Cork Trauma Sensitive Cities Strategy 2022 – 2025

Cork Our Vision for a Trauma-Sensitive City City-Wide Trauma Awareness, Sensitivity and Healing through Relationships

Trustworthiness Transparency

Safety

Peer Support

Collaboration and Mutuality

Empowerment, Voice and Choice

Cultural Sensitivity

Cork Trauma Sensitive City

Cork Trauma Sensitive Cities Strategy 2022 – 2025

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Foreword We know that trauma can affect any one of us at any time in our lives. Many of us will develop ways to cope with these experiences as they arise, and our lives will continue without any long-term consequences. During these times we may be supported by members of our family, our friends, or others in our community. These connections and the role of one supportive relationship must not be underestimated. We know that for some of us, the significance of these experiences is such that we will need to reach out and access specialist support to help us to recover from the impact of trauma. These experiences can impact not only our physical and mental well-being but also our relationships. Together we have an opportunity as a city to be courageous and transform how we understand and respond to Trauma. This strategy affords us as a city an opportunity to develop a ‘trauma lens ‘which can be applied across all our services. The Covid-19 pandemic highlighted for us all the impact of collective trauma, and while we were all in the same ocean, we were not all in the same boat. Covid 19 has illustrated the role and impact of trau- ma, particularly for those who are already affected by inequalities and have experienced Adverse Childhood Experiences (ACES). Importantly, this strategy helps us to understand the roles we all play, and the difference we can all make by simply being more compassionate and more understanding of each other. By shifting our perspectives firstly as individuals, collectively within our organisations and as a city shifting our focus from the narrative of ‘What is wrong with you?’, and instead asking ‘What has happened to you?’ As a city, we want to promote a culture where people experience empathy and kindness and are empowered to access the services they need for support. We want to provide services and policies that build and strengthen trusting relationships. This strategy aims to develop a bespoke trauma framework at a city-wide level that will support statutory, community and voluntary organisations, in addition to local communities. At its core is the development of principles and practices which further Cork City becoming Trauma-sensitive. This framework comprises a number of overarching goals including the development of a bespoke training programme and toolkit that will be developed for, and offered to, all partner organisations. Further, this strategy is the beginning of the development of a road map for Cork City charting our courageous and exciting journey towards becoming Trauma-sensitive City. Thank you Ann Doherty CE Cork Council

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Foreword Lord Mayor The introduction of this Strategy and E- training module could not be more timely. We have witnessed so many shifts and changes in our world over the past 24 months, COVID-19 and the more recent events in Ukraine have brought the impact of trauma to the forefront of our minds. We have all become far more mindful of the potential impact trauma can play on the lives, health, and well-being of people. Simple acts of kindness, and help, can have a positive impact on the lives of those affected by trauma. Across Cork, we have seen how individuals, communities and groups have come together to help others, including offering sanctuary to those who have fled from conflict. It is these kinds of actions both individually and collectively which underpin how we can live in a Trauma-sensitive way. Responding in a trauma-sensitive manner can influence our overall well-being, it promotes belonging, kindness, safety and trust. Here in Cork want to see public services, third-sector organisations, communities and individuals embracing this strategy and embedding it into their daily practice. This brave call to action challenges us all to work towards ensuring our interactions with each other and the people we serve are based on a trauma-sensitive approach. Through this collective action we can all make a difference in building a city that is Trauma-sensitive Lord Mayor Cllr Deirdre Forde

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Executive Summary Trauma and adversity are a growing public health concern (Thorley, 2019). Van Der Kolk (2014) noted that childhood trauma had been identified as one of the most important public health challenges facing societies today. Bellis (2021) in his address at the Five Nations Adverse Childhood Experiences (ACEs) Meeting noted that the cost of trauma to the health and justice systems across Europe is approximately $581 billion dollars per annum. Previous research reports that our earliest experiences in life inform the foundations for lifelong health, well-being, and quality of life (Thorley, 2019; Romero et al, 2018; Liming et al ., 2014). Notably, responsive relationships and supportive family and community environments have been shown to shape a child’s future well-being, development, educational engagement, and health (Romero et al ., 2018), and are indeed key to positive life outcomes (Campbell et al. , 2016). Several nations across the globe have accelerated their respective trauma/ACEs movement significantly in recent years. Countries including Scotland and Wales have implemented impactful trauma-focused frameworks with great success. These frameworks have been reported to decrease social isolation, improve educational outcomes, and build resilience in young people (Skuse & Matthew, 2015). Cities including Plymouth (UK), Lancashire (UK), Tennessee (US) and Tarpon Springs, Florida (US) have begun the journey to implementing Trauma Informed Practice at a city and community level. Mental Health Ireland and Alcohol Action Ireland (2021) advocate that cultural changes must take place within our public and social systems to reflect the impact of trauma. They call for a multi-agency, multi-pronged approach to trauma-sensitive services. The Government of Ireland report prepared by the Department of Health, ‘ Vision ~ A Mental Health Policy for Everyone’ (2020) gives a very clear mandate regarding the provision of Trauma-Informed Service Delivery Principles and specifically states that staff in every part of mental health organisations change their language, behaviour and policies to take into consideration the experiences of those who have trauma histories, including staff members themselves. This mandate needs to transcend all organisations, where at an organisational and individual level people are given an opportunity to reflect and retrain using a ‘trauma-sensitive lens’. In “Cork: Our Vision for a Trauma-Sensitive City” we are providing a framework and opportunity for us collectively as a city, collaboratively at an organizational level as well as at an individual level, an opportunity to embrace and adopt a trauma lens in the work that we do and the lives that we live. Fundamentally, taking a population-level, trauma-sensitive approach means • developing proactive systems that aspire to prevent trauma from occurring in the first place • promoting protective factors for all • recognising the behaviours that may be the result of trauma and intervening appropriately, and • helping people who are suffering adverse consequences in a trauma-sensitive way. At the most basic level, trauma is the presence of toxic stress in the body, leading to the overproduction of cortisol, which in turn activates our innate fight/flight/freeze/fawn response and occurs without the buffer of a secure relationship (Mulcahy, 2018; Siegel, 2012). t Stress, when mild, can promote healthy development; however, when stress is prolonged and unpredictable and occurs in the absence of a ‘buffer’ or caring relationship, can have a negative impact on how our brains and bodies function and how we view the world around us. (Hornor, 2015). Fundamentally, healing and recovery from trauma occur through responsive

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

and nurturing relationships (Brooks, 2019; Treisman, 2018). This strategy aims to promote the role we can all play in our relationships with each other. We in Cork city aspire to have an understanding that trauma is everyone’s business, and we all have a role to play in providing support. In shaping a vision for our city, Cork Trauma-Sensitive Cities Steering Committee have been working, learning, and reflecting in collaboration with other cities and trauma-sensitive organisations over the past 24 months. This is to ensure we fully comprehend the science of trauma and how it relates and translates to the local city context, in order to better understand what a trauma-sensitive approach should look like for Cork City. This strategy provides a framework for the city to develop pathways and opportunities to ensure as a city we are adopting a trauma-sensitive approach, which will involve a comprehensive change in the manner in which we develop and deliver services and programmes across the city. This will ensure that all partners can demonstrate a basic understanding of trauma and consider the implications for people experiencing trauma in their planning and delivery and where appropriate utilise trauma- sensitive responses (Kimberg &

Wheeler, 2019; SAMSHA, 2014)). Sandra Cogan Williamson Chair Cork Trauma- Sensitive City

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Contents Foreword . ..................................................................................................................................................... 1 Ann Doherty, CE Cork Council................................................................................................................1 Foreword Lord Mayor ................................................................................................................................ 2 Lord Mayor Cllr Deirdre Forde.................................................................................................................2 Executive Summary . .................................................................................................................................. 3 Sandra Cogan Williamson, Chair Cork Trauma- Sensitive City...........................................................3 Cork Trauma Sensitive City Steering Group Members 2019 to Present..............................................6 Section 1 ....................................................................................................................................................... 7 1.1 Vision: Growing Cork as a Trauma-Sensitive City..........................................................................7 1.2 Mission: to promote city-wide trauma awareness, sensitivity, and healing through relationships.............................................................................................................7 1.3 Values and Principals of becoming Trauma- Sensitive.....................................................................7 1.4 What is a Trauma-Sensitive Approach?..............................................................................................7 Section 2 ..................................................................................................................................................... 10 2.1 Introduction.........................................................................................................................................10 2.2 Definition of Trauma and Trauma-sensitive Practice.....................................................................11 2.3 Adverse Childhood Experiences.......................................................................................................12 2.4 The one good adult/ The key person.................................................................................................12 2.4.1 What difference does One Good Adult make?.............................................................................13 2.5 Types of Stress Response: Positive, Tolerable and Toxic Stress......................................................13 2.6 A City focused on partnership, prevention and upskilling............................................................14 2.7 Strategic Goals......................................................................................................................................15 2.8 Steering Committee.............................................................................................................................15 2.9 Training & Workforce development:................................................................................................16 2.9.1 Training – Dr Karen Treisman........................................................................................................16 2.9.2 Trauma Responsive Schools Pilot Programme:............................................................................18 2.9.3 Munster Technological University Trauma Awareness Training:..............................................18 Section 3 ..................................................................................................................................................... 19 3.1 Systems development.........................................................................................................................19 3.1.1 Tier 1: General Awareness...............................................................................................................19 3.1.2 Tier 2: Trauma Champions.............................................................................................................20 3.1.3 Tier 3: Strategic Planning and Organisational change using a Trauma lens............................20 3. 2 Pledge/Memorandum of Understanding MOU.............................................................................21 Section 4 ..................................................................................................................................................... 22 4.1 Research/Evaluation............................................................................................................................22 Phase 1: -Review of extant literature in the field, globally and in Ireland. – 2019-2022..................24 Phase 2: - Research design based on the findings of Phase 1 – 2021-2022........................................24 Phase 3 – Implementation -2022-2025...................................................................................................24 Phase 4 – Evaluation of Bespoke Cork City Trauma Lens/Model/ Framework – 2025...................24 Section 5 ..................................................................................................................................................... 25 5.1 Conclusion............................................................................................................................................25 References: . ................................................................................................................................................ 26 Appendix 1 ................................................................................................................................................. 29 MEMORANDUM OF UNDERSTANDING ........................................................................................ 30 Pledge to become a trauma-sensitive Organisation .......................................................................... 31

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Cork Trauma Sensitive City Steering Group Members 2019 to Present Dr. AnnaMarie Naughton Health Service Executive Ingrid O’Riordan School Completion Programme Dr. Judith Butler Munster Technology University Katherine Harford Cork Healthy Cities & Lets Grow together Dr. Mary T. O Mahony Health Service Executive Sandra Cogan Williamson Cork City Council Garda Timothy O’Donovan An Garda Siochana Adrienne Rodgers Cork City Council David Lane Health Service Executive Dr. Jennifer Hayes Health Service Executive Dr John Sheehan (Former Lord Mayor) Cork City Council & General Practitioner (GP) Judy Cronin Health Service Executive Cllr Mick Finn (Former Lord Mayor)

Cork Education and Training Board & Cork City Council Cork City Council & Health Service Executive

Rebecca Loughry Dr. Sharon Lambert Siobhan Goulding

University College Cork Department of Social Protection Cork Education and Training Board Mercy University Hospital Munster Technology University Matt Talbot Adolescent Services CLG Munster Technology University

Ruth Griffin

Margaret McKiernan

Honor Carroll

Edel Foley

Dr. Annie Cummins

Kerry Brennan Mick Devine

Cork Simon Community

Tabor Group

Traolach O’Callaghan

TUSLA

Eileen O’Shea

Cork Traveller Visibility Group

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Section 1

1.1 Vision: Growing Cork as a Trauma-Sensitive City A trauma-sensitive city approach is a commitment to all citizens, not just children. It endorses and supports relationships, practices and environments that promote safety, predictability, empowerment, and control (Nicholson et al ., 2019; Jedd et al ., 2015). Trauma Informed Practice (TIP) and a trauma-sensitive approach support a deeper understanding and awareness of the prevalence and role that trauma plays in people’s lives, and that healing comes from responsive relationships. Through the integration of this knowledge and understanding into the fabric of our daily way of working, we promote resilience and understanding (Butler, 2020). 1.2 Mission: to promote city-wide trauma awareness, sensitivity, and healing through relationships. This strategy aims to develop and establish a bespoke trauma framework at a city-wide level that will serve to support statutory, community, voluntary organisations and local communities in the development of principles and practices with regard to becoming trauma-sensitive. This framework will comprise the development of a bespoke training programme and bespoke toolkit that will be developed for, and offered to, all partner organisations at an individual and city-wide level. The mission is to promote city-wide trauma awareness, sensitivity and healing with a focus on relationships. 1.3 Values and Principals of becoming Trauma- Sensitive For Cork City to become trauma- sensitive, we must • realise the widespread impact of trauma and understand potential paths for recovery; • recognise signs and symptoms in our citizens who are involved with the systems that operate within the city; • respond by fully integrating knowledge about trauma into our policies, procedures, practices, and • seek to actively resist re-traumatisation (Trauma and Justice Strategic Network; SAMSHA, 2014). A city that holds a trauma lens at its core holds the values of trauma-sensitive practice as one that is 1) safe, 2) person-centred, 3) kind in its responses, 4) works collaboratively and 5) is empowering and recognises 6) resilience within a person, family, and community . (Adapted from Envisioning Plymouth as a Trauma-Informed City). Treisman (2018) advocates, we need to create services that consider, acknowledge, and integrate our understanding of adverse adult experiences, adverse community experiences, adverse cultural experiences and adverse organizational experiences 1.4 What is a Trauma-Sensitive Approach? A Trauma-sensitive recognises the prevalence and impact of trauma, the role trauma plays in people’s lives and most importantly, advocates that healing from trauma is through relationships. (Butler, Clerkin & Cummins et al ., 2022) Fundamentally, a city-wide approach to understanding the prevalence and impact of trauma across the lifespan necessitates understanding the impact of adverse childhood experiences (ACES) and trauma within organisations and communities, along with the interaction and experiences of the individual within those structures.

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

The Substance Abuse and Mental Health Services Administration, (SAMHSA, 2014) posit that Trauma- informed Practice is a strengths-based framework that is underpinned by six core principles which are; 1. Safety 2. Trustworthiness and Transparency 3. Peer Support 4. Collaboration and Mutuality 5. Empowerment, Voice and Choice, and 6. Cultural, Historical and Gender Issues (Pemberton & Loeb, 2020). “Research would indicate that exposure to adverse experiences is common, the psychological impact of these adversities varies from person to person. There are many people in our communities who have experienced adversities at a level that drastically impacts on their day to day living, including access to and use of public services. Creating an inclusive community requires us to think that how we can improve access to services to those who have experienced psychological trauma. Cork City’s journey to become a trauma aware city is an exciting development with the potential to improve outcomes and experiences for both the public and staff working in public services” Dr Sharon Lambert University College Cork The physical, psychological and emotional safety of service users and staff are prioritised, by: • people knowing they are safe or asking what they need to feel safe • there being reasonable freedom from threat or harm • attempting to prevent re-traumatisation • putting policies, practices and safeguarding arrangements in place Safety

Transparency exists in an organisation’s policies and procedures, with the objective of building trust among staff, service users and the wider community, by: • the organisation and staff explaining what they are doing and why • the organisation and staff doing what they say they will do • expectations being made clear and the organisation and staff not overpromising Service users are supported in shared decision-making, choice and goal-setting to determine the plan of action they need to heal and move forward, by: • ensuring service users and staff have a voice in the decision- making process of the organisation and its services • listening to the needs and wishes of service users and staff • explaining choices clearly and transparently • acknowledging that people who have experienced or are experiencing trauma may feel a lack of safety or control over the course of their life which can cause difficulties in developing trusting relationships

Trustworthiness Transparency

Peer Support

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

The value of staff and service user experience is recognised in overcoming challenges and improving the system as a whole, by: • using formal and informal peer support and mutual self-help • organisation asking service users and staff what they need and collaboratively considering how these needs can be met • focusing on working alongside and actively involving service users in the delivery of services Efforts are made to share power and give service users and staff a strong voice in decision-making, at both individual and organisational levels, by: • validating feelings and concerns of staff and service users • listening to what a person wants and needs • supporting people to make decisions and take action • acknowledging that people who have experienced or are experiencing trauma may feel powerless to control what happens to them, isolated by their experiences and have feelings of low self-worth Move past cultural stereotypes and biases based on, for example, gender, sexual orientation, age, religion, disability, geography, race or ethnicity by: offering access to gender-responsive services leveraging the healing value of traditional cultural connections incorporating policies, protocols and processes that are responsive to the needs of individuals served ( Working definition of trauma-informed practice - GOV.UK (www.gov. uk)

Collaboration and Mutuality

Empowerment, Voice and Choice

Cultural Sensitivity

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Section 2

2.1 Introduction Cork is the second largest city in Ireland with a population of 210,000 citizens. Cork is the only Irish city currently recognized by UNESCO for its excellence in the field of learning and was one of just 12 cities globally, and 3 in Europe, presented with the inaugural UNESCO Learning City Awards in 2015. Cork City is a World Health Organisation (WHO) Health City since 2012. As a city, we have a proven track record of strong interagency collaboration and project delivery. This was particularly evident during the Covid 19 pandemic, where 16 Community area teams ensured that individuals, families, and communities were supported and nurtured throughout the pandemic. A City-Wide Community response forum was established led by Cork City Council. The trusting relationships that have been established over years of collaborative working ensured that as a city we supported our citizens through a very uncertain time. In Cork, we recognise that trauma can occur at any time in the lifespan, so we need a broad, inclusive approach to being trauma aware, compassionate and supportive. We also recognise that some of the most vulnerable members of our community are at far greater risk of trauma. Our aim is to work towards increased awareness of trauma, and the impact of trauma in the context of social inclusion and connection. As a city, we are embedding ACE Awareness & Trauma-Sensitive Practice through a Whole Systems Approach in partnership with agencies and the community and voluntary sector. This approach is supported by national and international literature from neuroscience, public health and psychology. Cork Healthy Cities commissioned ‘Cork City Profile’ – a statistical and geographical profile of Cork City Local Authority area that focused on health and inclusion. The profile provides an in-depth examination and insight into the social determinants of health that influence the health of citizens. Further analysis from POBAL maps identified that 29% of the 519 small areas in Cork City are defined as being disadvantaged or very disadvantaged. Geographical disadvantage continues to be a key challenge facing Cork City. Cork City Council retained the Revitalizing Areas through Planning, Investment and Development Programme (RAPID), and adapted it to be reflective and responsive to the needs of the RAPID areas by embedding it within the Local Community Development Committee (LCDC) structures. Despite improvements in outcomes across a range of measures, there remains a distinct spatial component to the distribution of disadvantage within the city, with a concentration of deprivation and associated factors across the RAPID areas of the City and in particular north of the river. To address poverty and disadvantage it is essential that we have a multi-agency planned response, focusing on upstream approaches to health and wellbeing that are proactive and holistic. The 4 designated RAPID areas in the city have a DP score between -13.2 and -16.6. (Cork City Local Economic and Community Plan). The existence of trauma poses a threat to individuals and communities. Trauma occurs across all economic, cultural, racial and social groups, which can form a rootless trajectory that may be experienced by children worldwide (Brooks, 2017). Various cohorts are typically more susceptible to experiencing ACEs and trauma such as those encountering socio- economic disadvantage (Nicholson et al ., 2019). Due to increasing social and cultural factors (Nurius et al. , 2013), researchers devised the notion that communities that are vulnerable and marginalised are at a higher risk of experiencing trauma, including members of the Traveller community (Hughes, 2019; Coogan, 2019), members of the homeless community (Lambert & Gill-Emerson, 2017), children in poverty (Murray & Morgan, 2019), and children in direct provision (The College of Psychiatrists of Ireland, 2017; Fazel, Wheeler & Danesh, 2005.

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Cork City recognises that to achieve this ambitious and courageous goal of becoming a city that is Trauma- sensitive we need to embrace and embed a new approach to how we meet people. We are planting the seeds that will grow a city that is kind and inclusive. This is about caring, creating trustful relations and having in mind that difficult children do not exist, but many children are living under difficult conditions.

As a City we recognise that relationships are key, responsive relationships and supportive family and community environments have been shown to shape a child’s future well-being, development, educational engagement, and health (Romero et al ., 2018), and are indeed key to positive life outcomes (Campbell et al. , 2016). “As Cork continues to prosper as a Healthy City, a Learning City and a City of Sanctuary, it is crucial that an awareness and understanding of childhood trauma and the lifelong impacts of adverse child- hood experiences (ACEs) underpins its evolution. Putting children, young people and families front and centre in in service delivery across all organisations will strengthen the roots of Cork’s family and community life. Educating people working in the various sectors about ACEs through a self-guided learning continues the ground-breaking work already done to raise awareness in the city and will help lead to a Cork that is more inclusive, understanding and responsive to the needs of the more vulnerable among us.” Cllr Mick Finn, CETB and Former Lord Mayor Of Cork 2.2 Definition of Trauma and Trauma-sensitive Practice For the purposes of this strategy, trauma is defined at its core as an event(s), or a series of circumstances that are experienced as physically or emotionally harmful or life-threatening. It may overwhelm a person’s ability to cope and function which has a lasting adverse effect on their mental, physical, social, emotional, and/or spiritual well-being (Trauma and Justice Strategic Network; SAMSHA, 2014). Put simply, trauma is about the harmful experiences that people experience and the legacy of the impact.

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

2.3 Adverse Childhood Experiences Adverse Childhood Experiences (ACEs) is a term coined by researchers, Vincent Felitti, Robert Anda, and their colleagues, in their study conducted from 1995 to 1997. ACEs refer to traumatic experiences in a per- son’s life occurring before the age of 18. These include: • experiencing violence, abuse, or neglect; • witnessing violence in the home or community; • having a family member attempt or die by suicide. In addition, aspects of the child’s environment that can challenge their sense of safety (Butler, 2020) are also identified and include children’s experiences of • substance misuse; • mental health problems; • instability due to parental separation or incarceration of a parent, sibling, or other members of the house- hold ACEs are linked to chronic health problems, mental illness, and substance use problems in adolescence and adulthood. ACEs also have the potential to negatively impact education, job opportunities, and earning potential . However, having a key person or one good adult in our lives is linked to better outcomes and over- all health (Jigsaw, 2022) 2.4 The one good adult/ The key person Research (Nicholson et al., 2019) suggest that just one positive adult can dramatically improve the outlook of a child impacted by trauma and Adverse Childhood Experiences (ACEs). This relationship acts as buffer against toxic stress and has the potential to change the course of a child’s life. Those who spend more time with children have a greater opportunity to provide the tools that can really have a positive impact ‘Envisioning Cork as Ireland’s first trauma sensitive city fills my heart with joy & so much hope. Understanding the impact of Adversity and Trauma, help us all to find ways to look through the lens of “what happened” instead of “what’s wrong with you’. Trauma is common and if you work with people you work with trauma. However, we also know what can help mitigate trauma, a responsive, compassionate, and caring relationship. In fact, all trauma sensitive practices begin with a caring & compassionate relationship. A smile has the potential to change a person’s brain & your smile might be the single only smile someone sees in a day. Our daily interactions that we all have with each other are very important and relationships are built in the small moments. We all need to be aware and ready to play our part in healing the impact of trauma and adversity. To me, Cork as a trauma sensitive city means a city rooted in empathy & validation of all people’s life experiences & is a city that commits to building consistent and caring relationships. As Bruce Perry highlights, ‘Relationships are the agents of change, and the most powerful therapy is human love. People not programmes change people.’ Dr Judith Butler , Munster Technological University Quote

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

2.4.1 What difference does One Good Adult make? Young people who reported having one good adult tended to have: • Increased self-esteem • More success in school life • Better mental health • More likely to seek help • Less risk-taking behaviours Not having One Good Adult is linked to higher levels of distress, anti-social behaviour, and increased risk for suicidal behaviour. Having One Good Adult is essential.

2.5 Types of Stress Response: Positive, Tolerable and Toxic Stress The Centre for the Developing Child Harvard University (2022) distinguishes between three types of stress responses: positive, tolerable, and toxic. 1. Positive Stress- motivates us to get things done, it is short-lived and once it is over stress levels return to normal levels. 2. Tolerable Stress is more serious but as the name suggests it’s tolerable for one reason- we have a key relationship to help us through. 3. Toxic Stress – stress becomes toxic or traumatic when it is prolonged and occurs in the absence of a relationship. (Butler, Clerkin & Cummins, 2022: 130) Toxic stress is trauma. Toxic stress has the potential to profoundly alter the development of a child’s brain and can affect the immune system, with research showing a correlation between early adversity and poorer outcomes later in life (Butler et al., 2022; Burke et al ., 2011; ). Young children are especially sensitive to repeated trauma and adversity, largely because their bodies and brains are developing (Butler et al., 2022; Jedd et al., 2015; Bremmer, 2006).

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

2.6 A City focused on partnership, prevention and upskilling In 2019, Cork City Council led a call to action for interagency collaboration to provide front-line staff and management across the city to attend Trauma training free of charge. As a city, we wanted to ensure that as many barriers were removed as possible allowing a wide net to be cast to ensure the training reached as many front-line practitioners as possible. The aim was to enable the development of a framework, which would begin the groundwork towards a shared understanding and language in relation to Trauma and its impact right across the lifespan. The training also provided a foundation for the development of practical tools to be used across the services in Cork. To date over 500 front-line practitioners have been trained in 4 full days of Trauma training.

350 individuals attended 2 Days Training on Understanding the impact of relational and developmental trauma and disrupted attachment on children’s brains, bodies, emotional, relationships and behaviours, including Adverse Childhood Experiences (ACEs). April 2019 October 2019 Trauma Interagency Steering Group established October 2019

Cork Trauma Sensitive City

November 2019 Attended and presented at Trauma Informed Prevention of Adverse Childhood Experiences – A WHO European Healthy Cities Taskforce Presented to the Trauma Informed Care TIC Conference Dublin – Mick Finn CETB & Sandra Cogan Williamson

Dr Jennifer Hayes and Sandra Cogan Williamson attended Action On Trauma Conference Belfast

January 2020 450 individuals attended 2 days training on Moving towards being and sustaining an adversity, culturally, traumainformed, infused, and responsive organisation- Dr Karen Treisman

September 2020

50 individuals attended 2 screenings of Resilience Documentary to youth workers and family support workers

January 2021 onwards Monthly Steering Group meetings developing strategy and vision for Cork with sessions delivered by UCC, MTU, Public

October 2021 54 participants engaged in 6 Days Pilot Training to 10 Schools and 2 School Completion Programmes on Trauma Responsive Education

Health, Lancashire Police, Plymouth Trauma Network,Novis,Trauma Informed Education.

Development of a bespoke 45 min e-training module - Develop CoP - Grow and develop new partnerships and collaborations - Pledge - Developing Trauma Strategy for Cork City including a road map & Model of best practice -Grow and develop new partnerships and collaborations

2022 & beyond

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

2.7 Strategic Goals

Steering Committee

Training & Workforce development

Systems development

Pledge/MOU

Research & Evaluation

Embarking on a population-based Trauma-sensitive approach means developing proactive systems that aspire to prevent trauma from occurring in the first place, promoting protective factors for all children, recognising the behaviours that may be the result of trauma and intervening appropriately, and helping people who are experiencing adverse consequences in a trauma-sensitive way. 2.8 Steering Committee Cork City established a steering committee under the leadership of former Lord Mayor Dr John Sheehan in late 2019, with the overarching aim of making the city Trauma-sensitive . Upon recognising and understanding the connection between trauma and potential poor physical and social outcomes, we have a responsibility to develop a plan to raise awareness about trauma by educating local partners and service providers on what trauma is, the role trauma plays in people’s lives and that healing from trauma is through relationships. Becoming a Trauma-sensitive city means we will develop city-wide structures and frameworks that involve recognising, understanding, and responding to trauma that children, young people and communities are exposed to and will develop systems which support those impacted by trauma. This steering group is derived from a coalition of professionals from interdisciplinary services, with professional and personal experience of how trauma can affect people and a working knowledge of the importance of relational repair. Cork City Trauma-Sensitive steering group is made up of more than 30 professionals across public agencies and community groups including; • An Garda Síochána • Cork ETB (CETB) • Universities- MTU & UCC • TUSLA • HSE – Social Inclusion/Public Health/Mental Health/ Drug and Alcohol Services/GP’s

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

• Department of Social Protection • Cork City Council • TESS – School Completion Programme • Probation • Homeless Services • Traveller Visibility Group • Elected Members • RAPID • Healthy Cities • Addiction Services • Area Based Childhood Committee

All members of the steering group have gained insight into the long-term impact trauma can have on people. They are committed to developing and driving the goals of making Cork City Ireland’s first trauma-sensitive city. 2.9 Training & Workforce development Cork City recognised the need to support workforce development in relation to adopting a Trauma-sensitive approach in recent years and in April 2019, and in January 2020, training was provided for key service pro- viders across the city. Dr Karen Treisman delivered training over the course of 4 full days to over 500 individ- uals. 2.9.1 Training – Dr Karen Treisman Training in April 2019 : An Introduction to relational and Developmental Trauma The Objectives of the 2-day training included to: • Develop further knowledge and understanding about the impact of early trauma on children’s overall development • Gain further insight into the latest brain science and neurobiology around childhood trauma and neglect • Consider how emotional regulation develops in childhood and how it can be influenced by trauma and ACEs • Learn how to identify children’s multi-sensory triggers and emotional hotspots • Gain further understanding as to why therapeutic re-parenting and relationship-based trauma-sensitive practice is so fundamental to children’s progress • Increased understanding as to why trauma is a multi-sensory whole-body experience requiring multi- sensory whole-body interventions

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

Training in January 2020: Moving towards and sustaining being adversity, culturally, & trauma-informed, infused, and responsive organisation/group

Aims and objectives of the 2-day training included: • Learn about what being adversity, culturally, and trauma-informed, infused, and responsive means and looks like; and establish why it is needed, important, and beneficial. • Identify the key values, principles, and definitions within trauma-informed organisational transformation. • Learn about some of the key aspects to support successful implementation. • Learn about several best practice models for being more trauma-informed and trauma-responsive at an organisational level. • Increase knowledge and understanding around specific components and the nuts and bolts of the practice of being more trauma-informed, such as through induction and recruitment, the language we use, through to the physical environment, through to lived experience involvement, through to team meetings, through to supervision, through to behavioural responses, and much more. • Consider what some of the factors are for improving the effectiveness of trauma-informed practice; as well as what some of the potential obstacles and barriers may be. • Reflect on what is going well already and how can this be magnified, strengthened, and celebrated. • Develop action plans, momentum, and ideas from the group as to ways to become more trauma- informed and trauma-responsive. • Learn more about organisational and secondary trauma, as well as group processes. • Create well-being plans.

Participants received CPD certification from University College Cork (UCC) for full attendance. To date, over 500 individuals from a plethora of services including therapeutic services, homeless services, TUSLA, justice services, education services, youth services, nursing, and midwifery, the HSE (Health Service Executive), Cork City Council, academia, and Cork ETB (Education Training Board) have attended the training. The training programme aimed to develop and embed a common language and understanding across the city of trauma and adversity, and to further enhance service delivery to vulnerable children, families, and communities.

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

2.9.2 Trauma Responsive Schools Pilot Programme: Sept 2022 - Jan 2022

A pilot programme for schools was commissioned by Cork Trauma-sensitive Cities in 2022. This programme was developed and delivered in partnership with Trauma Responsive Education, which is a social enterprise. This pilot was delivered to over 60 staff nominated from 10 schools and 2 school completion programmes across the Rapid areas in Cork City. The programme was funded through Rapid and Cork City Council. The focus of the pilot was to build knowledge and understanding within the school of Trauma responsive education, it was delivered across 5 weeks and included pre and post-training follow up, the development of a trauma-responsive plan for each school and quarterly reflective practice sessions annually.

2.9.3 Munster Technological University Trauma Awareness Training: May 2022- December 2022

The Teaching and Learning Unit at Munster Technological University (Cork) funded 3-hour trauma awareness training delivered by Dr Judith Butler and Dr Annie Cummins (Lecturers/ Researchers MTU and steering group members) to Cork ETB principals, Further Education College teachers, Youthreach centres, Active Inclusion, post-primary teachers and primary teachers in 11 colleges and schools in Cork to date. This training introduced Trauma-sensitive approaches in education with a focus on supporting students fleeing war. The awareness training has been evaluated and highlights that 75% of teachers had no relevant training on the needs of children who have experienced trauma. In addition, 96% asserted that the training was ‘excellent’ (80%) or ‘very good’ (16%) asserting that it would positively impact their teaching and engagement with learners. The value of this 3-hour sessions can be seen in the responses from the teachers. I must remember to be kind towards learners, if there is a difficulty or a learner has a distressed response then I will think of the regulate, relate, and reason response mentioned. Smile. Give choices. Provide students with a sense of care and community in the classroom as you don’t know if they have had this before I’m going to focus on relationships. It’s obvious now that I may indeed be the only smile a student sees in a day! Not going to be annoyed & unwelcoming when students are late. I’m going to find what is going on & if I can assist. Meet needs - as you said Maslow & meeting needs come first. I now know I’m a key person in my students’ life. People change people.

Cork Trauma Sensitive City

City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

I hope to try and encourage others to focus on developing relationships, bringing hope, and allow as much autonomy/choice as possible in our communities. The impact that a key person can have on a person’s life, that relationships are a buffer for trauma. Students come in our doors, and we have no idea what baggage they may have so we must be aware of that and so be kind. Improving connections and relationships in my class. Changing my views on things e.g. relationship seeking rather than attention seeking Section 3 3.1 Systems development: Upon recognising and understanding the connection between trauma and potential poor physical and social outcomes, we have a responsibility to develop a plan to raise awareness about trauma by educating local partners and service providers on what trauma is, the role trauma plays in people’s lives and that healing from trauma is through relationships. Building Cork as a Trauma-sensitive city means we will develop city-wide structures and frameworks that involve recognising, understanding, and responding to trauma that children, young people and communities are exposed to while developing systems which support those impacted by trauma.

TIER 1

TIER 2

TIER 3

Leadership & Corporate Governance – pledge – organizational change – trauma lens on strategic planning, policies, physical environment etc.,

General Awareness – e-training module and pledge

Enhanced Trauma-Sensitive Practice Skills Development – trauma champions/trauma-focused services

3.1.1 Tier 1: General Awareness

Cork Trauma Sensitive City

Becoming Trauma Aware An introduction to psychological trauma

Let’s Begin

Module last reviewed: 11/08/2022

Cork Trauma Sensitive City

Tu nh di se 4r s5t-amn idn hu ot ewmt roaduuml ea aiismesv et or yroa ni see’ sa bwuasri enne es ss s. To hf et haeu idmi epnaccet foof rptshyi cs hmo loodgui cl ea li nt rcal uu dmeas aa nl l ds thaef lf pa yt oa ul l lPeuvbe ll isc wHoerakl ti nh g– aCcor roks s&o Ku er rcroyl lienc ct iovlel aabgoernact ii eo sn. wT hi ti hs pC roorgkr Ca mi t ymCeo wu na cs i cl , oCmo mr ki sEsdi ou nc ae tdi obny &t hTe rHa iSnEi nDgeBp ot .aor fd and TUSLA. Both programme and video content for the programme was provided by City-Wide Trauma Awareness, Sensitivity and Healing Through Relationships

•• DD rr SJ uhdairtohnBLuat ml e rb, eMr tT, UU C C •• DT hr eJ eTnwn oi f eNr oHr raiyeess , H S E •• MM aa ur iroanFRe ancnkeasrsdy AP lrci omhaorlyAScct hi oono lI rPerl ianncdi p a l • Sandra Cogan Williamson Cork City Council

Li seeavr enreyrbs owdiyl l’ sbree as bp loentsoi briel ictoyg. Tn hi seeywwhi al lt bi se ma belaentto bi yd et rnat ui f my tah, et hnaat t turraeu omf at rdaouems an, oi tt sdmi s ac rj oi mr fi onramt es aanndd cl oanugs et earsmwheol ll iasst iuc nhdeearl st ht a. nFdi nha ol lwy, lteraarunme ar sawf f ei lcl tasptphreewc i oa trek itnhgesi mo f pt oh ret ba nr ac ienoaf nrde ltaht ei obnos dhyi pasnadn idmt ph ae c t potential to mitigate trauma’s effects. Taking a Public Health approach to trauma requires many elements such as creating greater awareness, actively committing to prevention approaches, investing in early interventions, reducing stigma and most importantly; working in partnership and developing a shared approach. Cork City is leading the way as the first City in Ireland to recognise the benefits to the whole population in becoming trauma aware. Dr Anne Sheahan – Area Director of Public Health (Cork & Kerry) 3.1.2 Tier 2: Trauma Champions It is now proposed that partner agencies/organisations will identify Trauma Champions . Trauma champions will help facilitate the creation of trauma-sensitive approaches in their agencies/organisations. The role of the trauma champion is intended to promote and ensure a consistent approach is taken within agencies/ organisations when responding to trauma. There will be a programme of support for all trauma champions as they take forward this essential work in their organisation. Champions are expected to attend and participate in all components of the learning collaborative, have the ability to implement changes in their agencies, and will have the ability to train and coach other staff. 3.1.3 Tier 3: Strategic Planning and Organisational change using a Trauma lens Kpleayndnrinivgeirnscflourdseu: ccessful implementation of Trauma-informed organisational change and strategic 1) Governance and leadership 3) the physical environment; and 2) Policy development 4) Cross Sector Collaboration For the purposes of developing this strategy, we have adopted SAMHSA’s published guidance (Substance Abuse and Mental Health Services Administration (SAMHSA), 2014) which outlines more da ne tda fi rl eodmi mmpolde eml se no ft at tr iaounmdao- mi n af oi nr ms , ed dr apwr an cbt iocteh (fFraolml o tt,hMe aorrkgoafnf ,i s&a tRi oe ne da l, 2c h0 a0n5g; eH mu aannga, geet ma le. ,n2t 0l i1t e2r; aFtaul rl oe t & Harris, 2006). For the purposes of strategic planning and organisational change we have focused on four of the key domains as outlined by SAMSHA. These are all reflected throughout this strategy and the MOU. Cork Trauma Sensitive City 21

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