma and Guidance for a Trauma-Informed Approach, put together by the U.S. Substance Abuse and Mental Health Services Administration.) They tabulated the results and invited staff members to meetings where they offered ideas to put ACEs science into action.

“That generated a whole host of ideas,” says Bove. In April, the trauma team, the trauma guides, and DCF leaders talked through all the ideas that had been generated, and then every program in every division made a commitment to implement changes.

The changes include adding interview questions for new job applicants to put more emphasis on recruiting people who share trauma-informed values or who want to learn about ACEs science; providing ACEs science training to all new employees; designing space to create a trauma-informed physical environment in a new building the department is moving into — for example, making sure there are private spaces for people to deescalate if they need to; improving transparency; increasing wellness.

“Our plan is to have a department-wide meeting at the end of the year to celebrate what we’ve accomplished over the last year,” says Bove.

They’re also changing the forms that parents fill out when their children are removed from their homes for safety reasons.

“We found some language was very offensive,” explains Bove. “It essentially was worded to say that ‘you are incompetent to take care of your children, you’re a horrible parent, so you agree to have your child to be with another family’. We’re looking at the policies and language to make the forms more trauma-informed, more respectful, and to make sure that we’re engaging the parents so that they understand.”

Bove also emphasized that they’re still learning, and that they have a long way to go. And she recognizes that not all of the 800+ employees are enthusiastic about ACEs science and trauma-informed practices.

“We’re showing the pattern of what implementation science talks about: a bell-shaped curve where at one end there are really enthusiastic people — the trauma guides and the trauma team. Then we have a lot of people in the middle who think it’s interesting, but don’t know exactly what it is. And then there are the people who are resistant, mostly because they see it as just one more initiative. 

“The challenge will be a year from now, to make sure it doesn’t become a been-there-done-that initiative,” she continues. “We have to consider that in the future, we may have different leadership. So, our question becomes: How do we institutionalize that leadership commitment as well?” 

Department of Corrections (DOC), 10,000 employees, 23,000 inmates in 36 facilities, 68,000 probationers

“This initiative came at the best time for us,” says Cathy Jess, a 30-year veteran of the corrections system who became DOC deputy secretary in March 2016. “We had been implementing it (trauma-informed practices) in the juvenile system. And then we had the setback.”

The setback to which Jess refers is an ongoing investigation into accusations that youth in Lincoln Hills School for Boys and Copper Lake School for Girls were attacked and sexually abused by staff and other offenders. These accusations came to light as the institutions were implementing trauma-informed practices based on ACEs science; early results showed a 50% drop in incidents that resulted in youth being placed in solitary confinement.

Corrections union officials said the trauma-informed approach led to security breakdowns; those advocating for the trauma-informed approach said it had not been fully implemented. One of the report’s lessons learned says that because only a portion of the staff had been trained, there was a “considerable amount of misunderstanding and misinformation”.

Although the Wisconsin Department of Corrections had also started a trauma-informed group for incarcerated women at a small mental health unit it manages at a women’s prison, it seemed as if expansion of trauma-informed practices wasn’t in the cards. But with Walker’s directive, figuring out ways to integrate trauma-informed practices was back on the table.

“We decided to approach this as a cultural change,” says Jess. “First we’ll look at how we deal with each other and then the clients we serve.” They’re tackling workforce development first — specifically how to help staff understand how they experience trauma, either directly, secondarily or vicariously, and how that affects their work.

They began by providing a six-hour training for the DOC executive staff to obtain the leaders’ buy-in. For other staff, they’re providing training about trauma-informed practices for those who are interested; it’s not mandatory. And they’re putting information about ACEs science and trauma-informed practices in a wellness newsletter and on their intranet. They’ve sent 30 employees to a four-hour train-the-trainer workshop — “How Being Trauma-Informed Improves Criminal Justice System Responses” — put on by SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation. The workshop is geared toward law enforcement and criminal justice personnel. A team comprising people from several parts of DOC is rewriting job descriptions to include trauma-informed language.

“We’ll be developing an online course geared to corrections,” says Jess. “Something that gets traction, so that people don’t think this is a fad or it’s going away.”

Most of the DOC leadership is on board, says Jess. The juvenile corrections division has already added four hours of ACEs science to training for youth counselors. The trauma team wants to institute a wellness initiative and put peer-support staff trained in trauma-informed practices in all institutions, to teach their co-workers how to use trauma-informed practices to create a less stressful environment.

“We’re hoping that takes hold,” she says. Healthier employees can create a safer environment and better outcomes in dealing with offenders, she notes. People who are trauma-informed have a better understanding of their own and inmates’ responses to stress, and can diffuse situations before they become violent.

When Jess first learned about ACEs science, she says, “it was like: Oh, this makes sense. It explains some things. It’s a different way of looking at people. Trauma-informed care means approaching people with humanity. Asking what’s happened to them. Taking their life experiences into consideration when you’re working with them.

“This is a culture shift,” she reiterates. “Our goal is to reduce our incidence of staff getting hurt, to change the way we treat other people — coworkers or offenders — to prevent escalation. It’s putting the human back into human services. In my opinion, the custody piece of corrections is not all about guns and gas; 99.9 percent of the job is how we treat each other. This will make a big difference.”

Wisconsin Department of Health Services (WDHS) Division of Public Health (DPH), 450 employees

Karen McKeown, state health officer and administrator of the WDHS Division of Public Health, came into the two-year learning community already knowing about ACEs science from previous work in public health.

“I am very blessed to have grown up without any ACEs,” she says. “But I have a close friend who has. When I read about it, her face was in front of me. It just hit me about how well she’s done, and helped me understand the areas where she may still struggle.”

But the department doesn’t provide direct services, so even though McKeown

was leading a team that was passionate about ACEs science, and understood that they needed to think about treating the workforce differently, they didn’t have a clear idea about how to do that.

“We learned from another organization that the first step was awareness,” recalls McKeown. “That’s something we knew we could definitely do. Some of our team put together a really good ACEs presentation. After three pilot cycles, it was good enough that we required all staff to attend a presentation — 450 people. By the end of last year, we had trained all 450.” Most people loved learning about ACEs science, because they said it helped them understand their colleagues better, and they wanted more information about how to integrate trauma-informed practices. But there were a few bumps in the road.

At first, they put an ACEs survey in front of every person attending the presentation and asked them to fill it out. But when a few people started crying, they decided to let people calculate their ACE score after they heard the presentation. They also started offering trigger warnings before people attended a presentation; at the beginning, they told attendees that it was fine if they wanted to step out of the room at any time. They decided that social workers were probably best equipped to lead the presentations because they could provide solid support for anyone who wanted to talk afterwards.

“But we still didn’t know what the next steps would be,” says McKeown. So, in true trauma-informed fashion, they decided to ask the employees.

The team members held two brown-bag lunch meetings, they sent an anonymous survey to all employees, and team members who weren’t supervisors held open office hours for employees who wanted to talk one-on-one. Through those three methods, 200 employees said what they wanted: Basically, to learn more, to change practices and policies, and to know what worked and what didn’t.

So, this is what DPH has slated for year two of the learning community:

1. Training. All new staff receive the same ACEs science and trauma-informed training. They’re planning to train more trainers to meet the demand. For existing employees who want to learn more, they put together a curriculum comprising a matrix of classes. Everybody has to take one class. If an employee takes two, they’re given a Fostering Futures certificate of completion.
2. Resources. They’re setting up an intranet page that has additional resources. They are also developing a supervisor toolkit that will include a menu of tips and tricks for handling difficult situations, such as a death in the family or the death of a colleague.
3. Qualitative interviews. These will help the department figure out subsequent steps in their evolution of becoming a trauma-informed state agency.
4. Policies. They plan to review them with a trauma-informed lens. This includes asking job applicants at least one question about soft skills, and integrating information about trauma-informed practices in the employee assistance program.
5. Evaluation. “If we’re successful, how would we know?” asks McKeown. “That’s not an easy question. The two long-term results that are hard to measure are: Do we have a trauma-informed, resilient workforce? and Are we engaging the rest of the world in trauma-informed way? We plan to develop a burnout scale for the first, and a customer satisfaction scale for the second.”
   
   

The trauma team also wants to roll out a resilience initiative, and has designated a person to figure out how resilience practices can be incorporated into the workforce and the organization.

McKeown says that throughout the process, senior leadership was on board, and for the most part, members of the DPH staff weren’t opposed to participating in the learning community; their main concern was that they didn’t know what it was, and what it meant for them.

But there were still people in the organization who weren’t enthusiastic. One person, who was very angry about actions the department had taken, expressed her concerns at a feedback session, McKeown says. After she finished, one of the other staff members asked: “So, do you think we should stop?” And the person responded: “No. I think we should keep going.”

“Even somebody angry enough to do that still wants this process to move forward,” says McKeown. “It’s hard, working in a state agency; it’s a political environment. And that’s one of the challenges throughout this: How do you navigate those waters? How do you move forward when not everyone agrees on the direction the state is taking?”

Year Two Surprise: Everyone’s still in

At the beginning of the second year of the learning community, Fostering Futures hosted another meeting with all the teams.

“We had allowed for loss,” says Laurie Lambach, “but 100% of the state agency teams are still with us and moving into year two. This exceeds our expectations. But success looks quite a bit different over these teams. For some, just being together and meeting is an accomplishment, because there has been much turnover.”

She thinks another year will pass before the teams are ready “to start creating ripple effect in their respective communities. Changing the culture of government has been challenging, from seeing itself at the top of the pyramid, to serving and supporting the process” of what happens in local communities, says Lambach. One indication of that perspective is that most of the state agencies did not achieve one of the goals set by Fostering Futures: to involve their consumers or clients.

“Some teams are very good at it,” says Lambach. “Other teams have not been able to do it yet. Corrections is one that’s a leader.” They have a person who was once incarcerated as a full and active member of their team, she notes.

In this second year, which ends in April 2018, the Fostering Futures team hopes that the agencies integrate enough awareness and change that the process will continue.

“The state agencies have started where it makes sense to start, by educating their employees around ACEs science and resiliency,” says Carol Howard, director of Fostering Futures. “Depending on the organization, they spent some time looking at their procedures through a trauma-informed lens. Some agencies will take longer than others. The Department of Corrections has close to 10,000 employees; that’s not a small thing to change. But they’re all creating systems that start to infuse this new knowledge.

“This is not a journey with a final destination and, boom, you’re done,” she continues. “This movement is gaining momentum. I would be stunned if it fizzled away.” ACEs science isn’t “something you can unlearn,” she says. “Once it’s there, it’s there.”

Now that the teams have figured out the training that works best for them, Fostering Futures is taking off the water wings and developing its own methodology and approach that they think works best in Wisconsin. They’ll launch a new group of state agency and county agency teams in January 2018, and will provide Wisconsin coaches for more hands-on support. In January 2019, they anticipate being able to offer their services to other states.

The First Spouses meeting

“What we’ve done so far has exceeded my expectations,” says Tonette Walker. “It’s amazing how far we’ve come in five years. There isn’t a pocket in Wisconsin where we don’t hear about trauma-informed practices and ACEs. We know what works now, and we want it to work. But most important, it means that we’re treating people with people a little more dignity and respect.”

Word of Wisconsin’s work has reached some national ears. In June, Walker met with Secretary of Health and Human Services Tom Price, Department of Labor Secretary Alex Acosta, Housing and Urban Development Secretary Ben Carson, Department of Education Secretary Betsy DeVos, and with staff at the Department of Justice. Among the things she told them: She noted that ACEs were at the root of Price’s health priorities; she advocated that a learning collaborative be formed in which federal partners contributed to the resources for states and local communities; and said that trauma have its own national awareness day.

Walker was also the impetus behind the introduction of a bipartisan resolution “Recognizing the importance and effectiveness of trauma-informed care” (H. Res. 443) that was introduced in the U.S. House of Representatives on July 13 by Mike Gallagher (R-WI) and co-sponsor Danny K. Davis (D-IL).

Starting this evening, Walker and Casey Family Programs are hosting the first Trauma-Informed Care First Spouses conference. First Spouses planning to attend are from Alaska, Arkansas, Arizona, Massachusetts, Mississippi, Missouri, North Carolina, Oklahoma, South Dakota and Tennessee. They are Democrats, Independents, and Republicans. For the next two days, they’ll learn and talk about ACEs science, trauma-informed and resilience-building practices.

“We just want them to be aware that this is out there,” says Tonette Walker. No matter what program the first spouses work on — whether it’s homelessness or children and families — ACEs science is critical, she explains. “We’re not asking them to do what we’re doing, necessarily. We’re just asking them to embed ACEs science and trauma-informed care into their work.”