Hello and welcome to Listen Up People, a podcast
of the USC Suzanne Dworak-Peck School of Social
Work. I am Dr. Eric Rice, professor and associate
dean for a search. Approximately 13 million Americans
suffer from post -traumatic stress each year.
The traumatic incidents can include events such
as child abuse and neglect, sexual assault, battery,
community violence, grief and loss, and human
trafficking to name but a few. In 2022, USC Social
Work received a grant from the California Victim
Compensation Board to develop the Trauma Recovery
Center, or TRC as we often refer to it as. This
is dedicated to providing free, safe, and culturally
sensitive mental health and supportive services
to those affected by a traumatic event. My guests
today are the creators of the TRC at USC, and
they strive to help individuals in the community
heal from the scars from violence and trauma,
so survivors can live long, healthy, and productive
lives. I'd like to welcome my colleagues, Dr.
Ruth Supranovich, who serves as the Associate
Dean for Clinical and Community Programs at the
School of Social Work, and Dr. Sarah Caliboso -Soto,
who is the Clinical Director for the Trauma Recovery
Center, and also our Telebehavioral Health Clinic.
Great to have you both here with us today. Before
we jump into talking about the TRC and the Telebehavioral
Health Clinic, I'd love to ask a more personal
question that I frequently start these podcasts
off with, which is, how did you get involved
in this kind of work? So maybe I'll turn to Ruth
first. Was there something in your life that
led you to want to work with people who are suffering
from traumatic events? Probably the turning point
for me was I was a young person who had graduated
with my degree in psychology, not quite sure
what I was going to do with that, and was kind
of drifting around doing different jobs in the
service industry and started volunteering on
a suicide hotline. Somewhat oddly, I found those
four hours a week volunteering there were my
favorite time of the week. I just found it really
rewarding and meaningful. And so many of the
people that I talked to on that hotline had experienced
all types of difficult situations, health issues,
grief and loss, crime, sexual assault, child
abuse, and so forth. So it wasn't too long after
that that I decided to pursue my master's in
social work. And I was very fortunate that I
had two great internships. One was working for
Child Protective Services, and again, obviously
being exposed to... dealing with a lot of families
that were dealing with with a lot of trauma.
And my second one was actually providing psychotherapy
services, trauma counseling to children and parents
of kids who had experienced abuse and neglect.
So I think that kind of set me up on the trajectory
to be very interested in this area and kind of
develop a level of expertise, so to speak. Yeah,
yeah, I know. Certainly would seem that way.
Sarah, how about how about you? What got you
interested in working with people who are trauma
survivors? Interesting question. It didn't really
come from my background. It kind of fell into
my lap. In 2019, I was asked to manage, provide
leadership to the telebehavioral health clinic
at that time, overseeing the interns' training,
as well as ensuring that we were meeting contract
obligations. And some of the trends that we saw
were a lot of the clients we were seeing were
victims of trauma or experiencing trauma or victims
of crime. And to just cut really quickly to the
pandemic, the pandemic happened. And we were
we were asked to expand the capacity of the clinic.
And we just so happened to run across a NOFO
to provide mental health services for victims
of crime. And Ruth and I just kind of said, let's
let's write it up. We see a common thread with
our clients, our capacity, the evidence based
practices we were using. And it really fit with
the NOFO and what we knew the clinic was capable
of. And so it kind of just fell in that way.
We really focused on that that population using
our available resources, using our infrastructure
from the clinic. And it really just took off
from there. And that really leads me to one of
my first questions, which maybe I'll push us
back to you, Ruth, again, which is, can you give
us an overview of what the TRC provides to the
community? I mean, what is this Trauma Recovery
Center? Sure. So the Trauma Recovery Center is
actually a model of service delivery that was
developed at the University of California San
Francisco and has now been proliferated across
California. There are actually 22 Trauma Recovery
Centers in California, and there are now multiple
across the nation. And it really is a model that
provides holistic services to victims of crime,
that after someone is a victim of a crime, they
may have multiple needs. So yes, we know that
there is trauma counseling and therapy that can
be really helpful, but they may have become homeless
as a result of the crime. They may have physical
injuries, they may have legal repercussions,
and it may have happened a long time ago, and
they're dealing with the after effects of it,
and that again, leaving them with multiple needs.
beyond just psychotherapy. And so the TRC model
provides case management and therapy and medication
and consultation and management, but really kind
of holistic wraparound services to meet clients
where they're at to help them heal and recover
from the trauma that they've experienced. What
a great set of services. How does a person get
access to that? If you want access to our trauma
recovery center specifically, you certainly can
just make a phone call. We have people that answer
the phone during regular working hours, and if
not, leave a message and people will call you
back within 24 hours. But we also have, you can
go to our website. put in a request to referral
and a call back there. But similarly for trauma
recovery centers, if you look those up, you may
be able to find one that is in your community
that maybe is a better fit for the person. One
of the advantages to us coming from the telebehavioral
health background is that we do provide a majority
of our services virtually. So obviously if someone's
living in Los Angeles, they can come into our
clinic and meet with us in person, or we can
go out into the community and meet with them
there. but anyone across anywhere in California
can actually access our services. That reminds
me of what Sarah had said about the pandemic
and leaning into these telebehavioral health
services. Are you seeing more of your clients
coming in person or more of them come through
this telebehavioral health clinic? And has there
been sort of a shift in the last few years in
that way? Well, you know, we, as Sarah was just
describing, we really established us during the
time of the pandemic because we discovered that
most of the other trauma recovering centers were
kind of struggling to pivot and we already had
an established telehealth clinic. So we kind
of started as a telehealth option always because
the trauma recovery model particularly says we
meet clients where they're at. So if they want
to meet in person, we absolutely will. But really
the majority of our services have ended up being
virtual. Sometimes a client will want to come
in the first time to meet us and then they often
pivot and say, you know, the virtual is easier.
Probably at this point, I would say probably
80 % of our meetings with clients all occur virtually.
Sarah says it's even more than that. Okay. Maybe
I'll pivot this to you since you're the director
of the telebehavioral health clinic. I mean,
about how many people are you seeing and what
is the breakdown of this? I'm really curious
about this post -pandemic shift in therapy modality.
I think we're probably closer to 90. 95 % of
our clients are being seen virtually. Like Ruth
said, some will want to start in person and we
can provide that to them. As the rapport builds
and the trust builds, many of our clients will
say, I want to try or I can't make it this week.
Can we try online? Can we try virtual? And once
they do that virtual appointment, then they want
to continue it. Like Ruth said, it's just easier.
They can do it from the comforts of their home,
the security of their home, and they just like
it. I mean, I hate to bring up the specter of
traffic, but I mean, you know, in Los Angeles,
I mean, just getting from place to place is such
a hassle. And I would imagine even that alone
helps it out. Sorry, Ruth, I didn't mean to cut
you off. No, no, not at all. Traffic is definitely
a thing, as in childcare and work commitments.
But also people who've been victims of crime
and, you know, have had traumatic experiences
often will feel safer if they can be in their
own environment. And so that can it may even
be re -traumatizing. or challenging to perhaps
leave their homes or come to a part of the community
that they don't know. And so it also can be a
trauma -informed approach to offer clients to
have their services delivered in whatever mode
feels most safe and comfortable to them. That
totally makes sense. I really hadn't put those
pieces together. I was just thinking more about
the pure convenience of being able to teleport
in on a Zoom versus having to slog your way through
the Los Angeles traffic. that makes a lot of
sense that people would have a comfort level
of sitting in their home versus coming to some
strange environment where they haven't been.
Sarah, thinking about your work in the past few
years with these clients, what are some of the
services that they most need? I mean, obviously
they're coming to you for some sort of therapy
service, but what does that really mean for somebody
who is coming to the TRC? Really good question,
Eric. So when you think about someone who is
a victim of crime, you know, at first or they're
seeking mental health services and it might just
that might be all they need. But as we get to
know our clients and what we've learned is our
big our clients might have. suffered a physical
injury or have experienced extreme anxiety about
even leaving their home. Maybe not a lot of our
clients, but I would say a good portion of our
clients after they have been victimized, they
stop going to work. They lose their source of
income, which leads to possibly not paying the
rent, not paying their car note, not paying their
utilities. So what I've seen from that level
is not just they need mental health services.
When you're a victim of crime, they might need
other resources like Ruth mentioned, case management.
We have provided lots of resources to food resources,
buying them food. helping them pay their utilities.
So it's not just this sort of linear mental health.
It's not just that's all they're getting. They're
getting a host of other services, case management,
advocacy, linkages to wrap them around, wrap
services around them so that they can return
to a sense of functionality, that they can return
to work and pay their bills. So that's what we're
seeing. It's not just like getting mental health
services, relieving some anxiety. It's a whole
host of other issues that a lot of our clients
are experiencing and that we provide that help
with. Sounds really complicated. It can be. Yeah,
yeah, yeah, no doubt. And Ruth, I know you're
really as the as the Associate Dean for Clinical
and Community Programs, you are an expert in
making connections with community partners. And
I would imagine that some of this complexity
that Sarah was just talking about isn't all handled
in -house, right? I mean, is this something that
you do in partnership with other people, I would
assume? Yeah, absolutely. We work across the
community with other community -based organizations
that are working with similar populations. We
get a number of referrals, for example, from
agencies that are working working with victims
of human trafficking, domestic violence, organizations
like Volunteers of America. So those organizations
often are set up to help support with some of
those. basic needs and then we'll collaborate
closely with them and then we'll provide the
mental health care in collaboration with their
case workers and with the support services that
they have there. But we do get a lot of referrals
coming straight from the hospitals and the ER
rooms. We get a large number of referrals actually
from Los Angeles General Medical Center and the
emergency room there and the hospital violence
intervention programs. Sometimes they are or
aren't ready to engage in psychotherapy. So that's
when we do the linkage and the connection. And
actually, to be honest, it's our masters social
work student interns that work in our clinic
that provide a lot of the case management. And
they're the ones that really become masters in
this linkage. And they work across the community
to find resources to support the clients so that
then the therapist can help prepare and get them
ready for doing some psychotherapy. I didn't.
I think I realized quite how much the MSW students
were the workforce that drives this. Could you
maybe explain how that works and who it is that
actually does the work at the TRC? I'll kick
it off, and then Sarah, you can jump in. So the
TRC model uses what's called a multidisciplinary
team. So yes, we have LCSWs on the team. We have
a psychologist. and we have a psychiatrist actually
that's also available for consultation. But the
primary treatment is provided by associates in
social work. So these are actually all of our
current employees, our alumni of our program.
They got their MSW through the Suzanne D 'Arpeggio
School of Social Work and they applied and we've
hired them as clinicians and they provide the
majority of the psychotherapy services and they
are students. advised by one of our faculty who
is an LCSW with a lot of experience in this area
of treatment and care. And then we also have
MSW interns that are currently in the program
and they do their internship, their practicum
placement with us at the TRC. They work alongside
the therapists and so they're providing the case
management services side by side with the therapists
that are doing therapy. And sometimes towards
the end of their internship, they'll get a couple
of clients themselves and they do therapy as
well. That's great. I mean, sorry, is there more
that we should know about kind of this model
of how you've integrated people across these
different levels? Well, just to add on to what
Ruth's saying. So like, for example, this semester
we are taking two second year MSW students who
they will be specifically providing the mental
health treatment. They are going to be trained
in psychosocial assessment and diagnosing and
treatment planning. and they will be getting
trauma specific training. In addition to those
two, I have a first year MSW student, their role
will be as case manager. So that student will
be working with all the clinicians to do needs
assessment and to provide resources and linkages
for all the clients who may need case management.
So it's kind of. tiered. So we have our ACSWs
who are graduates who are providing the care.
We have our MSW interns who are in training but
also providing care. as part of their training.
And we have a case manager, first year student
who's really new and has no social service experience,
but will be exposed to case management. So we
have different levels of learning, different
levels of service provision all within this program.
That's great. You know, I was thinking about
this must be such a both challenging and also
rewarding. area to work in. And I'd love to hear
both sides of that coin, if you don't mind. I
mean, so thinking about your own experiences
working in this space and maybe Sarah, you know,
just throw this back your way first. What is
the most challenging part of doing this work?
I would say particularly with telehealth, like
doing virtual therapy is crisis and emergency
situations. I think we have clients who are presenting
risk, maybe suicidal or homicidal risk and providing
that service. virtually is always a challenge,
making sure that we have emergency protocols,
that our providers are following those protocols,
that we're providing supervision, proper supervision
for those clients. We have clients who have very
complex issues, very acute symptoms that sometimes
we often use the word, maybe they need a higher
level of care because sometimes the virtual nature
of the services doesn't seem enough. So those
types of challenges that go alongside clients
who have experienced trauma. That can be very
challenging because we just aren't in the same
room with the client. So with providers, it can
be a little scary, a little challenging, but
at the same time rewarding when we can overcome
those barriers, wrap that client with services
and resources, and hear the progress with those
clients. Right? And hearing that they've met
these needs and hearing that we're discharging
them because they're doing well. So yes, sometimes
we have to get through those challenges to get.
get them there, or they might have a lot of needs,
right? Lots of housing needs. And that's particularly
complex too. Yeah, yeah. What about for you,
Ruth? What are the challenging aspects of being
a part of this program for you? So I think for
me, one of the challenges that I think about
a lot is actually the well -being of our clinicians.
I mean, this is hard work. Right. And part of
the work is to sit there and be beside someone
and hear about their experiences having had some
really, really difficult things happen to them
and help contain that. And they're all wonderful
and they do a great job, but that takes his toll.
And particularly, again, in a telehealth environment,
there's all the advantages we've talked about,
but they're mostly working at home alone and
can be isolated. So we've particularly focused
on building in processes and things that we do
at the clinic to try and mitigate. We meet very
regularly. We try to do in -person things when
we can to bring ourselves together. We focus
a lot on wellness. In fact, there is the National
Association of Trauma Recovery Centers has a,
I think it's a bi -weekly meeting that really
focus on wellness and self -care that we encourage
our staff to go to. We've had the opportunity
to have them all trained in transcendental meditation,
actually, through an opportunity provided by
the David Lynch Foundation. And so, you know,
just offering that as a wellness tool for themselves.
But we're always looking for different ways to
support our staff and clinicians as they do this
very difficult work. And then the positive side
from that is just seeing, actually seeing them
move on. that might sound strange but you know
we're really you know we're an educational institution
and we're doing kind of workforce preparation
and development and so when our interns move
on and we hear about them getting great jobs
in the community using their skills and when
our ACSWs get their license and then they're
now eligible to go and work in other places and
take those skills with them elsewhere so those
are from my perspective the positive things.
Yeah, yeah. And Sarah, you had mentioned this
a little bit too toward the end of what you were
saying about some of the positive things, but
what would you say is the most rewarding part
of doing this work for you personally? I think
just like what Ruth's saying, just seeing the
growth from our interns, the growth from our
clients, it's such a joy to hear in our weekly
meetings when they're doing well, right? That
they're able to get a job, that they secured
housing. I think that is So, um, inspiring for
me that we're doing really good work just to
hear that. One of the things we always ask, well,
I try to prompt our providers is like, what's
going well, like, let's hear it because we often
will hear. the challenging clients, what's difficult
this week, or the difficulties they're experiencing
with their clients. But we want to focus on the
strengths and the work that we are accomplishing.
And we know that this work, sometimes growth
and accomplishments take a long time and so we
want to focus on just those little strides being
strength -based and just noticing those things
that they weren't doing this a month ago but
they now are I think focusing on that because
we know change doesn't happen overnight and it
takes a while it takes some time to do that.
but just focusing on that so that we know that
we're doing really good work. Yeah, that's beautiful.
That's beautiful. I mean, Ruth, is there anything
else that you think about as being really rewarding
about this? I mean, you had mentioned about the
growth in the workforce, but what else about
this work speaks to you? the outcomes for our
clients. And I have the opportunity to sit in
on our weekly multidisciplinary team meeting
and I get to hear the stories. And I think sometimes
being administrator, I'm a little bit far from
that. So it's really nice to be there and hear.
And actually just brought to mind a letter we
received from one of our clients who just spoke
about, actually, this was somebody who had been
a victim of clergy abuse, struggled for years
with this and had been in treatment many times,
but wrote this letter about that this was the
time that he just really was very complimentary
about his therapist, but felt really heard, really
listened to, and really felt like he's been able
to move on with his life since getting treatment
there. So receiving those letters, hearing some
of the stories, hearing the great outcomes that
we can really help people move on with their
lives, many of whom have been really quite debilitated
by the experience that they've had. And being
able to help them heal and move on is just, I
think that's why we do this. I'm wondering, for
the sake of our audience who probably doesn't
know much about the TRC, what's the scale of
this work? I mean, you're talking really about
the personal impact that you have on individuals'
lives, but are we talking about a couple dozen
people that you see every year? I mean, honestly,
actually, I don't know. I mean, I'm part of the
same institution as you all, but I don't know
how many folks you see. Sure, I can answer that,
Eric. Past fiscal year 24 -25, we served 204
victims. The year before that, we served 171.
And the year before that, we served 16. We are
growing in our capacity. The more we see ourselves
expanding using MSW students, right, having them.
practice, learn as a training environment, but
also serving the community. We're having our
processes and protocols refined. And I feel like
we're a well -oiled machine. We have learned.
Every year we learn. We reflect on our practices.
We try to serve as many as we can, increasing
that. Also, as our numbers demonstrate, we are
able to increase it. not changed our staffing
pattern whatsoever, but you see that we are able
to see more clients. We hope to serve even more
this year, given our two new MSW interns coming
on board and our case manager. That's great.
I mean, honestly, that's a big practice, if you
think about it as a practice, right? Which it
is in many regards. have goals for how you see
this program moving forward in the future? I
mean, I know you sort of mentioned that you want
to see it grow in terms of having a few more
people involved in the educational programs and
more clients that you reach, but is there a vision
for where this is going to go in the future?
Maybe you'll turn this to Ruth first, and then
Sarah, you can add to this as well. Yeah, I mean,
I think our vision has really been to see where
are there gaps or needs in the community and
populations or types of services. that it's important
for our growing professional social workers to
learn and know about. And so if we can combine
those two. So since we actually opened the Trauma
Recovery Center, we've been fortunate to be able
to secure a couple of other funding sources that
focus on particular populations that have experienced
trauma. So one of them is serving youth and their
family members. And we were able to train all
of our clinicians through that grant in two evidence
-based practices, trauma -focused cognitive behavioral
therapy. and EMDR, which is Eye Movement and
Desensitization Reprocessing Therapy. That's
a long one. But these are both therapies that
have been shown to be very effective in treating
trauma. And so we were able to train all of our
clinicians on that, and then we're actually able
to deliver that to youth. And then we have another
one in partnership with a refugee resettlement
agency here in Los Angeles. And we're providing
trauma treatment to refugees. So we've been able
to grow in those two areas where there is great
need. And so I think that's what our vision is
to continue to be scanning the environment for
where is the need, what are the population and
service need and how. Are we the position to
be able to support and help with that with our
particular combination of being in a teaching
institution, an educational institution, and
having this focus on telehealth? Is there anything
else to add to that? Yeah, I just wanted to add
on to what Ruth was saying, which was really
leaning into our strength. I always say our strength
is the telebehavioral health and our infrastructure,
our training in that area. While it was introduced
more commonplace because of the pandemic, it's
still not accepted everywhere, right? So it is
a practice that we like to lean into. We like
to promote as part of what we do. We just feel
that it increases accessibility. It fills in
gaps for others who might not want to go into
a building and just provides another option for
clients. So cool. I mean, I'm so excited to hear
about the needs that you're filling in the community
and the innovative ways that you're approaching
this. It's been so much fun to talk with you
about this. I could keep talking with you about
this for a very long time, but I think we're
just about out of time. So I want to just give
you a moment before we wrap things up to maybe
comment on, is there anything else that you think
about either the folks that you work with or
the services that you offer that you would like
to share with our listeners that you haven't
had an opportunity to share with them yet that
would be illuminating? And maybe I'll turn to
Sarah first and then Ruth, you can close us out.
I think one thing about working in trauma and
maybe everyone should know that's looking to
do this type of work. It's trauma work is not
just an end result, right? It's not just a one
sort of solution. It's a whole way of working
with an individual and teaching them how to integrate.
what has happened to them in their life. It's
not just like, you're going to resolve this trauma
and you're going to move on. It's really a much
bigger picture is like how has the trauma impacted
their life and how do they integrate that experience,
the things they've learned in therapy for the
rest of their life, right? Not just like getting
to a point where they have forgotten it or they
have processed it. It's more of a different way
of looking at it. Being an agency or a provider
that is trauma informed and knows that I think
is really important for people to know when doing
this type of work. Ruth? So yeah, I'm going to
go back to like the social work perspective,
right? We've been talking a lot. clinical programs
and the clinical services that we offer. But
part of our Trauma Recovery Center, we also do
a lot of, we often talk about micro, but we also
do mezzo and micro work. Yeah, the mezzo, we
think about groups and we work with our community
partners and we offer groups to our clients as
well. But from a macro perspective, we're really
into education and training as well. So part
of our TLC model is that we go out to the community
and we provide training to our community partners
such as law enforcement or medical providers.
In fact, Sarah provides a lot of this training.
and gets great reviews really on trauma -informed
care. Like how do we identify when a patient
or a person that you're interacting with, their
response might be based on their prior trauma
and how the law enforcement or the medical provider
or the individual can actually interact with
the person in a way that does not re -traumatize
them. And they do trainings and presentations
on all kinds of topics related to this work,
such as sexual assault identification, digital
violence and its effects on young adults, gang
and... trafficking, recruitment and perpetration
and interpersonal violence. So it's a very victim
centered training and it includes skill development
and what have you. But I just want to let you
know that we're also thinking on the macro and
how can we support this beyond the individual.
And we also engage with our partners through
the National Association of Trauma Recovery Centers
on advocacy, you know, at the local and at the
state and national level on services for victims.
There is a lot of this model has to to do with
actually interrupting crime. There's that saying,
and I think I've heard it from Homeboy Industries
and Father Greg Boyle, he says, hurt people,
hurt people, and heal people, heal people. I
mean, a lot of victims of crime. they may go
on to perpetrate crime, they may go on to be
victims over and over again. And so being able
to interrupt that cycle and start the cycle of
healing is something that we try to do across
all levels of integrated social work practice.
That's amazing. That's amazing. What inspiring
work. I'm so happy to have gotten the chance
to spend some time chatting with you both about
this. Thank you so much, Ruth. Thank you so much,
Sarah, for joining such a great, lively, inspired
discussion. I just want to say to our listeners
that if you want to learn more about or somebody
to the Trauma Recovery Center, you can go to
our website, which is dworakpeck .usc .edu slash
trc. And if you have questions for the guests
on our show, or you want to support our transformative
research and programs, you can email us at listen
up people at usc .edu. And thank you both once
again, very much. It's been just such a pleasure.
Thank you, Eric. Thank you. you