Inside a Room of Secret Agents at Children's Hope Alliance

The LCSW’s (licensed clinical social workers), QP’s (qualified professionals), and LMFT’s (licensed marriage and family  therapists) are the staff members on the ground with our clients who have caused sexual harm. These TASK (Treatment Alternatives for Sexualized Kids) agents are less known to the rest of the world but celebrity to our kids and the communities impacted by their actions. They meet clients at school, over a basketball game, or with a mouthful of McDonald’s fries. Neither traffic, round-a-about Charlotte city routes, backcountry western Carolina roads, and unlisted addresses prevent them from spending time with the clients’ families. Trashcans, Jenga blocks, and snack packs are their weapons of choice to teach concepts like the difference between consent, compliance, coercion, and cooperation. TTFOFLA(two-three-four-or-five letter acronyms)is their language of choice:

TF-CBT: trauma-focused cognitive behavioral therapy

SA: substance abuse

CFT: child and family therapy

PCP: person-centered plan

DSS: Department of Social Services

DJJ: Department of Juvenile Justice

They encounter stories about clients stealing dirty underwear, experiencing daily emotional abuse, and getting into fights at school. And yet, our TASK staff find ways to laugh and continue to serve kids another day. As a result, our teenage clients and their families trust the agents who jump right into the mess of their real lives. In the short few months since joining the TASK and CHA (Children’s Hope Alliance) team, this physics major has watched people bring hope to hurting children and families when the world can’t always be explained with formulas and algorithms.

An update on our project

The TASK team has been working hard to establish a manual that reflects the diverse experiences of our staff from Charlotte to Guilford. Staffing and time with the kids allow us to watch the TASK model in action. Data collection is underway as we determine what TASK elements are most effective and efficient in bringing change to the lives of our clients’ and families. We are developing research procedures and structures to produce relevant and rigorous results. Those will be presented to our field and related subfields which include child psychology, sexual abuse, trauma care, child development, and juvenile delinquency.  The more research we do, the more excited we are about TASK and its potential to reach others who have caused sexual harm.

Adversity Against Adversity

When I walked through the doors of the Education building at MAHEC, I wasn’t sure what to expect. I had never done an employee orientation of any kind before. ‘It’ll just be an extended series of PowerPoint presentations… right?’ Well, little did I know that said presentations would have such a great impact on my future goals. The very first presentation focused on the mission, values, and structure of MAHEC and began with one phrase – Your Doctor. Your Teacher. Your Advocate. Contemplating these words over a matter of weeks struck me sufficiently enough to lead me to shred my first medical school personal statement and write something entirely new – a piece largely influenced by this simple statement. Yes, really… the root of my motivation to go to school for yet another 4 years had transformed by observing the essence of this statement first-hand every day.

My very first day of actual work began with a 2-hour discussion with Dr. Letson, my supervisor, and former Davidson Impact Fellow/new MAHEC employee, Cate Hendren. We went from Medicaid expansion to neonatal abstinence syndrome, then to the unique academic life at Davidson, off to ‘best-practice’ pun delivery techniques, back to Dr. Rishi Manchanda and upstream medicine… and back again. Needless to say, it was a relaxed and friendly conversation on the surface. But I’m sure my new colleagues could see the whirlwind behind my eyes, as though I was literally screaming, “There is so much to be done! Where could I possibly begin?!?!” Even now – three months in – narrowing my focus has not helped much in the complexity of these important problems. What has helped is meeting people who have dedicated their lifelong careers to trying. How do we end sexual assault for good? Completely eradicate the rampant spread of HIV in the Southern U.S.? Find a sustainable and effective way to close the health outcome gap between races and ethnicities? Well. You simply start by trying.

In my opinion, I am meeting the most extraordinary people this nation has to offer. A woman who goes to work to raise money for Planned Parenthood, knowing she will likely be met by an adamant pro-life protestor. A man living with HIV who leads community engagement to ensure access to medicine and frequent rapid testing to stop the cycle of transmission. A health system innovator who says that her work is informed by her deepest personal values. Almost every day, I meet a new person who inspires me to consider the breadth of what I could do as a Davidson Impact Fellow and (fingers crossed) as a future primary care physician. Instead of simply being a doctor, why not be a doctor AND teacher AND advocate each time I enter an exam room? Holding the responsibility of charting symptoms and advising treatments was never my dream job – it has always been more than that. I want to make people healthier and sustain healthy states, not merely cover-up symptoms. Most will need medications. Others will require knowledge on how to manage their chronic illness. And every patient deserves an advocate who will stand in their place in front of the legislator, the landlord, or the peer physician when their voice is being silenced.

I am exciting about my current projects and initiatives here at MAHEC and beyond as an advocate for women’s and children’s health and well-being. And I could not be more grateful that this opportunity has directly informed my future as a primary care physician.

A Day in Court

I enter the new county court house, a shiny downtown number that has been open for less than a year; floor-to-ceiling glass windows line the hallways, and the floor gleams like it’s just been waxed. A motley assortment of stoic and grinning police officers greet me as I shuffle through the metal detectors and make my way to the second floor where I will be observing domestic violence court proceedings for the day.

At the top of the stairs there is a waiting room set aside for those who have been victims of domestic violence. Here they can request emergency restraining orders and wait with their families before their cases are heard in court. I tap on the waiting room’s thick glass windowpane, and my host Susan buzzes me in. Susan is a Presbyterian minister and courtroom advocate for Helpmate, Asheville’s domestic violence agency, and today she is my host. Susan ushers me into the office with a welcome and a reminder that I should not open the door for anyone.

The room is filled with women, mostly, though a few men dot the walls, too. Some are alone, others with a mother, father, or friend close by.  A few start conversations with me, asking me to look up an address on my phone or comparing jobs (one is a nursing tech. at the hospital just a few blocks from my office). Some wear graphic tees and sweatpants; others expensive slacks and freshly pressed blouses. One speaks Spanish, another Thai, many more with the sweet twang that marks them as long-time residents of Western North Carolina. They have names that rhyme. Marla. Carla. And names that don’t. Tanya. Janet. Maria.

I am awkward, wanting to help but unsure what my role here is supposed to be. Do people want someone to talk with, or do they want privacy? Am I intruding in what is already for many victims a harrowing experience? My face feels rubbery, my arms artificially stiff as I grasp my responsible-young-professional notebook and pen.

Domestic Violence Court cases are heard en masse every Thursday with forty to sixty cases on the docket. Today, however, there are seventy-one.  Increasing national awareness and a new comprehensive plan developed by Buncombe County to address domestic violence has increased the number of people seeking services and judicial recourse. The paradox of this situation is obvious but true: It’s a good thing that so many people are here; it’s a horrific thing that so many people are here.

The actual courtroom experience is a bizarre combination of wrenching and utterly boring. One woman shakes visibly as Susan rubs her back.  Several men file in handcuffed, brought directly from their jail cells to face charges. One defendant yells an impassioned speech that no one understands, and the judge orders a psych evaluation. Still, it’s hard to hear: judges and lawyers rarely raise their voices, and people are constantly shuffling in and out of the courtroom slamming a heavy latched door as they do. Most of the conversation is about procedure, not Atticus Finch-esque orations on the nature of justice.

Two things stand out:

1)     The courtroom is confusing, and

2)     Most of us need legal representation to navigate it.

People can be appointed free lawyers in criminal cases, but not in civil cases, which all these cases were.  Multiples times, the judge had to re-explain the process to the plaintiff or defendant. For example, the judge would tell the plaintiff, “You can request a continuance if you are not ready to proceed at this time,” and the plaintiff would respond, “Yes your honor, I would like to continue and resolve the case now,” not realizing that requesting a stay would mean the opposite of resolving now. Both used the same word, but they were not speaking the same language.

It’s confusing for anybody, but this system is particularly trying for those who are experiencing abuse. A victim often experiences symptoms of trauma such as difficulty concentrating and memory loss that make accessing any services difficult in addition to any coercion leveraged by their perpetrator (threats if the victim presses charges etc.). Add to this a system as complex and intimidating as the one I saw, and the need for legal aid becomes obvious.

Here in Western North Carolina, an organization called Pisgah Legal Services provides free legal help to low-income people on issues of housing, immigration, and domestic violence among others.  Those who have their help look noticeably relieved. In 2013, Pisgah closed 1,305 domestic violence cases.

I know six hours in a courthouse paint an incomplete picture, but they do paint a powerful one. That Thursday I felt the fear victims knew in facing their abusers; I saw their resolution and reliance in the same moments.  I sensed the comfort given by court advocates’ presence and the importance of legal representation for people when they are most vulnerable.

Again, all I can think of is obvious and contradictory. It’s a good thing that so many people are here; it’s a horrific thing that so many people are here.

If you think you or someone you know is experiencing abuse, help is available. Please call the national domestic violence at 1-800-799-SAFE (7233). Get tips on how to help a friend or family member here.

 

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