Cleveland City Council Learns about Trauma, Debates Counselors at Rec Centers

Representatives from MetroHealth and Frontline Services gave presentations to Cleveland City Council Monday morning in a meeting designed to "frame the conversation" around trauma and toxic stress, and to outline strategies that the nonprofit Frontline Services would undertake in its execution of a proposed $1 million city contract.

Duane Deskins, who announced his retirement last week as Mayor Frank Jackson's first-ever Chief of Prevention Intervention and Opportunity for Youth and Young Adults, gave a presentation to council on his team's research in conjunction with his resignation (see below). His approach has advised viewing crime and violence through the lens of public health.

In keeping with that view, and presumably in keeping with Deskins' plans, Frank Jackson said he intends to place counselors at all of the city's 21 recreation centers. The city also proposed legislation to engage Frontline Services to train all rec center staffs in Toxic Stress and Trauma Management.

The meeting Monday, a joint meeting of the Health and Human Services and Municipal Services committees, was intended to add detail and expert analysis to Deskins' presentation.

Lisa Ramirez of MetroHealth spoke first. She discussed, in clinical terms, the ways long-term toxic stress can affect the brain. In a much-referenced slide, she showed a graph dramatizing that the earlier interventions occur, the more effective they are at counteracting the negative effects of trauma. She highlighted the need for safe, responsive caregiving for children, and she noted, in a moment of hope, that any stable, nurturing relationship (from anyone in any place) can positively influence children living in extreme poverty and with unstable caregivers.

Rick Oliver and Rosemary Creeden, from Frontline Services, explained their program in broad strokes, though they found themselves grilled by councilman Ken Johnson, the municipal services committee chair. He endeavored upon several lines of inquiry related to the stigma of the "mental health" label. His stance was often combative. He seemed to interpret the proposed contract as an an incursion by Frontline on his territory. By his own account, Johnson spends every day at the rec center that bears his name. And rec centers, to this day, seem to be the only topic about which the veteran councilman gives anything resembling a shit. Johnson's very first question, posed to Ramirez, sought to understand the difference between a psychiatrist and a psychologist. (A psychiatrist is a medical doctor who can prescribe, Ramirez responded. She herself is a psychologist.) Was this a quiz? It may have been, for later in the meeting, Johnson mentioned that his own son was a psychologist (who may also work at the Ken Johnson Recreation Center.) 

Elsewhere, Councilman Kevin Conwell probed the security of Frontline's electronic records and badgered Public Works Director Michael Cox about the availability of wi-fi and soundproof rooms at the city's rec centers. That line of inquiry was off-base enough that Councilman Blaine Griffin, the Health and Human Services Chair, interjected to clarify that the legislation would not convert the city's rec centers into mental health hospitals; it was intended to train staff on how to recognize symptoms of toxic stress.

As Lisa Ramirez said, if she were in charge, she certainly wouldn't be putting masters-level therapists at every rec center. It was much more important, in her view, to have adults on site who knew the children and the community and who, being "trauma-informed," could direct young people along appropriate channels.

"We're talking all levels: cafeteria workers, security guards, bus drivers," she said. "We use the metaphor of a relay. We want them to be able to pass the baton to the point where the young person can see a therapist. They're not going to be working with a therapist the moment they walk in the door."

Councilman Brian Kazy and others suggested that council should opt for a school-based approach instead of a rec-center-based approach. Councilman Basheer Jones stressed that these communities did not need therapists "from the outside" if they weren't culturally sensitive.

The most important question of the morning, in fact, came from Council President Kevin Kelley, who is not a committee member, but who said he was attending because of his interest in the legislation. He had the good sense to ask Lisa Ramirez, after her presentation, whether or not she thought the city of Cleveland's approach would be effective, based on her experience.

Ramirez confirmed with her MetroHealth colleagues that she should speak candidly. She then said that in principal she thought the legislation was a terrific idea. But she worried about its effects if council weren't committed to funding it for at least two to three years.

"I do feel that the components are important," she said. "What I worry about is that there's not a sense of dedication to being stable over an extended period of time. Some of those rec centers are absolutely community centers, but for those that are not, you need time to allow for positive experiences and to build credibility. I think it's a fabulous framework. I just hope that portions of it are thought through so it's not set up to fail." 

(Here is Duane Deskins' presentation from last week.)