Community Connections
President's Commission on Mental Health Testimony of Maxine Harris, Ph.D. -- February 5, 2003
 
As clinical director of Community Connections, I have the opportunity to supervise programs that serve over 1500 consumers annually. This makes Community Connections the largest private, non-profit provider of mental health, addictions and residential services in the District of Columbia. More than 90% of those served are African-American. I'd like to briefly share with you the evolution of our clinical programs over the last twenty years as a way of illustrating the centrality of sexual and physical abuse in the lives of the women and men whom we serve.
 
When Community Connections opened its doors almost 20 years ago, our mandate was to provide mental health services to consumers who were leaving institutional care. We assumed, somewhat naively, that we would be providing treatment solely for major mental disorders and helping people to relearn skills lost after years of institutional care. What we quickly learned, however, was that we could not address issues of mental health without also focusing on problems of substance addiction. By the early 1980's, the use of crack cocaine had reached epidemic proportions in the District of Columbia.
 
Consequently, we adjusted our clinical programming to include a full range of residential and outpatient services for dually diagnosed individuals.
 
But, almost immediately, we were confronted with another problem. We could not treat dually diagnosed individuals without also addressing issues of homelessness. Many of the people we treated found themselves without shelter as their addictive disorders spiraled out of control. Once again, we redesigned our clinical services and added outreach and residential programs specifically for homeless dually diagnosed adults.
 
But we still were not finished. As we strove to understand the dynamics that kept our consumers locked in the vise grip of poverty, despair and disability, what we heard over and over again were stories of violence and victimization, sexual and physical abuse that began in childhood and continued into the present. Among homeless, dually diagnosed women, we could not find a single individual who had not experienced and suffered from violent abuse. The prevalence rates for childhood and adult victimization approached 100%.
 
So once again, we redesigned our service components and developed specialized treatments for the survivors of sexual and physical abuse. The very symptoms we were treating as being solely the product of mental illness, substance addiction, or homelessness were, frequently, the long-term after effects of abuse. Depression, anxiety, panic attacks, dissociative states, drug and alcohol addiction, and high-risk behavior have all been linked to sexual and physical abuse in childhood and adulthood. Between 50 and 70% of women hospitalized for psychiatric reasons, 40-60% of those receiving outpatient services and 55-99% of women substance abusers all report significant physical or sexual abuse at some point in their lives.
 
While we initially heard the stories of women survivors, sexual and physical abuse was not solely a women's story. Over 50% of the men we serve are also survivors of sexual or physical abuse.
 
Beyond the development of a range of trauma-specific service interventions, we have moved deliberately to ensure that all aspects of our service program, from our psychiatric care to our residential programming, is trauma-informed. And by trauma-informed, we mean fully aware of the impact trauma has had on the lives of consumers, fully aware of the behaviors and responses that might trigger a retraumatization, and open to understanding how current behaviors are often adaptations to past abuses. This shift in our approach has resulted in a higher retention of individuals in the service system, a decrease in the use of expensive services such as emergency rooms and inpatient hospitals, a decrease in high risk behavior and rates of substance use, and a high rating of consumer satisfaction with services.
 
At Community Connections, we are encouraged that research and evaluation currently being conducted demonstrates that trauma-specific services provided in a trauma-informed environment have a significant impact in reducing the symptoms of mental illness and post-traumatic stress and the rates of substance use and abuse.
 

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