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Hundreds to thousands to tens of thousands: The ACEs/trauma-informed/resilience-building movement accelerates in the San Francisco Bay Area


Briana Moore (l), SFDPH trauma-informed trainer, surprises Jen Leland, director of Trauma Transformed, with a plaque of words that describe her leadership.


Last Friday, on a sunny Spring day in Santa Clara, CA, about 100 people gathered to celebrate a milestone: Over the last 10 months, 65 trainers from Trauma Transformed, a regional trauma-informed center and clearinghouse in the San Francisco Bay Area, have educated 4,048 people in six counties about trauma-informed principles and practices. It’s been a cross-sector effort — the people who learned about trauma-informed practices work in probation, child welfare, First 5, health, public health, community-based organizations and education. 

Add to that San Francisco City and County, where since 2014, the San Francisco Public Health Department has trained 6,509 out of about 9,000 in its workforce, and you’re starting to see that this isn't some transitory exercise. 

The Bay Area isn’t alone; hundreds of other workshops have taken place over the last year in states across the nation; in Wisconsin, seven state agencies and 14 county health agencies just finished the first of a two-year trauma-informed learning collaborative managed by the National Council on Behavioral Health that has reached thousands of people; ACEs Interface has done several train-the-trainer workshops, including for a group in Sonoma County, CA; St. A in Milwaukee trains thousands annually through its community training and train-the-trainer workshops. The 14 communities participating in the Mobilizing Action for Resilient Communities (MARC) have engaged thousands more (as Anndee Hochman explains in her recent posts). The list goes on.  

But Trauma Transformed (T2), which is funded by a grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), is taking a slightly different approach from some other organizations in that its goal is long-term organizational change in the Bay Area’s community-based organizations and six systems of care, including behavioral health, probation, and child welfare. That starts with an introduction to trauma-informed approach and continues to working with academic and research institutions to identify and evaluate grass roots projects, such as the work of Youth Uprising and RYSE, to support their expansion to people “who usually don’t get access to those resources,” says Jen Leland, Trauma Transformed’s director. 

Jen Leland starts with an overview of T2's accomplishments 

The story of how this effort began in the Bay Area, and where it’s going played out on Friday, beginning with Dr. Joyce Dorado, clinical psychologist at the University of California San Francisco (UCSF) and Lynn Dolce, now CEO of Edgewood Center for Children and Families, who explained their path to founding HEARTS — Healthy Environments and Response to Trauma in Schools. They implemented this whole-school approach in several schools in the San Francisco Unified School District, with some remarkable results, including a 95% drop in suspensions over five years. That eventually inspired the school district to embed a goal of the system to become trauma-informed in its policy that eliminated willful defiance as a reason to suspend or expel students. 

Dorado and Dolce convinced Barbara Garcia, director of health at the San Francisco Department of Public Health, that the trauma they were seeing in schools wasn’t a mental health problem, but a public health problem. “Mental health can’t solve this,” Dolce told Garcia. 

Dr. Ken Epstein picked up the story from there. Two weeks after he showed up to become director of SFDPH’s Children, Youth and Families System of Care, Garcia gave him the challenge of training all 9,000 people who work in the department, which includes everyone at Zuckerberg San Francisco General Hospital. 

It was clear that “our delivery system” for health and social services is traumatized, something, he often points out, that many people, including Dr. Sandra Bloom, who created the Sanctuary model of organizational change, have recognized for quite a while. “We are fractured,” he says. “People are not getting better; they are getting worse.” 

He didn’t go into the project to train 9,000 people undaunted, but he was determined. To improve services, people have to change the systems that deliver them, he said. “Bureaucracies are inhumane,” he explained. Just one of many examples is that “black and brown people are disciplined at higher rates and not promoted as much as white people.”

But people are humane, he pointed out. Taking an intentional approach to integrate trauma-informed practices is the best hope of turning bureaucracies into systems that help people instead of hurt them, both the people who work in the systems as well as the people they serve. So, he began working with a small group, including Dorado, to develop the training and approach. Through many iterations and discussions and edits, they compressed a LOT of information into a 3.5-hour training program, which launched its first workshop in 2014.

“The beauty of what we’re doing today,” he said, “is that this is not just another initiative. It’s a foundational change.”

So far, the response to the first round of workshops has been good — participants were asked to implement just one change. These ranged from simple things, such as taking daily walks with their team to help reduce stress and increase health, to more complex. Of those who agreed to implement just one change, which was most who participated in the workshops, 86% said they plan to continue, 23% were unsure, and only 4% said they weren’t planning on it.

When SAMHSA issued the announcement of the five-year grant opportunity for a regional effort to change systems, SFDPH had established enough of a foundation that they put together a team to apply for the grant. East Bay Agency for Children was chosen to administer the grant, and Trauma Transformed was born. It launched a year ago, and began its first workshops 10 months ago. 

The next part of the story is partly what’s happening now, and partly what SFDPH and Trauma Transformed have committed to for the next year. Dr. Kenneth V. Hardy, professor at Drexel University College of Nursing and Health Professions, walked to the front of the room to address how he’s working with SFDPH to integrate awareness, and discussion of racism and historical trauma, so that it — and all systems in the Bay Area through Trauma Transformed, which comprise at least another 10,000 to 20,000 people — can become self-healing. 

Ken Hardy (center, in suit), listens to participant's response to his talk.

The best way to understand and take in Hardy’s remarkable work is in person. The second best way is through the videos of his presentations that appear on YouTube. I can’t do his presentation justice, so I will provide a few quotes that resonated with me, a white woman who has privilege and a history of ACEs. 

  • "I’ve been grateful for the term trauma. It has enabled me to talk about a set of ideas that have been  difficult to bring up. When I did a video about slavery, some whites asked ‘Why do you insist talking about slavery? When historical trauma started being talked about, the same folks got that. We know that alcohol in one generation of a family creates havoc in the family system for multiple generations. That’s accepted, but the effects of slavery weren’t."
  • "Socio-cultural trauma is a better way to describe historical trauma." 
  • "Accountability begins with the SIRO factor: self in relationship to others. The more privilege you have, the more difficult it is to see yourself in relationship to others. It’s difficult to give privileged people feedback, because they say: ‘That’s not how I see myself.’ "
  • "Black and brown people never have the freedom to NOT be cognizant of how they are seen. It shapes virtually everything that we do.”
  • He tells people who are uncomfortable with him bringing up race: “I bring up race because you don’t. And I promise I’ll never bring it up again, if you will.” 
  • "We are all racially socialized. People of color racially socialized, and it is explicit. For whites, it is  implicit. Race has been with me since I graced the planet. But many whites don’t think about being white until they’re in their 20s."
  • "Whiteness, maleness, and heterosexuality so integrated into our culture, that they can be right in front of your eyes and you don’t see them. When institutions become mostly white, male and heterosexual, it doesn’t matter if a person of color runs the organization, it’s still a white institution." (Especially, since in most institutions, black and brown people are disciplined more often and promoted less.)
  • "We can’t create community without an appreciation of diversity. We give up pieces of ourselves so that other people are comfortable. What kind of community is that when your growth is predicated on my sacrifice?"
  • "What gets hard is that the issues of safety and comfort become conflated. A white person will say: ‘I don’t feel safe,’ and that stops the conversation about race. A woman of color says the same thing, and it doesn’t stop anything. We have to lean in to have these conversations, they’re tricky to have."
  • "The only racial problem we have is a relationship problem. Only way to fix it is to be in a relationship." 

Other parts of his presentation deeply touched people in the audience, and he gave them time and room to explain how. That’s why I recommend watching some of his videos, because you will hear something different than I did. 

That is the essence of being trauma-informed and building resilience: listening, acknowledging and responding. And, as people spent much of the afternoon meeting in small groups, that’s what Friday was -- and Trauma Transformed is --  all about.

Trauma Transformed leaders explain how work touches them personally.

Trauma-informed training is just one part of what Trauma Transformed does. To find out more, go to


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So much here - thank you for this in-depth write up. Loved Dr. Epstein's comment/mission, “The beauty of what we’re doing today is that this is not just another initiative. It’s a foundational change.”

I would REALLY like to see how more people can see TRIGGER. I'm so sorry that I missed it, but Alex's short performance at the event featuring Ken Epstein moved me to tears. Looking forward to the email, DeAngelo!

This is so awesome. Great write up and great movement taking place. All it's missing is TRIGGER the stage play to cap it off!! Jane, Jen, Ken, Joyce...What do ya say??? (Email to follow)

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