First Sem-Midterm Requirement
First Sem-Midterm Requirement
First Sem-Midterm Requirement
-You can also find all three working in community settings, such as a hospital or the health
department. Often professionals in these settings would assist individuals with diagnostics and
referrals for further treatment.
Professional counselors do not practice in a vacuum. Counselors practice, regardless of the setting,
in community with others. Counselors practice in neighborhoods, in schools, in mental health
agencies, in inpatient mental health hospitals, in colleges, in homes, in homeless shelters, in
assisted living homes, in prisons, and the list goes on. All of these areas of practice are in
communities. Therefore, we must be aware as counselors of the issues that affect the communities
where we practice.
Communities are often affected by traumatic events and experiences such as community violence,
drug and sex trafficking, police shootings, crime, substance and alcohol abuse, and parental abuse
and neglect toward children. As a licensed professional counselor, I work primarily with children and
adolescents who have extensive trauma histories. I provide trauma therapy in the form of trauma-
focused cognitive behavior therapy. I also work within my community to provide trauma education to
organizations such as day care centers to help these educators understand trauma’s effects on
young children. My goal is to provide more community outreach through education and training to
enable communities to become more trauma informed and resilient.
In this article, I will discuss the pivotal role that professional counselors can play in developing
resilient communities through outreach. Counselors possess the expertise, experience and training
to help communities develop programs necessary for addressing and ending the adverse effects of
events that have taken place within these communities.
Adverse childhood experiences (ACEs) have been shown to have an impact on future health
implications and violence victimization. These experiences can include:
Abuse
Neglect
Witnessing violence in the community
Witnessing domestic violence in the home
Having a caregiver or loved one experience a prolonged illness, mental health crisis or death
Having a loved one die by suicide
Being separated from biological parents
Being in the foster care system
Having a loved one engage in substance or alcohol abuse
Each of these experiences can lead a child to feel unsafe and to struggle with stability and
attachment.
Early ACEs will have long-term impacts on children well into adulthood. ACEs have been linked to
unsafe behaviors, chronic health problems, poor academic achievement, lower rates of graduation,
more lost time at work, and early death. The original ACEs study was conducted by the Centers for
Disease Control and Prevention (CDC) and Kaiser Permanente from 1995-1997 in Southern
California. The conclusion of the study was that those who had experienced four or more ACEs were
more likely to experience increased health risks for alcoholism, drug abuse, depression and suicide.
These individuals were also more likely to experience poor physical health, have multiple sexual
partners, contract sexually transmitted diseases, experience obesity, have limited physical activity,
and engage in smoking. Among the physical problems noted among adults who had experienced
four or more ACEs were ischemic heart disease, cancer, chronic lung disease, liver disease and
skeletal fractures.
Another study, the Philadelphia Urban ACE Study, was conducted to determine how ACEs affected
those in a large urban city with a socially and racially diverse population (the original ACEs study
from the CDC and Kaiser Permanente involved mainly individuals who were white, middle class and
highly educated). The Urban ACE Study found that 33% of adults in Philadelphia had experienced
emotional abuse in childhood, while 35% had experienced physical abuse in childhood. Other
findings included that 35% of adults in Philadelphia had grown up in homes with a family member
who abused substances, whereas 24% had lived in homes with a family member who was mentally
ill. About 13% of adults had childhood experiences of someone from their household being
incarcerated.
These two studies demonstrate a need for a) early intervention trauma treatment and b) outreach to
provide collaborative support to build more resilient communities. For communities to become
resilient, there must be support for the well-being of children and their families. This is where
professional counselors can become strong advocates for the clients they treat. Many of the
children, adolescents, adults, families and couples that we treat are currently experiencing problems
that may be related to ACEs. So, what can we do as counselors to build resiliency within our
communities?
1) Understand the trauma response. Counselors should do what they can to become more trauma
informed. This means understanding what trauma responses are and what these responses look
like. In my own practice as a trauma-informed child and adolescent counselor, many children come
to me with diagnoses of attention-deficit/hyperactive disorder, oppositional defiant disorder,
depression, anxiety, conduct disorder, obsessive-compulsive disorder, developmental disorders,
intermittent explosive disorder, and pervasive disorder. Many of these children have been seen by
multiple mental health providers who have worked to extinguish the challenging behaviors that
accompany these disorders. Parents are at their wits’ end because “nothing seems to work.”
What I often find is that no formal assessment of trauma symptoms has ever been performed to
determine whether these children might be experiencing a trauma response. Understanding how
trauma affects the brain can provide counselors with an awareness of where certain behaviors are
originating. Traumatized children are not able to regulate emotions, tolerate distress or learn
because the centers of the brain that control these functions have not developed appropriately. The
body is in a constant state of stress, and the child is in the fight, flight or freeze state. So, the
behaviors and emotional problems that we are seeing may actually be stress responses from
trauma.
2) Screen for trauma symptoms. Trauma screening should be done on all clients whom
counselors see. It should be a part of every intake. Not every client will screen for trauma symptoms,
but when they do, counselors will have the information needed to begin trauma-focused therapy or
to refer to other counselors who have that training.
3) Advocate for appropriate mental health services within schools and communities. Budget
cuts in many organizations within the communities where counselors practice often target mental
health services, resulting in the discontinuation of services. In my area of practice in Pennsylvania,
when the educational budget needs to be trimmed, school counselors are usually cut. This leaves
one or two counselors to serve a school with hundreds of students. Some schools do not have the
benefit of having other mental health professionals in their buildings. There may be one or two
school psychologists to serve a district of five to 10 schools. Thus, the ability to screen for trauma is
nearly nonexistent due to the absence of personnel to conduct those screenings.
Professional counselors can reach out to collaborate with school districts in the areas where they
practice. In my practice in both agencies and private practice, I enjoyed working with many school
counselors who asked me to help support their students. I always reached out to coordinate with
school counselors to plan how to best help my clients. This is very beneficial for clients because they
then receive collaborative support within the school. Counselors may also have the opportunity to
contract with schools to provide supportive mental health care to students.
5) Support the integration of mental health care in pediatric medical offices and physicians’
offices and training for first responders. Counselors can reach out to pediatricians and medical
providers to raise awareness of the need for trauma screenings. Some already conduct these
screenings. Some may conduct these screenings but offer no referrals for help. Partnering with
these medical services and working collaboratively with medical personnel will encourage greater
screening of trauma among patients and allow medical personnel to provide their patients with
referrals to mental health services. In addition, counselors can offer to provide trauma training to
organizations that train medical workers. The more trauma training that medical professionals have,
the more resilient the community is likely to become because referrals for mental health services will
be made earlier.
One trend that is occurring is more first responders being trained to identify trauma symptoms. First
responders are often the first to arrive when someone is in a mental health crisis. Unfortunately, the
news is too often filled with stories about law enforcement personnel shooting and killing individuals
who were having a mental health crisis. Teaching safer alternatives for first responders to engage
with and de-escalate those in crisis is another area in which counselors can provide outreach to their
communities. Creating more mental health crisis teams within communities can be effective in
reducing the number of deaths that occur when individuals suffering from a mental health crisis meet
untrained first responders.
Counselors can also collaborate with schools to develop anti-bullying programs and sexual assault
awareness programs. Bullying and sexual assault cause trauma to many students and will result in
emotional and behavioral problems in school. Traumatized students are unable to focus and learn
and will tend to isolate themselves. Students may exhibit acting-out behaviors such as tantrums or
oppositional behaviors. Some students may hold their trauma inside and exhibit depression and
anxiety symptoms.
In my experience working with adolescents where anti-bullying and sexual assault awareness
programs are already in place, I often hear reports that these programs are ineffective. I see this as
an opportunity for professional counselors to develop evidence-based programs that are
truly effective.
Conclusion
Studies have demonstrated the long-term effects of ACEs, particularly in communities where
poverty, substance abuse, alcoholism and violence are the norm. Counselors can provide outreach
to their communities and advocate for their clients and communities to develop trauma-informed
programs and early intervention.
The ACA Code of Ethics tells us that advocating for our clients is an important part of the work we
do. My challenge to you, my colleagues, is to think about the many ways that you can advocate for
your clients and your communities.
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Denise Takakjy is a licensed professional counselor, national certified counselor and licensed
behavioral specialist working in private practice in Harleysville, Pennsylvania. She specializes in
providing trauma-informed care to children and adolescents with extensive trauma histories. Contact
her at [email protected].
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members. To access writing guidelines and tips for having an article accepted for publication, go
to ct.counseling.org/feedback.
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Opinions expressed and statements made in articles appearing on CT Online should not be
assumed to represent the opinions of the editors or policies of the American Counseling Association.