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Developers of the ACERT Project, from left to right: Project LAUNCH Local Program Director Lara Quiroga from Manchester Community Health Center; Jessica Sugrue, president of YWCA NH; Lt. Nicole Ledoux from Manchester Police Department; and Lt. Paul Thomps




How to get help

There is no central statewide number for children’s mental health services. But calling the organizations below is a good place to start if you or your child need trauma-related resources.
• DCYF: 271-6562
• CFS: 518-4000
• Southern NH Services: 668-8010
• Riverbend Child Services (Concord): 228-0547
• The Mental Health Center of Greater Manchester: 668-4111
• Greater Nashua Mental Health: 889-6147  




Early intervention
NH’s emerging focus on early childhood trauma treatment

11/03/16
By Ryan Lessard news@hippopress.com



 Traumatic experiences can take many shapes for children. 

It can come from animal attacks, automobile crashes, abuse, hospitalization or not getting their basic needs met. On Sept. 18, a 2-year-old girl’s trauma came from witnessing her mother, Mandy McGowen of Salem, pass out in front of her in a Lawrence, Mass., general store. Bystanders called 911 and recorded the toddler crying as she pulled at her unresponsive mother’s arm and tried to prop up her head. McGowen had overdosed on opiates.
“All I could see was a child experiencing trauma,” Manchester Police Chief Nick Willard said of watching the video.
Research shows the traumatic experience can continue to affect children later in life if they are left untreated, leading to problems in school and at work, and to health problems, including substance abuse.
“Children who maybe experienced trauma can have some pretty profound behavioral health needs,” said Erica Ungarelli, the head of the state’s Bureau of Children’s Behavioral Health.
 
The impact
The foundational study upon which most child trauma research is based is a study conducted in the mid to late 1990s called the Adverse Childhood Experiences study. Maryann Evers at Child and Family Services said that was the first major long-term study that found a strong correlation between traumatic experiences from ages 0 to 7 and a variety of negative outcomes, including risk factors for leading causes of adult deaths.
Research also shows the inverse is true, if adverse exposures are prevented or treated early, and parental relationships are key.
“Supporting parent-child interactions to be healthy … is something that is highly correlated with good outcomes for children in general,” Evers said.
The ripple effects from trauma appear to be so far reaching that catching it and treating it early could improve the economy and save the state and federal governments money on things like prisons, courts, foster care, residential treatment and special education services.
“There’s a potential here for a tremendous impact on all of those budgets,” Evers said.
Those on the front lines of addiction and mental health treatment are able to point to countless examples of how the root of the problems began from trauma.
Stephanie Bergeron, the CEO of Serenity Place, a substance use disorder treatment center in Manchester says the public and news media too often focus on the drugs themselves and misunderstand what addiction is. The actual substance use, Bergeron says, is just a symptom. Underlying it are the untreated mental health issues people with substance use disorders suffer from, which can often take root at a young age after they’ve been exposed to things like violence, neglect or sexual abuse.
And Evers said children exposed to parents with substance use disorders are more likely to be neglected.
“Years ago, they used to think that child abuse was the big thing. And now, people pretty much recognize that neglect is far more devastating than abuse,” Evers said. “And the implications of that on that child’s development are enormous.”
A psychological study published last month found opioid addiction in particular blunts the parental instincts of the addict.
 
What we’re doing
Lorraine Bartlett, the director of the state Division of Children, Youth and Families, said DCYF began looking at how it could become a more trauma-centered children welfare system about four years ago. 
With the help of the Dartmouth Research Center, DCYF staff were trained on how to screen for PTSD symptoms in children or discern other signs of potential exposure. 
Today, that screening is used in every open child protective case, certain preliminary assessments and with kids in the juvenile justice system.
Bartlett said whenever it’s deemed a child would benefit from treatment, they refer their caregiver to a provider. 
Some new programs have been making important strides in getting kids access to treatment. One is called Fast Forward. Ungarelli said it provides quicker access to treatment and goes beyond just those kids in the juvenile or foster system.
Fast Forward came out of a $4 million four-year federal grant that just ran out. Ungarelli said it was spent to help build up the state’s childhood treatment infrastructure through training and freeing up department resources that had previously been siloed in different programs. 
Another thing that came out of this grant was the creation of a New Hampshire chapter of Youth M.O.V.E. (motivating others through voices of experience), a peer-support service that just launched in a sort of pilot phase. 
“It’s being implemented but it’s very small right now,” Ungarelli said.
Many of these programs are designed to help kids after they’ve begun to exhibit the bad behaviors that trauma-related psychological issues can give rise to,  but there is one program that breaks from that pattern. 
In Manchester this past summer, Willard launched a unique initiative called the Adverse Childhood Experience Response Team. 
The ACERT team, currently funded by a $150,000 grant from the HNH Foundation, consists of a juvenile detective, the domestic violence child advocate and a social worker from the YWCA.
It’s only active eight hours a week during the times when domestic violence calls tend to spike, but when a call comes in where a child is present, the ACERT team arrives to explain how a child’s exposure to things like domestic violence, overdose and even SWAT raids is likely to affect them and refers them to treatment services.
As far as Willard’s department can tell, this is the first team of its type in the nation, and he thinks it’s a simple model for other departments to replicate.
But for Willard, getting kids access to trauma treatment early is personal.
“I grew up in a violent home with alcoholism,” Willard said. “There were eight of us … Irish Catholic family, and there really wasn’t a system for us. Law enforcement, they weren’t helpful to families back then. They would tell your father to take a walk and tell your mother to stop making him angry and they’d line the eight kids up on a couch and you felt … less human.”
So far, the response to the ACERT program has been positive, according to Christina Lachance at the New Hampshire Charitable Foundation, who works on early childhood and family initiatives. When news of the team first came out, Willard said, U.S. Sen. Jeanne Shaheen came to the police department to ask questions and discuss the potential for expanding services like these. 
Lt. Nicole Ledoux at the MPD said 78 of the 213 families who have been offered help for their children received services, 91 declined help and the rest are pending referrals or seeking help independently.
Still, this program is new and small, and most of the kids getting this kind of help are either already in the court system or at risk of entering it. Hundreds of other kids who could benefit from treatment aren’t being reached. 
 
Falling through the cracks
Evers said there are a few common types of treatment for exposure to adverse experiences, including child parent psychotherapy or trauma-focused cognitive behavioral treatment. Those services exist already in the state, she said. 
One of the key steps in treatment, according to Bartlett, is getting the kids to let go of their trauma.
“It’s kind of like you’re holding a … beach ball under the water and once they can start to let it up and let it up a little bit at a time and then it comes all the way out, they’re able to go through the healing process and potentially not become future aggressors or people that hurt other people. They’re able to manage their feelings and their trauma,” Bartlett said.
One roadblock is a shortage of psychiatrists who specialize in children.
“Probably the biggest struggle that we have is getting the children into treatment. … Sometimes, there’s lengthy waiting lists for children and their parents to get into and access the therapeutic intervention that they need,” Bartlett said.
She said it can take four to six weeks before a child gets access to trauma treatment, sometimes longer. Some are referred to family resource centers for interim services before they are able to get a first appointment with a treatment provider. And Evers said a study of the general population showed high demand for trauma intervention.
“According to the public health data that we had, we estimated that there’s probably … close to 1,000 people born every year in those counties that could benefit [from intervention services],” Evers said. “The people getting those services are a very small number compared to the numbers of people that could benefit from it.”
She said the hard part is connecting the people who need it with the services available. It requires a system that identifies the need early, offers referrals and builds up the capacity to meet the demands. 
Steps are already being taken to create such a system.
On June 6, Gov. Maggie Hassan signed Senate Bill 534 into law. It directed the Department of Health and Human Services and the Department of Education to work together to build a “comprehensive system of care for children’s behavioral health services.”
But change can’t come fast enough, as Willard said hundreds of kids in the state are still not getting the help they need; he sees it all the time in Manchester and not just in abstract reports.
“I went to Parker Varney School last year, had lunch with the kids. I just do it on a whim, it’s fun, and I was sitting with a girl [in] sixth grade and she said that she lost both her mother and her father to drug overdoses,” Willard said. “That’s going to have an effect on her life. She can certainly rise above it, but it’s still something that will never leave her.” 





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