Communities Healing and Transforming Trauma (CHATT) is a speakers’ collective developed at the University of California, San Francisco (UCSF) Trauma Recovery Center (TRC). The UCSF TRC was founded in 2001 to test a new model of comprehensive services for victims of crime that integrates assertive outreach, clinical case management and trauma-informed, evidence-based mental health services. TRC also provides coordination, advocacy and linkage to help survivors navigate complex systems and access the resources they need to heal, including medical, legal and other services. It was developed as an alternative to the claims-based crime victim compensation model that was not accessible for the majority of victims, and it was initially funded as a pilot program by state legislation for five years.
Although a randomized trial during the initial funding period demonstrated that the TRC model was clinically and cost effective (Alvidrez et al., 2008; Kelly et al., 2010), state funding was not immediately renewed at the end of the pilot due to shifting political priorities. Subsequently, the UCSF TRC struggled for a number of years to obtain San Francisco city funding while continuing to lobby for state funding. As San Francisco faced growing economic constraints during the Great Recession, the TRC was listed for closure, and TRC clients voiced their concerns and desire to be involved in public testimony. With some trepidation due to concerns that it may be distressing, and potentially re-traumatizing, several TRC clients were supported to speak at city Board of Supervisors meetings to advocate for funding.
Carla Richmond is a licensed clinical social worker at the TRC and has been at the heart of the development of the CHATT speakers’ bureau. She recalls that clients gave incredibly moving and persuasive testimony, which resulted in the TRC being funded. She describes, “People who were at City Hall to testify for other programs stood up and supported the TRC. This experience gave rise to others.” Carla and other clinical staff observed that clients found speaking in these settings to be empowering. “It helped to make meaning of their own trauma and suffering; it provided an opportunity to give back to the TRC and to help their communities… it also appeared to promote posttraumatic growth in these clients.”
Indeed, there is increasing recognition of the value of consumer participation in advocacy, community activism and peer involvement. The consumer movement has generated an important paradigm shift towards empowerment of survivors. Among trauma survivors, finding meaning or purpose despite the suffering, or “survivor mission,” may include a call to social action, involvement in social justice activities, or public speaking. These may aid survivors in reconnecting and accumulating restitutive emotional experiences for reparation of injuries to the self as well as aid in promoting further growth. Collectively, such efforts may decrease stigma and increase awareness about community violence and the value of trauma treatment.
The organic speaking experiences among TRC clients advocating for the UCSF TRC to stay funded led to the development of the CHATT Speaker’s Collective, which had its first speaker training in 2011.
“When we began the planning process, we were unable to find an evidence-based training curriculum that took the unique needs and experiences of trauma survivors into account. The curriculum we created borrowed elements from the San Francisco Mental Health Association’s Speaker’s Bureau training program, a TRC intern’s thesis, and concepts related to limiting trauma details and staying grounded in the moment from Seeking Safety.”
The CHATT speaker training program includes a comprehensive manualized two-session, six- to seven-hour total curriculum for trauma survivors to increase public speaking and advocacy skills, provide tools to educate others about the impact of violence and process of recovery, and increase comfort and safety in speaking about trauma publicly. The curriculum includes PowerPoints, participant and trainer manuals, handouts and experiential exercises. “We were excited about the potential for a survivor’s speaker’s collective, but also mindful of challenges of sharing trauma stories, especially the potential for speakers and audiences to be triggered.”
Another component of the CHATT program includes a structured monthly speaking support and work group for trauma survivors involved in public speaking and advocacy work as members of CHATT. The monthly support and work group provides a safe and consistently available space for survivors to develop skills to speak about the trauma they survived in a way that facilitates their healing process and educates the public about trauma and trauma recovery. Group components include: (1) coaching on developing their stories and message, speaking tips and practice, addressing performance- and trauma-related anxiety; (2) supporting one another in the mission of recovery, growth and advocacy work; (3) discussing recent speaking experiences; and (4) discussing upcoming speaking opportunities.
Reflecting on the development of CHATT, Carla says,
“As a clinician, I’m excited by the potential of this intervention to act as ‘a lovely bridge’ (to quote a CHATT member) between therapy and the larger context of survivor’s lives that allows survivors in the meaning-making stage of recovery to give voice to, and even master, their story and re-story traumatic victimization for themselves and a broader public.”
The CHATT Speakers’ Collective borrows elements from other speaker’s bureau programs but is unique in its trauma-informed approach. First, it provides space to re-story the trauma – survivors can change how they relate to the trauma and give voice to silenced experiences. Second, it integrates containment strategies—structured activities in the training and support/work group meetings demonstrate how to contain anxiety and trauma detail as well as model how to hold boundaries that distinguish this as a work group rather than a therapy group. Third, it builds community—it breaks the isolation inherent in the aftermath of trauma and creates a survivor community. Fourth, it restores agency and a sense of competency. Indeed, the program was developed to maximize survivors’ choice by providing opportunities to develop their personal mission and message, to increase public speaking skills, and to provide feedback that is elicited and integrated in iterations of the program.
CHATT speakers address audiences about the impacts of violence, facts about community violence, the recovery process and the value of trauma-sensitive services. The evaluation of the first three cohorts of the CHATT Speakers’ Collective found speaker self-efficacy and posttraumatic growth significantly increased after one year in the program (Fields et al., 2020). Furthermore, results showed that the panel talks given to a variety of audiences at multiple different types of venues during the first three years of the program increased audience member knowledge about trauma and recovery (Fields et al., 2020). Anecdotally, CHATT speakers have been instrumental in advocacy to implement the TRC model throughout California, as panel talks presented multiple times to California legislators impacted Proposition 47, a statute that provides more funding for trauma-focused mental health services. There are now 14 TRCs throughout California and 34 across the United States. Thus, survivors have deeply personal, powerful and very moving messages to share with policymakers, providers and the community that can impact trauma recovery, individually and collectively.
Clinical Implications for Supporting the Survivor’s Mission
During a surge in bias-motivated and hate-based violence, many clinicians are seeing an associated rise in outrage among clients and a call to action to uphold justice for those who have been historically marginalized and are currently being subjected to prejudice and discrimination. How do we as clinicians sitting with clients who are experiencing this moral and collective outrage address this in the trauma work?
Carla reflects,
“I think that the aspects of the model focused on attuning and acknowledging distress triggers and speaker agency have utility when holding the impact of racism and oppression on the experience of and recovery process after trauma -- especially when you consider the realities of continuous trauma exposure in a white supremacist (and patriarchal, homo and transphobic, ableist, capitalist) context that endangers marginalized bodies. Making sure speaking is in the service of one's healing and balances self-care needs with work for others and community are important considerations. I work with survivors to develop their own practice of how to be attuned to themselves. The more that we can notice when we are being triggered, contextualize that as best we can with what we understand about trauma and what we understand about our own place in that moment of recovery, the more that we can draw from our bag of tools for how to re-regulate.”
Sometimes the survivor’s mission can pop up early in therapy, and sometimes this can manifest as avoidance around processing one’s own trauma. Having these conversations ongoing about deciding how someone will know when they are ready to engage in community advocacy can be therapeutic, as well as discussing safe and helpful ways to get involved. When there is a sense of alignment between a person’s values and actions, they can tolerate more in terms of approaching their trauma in therapy and be more courageous.
“I do think the question of readiness can be a complicated one. We do encourage survivors (and referring therapists) to consider a number of factors when considering readiness for CHATT – self-regulation tools when distressed, triggered/confronted with trauma reminders is a vitally important one. I have also seen in CHATT how speaking readiness is an ever-changing state based on multiple variables and not static over time -- which makes ongoing distress/anxiety, readiness assessment and the agency to step into and out of speaking critically important. We talk about the ability to choose NOT to speak as a vital part of voice and agency. Using substances to speak would be a big flag for stepping away from speaking and prioritizing self-regulation and self-care at that time. I talk a lot with clients about where their tank is today, and where it is this week, and what they and we can do about filling their tank. Making sure that before they give out to anybody else, whether it’s their children, or their partner, or their community, they’re checking their tank to see if there’s enough to give out. If their tank is more depleted, then we explore what boundary setting looks like.”
There are multiple ways to engage in advocacy, including educating others, organizing community efforts, and developing and sharing resources. If taking action through speaking advocacy is a client’s goal, the CHATT model can inform ways to create a social space for speaking about trauma. “It’s hard to limit trauma exposure in this moment in our history. Exposure is so layered depending on our intersectional realities and individual stressors.” The four-step story-building process of Headline (what is the trauma/s)-Impact (how has the trauma/s impacted me)-Recovery (what was the recovery process)-Now (where am I now in my healing) model minimizes specific trauma details that might be triggering to the survivor and/or be overly upsetting for audiences in a way that might obscure key messages that a survivor wants heard most. The self-care strategies that are taught and developed (e.g., checking Subjective Units of Distress ratings, boundary setting) provide a framework for when and how to share.
We are in an important moment to highlight and broadcast the voices of those who are often underrepresented and silenced in our society. The CHATT Speakers’ Collective provides an effective and therapeutic model that can increase awareness about trauma and impact trauma recovery at the individual and community levels.
Carla Richmond, LCSW, has been a social worker at the TRC since 2007 where she works with survivors of interpersonal violence. She was interviewed for this story about the CHATT program. She assisted in the development, implementation and dissemination of CHATT and co-facilitates monthly support groups for CHATT speakers as well as helps to coordinate speaking opportunities for the group.
The evaluation of the first three cohorts of the UCSF TRC CHATT Speakers’ Collective was published in the Journal of Trauma & Dissociation’s 2020 special issue on Trauma, Advocacy, and Social Movements (Fields et al., 2020). It received a Richard P. Kluft Award Honorable Mention for the Journal of Trauma & Dissociation 2020 Best Article. A digital copy of the manual for the CHATT Speakers’ Collective can be found here.
About the Authors
Christine Valdez, PhD, is associate professor of clinical psychology at California State University, Monterey Bay and a licensed clinical psychologist. Her clinical expertise is in treating interpersonal violence, and her research interests focus on understanding cognitive and emotional processes that contribute to posttraumatic sequelae and recovery from trauma. She completed her predoctoral clinical internship and clinical research postdoctoral fellowship at the UCSF TRC where she was involved in the evaluation of CHATT.
Laurie Fields, PhD, is professor emeritus at UCSF in the Department of Psychiatry and Behavioral Sciences. Her clinical research focuses on developing accessible interventions integrating the best of evidence-based practices in community settings for trauma. Her clinical practice is in adult therapy and wellness, including trauma, vicarious traumatization and burnout that can occur in high-stress professions. She is based at the UCSF TRC where she was involved in development, implementation, evaluation and dissemination of CHATT.
References
Alvidrez, J., Shumway, M., Boccellari, A., Green, J. D., Kelly, V., & Merrill, G. (2008). Reduction of state victim compensation disparities in disadvantaged crime victims through active outreach and assistance: A randomized trial. American Journal of Public Health, 98, 882-888. https://doi.org/10.2105/AJPH.2007.113639
Fields, L., Valdez, C. E., Richmond, C., Murphy, M., Halloran, M., Boccellari, A., & Shumway, M. (2020). Communities Healing and Transforming Trauma (CHATT): A trauma-informed speakers’ bureau for survivors of violence. Journal of Trauma & Dissociation, 21, 437-451. https://doi.org/10.1080/15299732.2020.1770149
Kelly, V. G., Merrill, G. S., Shumway, M., Alvidrez, J., & Boccellari, A. (2010). Outreach, engagement, and practical assistance: Essential aspects of PTSD care for urban victims of violent crime. Trauma, Violence, & Abuse, 11, 144-156. https://doi.org/10.1177/1524838010374481