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Child advocates across Missouri are working to change how they respond to clients affected by trauma — ultimately changing the question from "what's wrong" to "what happened."

"We recognize that some of the traumas that are most damaging happen through relationships, so if we're just addressing treatments options, we're not changing relationships, interactions or environments that may be actually causing harm to people," said Patsy Carter, trauma lead at the Missouri Department of Mental Health.

Some people think being trauma-informed involves only mental health, but it should cross with corrections, juvenile justice and schools — because all of those agencies interact with people suffering from trauma, Carter explained.

"It means more than treatment, but it's addressing the impact trauma has on brain development and recognizing how that impacts them across their lifespan," she said.

The Department of Mental Health has worked to shift the way organizations respond to people affected by trauma since 2008. As a result, the Missouri Model was created five years ago.

In Missouri, 47.8 percent of children under age 18 have had at least one adverse childhood experience (ACE), according to a recent study conducted by the National Survey of Children's Health. The report indicates 27.2 percent of children have had two or more indicators.

Some ACE indicators include the death of a parent, witnessing or being a victim of violence, and living with someone who is suicidal or has a drug or alcohol problem.

Jennifer Dochler, public policy director at the Missouri Coalition Against Domestic and Sexual Violence, said the Missouri Model gives advocates concrete tools for responding holistically to people affected by trauma. MCADSV has partnered with DMH on the model for the past five years.

"The ACE (adverse childhood experience) is focused on kids, but kids aren't living in isolation. They're living with their parents," Dochler said. "So if we can also meet the needs of what trauma parents are going through, then that would also stabilize the kids and the environment they're in."

Since they began using the model, she explained, they have started giving survivors the choice of what services best fit them and have updated standards for domestic and sexual violence programs as well as training to prepare advocates for families.

"Oftentimes, it is mom coming in with kids to our shelter facilities, so we want to respond holistically," Dochler said. "We stick with this model because it works."

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Andrea Blanch, acting director of the Campaign for Trauma Informed Policy & Practice, said Missouri is unique how it has approached the model.

"No one else has taken such a clear developmental tact describing the staging and thinking about the stages you move through. Plus, it was developed in a very participatory process over time with leaders from different sectors," Blanch said.

Carter added: "The model is also unique in the sense you can look at this from an individual perspective, organizational perspective, community perspective, and now we're taking it through historical and cultural perspective."

Other Missouri Model adopters like the Missouri Division of Youth Services, Truman Medical Center, Alive and Well STL, and the Crittenton Children's Center agree the model is a culture shift in the way they have addressed trauma individually.

"Becoming trauma-informed has had more challenges than we realized initially, but part of what has helped us grow throughout the process is being honest about how tough it has been," said Sharon Freese, chief operating officer at Truman Medical Center, based in Kansas City.

Since adopting the model, Freese said, they focus on the language used among staff promoting trauma sensitivity, monitor environmental practices by keeping them clean and inviting and have created cards for patients to help articulate their needs to medical providers.

In addition to internal modifications, they have instituted Trauma Sensitive School Summits, training 174 educators and expanding their reach to Indiana.

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