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0:00:08.6 Jackie Strohm: Welcome to PA Centered, a podcast designed to help listeners be a part of the solution to end sexual harassment, abuse and assault. Each episode, we will take on a topic or current event to help spark conversation and break down barriers to building communities free from sexual violence.

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0:00:32.2 JS: Hi, I'm Jackie Strohm, the Prevention and Resource Coordinator at the Pennsylvania Coalition Against Rape. I'll be your host today as we're joined by Dan Jurman and Erika Brosig to learn about the Trauma-Informed PA plan. Dan is the Executive Director of the Governor's Office of Advocacy and Reform. He has worked in the non-profit and human services field for over 20 years. Erika is a licensed clinical social worker and the Clinical Director at Victim Services Inc in Cambria and Somerset counties. She has been at the agency since 2003. Welcome, Dan and Erika.

0:01:10.8 Dan Jurman: Hi.

0:01:11.3 Erika Brosig: Hi.

0:01:13.1 DJ: Thanks for having us, Jackie.

0:01:13.2 JS: We're so excited to have both of you here to tell us all about the Trauma-Informed PA plan that you've both been working on this year. And so just a little background before we get started, the plan was created to guide the commonwealth and service providers state-wide on what it means to be trauma-informed and healing-centered in Pennsylvania. It is a companion to Governor Tom Wolf's anti-stigma initiative Reach Out PA: Your Mental Health Matters. In February 2020, the Office of Advocacy and Reform formed the Trauma-Informed PA Think Tank, which worked for four months on the plan. The think tank was made up of a diverse multi-disciplinary group of 25 experts chosen to participate from urban, suburban and rural communities throughout the commonwealth. Members of the Think Tank were then invited to join state agency representatives to form a new leadership team called HEAL PA that is currently made up of over 100 trauma experts and volunteers, each who serve on action teams that prioritize and implement recommendations. So before we dive too far into our conversation, Dan, could you tell us what it means to be trauma-informed? 

0:02:33.5 DJ: Sure. Well, I think one of the easiest ways that I remember it and think of it as it's been described to me is to think of shifting from a mindset of asking people what's wrong with them, and instead asking what happened to them. And so, so often what we do is assume that there's something wrong, or a lot of times people get diagnoses that aren't based on what the core cause is for what might be challenging them and instead we wanna shift to a mindset of getting to core causes, of helping people identify if they've experienced chronic stresses or traumas or toxic stresses as children that have got them stuck, and then figuring out what we need to do to help them process what happened to them and heal from it and be able to move on. And a lot of times what we see is, in the worst case scenario, we see punitive measures being taken against people, and never, never in any context of asking what might have happened to them and really figuring out, "What was the root cause trauma at the heart of this?"

0:03:49.6 DJ: And for us, thinking about it as a state, I think this goes across every state agency, everything from the obvious things like physical and behavioral health to the not so obvious things like workforce development and the criminal justice system, our children and youth system. We have a lot of people who are being punished essentially because of things that have happened to them and traumas that they've experienced. Another key thing is that is to understand that no two people experience a trauma in the same way. People have different resources and different resiliency levels that they've built up through their lives. And so for some people, they might experience a trauma and be able to move on from it very quickly, and for other people, they could experience the exact same trauma and it could be something that derails their entire life. And so I think building a practice, and I think not just from the frontline worker standpoint, social service worker, therapists, people that... Case managers that intersect with people every day, but also for the folks that are creating policy in Pennsylvania, understanding that as a core lens to look at everything that we do is a big part of how we see this whole trauma-informed movement playing out.

0:05:06.9 EB: I'm just gonna echo what Dan said. I think that being trauma-informed really is a lens through which we look at everything, and that's, I think, how we shaped the plan that we're about to talk about, is just really looking through a different lens, a lens that shifts from punitive to compassionate, a lens that really allows a perspective that we're here to help people instead of punish, we're here to support people and really help guide people into a different life than maybe they have been living. And it's a shift, I think, in a lot of areas and a much needed shift.

0:05:51.3 JS: So Dan, you've been doing this work for a long time. So what does it mean for Pennsylvania to have a group focused on being trauma-informed, and where does this put us on the map compared to some other states? 

0:06:05.9 DJ: I think there's really only a handful of states that have gone down this road of creating an intentional plan to become trauma-informed, and so we're one of the first few states to do this. I think for me in my career, I've seen a lot of things that harm people. A lot of my work has been in anti-poverty work, and I've worked for two federally qualified health centers, and seen some of the severe behavior and physical effects of people living in poverty and struggling with abuse. One of the agencies that I ran provided domestic violence services for Lancaster County. So you see all of these different traumas and you see the ripple effects that they have in people's lives. And so many times what happens is people will turn what they see, those ripple effects, into statements about culture or individual behavior, as opposed to understanding what's at the core of those and the context that people are living in when they've not only been traumatized, but continue to experience trauma day after day or chronic stress day after day.

0:07:13.1 DJ: And so I think for Pennsylvania, what this means is a pathway to progress. I don't really believe in silver bullets, but I think being trauma-informed and healing-centered is the closest I've seen to a silver bullet for so many different community ills that we struggle with that are not only very costly financially to continue to only address as crises as opposed to preventative, but also the human toll that these things take, where because we're not appropriately addressing the core issue of trauma or toxic and chronic stresses, we're instead throwing people away and just denying that they have the potential to be on a different pathway.

0:08:01.8 DJ: And so to me, this is critical. If we really wanna be a prosperous commonwealth, this is critical to that. And I think there's a major shift that has to happen in a whole lot of mindsets to make this happen, but you start with the people that understand it and a coalition of the willing who are ready to push back on the status quo to say, "If the status quo was so great, we'd be in a different place." At the moment, according to the Department of Health, 38% of all Pennsylvanians have experienced either physical or emotional child abuse. 38%. And if we said 38% of all Pennsylvanians had cancer, we'd be alarmed, or if we said that there was that high a number in any other issue.

0:08:50.3 DJ: So essentially, we have an epidemic, and that's just one category. There are a lot of other categories of trauma, and certainly chronic stress and toxic stresses that are out there. And so when you put them all together, this is a huge issue. And the way that we've addressed it in the past just hasn't actually helped people heal, which means that we're not really solving the problem. We might be putting band-aids on symptoms, but we're not solving the core problem the way we've gone about it before. So to me, this is how we become truly a thriving and a prosperous commonwealth in lots of ways and in lots of categories, and it just requires the same mental shift through a lot of different disciplines.

0:09:33.0 JS: So Erika, from your perspective working at a local rape crisis center, what does this mean for survivors of sexual violence? 

0:09:42.3 EB: I think this means, it means the world for those of us who have been doing this work and for survivors, because having been in this movement for a while when I started and the entire, let's say first half of my career, if not more, so much of our time was spent working with survivors who would come in to see us because other people were not able to serve them. They would come in and they would tell us, "I went to this doctor, this psychiatrist, this therapist, and they told me I just needed to get over the abuse that happened. They told me that I needed to move on. They told me that I needed to just be put on medication and I would be fine." And they would seek services from us. And I'm sure that other people at centers, this is so familiar to them. They would seek services from us because we were sympathetic to the fact that that's not the case, that it doesn't just go away. And it always felt like we were doing work that was even outside of our scope half the time, because we were the ones who would listen, we were always the ones who had listened. And so as much as we would search for other people to help support us outside of other centers and PCAR and some of us in this world, we weren't able to find it. And so then we've created it.

0:11:06.5 EB: We have centers now. At our center, we've created a therapy department, we've networked, we've tried to do this work in our own communities. And so to see this happening at the state level is just so powerful because you see survivors of sexual violence. But like Dan said, it's not just one type of trauma. Trauma is physical violence, it's witnessing violence in your home as a child, it's having someone in your home who might be struggling with addiction, it's so many different things across the board. And having providers, having government who understands the impact of trauma shifts the entire way that services are provided, that education is provided. It just allows for a more compassionate existence for all of us. And I think that in terms of us, in terms of our centers, that builds so much support in our community for survivors that it's just gonna lift us all up higher in our ability to serve the people that we are here to serve.

0:12:15.9 EB: And again, just to echo what Dan said, this is... Trauma is, it's a thread that connects so many of the ills that we're struggling with in our state. You look at the opioid epidemic, you look at poverty, you look at all of these things that we're constantly talking about, "How do we fix this? How do we help people?" And we're never looking at this. This is not the conversation that happens. And it's been so frustrating to hear that there's WARP groups convened, there's all these things that come together and nobody ever mentions trauma. Until now. Now we have this conversation. And so no, there's not a silver bullet, but I do feel like there is this thread, there's this common denominator that underlies, and so I think that there is real hope here for survivors of sexual violence, for survivors of all types of trauma, that this can make a difference. And it's not tomorrow, but this is a shift, it's a change that will happen that will make a difference in the long-term.

0:13:14.1 JS: So I know that the plan focuses on six key areas, and there are 43 recommendations to be enacted, and some of which have already happened. So Dan, can you tell us some of the top action steps that you're working on right now? 

0:13:30.3 DJ: So it's a little bit in progress, so I can give you a sneak preview of a couple of things. But there's one of the beautiful parts about this is with 14 action teams and 28 co-chairs and all those different folks involved, it has a life of its own now. And so if you... There's an old proverb that if you wanna go quickly, go alone, if you wanna go far, go together. So we're going together, and what that means is I have to let go and let a whole lot of other people be in charge, which I'm good with 'cause they're really great people and it's exciting to see what's gonna happen. So we're in the process of all those action teams setting short-term and medium and long-term goals right now. So the groups will come together in late January to report out on what their long-term goals are, but I can share with you the sneak peak from the action teams that I've been able to attend. And some really exciting stuff. We're talking about, for instance, a lot of training that's out there for trauma-informed care happens for practitioners, but I'm not aware of very much that happens for the people who are experiencing the chronic stress and the trauma.

0:14:44.9 DJ: And so one of the short-term goals is going to be to start a series of community conversations all across the commonwealth with populations that are at high risk for chronic and toxic stress and trauma, and being able to have... Again, no lingo. I try to keep my definition pretty simple, but the same thing, no lingo, just conversations about what trauma is, helping in very conversational terms, helping people understand the neurobiology of what's happening to them as they're experiencing chronic stress and trauma. And honestly, I would say at this moment in time, probably everyone is experiencing at least chronic stress, if not trauma, because of the pandemic and the civil unrest and the politics of 2020. There's so much going on that can become toxic very quickly. And it's every day, and that drip drip drip, I think, creates a moment of empathy maybe for people who've never experienced chronic stress. And folks like my wife, my wife is a zero on the Adverse Childhood Experiences survey, I'm an eight, and so she's been sympathetic to me for our 20 years together, but this is the first time she's ever been empathetic because she's experiencing it herself because she works in a school and feels danger every day and she's worried about our kids and all these other issues.

0:16:10.4 DJ: So I think there are more people now that need to understand that than ever, because I think there are a lot of people who've never experienced poverty, who've never been abused, but who don't feel right, right now, who don't understand why they feel so exhausted or they can't put two thoughts together or why their temper is so short. And all of those different symptoms that can be tied back to chronic stress, there are tools to help you try and mitigate that. There are techniques and different things that you can do to make that better. And if it gets bad enough, there are professionals that can help. So we wanna go around the commonwealth and help people understand at the community level exactly what's happening and things that they might have been experiencing for years but could never put words to, or that they blame themselves for, or that other people blame them for and they internalize that message that, "This is my fault, or maybe I'm lazy or I'm just an angry person," or whatever messages that they've been getting and internalizing, to help people process that. Again, it's not what's wrong with you.

0:17:22.5 DJ: There's something happening to you, and we can try and help you understand what that is, and we can connect the resources of your community together so that they can wrap around you to help with that conversation. So that's one important piece. I can tell you that we're gonna have some very serious conversations about racism, and not just the typical conversation of how we help the person who has been discriminated against, how we help them process and heal, but also to dig into what kind of trauma does it take for the abuser in that case, the discriminator, the bigot, what kind of trauma does it take for them to feel that another human being is somehow worth less than them based on their religion or gender identity or the color of their skin? And what are they acting out of when they try to hurt another person like that? Because if we don't actually dig into the trauma of our abusers, and I've had this conversation around domestic violence and child abuse. Three of my ACEs are experiencing domestic violence and child abuse for 10 years. If someone had gotten to my abuser, to our abuser, before that, a whole lot of pain would have been saved.

0:18:39.0 DJ: And since at the time, all that really happened was some care for the survivors, then what happened is he just moved on to another relationship and took that abuse somewhere else, and the cycle didn't end. And I'm old enough now to know that he was an abused victim as a child, so we let these cycles continue because it can be hard sometimes when the person who's committing the abuse also needs care, it can feel distasteful to even talk about it, but we've gotta have those great conversations.

0:19:10.1 DJ: So there's some early work going on around what that might look like, and then we have a lot of work going on around changes at the more macro level, changes in Harrisburg, working to make sure that every single state employee, no matter what their job is, that every single state employee has a trauma-informed training as part of their onboarding, and that that just becomes automatic and part of state culture, and also looking at how we do that for a lot of other fields that help people, whether that's social workers, judges, police officers, you name it. For folks that connect with other people and are in helping fields, we want them to have trauma-informed training as a part of their core curriculum when they're getting certified or licensed, all those different pieces. And licensure for some state-funded entities is under way, as we speak with a goal of this time next year, having our first crop of residential providers for behavioral health working on getting licensed, having trauma-informed care as part of their licensing.

0:20:16.7 JS: I love that the... Trauma-informed to me is a buzzword, at least for some of us, like I know Erika and I are both social workers, and so thinking that as being a buzz word, but people not always knowing exactly what it means or what it looks like in practice. And so what I love about this whole plan, I love a lot of things about it, but one in particular is that you want people to not only know what... Have heard of this word before, know what trauma-informed is, but actually put it into practice and actually learn all of the amazing things that it can do when we use that trauma-informed lens.

0:20:56.7 DJ: I think it's every level. So I think we can make the argument that we can save cost in the system by going upstream and by being trauma-informed and healing-centered, I think we can make the argument that we're gonna save lives and potentials and futures for people by doing this. But there's also at the micro-level, as Erika said, this doesn't go away. You don't just get over it. My abuser left our home when I was 14, I'm 50 now, I'm not over it, I'm not past it, I get better at managing it with help with therapy, with all the things that I learned from people like Erika and others, as we have conversations about this work, but I'm never gonna be over it. I can heal and I can get better. But doing that work, understanding it, because I was in my 40s before I even heard of any of this, and to hear it for the first time and to have the light bulb go on and to be armed then with understanding myself has allowed me to be a better employee, a better father, a better husband, a better friend, because I'm not stuck the way that I might have been before, and when I get stuck, and I know that I'm getting stuck, I understand what's happening to me at a very personal level.

0:22:18.3 DJ: And so I think not just can our state be better, our organizations can be better, but we can feel better as people, we can get healing, and it's not too late. If I can start healing in my 40s, a lot of people think your brain is baked in, it's not, you can heal and you can get past this. But you'll need help to do that, it's hard to do it alone, there are steps, there are things you can do alone like the things I do all the time to help mitigate how I feel, but a lot of what we have to do is erase the stigma of reaching out for help. When you have experienced trauma and haven't healed from it, it's okay to ask someone else for help, it's okay to reach out for behavioral health help, and we've gotta make sure both the people understand that it's okay, and then we also have to make sure that when they reach out, that there's somebody there and that their insurance is gonna pay for it. That's a big long-term goal for us, is to have just better insurance coverage for these.

0:23:16.1 DJ: When I first reached out and tried to get help for PTSD, which is what I was diagnosed with, my insurance company didn't cover it, and when I called them to ask about it, they walked me through the website so I could see based on my diagnosis code, what they would pay for, the answer was electroshock therapy. And I said to the person on the phone, "I know you're just in customer service, I don't wanna take this out on you, but I have to ask, do you also cover leeches?" Electroshock therapy is where we are in 2020. When I know as a layman that there are therapies out there that work, and that's still where we are, and so we've got a lot of work to do as we look at our goals and what we need to get done, but they're at all levels, and it's not gonna be overnight, it's gonna take years and building an army of people who care about this, and given the number of people that have experienced trauma, I think we can build that army.

0:24:11.6 EB: And I think we have the right people to do that. And again, just to piggy back off of what you were saying, Dan, my experience was so similar as a survivor coming into this work, when I started this and started to understand what the impact of trauma was, it was like a light bulb went off for me and it was like, "Oh my gosh, you mean I'm not crazy? You mean all these years that I've struggled, it wasn't because it was just me? There really was a reason?" And when you know that, all of a sudden there's a weight lifted, and the knowledge that we can hopefully lift that weight for people by helping them to know more about trauma is just... It's a gift to know that hopefully we can provide that, just by normalizing it, as part of this to really make knowledge of trauma normalized, and to make reaching out for help normalized, and this is a conversation. The conversation of trauma needs to start always, we need to understand that this is just something that happens, It's like catching a cold, it's gonna happen, and this is what we do when it does, and I think that's gonna go such a long way for all of us in the State to really making us more successful, more healthy, more vibrant, and it makes me as a mom look forward to what my kids will see in Pennsylvania when they grow up.

0:25:48.2 JS: So Erika, I know you've been part of this from the beginning, serving on the Think Tank, and now you're volunteering your time to be on multiple action teams. So what are you most looking forward to as you continue this work? 

0:26:02.7 EB: I think just really seeing the plan moved into action, and that's one of the things that I've loved from the beginning is that, that was the goal the entire time, this was never meant to be a plan that sat on paper and was stagnant, and I have to give Dan so much credit for the way that he facilitated the writing of the plan and just this entire process, because it was always meant to be something that was taken from paper and put into action from day one. And that was the conversation we had the first time we met. It was always the plan, and it became a real labor of love for all of us, that we put heart and soul into this to make sure that we could take these recommendations and make them happen, and that we would all stay invested and that truly has happened. Most, if not all of the original members of the Think Tank, I think are still participating in some way on the action team, there are so many other people who have gotten involved, and it's just so wonderful to see so much commitment and what I'm looking forward to is seeing it happen because it's going to. There is no way, it's not because of the commitment of all of these people, and that is just so powerful. So really seeing the action happen is, it's just amazing.

0:27:31.4 JS: Dan, is there anything else you'd like to add? 

0:27:34.1 DJ: I think one of the big pieces for me when you're talking about wanting a plan to actually be an action plan and not just aspirations, is accountability. And so in addition to the goals that we'll be sharing in January, one of the other pieces that we'll do is we'll introduce our dashboard, and so the dashboard will lay out all of the recommendations that we made, and we'll have a very simple way for all the residents of Pennsylvania, to hold us accountable, there'll be a yellow, red, green color coding, and if it's on track, it'll be green, it'll be simple for anybody to read and go, are these folks serious and are they getting things done? And so we'll be able to track the items that are in progress, and we'll have some notes in there so people can see what we're doing or what level we're at. In some cases, there are some things that I'm hoping by the time we publish this dashboard publicly that will be done, then we'll be able to mark off the list and it'll make room for other thoughts and other things, and that's an important piece that I've said to the group from the time we got started, is that I didn't climb a mountain and get the recommendations on stone tablets, we worked on this together, and it should evolve, it should breathe.

0:28:49.1 DJ: And as we identify the things that we might have missed and new things that emerge, so for instance, we weren't talking about pandemics when I first was doing my interviews, but by the time we were meeting there was a pandemic, so talking about how we heal from a pandemic became part of our focus, and so other things might happen in the world that need to get added, and the plan should be a living, breathing plan that's owned now by over 100 people and hopefully soon thousands of people who are doing this work in their own communities and counties and towns, because now they're not alone. Our ability to connect them all with a whole lot of people and be able to share strengths and weaknesses and failures and successes together and help each other go on, I think is gonna be really powerful.

0:29:40.7 JS: Well, Dan and Erika, thank you both for sharing your stories with us and for taking the time to talk to us today about the Trauma-Informed PA plan. That is all the time we have today, but I'm hoping we can meet back up in the future to hear how things have developed. So thank you everyone for listening to this episode of PA Centered. You can learn more about the trauma-informed action plan at the links in our description.

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0:30:14.7 JS: If you or a loved one needs help, a local Sexual Assault Center is available, 24/7. Call 1-888-772-7227 for more information, or find your local Center Online at pcar.org. Together, we can end sexual violence. Any views or opinions expressed on PA Centered by staff or their guests are solely their own and do not necessarily reflect the opinions of PCAR or PCAR's funders.

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