(Becky Haas and Dr. Andi Clements)
Since 2015, I’ve been a regular contributor in PACEs Connection providing updates on the growth of the Northeast Tennessee Trauma Informed System of Care with the hopes that these updates would serve to encourage others doing this work in their communities. By keeping the message simple, urgent and conveying an expectation of use by the hearers, thousands of cross sector professionals in Northeast Tennessee have received training resulting in many of them now providing services using a trauma informed approach. When first learning of the Adverse Childhood Experiences (ACEs) Study in 2014 while working for the police to reduce drug related and violent crime, immediately it was clear this message needed to be shared with my community. At the time I was overseeing 19 police programs implemented by a cohort of 35 community stakeholders. These amazing stakeholders performed so well that together we reduced drug-related and violent crime by 40% in one of the neighborhoods we were focused on as well as twice receiving national recognition including the U.S. Department of Justice listing our program as a success story in 2015.
(The "notebook" Becky created in 2015 while researching to learn if a trauma informed approach was being used in a diverse cross sector of professionals)
Before reaching out for help to share this message regionally, there was only had one question I needed to settle, and that was, “is there a meaningful application of mitigating the effects of childhood trauma within any or all of the various professional sectors I was reducing crime with?” To answer this question, I took a large binder and filled it with 35 tabs representing all the community stakeholders working with me to enhance public safety. Among these were mental health, corrections, juvenile justice, housing authority, libraries, police, schools, university faculty, downtown development, neighborhood restoration, healthcare - to name a few. With the help of ACEs Connection as a resource and many hours of reading, within a few months I had my answer and my notebook was filled with inspiring programming I had found being done to promote resilience science. I was able to email or have a phone conversation with those involved in several of the programs I located in order to learn more.
Now that I was convinced that beyond educating my town, we could also create practitioners. So, the next step was to find help. In the summer of 2015, I reached out to several faculty members at East Tennessee State University to hear my idea. My longtime friend and Psychology professor, Dr. Andi Clements came to the meeting as well. Though at the time, none of the other faculty members felt this was a project they were in a position to embark on, thankfully a few days later, Andi emailed and said, “count me in!” I’m extremely grateful for her partnership in this effort and for sharing my passion in getting this message out.
Recently I interviewed Andi in order to share her side of the story in helping to develop the Northeast Tennessee ACEs Community.
Can you tell us who you are and what you do?
I am a professor of psychology at East Tennessee State University and the president of a nonprofit called Uplift Appalachia. Both my research and community work are focused on reducing addiction, particularly mobilizing the faith community to address addiction. I am working on a theory of interpersonal connection as a treatment for addiction, which includes editing a special issue of an academic journal focused on that topic. I primarily teach research methods, psychological measurement, and direct doctoral students' research.
Prior to partnering to raise awareness about ACEs, how were you involved in the crime reduction program I was leading at the Johnson City Police Department?
Becky and I had been friends for years when she took a new position with the Johnson City Police Department in 2012 managing a federal grant to reduce crime in Johnson City. As she was working toward that crime reduction, she created a consortium of many community partners from a great variety of organizations with interests in the highest crime areas. She knew that I and some others had planted a church in the grant target area, and we were invited to participate as a partner. Monthly meetings created new awareness among these partners. Our church became most involved in volunteering with a corrections program aimed at reducing recidivism which she pioneered. This was a prison diversion program for high risk, high need felony offenders with addictions. To this day, I credit much of my current addiction and trauma informed care research and other nonprofit endeavors to my experiences during this volunteering. This program was so successful, at the end of her grant in 2016, it was acquired by the Tennessee Department of Corrections and has been replicated across the state in numerous locations.
How did you first learn about the Adverse Childhood Experiences Study?
Becky came to me in the spring of 2015 terribly excited about the ACE study and trauma-informed care, which she had learned about at a couple of conferences. She shared with me about her “notebook” and her findings how this science was being used within various professional sectors to mitigate the effects of childhood adversity. At first, as a research scientist, I was skeptical and went to do some investigation on my own. I was thrilled to find an extensive body of research supporting it. After she presented to several of my colleagues at ETSU in the summer of 2015 asking for help to “educate our town” I felt strongly this was something I should do.
Since this work began in 2015, in what ways have you seen it impact rural Appalachia?
We have done research all along on community awareness of ACEs and Trauma Informed Care by collecting evaluations at the end of trainings over the first three years. Prior to our first event in October of 2015, very few people had even heard of ACEs or Trauma Informed Care. Following that first event that was attended by almost 400 people from all types of organizations, the awareness snowballed. We were then running to keep up with all the requests for training while still maintaining our “day jobs.” Since that time, ACEs and TIC have become everyday conversation in social service and education circles. Over time, ACEs have become regionally accepted as a social determinant of later health and also health disparities within our healthcare system.
In three years, how were 4,000 professionals trained when this was not part of your job at ETSU (nor mine at the police department), nor having a budget to do it, and continuing to keep up with everything else?
Becky and I both felt that this information was critically important and could potentially provide Northeast Tennessee with an upstream approach to tackling the addiction epidemic. By both of us becoming involved directly with individuals who were court ordered to the new probation program, this mission became personal. Hearing their stories of childhood trauma leading to addiction, we couldn't help but share it. Though much of this was done in addition to our day jobs at the time, it has been very rewarding. Luckily as a psychology faculty member, I am able to determine a lot of my research direction. I have gradually focused much of my research and service in this arena over time.
Has this message made our community a more resilient one? If so, in what ways?
While there is still plenty of work to be done, I feel that these efforts definitely have increased resilience in many sectors of our community. We have had many ACES champions join our efforts. As people have come to understand this message, many become advocates, or even champions. However, it wasn’t until we wrote to the SAMHSA funded National Center for Trauma Informed Care in October of 2017 requesting to host a webinar inviting other likeminded cities, that we realized how much we had accomplished. We wanted to host a webinar in 2018 to which we would invite other communities that had been training a cross sector of professionals as recommended in SAMHSA’s 2014 Concept Paper. At that point, we learned that no other community had accomplished what we had, and we were described as a leader for other cities to follow at the time. Instead of a webinar in 2018, we ended up hosting a SAMHSA Forum in September of 2018 which was attended by two state First Ladies, people from twenty states, and the Executive Director of the National Center for Trauma Informed Care who all came to hear us tell our story. Sharing how we had rigorously used the steps “advocate, educate and collaborate,” forum attendees then heard from over a dozen community partners presenting on trauma informed programming they were now implementing on a regular basis. School attendance and graduation rates went up, healthcare began viewing procedures through a trauma-informed lens, and the faith community began being trained to consider past adversity among those being served.
How has being involved in this pioneering effort impacted your role at ETSU as a faculty member?
At first this effort was completely in addition to my role as a faculty member. In fact, there were several faculty members at ETSU who were doing work in this area. We were all pretty much functioning as lone rangers. In 2018, Dr. Wally Dixon, now founding director of the ETSU Ballad Health Strong BRAIN Institute (SBI), pulled us together to try to combine our efforts. The effort paid off as we now have a research and training institute focused on ACEs, TIC, and building resilience. What began as siloed endeavors is now a firmly grounded institute, with faculty representing every college at ETSU, funded by Ballad Health, a 21-hospital healthcare corporation.
In what way are you involved with the ETSU Ballad Health Strong Brain Institute?
I am one of the founding members of the SBI. As part of the SBI, I serve on the "institutional" committee which is very much focused on making ETSU a more resilient campus as well as pioneering ways to help other higher education institutions do the same. I also promote research in ACEs/resilience science through designing studies, developing measures, writing research articles and reports, and consulting with organizations to evaluate their efforts. We were also awarded a grant to test whether we can increase resilience through ACE/TIC training in an entire college at ETSU, the Gatton College of Pharmacy. That project is underway and its findings should help to inform not only our work at ETSU, but also give us tools to share with other institutions.
In 2016, under the leadership of then Governor Bill Haslam and First Lady Crissy Haslam, they embarked on an effort to create a Trauma Informed state. This successful work is now the TN Building Strong Brains program. As a recipient of two TN Building Strong Brains innovation grants, how do you see the state of TN advancing this message?
I wrote three BSB grants, two of which were funded. The first was to fund the implementation of TIC training at our local boys and girls club. It was only funded for one year, so the research on effectiveness was not completed, but there are still lasting effects of our intervention. Since that grant was funded in summer 2016, the club has consistently maintained TIC training for all staff and volunteers, and they created a calming room children or staff to be able to "deescalate" when upset. This grant was awarded in the state's first round of funding, and we were glad to be involved from the very beginning. Boys and Girls Club leaders from across the state have visited this club to learn more about the implementation of trauma informed care and to see the Tree House calming room.
In summer 2018, after we had been training professionals across the community creating a collaboration of stakeholders around ACE/TIC, we applied for and received another BSB innovation grant. This one funded us to write a toolkit which could be used to guide other communities to create Trauma Informed Systems of Care as we had done in the Johnson City area. This guide is available on the Tennessee Department of Children’s website and is free to anyone to download. It has also been promoted in ACEs Connection Growing Resilient Communities 2.1 and in December of 2020, we published an article in John’s Hopkins journal, Progress in Community Health Partnerships: Research, Education and Action, in which they showcase successful community health partnerships.
Since Tennessee Building Strong Brains was launched in 2016, the Tennessee Commission on Children and Youth has continued to do a marvelous job coordinating this work across the state. This effort has resulted in thousands being trained to become BSB trainers, numerous continuing education webinars being held, as well as various state commissioners including the Tennessee Department of Education leading efforts to create trauma sensitive schools statewide.
Recently you founded a non-profit "Uplift Appalachia" and you are taking this message to the faith community. Can you tell us more about this effort?
I have been focused the past several years on mobilizing the faith community to address addiction. We know how predictive ACEs are of addiction, and this is a central message that we regularly carry to members of the faith community. We have created faith-based trauma informed care trainings as a way to reduce stigma within the faith community toward people who live with addiction. It is also effective
for helping people who live with addictions to better understand possible origins of their own struggles. Every time we do a training, multiple people speak of how the training helped them to connect so many dots. We see ACE/TIC training as an indispensable part of what we do.
In 2020 you were the recipient of the Tennessee Higher Education Commission Harold Love Outstanding Community Service Award. What contributions did you make in the community that made you stand out from other nominees statewide?
I was so humbled to receive that award and was kind of amazed as I was asked to list things I had been involved in at what all has happened in the past few years. I think I would be much more comfortable just to share the press release with you. It said:
“Clements, a professor and assistant chair of curriculum in the College of Arts and Sciences’ Department of Psychology, is praised for her work in the community and region in two areas: promoting trauma-informed practices in court, police, education and mental health systems, and collaboration with faith-based groups to address the problem of opioid use and addiction.
Beginning in 2015, Clements partnered with Becky Haas, then of the Johnson City Police Department (JCPD) and now of Ballad Health, to implement trauma-informed practices in various Johnson City service agencies. Through this effort, more than 4,500 professionals throughout the region have heard Clements’ talks on the effect of adverse childhood experiences (ACEs) on brain development, behavior and interpersonal relationships. These talks have led many to incorporate trauma-informed care approaches in their agencies.
Working with the JCPD and the federal Substance Abuse and Mental Health Services Administration, Clements played a leading role in hosting a regional forum showcasing advances in trauma-informed care in the fall of 2018. Following the event, SAMHSA officials called the forum “a national model other cities should follow.” As part of her work with Haas, Clements has worked directly with those in need of care, in addition to educating professionals. For five years, she served as a mentor through a reentry program for felony offenders with addictions, bringing a home-cooked lunch each Monday and spending time with participants.
In addition, Clements has been instrumental in engaging faith-based organizations in the fight against the opioid epidemic in southern Appalachia. She has been instrumental in founding two non-profits to mobilize the faith-based community at the individual church level to integrate their resources to counteract the opioid crisis. She helped plan and coordinate the 2018 Holy Friendship Summit, which drew approximately 450 clergy, clinicians and others together to discuss needs and strategies involved in combating addiction in the region. In 2020, Uplift Appalachia, founded and led by Clements, has taken over the work of the Holy Friendship Collaborative. This non-profit serves as a liaison between Ballad Health and the regional faith community and recently created a call to action for faith communities across the state of Tennessee to join in serving those struggling with addiction.”
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