The daughter of an alcoholic, abusive father, Tamra Oman remembers trying to protect her mother from his violent outbursts, even though she was not yet in kindergarten.
“I remember him choking her over the sink. Spitting out blood. Blooding coming out all over the place and landing on me,” Oman said, recounting one incident in her early childhood in Crown Point, Indiana. “I remember going into this situation trying to save her. Trying to jump on top of him and save her.
“I can remember what I was wearing,” she continued. “That’s what trauma does. It also gets you stuck in those places.”
It was one painful episode in a childhood punctuated by sexual and physical assaults and teenage years tinged with cocaine use. Oman, now 45 and living in Fond du Lac, said she went to drug treatment more than a dozen times.
Wisconsin is part of a growing nationwide movement to adopt trauma-informed care, or using information about children’s troubled pasts to improve mental health, provide social services and address a wide range of criminal justice problems. Research has shown that adverse childhood experiences can lead to a lifetime of problems.
For her part, Oman said the trauma she suffered as a young child set her on a path of self destruction. She sabotaged success by dropping out of a series of colleges. She committed crimes. Oman finally ended up in prison, including two and a half years at Taycheedah and Burke women’s prisons for forgery and writing bad checks.
“If you would’ve addressed my victimization as a child, I probably never would have ended up in prison,” Oman said. “I became a perpetrator — not intentionally, but because that (trauma) never healed.”
In Wisconsin, trauma-informed care burst into the news in recent months with investigations into allegations of abuse at the state’s juvenile prisons in northern Wisconsin.
Some staff there have blamed the more empathetic trauma-informed approach for breakdowns in security and discipline that they said led to assaults on workers and offenders. Those involved in the training counter that the technique was not properly implemented at Lincoln Hills School for Boys and Copper Lake School for girls.
For Oman, facing the trauma of her childhood helped her to heal. Her brother Brian, four years older, never “connected with his own pain.” Although he appeared successful on the outside, in 2000, Brian used a gun to take his own life.
Oman now works at the Wisconsin Resource Center for mentally ill offenders in Winnebago. She advocates and uses trauma-informed care to help people like herself move forward from terrible childhood experiences.
State pushes trauma-informed care
“Really, what we’re trying to do, essentially, with trauma-informed care is to bring humanity back into human services, slow down and treat people with care, compassion and respect,” said Scott Webb, who has been leading Wisconsin’s efforts to spread use of trauma-informed care across the state since 2014.
The state Department of Health Services spends about $112,000 a year, primarily on a contract that includes Webb’s salary from the University of Wisconsin-Madison and related expenses, to encourage and train agencies to use trauma-informed principles.
The Department of Children and Families, through its Wisconsin Trauma Project, also is rolling out trauma-informed care. In 2015, the initiative provided training to 77 clinicians and 123 child welfare workers and caregiver parents in trauma-informed principles in Jefferson, Rock and Walworth counties.
The state Department of Public Instruction this year is training staff at 30 schools in how to use trauma-informed care to help children learn and heal as part of the School Mental Health Initiative, and another 30 will join the program in 2017, according to Nic Dibble, a consultant with DPI’s school social work section. The effort is being financed with discretionary federal funds, he said.
The state Office of Children’s Mental Health also is working to raise awareness among the public and service providers on how to recognize and help traumatized children.
The office is taking advice from “parent partners” such as foster mother Tina Buhrow of Chippewa Falls. Buhrow said one teenager who had experienced a lot of trauma recently summed up the approach well: “Stop labeling the child. Instead, understand their story.”
Trauma common, crucial
Trauma is common. Between 25 and 61 percent of all children and adolescents in the United States have experienced trauma, a percentage that increases with age, said Ernestine Briggs-King, research director for the National Center for Child Traumatic Stress at Duke University.
Speaking to a group of journalists in New York City last fall, Briggs-King defined trauma as a physical or emotional experience threatening the life or integrity of a child or someone she or he loves. Such events can evoke feelings including terror, powerlessness and being out of control.
Trauma-informed care “acknowledges and responds to the role of trauma in the development of emotional, behavioral, educational and physical difficulties,” she said.
Exposure to trauma is often measured in 10 adverse childhood experiences, or ACEs. They cover a range of bad circumstances children can experience: an incarcerated parent, hunger, divorce, domestic violence, parental substance abuse, and physical and sexual abuse. Some practitioners have added more ACEs to the deck, such as witnessing a shooting or other violence in their community.
“As the number of traumas increases, so do the number of problems,” Briggs-King said at the symposium on violence prevention by the Center on Media, Crime and Justice and the Solutions Journalism Network.
In Wisconsin, data from 2011-13 show 58 percent of adults reported at least one adverse childhood experience. But the results vary by race: Among respondents, 79 percent of blacks reported having one or more ACEs, compared to 56 percent of whites.
Studies have shown that adults with high ACE scores are more likely to suffer from poor health, be arrested, unemployed or have substance abuse problems. Trauma-informed care is seen as a way to halt the cycle of violence and dysfunction and improve quality of life for people who have experienced trauma.
“There’s good stuff going on around the country … which, if adopted on a larger scale, we could chip away at this problem of violence,” Briggs-King said.
A recent Centers for Disease Control and Prevention study found many of the 569 perpetrators in gun crimes between 2009 and 2014 in Wilmington, Delaware, had significant trauma histories themselves, including child abuse or neglect; emergency room visits for intentionally inflicted injuries; and involvement with the social welfare system. The study suggests finding and helping such potential perpetrators before they commit crimes.
SaintA, a private nonprofit social service agency based in Milwaukee, is a national leader in the use of trauma-informed principles. Tim Grove, chief clinical officer for SaintA, told a group of Wisconsin juvenile justice and child welfare officials last fall that the relationship between high ACE scores and certain bad outcomes is “staggering.”
Grove said a person with an ACE score of 8 or above is 4,200 times more likely to use drugs than someone with a score of 0. An ACE score of 6 or higher is associated with a 20-year decrease in life expectancy compared to having no ACEs.
“These are powerful scientific findings — not theory, not hypothesis,” he said.
Stress, violence and one caring adult
David Murphey, senior research scientist for Child Trends, an organization that collects data and studies aimed at improving the wellbeing of children, told journalists gathered last fall that about 40 percent of U.S. children have multiple exposures to violence, either as a victim or witness.
If such experiences are frequent or severe, they can generate “toxic stress,” which causes learning difficulties, emotional problems, antisocial behaviors, poor health and even early death.
But a single supportive adult “can buffer the effects of toxic stress,” Murphey said.
Michael Lamb, executive director of Turnaround for Children, said when he was a young teacher at a school on Chicago’s South Side, many of his students were locked in a “fight, flight or freeze” mode from exposure to trauma.
Because of his own inexperience dealing with traumatized children, Lamb said a mock trial exercise went badly awry, triggering a strong response in students not accustomed to “healthy debate that doesn’t escalate.”
“Upon the first point of disagreement, all of the students started throwing books at each other. It was chaos,” recalled Lamb, who runs the program’s Washington, D.C. effort to help struggling schools serve traumatized students.
“Students who’ve been through a lot of trauma … their bodies are flooded with cortisol, and the impact is both on the learning part of their brain as well as the immune system,” Lamb explained, referring to the hormone released in response to stress. “So every day it feels like the bear … is right in front of them because of what’s in their brains.”
Lamb brought his mother into the classroom to calm his students and to humanize him as a teacher. He discovered one antidote to his students’ violent reactions: Adults they could trust.
Trauma-informed Waupaca County
Chuck Price remembers hearing Wisconsin’s first lady Tonette Walker speak about trauma-informed care about four years ago. Walker began the Fostering Futures collaboration of state agencies and private service providers in 2011 to raise awareness about the effect of childhood trauma on people’s lives.
As the new director of the Waupaca County Department of Health and Human Services, Price believed the approach endorsed by Walker could become a “cornerstone” for the agency. His department manages mental health care, Medicaid, food assistance, child welfare, juvenile justice and other services for some of the county’s 53,000 residents in this central Wisconsin county.
Now, trauma-informed care is infused in everything his department does.
Trauma-informed care is the reason for the brightly painted murals on the second floor of the Waupaca County complex leading to rooms where child victims of abuse or neglect are interviewed. Price points to a nature scene with 17 ladybugs hidden in it. He called it a “distraction element” designed to “make that a little less of a traumatizing walk.”
The approach also is reflected in the patience that operators at the regional call center are counseled to use as they help frustrated recipients access public benefits.
And it is in the partnership that the agency develops with parents facing loss of custody of their children after allegations of child abuse or neglect.
Season Westphal, who manages the foster care program, said Waupaca County uses the principles of trauma-informed care by taking a “much more humanistic approach” to allegations of child maltreatment.
“That means calling somebody over the phone to schedule an appointment, asking permission to talk to them and their child, as opposed to just doing it without permission or going to the school and interviewing children without parental consent,” Westphal said. “We’ve found that that isn’t the best way to develop a good working relationship with the family and to earn trust with people.”
At the call center, operators are instructed to help resolve as many problems as they can themselves rather than pass a client off to another person or department, said Chris Machamer, the county’s economic support coordinator.
“Many times, they (clients) are angry because they think their benefits are messed up or because they themselves maybe didn’t follow through,” Machamer said. “And so, using a trauma-informed approach, rather than putting the blame back on them … we take the approach of, ‘How can we help you now?’ ”
This more cooperative stance has resulted in a sharp reduction in formal complaints lodged against the agency, Deputy Director Shannon Kelly said. The department had an average of 10 to 12 per year in the past. There has been just one complaint in the past two years, she said.
“We’re being upfront. We’re not a ‘gotcha’ kind of agency — no surprises back to the folks we’re serving,” Price said.
Other metrics also are positive. Before taking a trauma-informed approach, just 21 percent of children in out-of-home placements were returned to their family home within 12 months. Now 73 percent are reunited within a year, said Alisha Haase, who manages ongoing child protection for the county.
Staff turnover also is down, Kelly added, while measurements of job satisfaction and well-being are up.
Price said the agency’s goal is “making sure that we’re leaving individuals and families better off having received services or having interaction with our agency than when they found us.”
Homeless, addicted — then hope
After 83 arrests, a stubborn crack addiction and 19 years living on the street, someone finally asked Tonier Cain, “What happened to you?”
The question, posed just over a decade ago, probably saved her life.
Since then, the deeply religious Cain has become an evangelist for trauma-informed care. She has spoken at conferences across the country and around the world. Her life has been featured in movies and an autobiography, “Healing Neen.”
Cain told her story to hundreds of juvenile court and child welfare officials in late September during a conference on trauma-informed care in the Wisconsin Dells.
She was the oldest of eight children of a single, alcoholic mother who sometimes left them alone and hungry for days in their apartment in Annapolis, Maryland. Her mother’s boyfriends sexually assaulted her in the bedroom she shared with her younger siblings.
Although she was often unwashed — earning the nickname “Pissy Neen” at school — Cain developed an obsession with tooth brushing “to get rid of the smell of the men that forced themselves around my face, in my mouth.”
At age 9, she began drinking. At 16, she married a man eight years older. Cain thought he would save her. Instead, her husband “beat me down until he saw blood” during fits of jealous rage. At age 19, desperate for an escape, Cain discovered crack cocaine.
Her life spiraled even further out of control.
She traded sex for drugs, beer and cigarettes. Four times Cain gave birth; each time, she was forced to give up her baby. Another baby died in childbirth while Cain was strapped to a gurney during a jail stint.
Cain estimated she went to drug treatment 30 times. One of her counselors raped her. He was sent to prison. When not locked up herself, Cain lived on the streets and ate chicken scraps from the garbage “like a rat.”
Eleven years ago, while incarcerated and expecting another child, a therapist finally asked Cain about her past. Telling her story was cathartic. The two worked through the pain — the physical and sexual abuse, her mother’s abandonment, the lost babies.
“I have four kids walking this earth. If I pass them in the streets, I wouldn’t even know it. How do you heal from that?” Cain asked.
But she did.
“I was believed,” Cain said, “so I was able to begin healing that hurt.”
Today, Cain has multiple homes and a “really smart” fifth-grade daughter — the baby she was expecting when she halted the multi-generational cycle of trauma in her family. Cain’s life now revolves around her child and telling her story — and getting people in charge to listen.
She showed one of her police mugshots on the screen of the conference room in the Dells.
“If this woman was yet again in your system … 83 times you’ve seen her show up. … My question to you this morning is simply this: ‘Would you be able to look at her and see me today?’ ”
She ended the talk with this:
“Where there’s breath, there’s hope. Treat the trauma. You will get results.”