Developmental trauma is real, and disproportionately affects children from poor neighborhoods. Prolonged exposure to stress and trauma has a deleterious effect on the developing brain. Moving from a "sickness model" to an "injury model" of trauma-informed care has had a positive impact on outcomes for the youth in the St. Gabriel's system.

1. Presentation at Eastern University
January 18, 2012

Joseph Lavoritano, MA, M.Ed., NCSP
Executive Director, Saint Gabriel’s System

James J. Black, Ph.D.
Director of Mental Health Programs, Saint Gabriel’s System

Martha Tavantzis, M.S.W., L.C.S.W.
Director of Treatment, Saint Gabriel’s Hall

2. 
DESCRIPTION OF SAINT GABRIEL’S SYSTEM

DEVELOPMENTAL TRAUMA

MAPPING DATA OF PHILADELPHIA
VIOLENCE AND POVERTY

EFFECTS OF PROLONGED EXPOSURE
STRESS AND TRAUMA ON THE DEVELOPING
BRAIN

3. 
ACES STUDY

SANCTUARY MODEL OF TRAUMAINFORMED CARE

TRAUMA-FOCUSED CBT AND TRAUMA
ART NARRATIVE THERAPY

COMMUNITY MEETING

4.  DATA:
POSTIVE OUTCOMES
 TAKE-AWAYS

5. 
500-600 youth in care on any given day

Serves both delinquent and dependent youth

180 youth in residential care in Audubon, PA
(Saint Gabriel’s Hall--SGH)

230 youth in three day-treatment programs in
Philadelphia and Bensalem, PA (De La Salle In
Towne, De La Salle Vocational, Brother
Rousseau Academy)

6. 
95 youth in group homes (dependent and
delinquent RTF’s) at St. Francis/St. Joseph

60 female youth in the St. Vincent group
homes (dependent)
The youth we will be discussing today are the Saint
Gabriel’s Hall youth

7. 184 YOUTH
(MALE)
EIGHT
“REGULAR
RESIDENTIAL”
UNITS
(16 BEDS EACH)
TWO
24 BED
DRUG AND
ALCOHOL
UNITS
FARM-BASED
PROGRAM
(MITCHELL
HALL)
(16 BEDS EACH)

8. WHAT IS IT?
WHY IS IT
IMPORTANT ?

9. MANY CHILDREN GO THROUGH
CHILDHOOD WITH FEW MAJOR
UPSETS…

10. 
Dannlowski et al. (2012). Limbic Scars: Long-Term Consequences of Childhood
Maltreatment Revealed by Functional and Structural Magnetic Resonance
Imaging. Biological Psychiatry, 71(4), 286-293.

McCrory, E., De Brito, S. A., & Viding, E.(2011). The impact of childhood
maltreatment: A review of neurobiological and genetic factors. Frontiers in
Psychiatry. 2:48. Epub 2011 Jul 28.

Evans, G. and Schamberg, M. (2009) Childhood poverty, chronic stress, and
adult working memory. By Gary W. Evans and Michelle A.
Schamberg. Proceedings of the National Academy of Sciences, Vol. 106 No. 13.

11. Developmental Trauma
Disorder will not make it into
the DSM-5, but there was
serious consideration to have
it included to capture life for
these children who have
histories of exposure to
multiple chronic traumas
usually of an interpersonal
nature.

12. “Developmental Trauma Disorder” (van der Kolk, 2005) which is
characterized by the presence of:
psychic conflicts
central nervous system alterations
distorted images of social life
chronic stress
a vulnerability to stress-related illnesses
warped moral values
rage
a profound loss of trust, and loss of a sense of security.
(NASP Communique, 2010)









13. IT DOES NOT APPLY WELL TO
CHILDREN AND YOUTH WHO HAVE
EXPERIENCED PERVASIVE AND
CHRONIC EXPOSURE TO LOSS,
VIOLENCE, NEGLECT AND ABUSE

23. 8483
9000
8000
7000
6000
Homicide
5000
2011 – 324 homicides
4000
3000
1608
2000
1000
0
306
2012-- 331 homicides
Philadelphia
Shootings
Assaults

24. • WHAT TRIGGERS IT – senses
pick up a threat – loud noise, a
scary sight, a creepy feeling – the
information travels two different
routes through the brain
A . THE SHORT CUT- When
startled the fear center, amygdala,
sends all points bulletin and
triggers the classic fear response:
• STRESS-HARMONE BOOST
• Cortisol
• RACING HEART
• FIGHT, FLIGHT ON FRIGHT
• DIGESTIVE SHUTDOWN
B. THE HIGH ROAD – Conscious
mind kicks in and some sensory
information bypasses the
amygdala and is routed to the
thalamus, processing hub of
sensory cues and then the cortex
for analysis of the raw data. This
signals a continued fear alert or
may signal the amygdala to have
the body stop alert.

25. • Due to the violence and trauma that was evident in the
neighborhoods we were seeing new behaviors
• Youth were hypervigilant and showed an inability to
distinguish real threats from benign actions.
• Brain research was saying continued exposure to violence,
poverty and trauma resulted in poor pre-frontal cortex
development. We were witnessing youth who had
a limited or no ability to control their emotions who
moved rapidly to a fight or flight response to any
perceived threat

26. 

Trauma is an overwhelming event that causes
intense feelings of fear, helplessness or
horror. There are many different kinds of
trauma, and not everyone responds the same
way.
Chronic Stress is an overwhelming external
element that impacts a person’s sense of
daily safety.

27. Largest study of its kind ever, almost 18,000
subjects
Examined the health and social effects of adverse
childhood experiences over the lifespan
Majority of participants were 50 or older (62%),
were white (77%) and had attended college (72%).

28. 10 categories of experience up to 18 years old
CHILD ABUSE
• emotional, physical, or sexual
CHILDHOOD NEGLECT
• emotional or physical
GROWING UP WITH:
•
•
•
•
•
domestic violence
substance abuse (alcohol or drugs)
mental illness
parental discord
Crime (imprisonment)
Add up the # of categories = ACEs score = trauma dose

32. ACE Study
Strong, graded relation to childhood adversity
Smoking
COPD
Heart Disease
Attempted suicide
Revictimization
Teen pregnancy
Diabetes
Obesity
Hepatitis
Fractures
Promiscuity
Sexually transmitted
disease
Poor job performance
Poor self-rated health
Violent relationships
Alcoholism
Other substance abuse
Depression

34. When a person experiences a traumatic event, some
sort of Loss is experienced. When a loss is
experienced, a person may feel overwhelming
emotions. These overwhelming emotions lead often
lead to unsafe behavior. This unsafe behavior has
consequences on a person’s future.

35. Understanding trauma
is not just about
acquiring knowledge.
It’s about changing the way
you view the world.

36. It’s Just Common Sense That..
 People avoid things that scare them
 People avoid pain
 If somebody hurts you, you get away from them
 We can tell who can be trusted and who can’t
 People learn from their experience
 Parents love their children
 You don’t hurt people you love
 People remember anything that is really terrible

37. But traumatized children
frequently..
 Put themselves in situations of danger
 Hurt themselves
 Get into and stay in relationships with hurtful people
 Are frequently unable to discern who is to be trusted
 Don’t seem to learn from experience
 Have been hurt by people who were supposed to love
them
 Frequently hurt the people they love the most
 Don’t remember the worse experiences of their lives

38. The Heart of Trauma Theory
Sickness vs. Injury Model
Changing the fundamental question from:
“What's wrong with you?"
to
"What's happened to you?“
Foderaro, 1991

39. Injury Model
What’s happened to you?
 Includes physical, psychological, social, and moral
forms of injury
 Includes deprivation, neglect, and developmental
insult
 Implies rehabilitation process that is mutual, longterm: Requires active collaborative relationship
between helper and injured party
 Removes stigma and shame
 Provides understandable shared framework
 Increase in compassion, increase in expectations

40. S.E.L.F.
•Safety: Physical, Psychological, Social, Moral
•Emotions: Handling feelings without
becoming self/other destructive
•Loss: Feeling grief and dealing with personal
losses, preparing for change
•Future: Re-establishing the
S
capacity for choice
F
E
L

42. I walk down the street
There is a deep hole in the
sidewalk
I fall in
I am lost . . . I am helpless
It isn't my fault.
It takes forever to find a way out.

43. I walk down the same street,
There is a deep hole in the
sidewalk,
I pretend I don't see it.
I fall in again.
I can't believe I am in the same
place.
But it isn't my fault.
It still takes a long time
to get out.

44. I walk down the same street.
There is a deep hole in the
sidewalk.
I see it is there.
I still fall in . . . it's a habit.
My eyes are open.
I know where I am.
It is my fault.
I get out immediately.
44

45. I walk down the same street.
There is a deep hole in the
sidewalk.
I walk around it.

46. I walk down
a different street.

47. Saint Gabriel’s Hall was
awarded a 3-year
grant that began in Fiscal Year
2008/2009
to implement the
Sanctuary Model of
Trauma-Informed Care

48. If children do not make substantial and
positive changes then treatment is not
working!
If treatment isn’t working maybe it’s US and
our systems of care that are the problems, not
the children.

49. A master program that controls a computer's basic
functions and allows other programs to run on a
computer IF they are compatible with that operating
system.

51. 
Evidence-Based

Specifically Targets Trauma

State Grant—7 Therapists

Free 10 Credit Course at www.musc.edu/tfcbt

52. 
Developed by Dr. Lyndra Bills

Research Underway with LIU to Establish
Evidence-Based Status

All SGH Therapists Trained (Arts Skills Not
Necessary!)

Process Speaks to Non-Verbal Part of Brain,
Specific Event-A Scene

53. 
Developed by Dr. John Briere in 1989

54 Self-report Items, 2 validity scales and 6 clinical
scales, and 4 subscales

Normed by age and gender on over 3000 children and
youth

Strong validity and reliability, easy to administer and
score

55. 
HOW ARE YOU FEELING TODAY?—
CONNECTS YOU TO YOUR FEELINGS

WHAT IS YOUR GOAL FOR TODAY?—
CONNECTS YOU TO THE FUTURE

WHO CAN HELP YOU WITH THAT? –
CONNECTS YOU TO COMMUNITY

56. 
Does it work?
Symptoms
Graduation
Rates
Vocational
Certifications
Positive
Outcomes
in
Program
Psychiatric
Hospitalizations

57. GRADUATION RATES

58. SAINT GABRIEL’S HALL GRADUATES
Fiscal Year
# of Graduates
Percentage
FY 08/09
28 of 70
40%
FY 09/10
39 of 89
44%
FY 10/11
52 of 104
50%
FY 11/12
68 OF 113
60%

59. 90
80
82
70
73
60
50
56
40
44
30
35
20
10
0
24
06/07
07/08
08/09
09/10
10/11
11/12

60.  Decreased Depression scores
(p = .000)
 Decreased Post-Traumatic
Stress scores (p = .002)
 Dissociation (p = .039)

61. 300
250
267
239
200
150
100
50
0
132
14
2008-2009
2009-2010
2010-2011
2011-2012

62. PSYCHIATRIC HOSPITALIZATIONS BY FISCAL YEAR
8
7
6
5
4
3
6
7
4
2
Psychiatric
Hospitalizations
4
1
1
1
0
FY07
FY08
FY09
FY10
FY11
FY12

63. 
Does it work?
Rearrests
Counseling
Attendance
School
Attendance
Positive
Outcomes
Post
Discharge

64. 70
60
50
40
30
20
60%
(297)
25%
10
15%
(127)
(72)
0
>75%
50%-75%
<50%

65. REARREST BY YEAR DURING THE PERIOD OF REINTEGRATION (3-6 MONTHS)
(N=775)
120
100
71%
86%
88%
88%
81%
(49)
80
(128)
(148)
(172)
(157)
Not Rearrested
60
Rearrested
40
20
29%
(20)
14%
(21)
0
07/08
08/09
12%
(20)
12%
(24)
09/10
10/11
19%
(36)
11/12

66. RATE OF SCHOOL ATTENDANCE
(N=427)
70
60
50
40
62%
30
20
(263)
19%
19%
(80)
10
(84)
50%-75%
< 50%
0
> 75%

67. Saint Gabriel’s Hall Finishes
#1
Among CBH-Funded RTF
Providers!
Several Outcomes Led to this
First-Place Finish according to CBH’s most recent
Provider Profile Report
Most Notably:
Less than 1% of youth FTA’d to another RTF
0% of youth FTA’d to psychiatric inpatient services
60% of youth attend a follow-up outpatient appointment within
30 days of discharge
Saint Gabriel’s Hall is Sanctuary Certified and Utilizes Master’s Level Therapists Trained
in Trauma-Focused Cognitive Behavioral Therapy—Both Sanctuary and TF-CBT are
Evidence-Based!
POSITIVE OUTCOMES AND EVIDENCE-BASED PROGRAMMING:
A WINNING COMBINATION!

68. 
DEVELOPMENTAL TRAUMA IS REAL AND
DISPROPORTIONATELY AFFECTS KIDS FROM POOR
NEIGHBORHOODS

PROLONGED EXPOSURE TO STRESS AND TRAUMA
HAS A DELETERIOUS EFFECT ON THE DEVELOPING
BRAIN

MOVING FROM A “SICKNESS MODEL” TO AN
“INJURY MODEL” OF TRAUMA-INFORMED CARE
HAS HAD A POSITIVE IMPACT ON OUTCOMES FOR
THE YOUTH IN SAINT GABRIEL’S SYSTEM