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Professional counselors do not practice in a vacuum. Counselors practice, regardless of the setting, in community with others. Counselors practice in neighborhoods, in schools, in mental health agencies, in inpatient mental health hospitals, in colleges, in homes, in homeless shelters, in assisted living homes, in prisons, and the list goes on. All of these areas of practice are in communities. Therefore, we must be aware as counselors of the issues that affect the communities where we practice.

Communities are often affected by traumatic events and experiences such as community violence, drug and sex trafficking, police shootings, crime, substance and alcohol abuse, and parental abuse and neglect toward children. As a licensed professional counselor, I work primarily with children and adolescents who have extensive trauma histories. I provide trauma therapy in the form of trauma-focused cognitive behavior therapy. I also work within my community to provide trauma education to organizations such as day care centers to help these educators understand trauma’s effects on young children. My goal is to provide more community outreach through education and training to enable communities to become more trauma informed and resilient.

In this article, I will discuss the pivotal role that professional counselors can play in developing resilient communities through outreach. Counselors possess the expertise, experience and training to help communities develop programs necessary for addressing and ending the adverse effects of events that have taken place within these communities.

Adverse childhood experiences

Adverse childhood experiences (ACEs) have been shown to have an impact on future health implications and violence victimization. These experiences can include:

• Abuse
• Neglect
• Witnessing violence in the community
• Witnessing domestic violence in the home
• Having a caregiver or loved one experience a prolonged illness, mental health crisis or death
• Having a loved one die by suicide
• Being separated from biological parents
• Being in the foster care system
• Having a loved one engage in substance or alcohol abuse

Each of these experiences can lead a child to feel unsafe and to struggle with stability and attachment.

Early ACEs will have long-term impacts on children well into adulthood. ACEs have been linked to unsafe behaviors, chronic health problems, poor academic achievement, lower rates of graduation, more lost time at work, and early death. The original ACEs study was conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente from 1995-1997 in Southern California. The conclusion of the study was that those who had experienced four or more ACEs were more likely to experience increased health risks for alcoholism, drug abuse, depression and suicide. These individuals were also more likely to experience poor physical health, have multiple sexual partners, contract sexually transmitted diseases, experience obesity, have limited physical activity, and engage in smoking. Among the physical problems noted among adults who had experienced four or more ACEs were ischemic heart disease, cancer, chronic lung disease, liver disease and skeletal fractures.

Another study, the Philadelphia Urban ACE Study, was conducted to determine how ACEs affected those in a large urban city with a socially and racially diverse population (the original ACEs study from the CDC and Kaiser Permanente involved mainly individuals who were white, middle class and highly educated). The Urban ACE Study found that 33% of adults in Philadelphia had experienced emotional abuse in childhood, while 35% had experienced physical abuse in childhood. Other findings included that 35% of adults in Philadelphia had grown up in homes with a family member who abused substances, whereas 24% had lived in homes with a family member who was mentally ill. About 13% of adults had childhood experiences of someone from their household being incarcerated.

These two studies demonstrate a need for a) early intervention trauma treatment and b) outreach to provide collaborative support to build more resilient communities. For communities to become resilient, there must be support for the well-being of children and their families. This is where professional counselors can become strong advocates for the clients they treat. Many of the children, adolescents, adults, families and couples that we treat are currently experiencing problems that may be related to ACEs. So, what can we do as counselors to build resiliency within our communities?

1) Understand the trauma response. Counselors should do what they can to become more trauma informed. This means understanding what trauma responses are and what these responses look like. In my own practice as a trauma-informed child and adolescent counselor, many children come to me with diagnoses of attention-deficit/hyperactive disorder, oppositional defiant disorder, depression, anxiety, conduct disorder, obsessive-compulsive disorder, developmental disorders, intermittent explosive disorder, and pervasive disorder. Many of these children have been seen by multiple mental health providers who have worked to extinguish the challenging behaviors that accompany these disorders. Parents are at their wits’ end because “nothing seems to work.”

What I often find is that no formal assessment of trauma symptoms has ever been performed to determine whether these children might be experiencing a trauma response. Understanding how trauma affects the brain can provide counselors with an awareness of where certain behaviors are originating. Traumatized children are not able to regulate emotions, tolerate distress or learn because the centers of the brain that control these functions have not developed appropriately. The body is in a constant state of stress, and the child is in the fight, flight or freeze state. So, the behaviors and emotional problems that we are seeing may actually be stress responses from trauma.

2) Screen for trauma symptoms. Trauma screening should be done on all clients whom counselors see. It should be a part of every intake. Not every client will screen for trauma symptoms, but when they do, counselors will have the information needed to begin trauma-focused therapy or to refer to other counselors who have that training.

Counselors can conduct outreach to their communities by providing trauma screening to organizations or by teaching those within organizations to screen for trauma. Trauma can be screened for in physicians’ and pediatricians’ offices, day care centers and schools. I conducted an in-service training in which I taught educators at a local day care how to recognize behaviors that might be a result of trauma and understand why these behaviors occur. The training was well received, and these educators are usually among the first to recognize when children are having behavioral or emotional difficulties. Once communities can conduct an initial screening, then an assessment for trauma symptoms can be made that will lead to recommendations for treatment.

3) Advocate for appropriate mental health services within schools and communities. Budget cuts in many organizations within the communities where counselors practice often target mental health services, resulting in the discontinuation of services. In my area of practice in Pennsylvania, when the educational budget needs to be trimmed, school counselors are usually cut. This leaves one or two counselors to serve a school with hundreds of students. Some schools do not have the benefit of having other mental health professionals in their buildings. There may be one or two school psychologists to serve a district of five to 10 schools. Thus, the ability to screen for trauma is nearly nonexistent due to the absence of personnel to conduct those screenings.

Professional counselors can reach out to collaborate with school districts in the areas where they practice. In my practice in both agencies and private practice, I enjoyed working with many school counselors who asked me to help support their students. I always reached out to coordinate with school counselors to plan how to best help my clients. This is very beneficial for clients because they then receive collaborative support within the school. Counselors may also have the opportunity to contract with schools to provide supportive mental health care to students.

4) Advocate to build more trauma-informed communities by reaching out to lawmakers. Counselors can reach out to legislators when issues of mental health come up. Counselors can advocate for more school counselors and for trauma-informed training of school personnel and personnel in other social services agencies, including children and youth agencies, foster care agencies and welfare services. Counselors can advocate for their clients by encouraging legislators to work within their districts to develop mental health programs that are more accessible. Many adults cannot afford mental health services. Counselors can be on the front lines advocating for affordable health care that includes mental health parity.

5) Support the integration of mental health care in pediatric medical offices and physicians’ offices and training for first responders. Counselors can reach out to pediatricians and medical providers to raise awareness of the need for trauma screenings. Some already conduct these screenings. Some may conduct these screenings but offer no referrals for help. Partnering with these medical services and working collaboratively with medical personnel will encourage greater screening of trauma among patients and allow medical personnel to provide their patients with referrals to mental health services. In addition, counselors can offer to provide trauma training to organizations that train medical workers. The more trauma training that medical professionals have, the more resilient the community is likely to become because referrals for mental health services will be made earlier.

One trend that is occurring is more first responders being trained to identify trauma symptoms. First responders are often the first to arrive when someone is in a mental health crisis. Unfortunately, the news is too often filled with stories about law enforcement personnel shooting and killing individuals who were having a mental health crisis. Teaching safer alternatives for first responders to engage with and de-escalate those in crisis is another area in which counselors can provide outreach to their communities. Creating more mental health crisis teams within communities can be effective in reducing the number of deaths that occur when individuals suffering from a mental health crisis meet untrained first responders.

6) Advocate for trauma-informed schools. Professional counselors can collaborate with schools to train all school staff on trauma-informed care. Helping school staff to recognize when a student might be exhibiting trauma responses will allow them to provide needed support until the student can be evaluated by the school counselor or a mental health professional.

Counselors can also collaborate with schools to develop anti-bullying programs and sexual assault awareness programs. Bullying and sexual assault cause trauma to many students and will result in emotional and behavioral problems in school. Traumatized students are unable to focus and learn and will tend to isolate themselves. Students may exhibit acting-out behaviors such as tantrums or oppositional behaviors. Some students may hold their trauma inside and exhibit depression and anxiety symptoms.

In my experience working with adolescents where anti-bullying and sexual assault awareness programs are already in place, I often hear reports that these programs are ineffective. I see this as an opportunity for professional counselors to develop evidence-based programs that are truly effective.

Conclusion

Studies have demonstrated the long-term effects of ACEs, particularly in communities where poverty, substance abuse, alcoholism and violence are the norm. Counselors can provide outreach to their communities and advocate for their clients and communities to develop trauma-informed programs and early intervention.

The ACA Code of Ethics tells us that advocating for our clients is an important part of the work we do. My challenge to you, my colleagues, is to think about the many ways that you can advocate for your clients and your communities.

Denise Takakjy is a licensed professional counselor, national certified counselor and licensed behavioral specialist working in private practice in Harleysville, Pennsylvania. She specializes in providing trauma-informed care to children and adolescents with extensive trauma histories. Contact her at dtakakjy@healingheartshealthyminds.com.

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