For this quarter’s partner spotlight, we want to highlight the excellent work being done at the Harborview Abuse & Trauma Center. The Harborview Abuse &Trauma Center, or HATC, provides comprehensive care for survivors of trauma, adopting a multifaceted approach that addresses both the physical and emotional aspects of trauma. In addition to supporting survivors, HATC champions several preventative measures to reduce the risk of harm in our communities. HATC serves a broad range of patients, including a great amount of work supporting youth and their communities.
To learn more about HATC, we had the pleasure of speaking with Rebecca Milliman and Cicily McNeal. Rebecca serves as the Prevention and Education Manager and has 15 years of experience working with HATC. The prevention and education team minimizes harm by raising awareness of the root causes of violence and trauma and working with communities on how to address them. While Rebecca focuses on prevention and education, Cicily works as a Clinical Social Worker providing support to those who have experienced trauma. As a newer member of HATC, Cicily brings a wealth of clinical social work, policy and advocacy experience to the HATC counseling team. Cicily works alongside 10 other clinical social workers providing therapeutic services to survivors of sexual assault and other crime victims. Cicily’s grant offers brief intervention services including therapy and other supports, focusing primarily on individuals identified by an “unmet needs” criteria. These are people identified as less likely to engage, or be offered services at HATC through a traditional pathway. Cicily and Rebecca shared their experiences working with HATC, the work they do with youth, and how HATC’s efforts promote positive changes in local communities.
“Our mission is to prevent and treat the harmful effects of traumatic experiences on survivors, families, and communities.” This is the HATC mission Rebecca shared with us. Given the complexity of trauma, putting this mission into practice requires a multifaceted approach. HATC does a great job of implementing such an approach, addressing both the physical and emotional aspects of trauma. On the physical side, the Harborview Forensic Nursing Program is made up of specially trained forensic nurses who provide services at 6 emergency departments in King County. These services include: sexual assault exams, domestic violence/ strangulation exams, and follow up support. The forensic team responds to the emergency departments 24 hours a day, 7 days a week. On the emotional side, HATC offers several modalities of therapy, as well as advocacy and support services for survivors of sexual assault, traumatic experiences, and other crimes. In addition to recovery services, HATC champions trauma prevention by prioritizing social and policy change, education and leadership training for communities. As Cicily highlighted, the broad range of services offered by HATC help meet the unique needs of each patient. “That’s one really great thing about HATC. Any kind of trauma, you can come here and we have something for you, to help you.”
Working with Youth
In the wide range of HATC services, there are several programs supporting the wellbeing of youth. HATC offers youth and family-centered therapy, including Parent Child Interaction Therapy and the Alternatives for Families program. These services help families to address behavioral concerns with youth of any age and support youth in developing coping skills and processing their emotions. “When comes in, we’re able to work with them to address clinical symptoms related to trauma such as post traumatic stress, anxiety, depression. For example, the counseling team works with patients on coping skills, which could be helping with facing difficult memories, processesing feelings and emotions related to trauma and much more.” “We also work alongside parents and caregivers when a child or teen comes in,” shared Cicily. For older youth, these services provide the space and agency to pursue care on their own terms. “Often times kids do not feel comfortable that [trauma] to a parent,” shared Cicily, “so they have the privacy to come here and receive most services if they’re 13 or older without parental consent, and so I think that that’s one of the things that we’re really proud of.” HATC’s counseling services provide important support for youth and their families to pursue happy, healthy lives following an experience of trauma, and HATC strives to make these services as accessible as possible. “We answer the phone 24 hours a day, so if folks do call us after hours and they’re in crisis, they will be routed to a trained social worker in the emergency department,” shared Rebecca. For patients whose care needs fall outside of the scope of HATC’s services, HATC makes provider referrals to ensure they receive the care they need.
The HATC prevention team also provides many programs aimed at supporting youth. HATC partners with K-12 schools to provide prevention education for kids, creating curriculum that advances the conversation on boundaries, consent, and preventing sexual assault. This curriculum has advanced the way youth talk about trauma, particularly when it comes to sexual assault. “I have, in my career, seen a shift in the way that young people talk about sexual assault. I think back in the day it was much more taboo,” Rebecca said. “The way many young people talk about consent is so advanced and so progressive and you kind of see how far the conversation has come, from just a simple ‘yes’ or ‘no’ when someone wants to have sex with someone, but really it’s like a lifestyle. It’s a culture. It’s like they want to infuse it into everything.” HATC’s prevention education plays an important role in healthy youth development, providing youth with the skills and knowledge necessary to promote safe environments in school and in larger communities. The impacts on safety are noticeable, with partner schools reporting decreased rates of harm after engaging in prevention work with HATC.
Building upon their prevention education, HATC offers leadership programs for school-age youth. “We offer a whole leadership program for high school athletes to help play a role in creating a more safe and welcoming environment for everyone,” shared Rebecca. Coaching Boys Into Men is a violence-prevention program for high school athletes on boys’ teams, focusing on developing healthy relationship skills and mental health practices. Athletes As Leaders serves a similar purpose for high school athletes on girls’ teams, encouraging athletes to be leaders in changing social norms to promote a culture of safety and respect.
HATC also partners with youth in policy work, participating and co-leading task forces to support youth voices and leadership in improving school policies. An example of this work involves a school dress code that was causing harm for youth. “I worked with a large group of youth at a local high school to help change their problematic dress code,” shared Rebecca. “It was being enforced in harmful ways, the students were being sexually harassed when they were enforcing this dress code. It was very concerning, the stories that I was hearing. And so the district was open to changing it and hearing from youth, and I helped organize, really just supporting the leadership of youth and getting their voices heard and what they wanted to see in this dress code.” Rebecca and HATC’s efforts led to the implementation of a more equitable dress code for youth and a safer school environment. Other policy victories include the establishment of Team Up Washington, an initiative that expands the efforts of Coaching Boys Into Men and Athletes As Leaders across the state, and the passing of state-level comprehensive sexual health education legislation, furthering the work of HATC’s prevention education. “Now we get to support school districts with how they can incorporate consent education from kindergarten through 12th grade,” said Rebecca. “It’s amazing!”
HATC’s work with youth is truly comprehensive. In addition to the programming outlined above, HATC also supports the Foster Care Assessment Program (a statewide program providing consultations and assessments for the most complex cases), engages in work on ending child sex trafficking, and is involved in many other endeavors. For more information on all of HATC’s services, we recommend reviewing the HATC website.
While HATC engages with youth in a variety of ways, the commonality across these programs is the centering of youth as leaders and changemakers in their communities. “I like to have youth involved not just as participants, but also as decision-makers and planners for what we are going to do to prevent this [trauma] in their communities,” Rebecca shared. “I’ve learned to challenge my own internalized biases that I have against them as an adult, that I know better, that I’m the expert… and I’ve really learned through meaningful partnership with them and striving to be an ally to them that I need to really intentionally challenge those beliefs that I have.” “Kids are highly dynamic and they’re very smart, and they have a sense of agency if you allow that to operate in the room,” added Cicily. “But if you come in the room and you just think that because they are only of a certain age that they only have this amount of knowledge or wisdom, then I think you’re at a deficit.” As Rebecca explained, this empowerment of youth is an important step in preventing harm. “We [adults] control their lives so much. Almost every little aspect of their life is controlled, and that can be taken advantage of, and that is how abuse happens.” As HATC advocates for continued empowerment of youth, there are still areas for growth. “Let’s put some of our students on the hiring committee for every [school] staff member,” suggested Rebecca, “because they should have a voice in deciding who’s going to be their new teacher at this school, for example. That is shared power. They know best what is going to work for them and their peers, much more than any adult.”
Working with youth creates numerous positive outcomes, but it also presents some unique challenges. For HATC, the greatest challenge of working with youth is mandatory reporting. Cicily described the balance between service and reporting responsibilities that providers need to be mindful of. “[I’m] trying to straddle that nuance between building rapport and engaging with youth, and then also at the same time we have to know that there are certain things youth may disclose to me that I do have to report.” “It is a problem, because they have absolutely no choice in the decision on whether or not we are going to report something,” Rebecca added. “They are just completely vulnerable to our decision. There’s so much bias that goes into that. In some cases making a report to Child Protective Services or the police can be helpful. In others, it can be very harmful and can make things worse.” To navigate the challenges of mandated reporting, it is important to be upfront with youth about your responsibilities as a mandated reporter, particularly for older youth who have a better understanding of these systems. “Hey, I’m a mandated reporter. If you share something with me like ABCD, I am going to have to report that to the police. I want you to be able to come to me and talk to me and share any struggles that you have because I’m here to help, but I also want you to be fully informed with the impact of that decision,” Rebecca demonstrated. Another suggestion is for youth to talk about a situation in the context of a friend’s experience. Additionally, youth can call HATC intake social workers and receive guidance without providing a name. Both of these methods allow youth to get the support they need without triggering a report.
Impact & Growth of HATC
After describing all of the ins and outs of HATC’s youth services, Cicily and Rebecca talked with us about their favorite parts of the work and how it has impacted them. One source of joy is the lasting community built through HATC. Some community members who have been impacted by the work come back to work with HATC. “I love when former students come back and intern or volunteer,” shared Rebecca. “We have our handout that’s designed for teenagers, and it was actually co-created with a group of students that I work with… It’s so good because it’s all really created by them about what they want their peers to know.” Other times, it is running into a former patient who is grateful for HATC’s support. “People have come up to me at meetings, this has happened several times over the years, where they’ll kind of whisper to me ‘I was a patient there. My child was a patient there, and I just can’t thank [the therapist] enough,” Rebecca shared. “Those comments demonstrate the impact, and it is amazing the recovery folks can find even after going through a horrific trauma or series of traumas.”
Another source of joy is getting to see the successes of HATC’s work, moving patients through the recovery process and into healthier lives. To highlight this, Cicily discussed the process of supporting a child who has experienced trauma within their home. “Building that rapport and that relationship with that kid and then helping them kind of spread their web and their network of other supports, whether that’s school, whether that’s other friends, friends’ parents, to be able to finally have a little family around them so when they do feel ready to do that [report], they do feel safe and supported if maybe they get placed out of the home, So I think just building that and having them call you and say ‘Hey, this is what’s going on with me now,’ just being like ‘Yes! I’m so glad, I’m so happy that it’s a different situation, although it’s not the ideal situation, it’s different and you’re doing better.”
The Future of HATC
So what’s next for HATC? With new changes to leadership at HATC, folks can anticipate new changes to the clinic as they continue to strengthen research, education, and practice elements at HATC in the community. Although the clinic has done so much for the community, Rebecca and Cicily share that there is still lots of growth within their field that they have to learn. Because HATC is seen as an expert, the clinic must continue to evolve with how conversation surrounds abuse and trauma in society.
Moving forward, Rebecca and Cicily are committed to continuing HATC’s growth to better support not just youth, but all people in need. One area of focus is continuing to develop the equity lens behind HATC’s work. “One of the critical pieces that we’re trying to be better at is having more equity in who we serve and how we serve,” shared Cicily. “For me, that’s one of the critical pieces that I really want to see improved upon and I want to make sure that all of the information we have on the website, being LGBTQ+, anti-racist, people with disabilities, all of those things, I want to make sure that that’s coming through and actually being represented in the data, in the work that we do.” Another area of growth is finding new ways to connect with local communities and make HATC’s services more accessible. “I’m hoping that we move more towards meaningful partnerships and being more responsive to specific communities,” shared Rebecca. “I think the way to build some of those relationships and build that trust is getting out and showing up for communities and being able to meet people where they’re at.” From our conversation with Ciciliy and Rebecca, it is clear that HATC has the vision and personnel to continue growing in a positive direction.
The OYPC team thanks Rebecca and Cicily for taking the time out of their busy schedules to help our community learn more about the great work they do at HATC. If you are interested in learning more about HATC, visit their website. Below are additional resources for you to share and share with others.
Additional resources from HATC:
Sexual Assault: A Resource for Young People