trauma resource institute - butte...

Trauma Resource Institute

Proposals

Community Resiliency Model® Wellness Trainings and Teacher Training

The Trauma Resource Institute – Community Resiliency Model® Teacher Training®

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Table of Contents

1. Introduction ..................................................................................................................2 Goals ......................................................................................................................................... 2 Objectives .................................................................................................................................. 2

2. CRM® Teacher Training ................................................................................................3 In-Person Portion of the CRM® TT ................................................................................................ 3 CRM® TT Online Certification (TRI Learning Portal) ...................................................................... 3 Certification Maintenance ............................................................................................................ 4

3. Becoming a CRM® Informed Organization ....................................................................5

4. Site Visit Enhancement Training**… …………………………………………………………………………….6Additional Implementation Consultations .................................................................................... 6

5. Appendix 1. TRI Team Background & Responsibilities ………………………………………………..7

6. Appendix 2: Research ................................................................................................107. Proposals for Phase 1 and Phase 2


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1. Introduction

� To learn simple biologically based skills, based upon current science, to help individuals and

communities get back into balance in body, mind and spirit;

� To educate about common reactions resulting from individual or communal traumas such as poverty, racism, family violence, natural and human-made disasters and historical trauma;

� To reduce common human reactions related to stressful/traumatic experiences;

� To help people learn wellness skills to increase resiliency;

� To learn the six wellness skills of the Community Resiliency Model®;

� To train individuals to be Community Resiliency Model® Teachers so that they can teach the Community Resiliency Model® wellness skills to their own communities, infusing the training with their own cultural lens.

Objectives Participants will be able to:

� Describe the six skills of the Community Resiliency Model®; � Demonstrate three teaching methods for teaching the three core skills (Tracking, Resourcing and

Grounding); � Demonstrate methods for teaching CRM® skills (Gesturing, Help Now, Shift and Stay); � List two or more ways to teach the CRM® skills in group formats; � Discuss three ethical considerations in teaching CRM® skills;

Founded in 2006, the Trauma Resource Institute (TRI) is a nonprofit corporation devoted to cultivating trauma- and resiliency-informed and focused individuals and communities throughout the world, respecting the wisdom of cultural diversity. The Community Resiliency Model® is designed to help individuals understand the biology of toxic stress reactions and learn specific skills to return the body, mind and spirit back to balance after experiencing stressful or traumatic events. These skills help to restore the hope that many people lose after natural and human-made disasters.

The Community Resiliency Model® (CRM®) trains community members to not only help themselves but to help others within their wider social network. The primary focus of this skills-based, stabilization program is to re-set the natural balance of the nervous system. CRM® skills help individuals understand their ner vous system and learn to track sensations connected to their own well-being, whic h CRM® calls the “Resilient Zone.” CRM®’s goal is to help to create trauma- and resiliency-informed and focused communities that share a common understanding of the impact of trauma and c hronic stress on the ner vous system and how resiliency can be restored or increased using this skills-based approac h.

Goals of the Community Resiliency Model Teacher Training

This proposal includes a Phase 1 which consists of offerings of CRM Wellness Trainings for communitymembers who experienced the recent fires in Butte County, California. Its has been requested to provide

one-one day training, four-1/2 day trainings and four -two hour evening trainings. CRM Trainings would take place over five days for approximately 150 people. The CRM Wellness trainings will teach the wellness skills to community members. Phase 2 proposes the CRM Teac her Training as set for th below to create capacity within Butte County by developing CRM Teachers.


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� Describe two research outcomes related to the CRM®; � Write at least two individualized CRM® lesson plans for clients; � Discuss three ways to bring cultural competency into a CRM® Training.

2. CRM® Teacher Training In-Person Portion of the CRM® TT The Community Resiliency Model® Teacher Training (CRM® TT) consists of either a four- or five-day training and follow-up consultation to ensure proficiency in the skills and in teaching CRM®. Trainees learn the key concepts and six wellness skills of the CRM®. The training is a combination of lecture, discussion, practice and student teaching. Upon successful completion of the training, participants will be provisionally-certified as Community Resiliency Model® Teachers, for a period of 6-months, if proficiency is demonstrated based upon the CRM® Fidelity Instrument, as determined by the CRM® Master Trainer. The CRM® Master Trainer will work closely with trainees who are having difficulty with the skills to help them develop proficiency. During the course, trainees learn key concepts of CRM®, the biology of traumatic/stressful reactions and resiliency, CRM® skills and teaching methods to enhance their training abilities. Trainees practice the skills individually as well as in large and small group formats. The training also includes education on how to spot warning signs in participants that attend CRM® trainings as well as an orientation on how to access referrals to local mental health services. After each component of training, trainees spend time creating teaching plans in pairs, and then teaching the material back to CRM® Master Trainers. This approach builds competency in teaching the skills and in explaining the CRM® key concepts. The final part of the training is designated for student teaching in pairs or groups of three. Trainees will prepare a one-hour CRM® Training of the CRM® Basic Three that can be presented to their community. The CRM® Master Trainer evaluates student teaching by using objectives (i.e. CRM® Fidelity Instrument) provided to the trainees during their training. On a case-by-case basis, individualized plans are created to help the motivated trainer increase their competency if more time is needed to develop their skills toward becoming a CRM® Teacher. Attendance at the in-person portion of the CRM® TT does not guarantee a person will be made a CRM® Teacher. At the outset of training, participants are provided a Statement of Understanding that explains the goals and objectives of the training. Competency in teaching the skills and concepts must be demonstrated before graduating to be a CRM® Teacher. Ultimately, some individuals may not want to be CRM® Teachers, but find the skills useful for self-care. Also, Master Trainers may determine that a trainee’s abilities are not well suited to become CRM® Teacher. CRM® TT Online Certification (TRI Learning Portal) TRI uses Litmos, a cloud-based learning management system, to deliver, monitor and record the certification and re-certification process for provisionally-certified CRM® Teachers online. In this way, provisionally-certified CRM® Teachers will be able` to complete their certification requirements in a user-friendly manner and will receive timely feedback on their certification submissions (listed below) as well as automatically receive their certificate of completion, once approved by TRI. Provisionally-certified CRM® Teachers will have access to this online learning portal for a period of 6 months, starting from the last day of the in-person portion of the CRM® TT, to complete the below requirements: � Attend two of the three-monthly follow-up sessions during the first three months following the

training either in person or by Zoom/Skype. In addition to follow-up sessions, technical assistance in implementing CRM® trainings is offered by phone, Zoom/Skype as well as by email;

� Complete the take-home self-evaluation within 60 days of completing the training; � Provide an outline of one projected CRM® Training (e.g. Basic Three, 1-hour orientation, etc.);


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� Provide one set of CRM® Training evaluations; � Prepare a strength-based personal story to interweave into the trainings; � Prepare a referral list of local mental health practitioners and clinics; � Provide a 30-minute video of teaching for community, if requested by the CRM® Master Trainer.

The provisional status will be removed upon the completion and approval of the components listed above. If the provisionally-certified CRM® Teachers does not complete these components within the 6-month period, they will lose their provisional status and will no longer be able to participate in CRM® trainings. Should this occur, the individual needs to contact their agency’s coordinator as well as TRI to make arrangements for completing their certification requirements. Proficiency in the subject material and ability to demonstrate CRM® skills is required to become a CRM® Teacher. Follow-up group sessions are incorporated into the proposed training plan. Initially, group follow-ups are scheduled for three consecutive months post-training. Thereafter, TRI will provide quarterly group follow-up sessions for the three remaining quarters of the year. Follow-ups are provided via Zoom/Skype. Additional technical assistance in implementing CRM® trainings is offered in-person through a site visit, as well as by phone, Zoom/Skype or email (see Becoming a CRM® Informed Organization). CRM® Training materials are offered in English as well as Spanish, if requested. Provisionally-certified CRM® Teachers who have successfully completed the training and have been approved by the CRM® Master Trainers to be a CRM® Teacher may copy materials to use in CRM® Trainings through their payment of the yearly use fee which is incorporated into the training fees for the first two years. CRM® Teachers must operate within the scope of their position of employment or in the scope of their work in the community. It is required that an Agreement be signed between TRI and the CRM® Teachers to protect the integrity of the materials. Upon completion of certification, CRM® Teachers can use the skills for both self-care and to teach individuals within their organization and community in formal or informal presentations within the scope of their job and/or work in the community. Because of the nature of CRM® Training, CRM® Teachers must teach in pairs. Only the Trauma Resource Institute can certify Community Resiliency Model® Teachers. It is important to underscore that the Community Resiliency Model® is not mental health counseling or designed to take the place of mental health counseling.

� Teach at least two (2) CRM® Trainings per year; � Attend a 1-Day CRM® Update, which will be provided by your CRM® Master Trainer/Mentor or

by the Trauma Resource Institute every two years by webinar; � Collect evaluations from each course participant to whom a CRM® Training certificate of completion

is issued; � Provide information to TRI as to the number of individuals trained; � Present the CRM® Training using the standard materials provided upon certification. (While

instructors are free to exercise creativity when contextualizing content in local settings, they may not otherwise alter course materials. CRM® Master Trainers welcome questions or concerns related to the fidelity of CRM®);

Certification MaintenanceTo maintain certification, each CRM® Teacher is required to:

² Respect the privacy of course participants, colleagues and others, including the responsibility to protect personal information acquired from registration and evaluation forms. The future use of

personal stories shared by participants, without explicit permission from the person is prohibited.


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Figure 1. Timeline of CRM® TT Certification and Recertification1

Privileges Once certified through the organization sponsoring the training and, CRM® Techers will have access to a variety of materials designed to help develop and present the program, including: � Access to Continuing Mentoring and Technical Assistance – connects CRM® Teachers with CRM®

Master Trainers who will respond to concerns related to the delivery of trainings. They will also be available to help connect skills trainers with others who share interests or areas of specialization.

3. Becoming a CRM® Informed Organization This is no easy feat and requires time, energy and perseverance. We can help with that. As an organization that has been providing CRM® Trainings for more than 8 years, we have supported individuals and the organizations they are a part of through the successes and challenges of bringing CRM® to a wider audience. Through these experiences, we have seen the tremendous impact that in-person enhancement training and further implementation consultations have on the sustainability and scalability of CRM® within organizations. That said, as an addition to what we offer during the 6-month CRM®TT certification process, we are also able to offer an in-person site visit and enhancement training as well as additional online implementation consultations to your organization:

*CRM® TT certification is contingent upon the provisionally-certified CRM® Teacher’s completion of the certification requirements, in a

manner that is in line with the fidelity of the CRM®, within a timeframe of 6 months.

**Completion of the online CRM® TT Recertify course, in addition to payment of the yearly material use fee ($100/year, sliding fee) is

required in order to be considered recertified as a CRM® Teacher.

CRM® Teachers must attend TRI’s CRM® TT Recertification course (offered online) prior to the expiration date listed on their Certificate of Completion, which is two years and six months from the last day of the in-person portion of the CRM® TT.


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Additional Implementation Consultations: Sometimes a year of online consultations is not enough. If that’s the case, our team here at TRI can schedule further consultations for you and your team of CRM® Teachers, based on your needs.

4. In-Person Site Visit & Enhancement Training: Need help along the way with rolling out CRM® trainings? Through an in-person site visit, a TRI CRM® Master Trainer can provide further guidance and training to your team of certified CRM® Teachers as well as meet with a designated individual(s) from your administration to assist with strategizing further implementation of CRM® within your organization.


The training team will be composed of our team members below:

Elaine Miller Karas, L.C.S.W. | [email protected] Responsibilities: Oversight of Education & Training | Senior Trainer Elaine Miller Karas is the Executive Director of the Trauma Resource Institute. Ms. Miller-Karas has 30 years experience in health education, teaching, social work and

advocacy. She has co-created the Trauma Resiliency Model® (TRM) and the Community Resiliency Model® (CRM) and its adaptations for active duty military and veterans. She has shepherded the Trauma Resource Institute since its birth in 2006 into a worldwide organization, bringing resiliency skills to the underserved. Ms. Miller-Karas, because of her social entrepreneurship, was invited to the International Skoll World Forum in Oxford, England in 2015, 2016 and 2017. She has presented at major conferences including the Skoll World Forum, the Transformational Resilience Coalition, the Annual Conference on Global Affairs at the University of Colorado, ISTSS and the Psychotherapy Networker. She authored a chapter in the book, “To the Rescue: Stories of Healthcare Workers at the Scenes of Disaster” and her book “Building Trauma Resilience, the Trauma and Community Resiliency Models”, was published by Routledge in March of 2015. Ms. Miller-Karas has traveled internationally and trained mental health, health professionals and community leaders in social service agencies, hospitals and community organizations.

Michael Sapp, Ph.D. | [email protected] Responsibilities: Oversight of Education & Training | Senior Trainer Michael Sapp is the Associate Executive Director of the Trauma Resource Institute. Dr. Sapp received his M.A. in General Psychology and his Ph.D. in Clinical Psychology from

The New School (formerly The New School for Social Research) in New York, NY. After earning his degree, Dr. Sapp worked as a supervising psychologist at the Child and Family Guidance Center in Northridge, CA, for three years before going into private practice and teaching as an adjunct professor at a nearby university.

Dr. Sapp has worked with TRI since 2010 and is now a TRM® and CRM® Master Trainer. As a TRM® and CRM® Master Trainer, Dr. Sapp has helped train clinicians and non-clinician community leaders both locally and internationally. He has helped provide trainings throughout Southern California, including Los Angeles, Claremont, San Bernardino, Oxnard, and San Diego. In January 2014, he was part of the TRI team that traveled to Cebu City where leaders from various NGOs throughout the Philippines were trained as CRM® Teachers to help communities impacted by Typhoon Yolanda. The following year, he was part of a training team that traveled to Istanbul, Turkey, to introduce CRM® to various community leaders working with Syrian refugees. He returned to Turkey later that year to provide follow-up trainings for some of the members of that original training. That same year, he helped Ms. Miller-Karas provide TRM® Level 1 training to clinicians and non-clinicians in London, England, who work with victims of trauma. In 2016, Dr. Sapp was team leader for two follow-up enhancement CRM® trainings in Kathmandu, Nepal, for community leaders who continue to work with those impacted by the 7.8 earthquake in April, 2015.

Lindsay Vos, Executive M.B.A. | [email protected] Responsibilities: Oversight of Education & Training | Invoicing

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5. Appendix 1. TRI Team Background & Responsibilities


Lindsay Vos is the Chief Operating Officer of the Trauma Resource Institute. Her responsibilities include managing all finances, developing human resource policies and procedures, and identifying strategies for scaling the organization.

Ms. Vos has an Executive MBA with a concentration in non-profit management from the Peter F. Drucker & Masatoshi Ito Graduate School of Management, and a Bachelor of Arts in government and economics from Claremont McKenna College. She is also a Senior Certified Professional through the Society of Human Resources Management. Ms. Vos first heard about TRI from a course at Drucker in 2009 and has followed the development of the organization since that time. She has been trained in TRM® level 1.

Ms. Vos previously worked at World Vision International, a large relief, development, and advocacy organization focused on children and dedicated to helping communities overcome poverty and injustice around the world. She worked in global human resources where she was responsible for using analytics and reporting to drive evidence-based decision making through a culture of data excellence. She was also a global project manager for key HR initiatives with significant scope and value to the organization. Previously, Ms. Vos led strategic projects for World Vision’s Global Supply Chain Management department, including playing a key role in developing a new humanitarian industry fourth party logistics service provider and leading global procurement process improvement projects.

As part of her work at World Vision, Ms. Vos served as a peer supporter, providing psychological first aid to staff members going through any kind of stress or trauma, as well as providing staff well-being education to staff members. She was also part of a surge capacity team that was tasked with deploying to emergency responses within 24-48 hours of a major disaster to oversee the set-up of non-food item distributions.

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Alena Cansler, M.S.W. | [email protected] Responsibilities: Monitoring & Evaluation, Certification | Consultation Scheduling Alena Cansler is the Education and Training Manager of TRI. Alena completed her Bachelor's Degree in Social Work at Fresno State University in 2008 and her Master’s in

Social Work (direct practice concentration) and the Early Childhood-Social Emotional Behavioral Regulation Intervention Specialist Certificate (EC-SEBRIS) at San Diego State University in 2014. Her experience includes working with high risk, developmentally delayed, and foster children ages 1-18 in their homes, schools, and in the community using a wide range of modalities. She is currently registered as an Associate Clinical Social Worker with the California Board of Behavioral Sciences and over the past few years has worked as a Mental Health Practitioner with preschool-age children in Head Start.

Alena was certified as a Teacher of CRM® and TRM® in 2015 and has been involved with CRM® trainings ever since. She has trained more than 100 professionals working with children from her local community in the CRM® skills. Ms. Cansler has also been involved in trainings with Crestwood Behavioral Health, Santa Barbara County Department of Behavioral Wellness, Santa Barbara County SELPA office, Aspiranet in Camarillo, CA, and multiple school districts in California. In August 2017 Ms. Cansler was part of the TRI team that trained the Asheville City School District in the CRM® teacher training curriculum. She is currently working as a part-time CRM® Teacher and Facilitator for Fighting Back Santa Maria Valley in order to continue to spread the CRM® skills in her community.

Deenise Kosct | [email protected] Responsibilities: Training Registration & Roster Management | CE Credits | Logistics & Coordination of Training Deenise Kosct is the Training Coordinator of TRI and has been affiliated with TRI since 2012. Deenise is now involved in setting up both CRM® and TRM® trainings in the United

States as well as in other countries around the world. She handles all the travel arrangements for our staff and contractors. Deenise also manages the arrangement of Continuing Education Credits for participants and staff. On occasion, she is involved in setting up retreats and training venues. She has also assisted with the facilitation of CRM Trainings in some states.

Karen Chatt| [email protected] Responsibilities: Handling of CRM® Training Materials | Online CRM® Orders Karen Chatt is the Administrative Assistant of TRI. She manages the TRI Office Monday-Thursday. She coordinates with Trainers all the materials that are needed

for trainings. She also handles all the merchandise on line if you have questions in regards to online purchases. In addition she also handles referrals about Trained TRI Practitioners if you are looking for a therapist in your area.

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Community Resiliency Model® in Sierra Leone LLUSBH has two publications currently pending, which reflect on the effectiveness and scalability of CRM® in Sierra Leone. Below, is the summary of their research: In 2016, Loma Linda University (LLU) provided CRM® interventions in Sierra Leone following the Ebola Crisis. The LLU crisis teams provided an initial two-and-half-day CRM® intervention to 40 community members. They then selected 22 individuals from that group of participants to complete a 5-day Teacher Training curriculum. Upon completion of the 5-day training, 19 of those 22 participants then went out and conducted CRM® trainings for various community members in their own communities. Data was collected from the 22 Sierra Leone CRM® Teachers (SLTs) at four different times: (1) prior to the 2.5 day CRM® intervention (baseline), (2) prior to the 5-day CRM® Teacher Training, (3) at the end of the 5-day TT program, and (4) at a 6-month follow up. Data was only collected on 19 of the 22 participants at the 6-month follow up due to non-attendance. 59 community members received a 3-day CRM® intervention from the SLTs, which was observed by the LLU CRM® Trainers. Data was also collected from this cohort of 59 at two different times: (1) prior to the CRM® intervention (baseline) and (2) at the end of the 3-day CRM® intervention. Each participant from both groups was assessed for their overall understanding of the emotional, physical and behavioral reactions to trauma, their perceived ability to manage trauma-related stress and anxiety of recipients, as well as their confidence in providing the CRM® services. A 5-point Likert scale was used to assess each of these three areas. Results showed that for the 22 SLTs, there were statistically significant increases across the trainings in the participants’ understanding of trauma, their knowledge of ways to manage anxiety and stress, and their confidence in providing CRM® services. Interestingly, results for the 59 community members that were trained by the SLTs, nearly showed identical statistically significant improvements in all three areas. This suggests that CRM® trainings can truly help develop trauma-informed communities wherein individuals participating in a CRM® TtT program can help other community members become trauma-informed, resulting in similar effects that ripple outward. In addition, each participant was assessed for resiliency and improved ability to manage stress and post-traumatic dysregulation. The Conner-Davidson Resiliency Scale 10 was used to capture changes in resilience pre- and post-intervention. Meanwhile, the Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire, were used to assess symptoms consistent with depression and anxiety, respectively. The Secondary Trauma Stress Scale was employed to determine the degree to which each participant experienced vicarious trauma. Moreover, the Harvard Trauma Questionnaire-Revised assessed the extent of pre-existing PTSD symptoms. Finally, the 5 Facet Questionnaire was used to evaluate various elements of mindfulness.

Results for the 22 SLTs indicated a statistically significant improvement in resiliency and a statistically significant reduction in trauma symptoms, secondary (i.e., vicarious) traumatic stress, depression and anxiety across the trainings. These improvements remained consistent amongst the 19 SLTs even when assessed at the 6-month follow-up. Likewise, a similar pattern was observed in the 59 community members that were

CRM® is a “research-informed” intervention, as evidenced by a State of California Mental Health Services Act Innovation’s Project, which yielded statistically significant reductions in depression and anxiety as well as reductions in hostility and somatic indicators. Since this research project, TRI has partnered with several academic institutions – Loma Linda University, Claremont Graduate School, Emory University, Fairfield University, Duke University, Michigan State University– in order to expand the breadth of research performed on CRM® by independent and external evaluators. Owing to the plethora of multi-national research conducted to date, we are noticing similar trends in improved mental health the world over, as was seen in our original research from 2013.

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6. Appendix 2: Research


trained by the SLTs. This suggests that the positive effects experienced in the 22 SLTs, originally trained by the LLU training team, were “passed on” to the community members that they themselves trained. This, in turn, suggests that CRM® trainings, especially the Teacher Training program, can help develop resiliency-informed communities wherein community members can learn skills that not only help in their own recovery, but can empower them to effectively help their friends and family recover as well. It’s also worth noting that the cohort of 59 community members, trained by the original 19 SLTs, were a very small portion of the total number of people who received the CRM® training. Between the months of February and May, in 2016, a total of 518 trainings had been given, with each SLT averaging about 22 trainings each. The total number of participants in each training is unavailable at this moment in time, but it was estimated that these 19 SLTs likely impacted more than 900 members of their community. Even if only half of the “untracked” community members experienced similar results as those of the 59 community members whose data was collected, the potential impact that the CRM® interventions and Teacher Training programs can have on a community is quite remarkable. State of California, Mental Health Services Act (2013) Community Resiliency Model Innovation Project The Department of Behavioral Health (DBH) in San Bernardino County Community Resiliency Training (CRM®) Innovation Project was initiated in December 2010 through the California Mental Health Services Act - Proposition 63 and completed December 2013. Implemented by DBH and the Trauma Resource Institute (TRI), the goal of the project was to bring biologically based trauma intervention training, the Community Resiliency Model® training, to seven marginalized groups in San Bernardino County who have limited financial and logistical access to mental health resources. The intent has been to expand local response capacity by offering training in CRM® skills, designed to address the needs of community members needing mental health education and coping skills. These groups were chosen because they were likely experiencing the effects of the cumulative trauma that is associated with racism, homophobia, poverty and untreated posttraumatic stress from military service including combat. All of the 109 participants among the six groups (Veterans, African-Americans, Asian-Pacific Islanders, GLBTQ, At-Risk Youth and Latinos) received group sessions of CRM®, as well as individual sessions in either demonstrations or in work with a Trainer under supervision.

✓ 62% of the participants were female ✓ 38% were male ✓ the age of the participants ranged from 22-75 years with an average age of 51.

The participants reported an array of physical and emotional symptoms, reflecting the extensive impact on the mind body system when one is a member of a vulnerable group in a high poverty county. Participants reported an average of 6 physical distress symptoms and an average of 6 emotional distress symptoms. In order to assess effectiveness of treatment, trainees were assessed immediately after the training was completed, and again 3-6 months later. Combined, the groups reported improvements in the distress indicators of depression, hostility, somatic, and anxiety.

✓ 82% of the respondents indicated less depression symptoms post training,

✓ 59% less hostility symptoms, ✓ 59% less somatic symptoms, and ✓ 58% less anxiety symptoms.

A major finding of the research conducted suggests that the fact that such a large percentage of depression symptoms are improved across populations suggests that using the CRM® skills, which stabilize the nervous system, and learning how to teach them to others, offers trainees a greater experience of control and empowerment, which can result in a sense of renewed hope. In order to have a preliminary assessment of the stability of treatment effects, trainees’ symptoms were assessed 3-6 months after the training. Findings indicate that at the 3-6 month follow-up, pre to follow-up

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comparison analyses show positive trends in the desired direction of improvement in every distress and well-being indicator, with statistically significant improvement pre to follow-up decreases in anxiety, depression and hostility symptoms.

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