The following was written by Jennifer Hossler and originally posted here on ACEs Connection, 2/8/2016.
There’s almost a Zen-like feeling when you walk into the office of Rosa Ana Lozada, chief executive officer of Harmonium, Inc. (second from left in photo, above). The deep red accent wall, large corner windows, and small Japanese fountain send a message that a trauma-informed, resilience-building mindset starts at the top of this organization.
For the last decade, Lozada has led the day-to-day operation of the 40-year-old non-profit organization whose work, she says, is “prevention and intervention to promote well-being.” But her role as CEO runs very deep, and I sense that she is involved on a very personal level. It shows in the way she speaks to her staff -- and in how they respond -- with respect, ease, and a sense of purpose. It is apparent that she “walks the talk” when it comes to trauma-informed care within her organization of nearly 400 people.
Harmonium provides an array of services to more than 30,000 children, youth, and their caregivers throughout San Diego County. The services include after school programs, youth support, community mental health, family youth partners, and training and education. Collaboration is integral to how they do business – they partner with schools, law enforcement, and community leaders.
“We know individuals don’t come to the door with a single problem,” she says. That’s why Harmonium focuses on overall child and family well-being, and incorporates a holistic approach to healing. She adds that the people Harmonium serves are the core of the organization, not the services Harmonium provides. The structure of Harmonium incorporates a public health approach, she explains; she cites the promotora model, or lay health worker model, as inspiration for how their services are delivered.
Lozada was aware of the impact trauma had on the lives of people Harmonium was serving long before first hearing about the CDC-Kaiser Permanente ACE Study. She thinks back about 13 years ago, when Harmonium was funded by The California Endowment to provide family support services in Southeast San Diego. They were working with an ethnically diverse population of youth who had been diagnosed with conduct disorder and oppositional defiant disorder.
“My team recognized that it was really trauma that these kids were reacting and responding to,” she says. She and her staff also saw that many of the families they served had also experienced trauma, she says, which “had not been identified by other providers.”
Then, in 2008, Lozada attended a workshop at which Dr. Stephanie Covington talked about ACEs and trauma-informed care, and how service systems can often unintentionally re-traumatize already traumatized people. This is the first time Lozada recalls hearing about the CDC-Kaiser Permanente ACE Study, which put language and science to what she, and many others, already believed to be true.
“We already knew there was a correlation, and the study just validated what we already knew,” she says. “It gave professionals the language and the science to back up what we had already been experiencing with the families we were working with.”
Six members gathered after this event and made a plan to seek change within the community as a result of this new information. The result of this small group was the development of the San Diego Trauma Informed Guide Team (SD-TIGT). SD-TIGT is a grassroots collaborative of service providers from a variety of service sectors who raise awareness about trauma and provide trainings to those that are interested in learning. A longstanding member of SD-TIGT, Lozada credits the group with leading many organizations in San Diego County to integrate trauma-informed care on a practice, program, and policy level.
Soon after the guide team was developed, Harmonium began to work with the County of San Diego and other community agencies to embed a trauma-informed lens throughout their organizations. A public health class expanded her understanding of trauma, its impact, as well as the implications for society as a whole. Pockets of change, or “sprinkles” as Lozada refers to them, began to occur across San Diego.
When the community started to implement change on a program/service level, then on a policy level, that, she says, “is when it all started to connect.” Larger system change began to occur across the county as a result of these efforts to tackle issues on both a program and policy level.
The SD-TIGT maintains an open-door policy, and anyone in the community can attend to learn about trauma-informed practices being implemented around the county, or to share new practices or policies they are implementing.
Lozada has integrated a trauma-informed lens throughout Harmonium. She’s deeply involved in training and education in the community and for the organization. Her current goal is to personally train all of her nearly 400 staff members.
“This helps me connect and relate to my staff,” she says. The executives and other top administrators must model what trauma-informed care looks like at Harmonium. For her, doing this from the top down is critical.
Training is not new territory for Lozada, who has trained hundreds of San Diego County probation officers over the last year alone. She credits this opportunity to Chief Probation Officer Mack Jenkins, a leader whom Lozada says recognizes the importance of trauma and the impact it has on the youth and families served by his staff.
Lozada’s trainings always contain six core essential concepts:
- The impact of trauma in early childhood;
- The impact trauma carries across the lifespan;
- A basic understanding of neurobiology as it relates to trauma;
- Empowering staff members to recognize how this applies to their work, regardless of their role in the organization;
- Secondary, or vicarious trauma, and the importance of self-care;
- Empowering staff members to incorporate this information into how they do their work.
Lozada states she always talks about the ACE Study during her trainings. Her goal is to look at things “from an integrated health perspective, tying together the mind/body experience.” She provides a brief history of how the ACE Study came to be, including how Dr. Vincent Felitti, who, along with Dr. Robert Anda, are the co-principle investigators, discovered patients developed chronic disease as a result of early childhood experiences. That helps make the mind/body connection she feels is crucial to raising awareness.
Lozada also focuses on overall well-being and resilience throughout her training. “This is the part where you get to tell them the good news, that this is all part of the umbrella of prevention,” she says.
Lozada also believes in the importance of addressing self-care as part of resilience. There is great power in truly comprehending how this is connected to your physical, mental, and overall well-being. At the end of her training, she asks participants to name something they will do for their own self-care that is “feasible and doable.”
During one training, she recalls, a male officer said he never realized how much babies understand. She noted that this shift in perspective “will change his reactions forever.” She recalls another officer whose “aha” moment was an understanding of how his attitude and those of his coworkers at the beginning of each day would influence everyone else in the building. These are more of the “sprinkles” of change she sees throughout San Diego County, she says.
“I always go into trainings with the assumption that the people I’m talking with are already implementing at least some level of trauma-informed practice,” she says. She feels this is more effective than asking: “Is your organization trauma-informed?”
If you ask “What are you doing?” she says, it allows a person to explain, and often times, what they are doing IS trauma-informed. Lozada is “cautious to use labels.” She has a vision “that we don’t focus on what we call it; that it is evident by our actions and behavior.”
This knowledge and small changes in practice have changed Harmonium, she says, by changing her first.
“It has strengthened my commitment that this is imperative and has helped me understand that you have to start where the individual or system’s journey starts, and that’s how you change systems,” she says. She adds that organizations from all sectors – education, social services, healthcare, criminal justice, business, faith-based community -- need to be invested to create real culture change.
Lozada is a licensed clinician by trade. It’s important to her that she maintains her clinical lens in everything that she does, and that people understand this is a concept that can be applied to enhance the way we interact with everybody. She believes this is her lifelong work: to look at human needs, to reserve judgment, and to ensure that systems do not further contributing to people’s trauma.
Late last year, along with 13 other counties and states across the U.S., the SD-TIGT was invited to participate in the two-year Mobilizing Action for Resilience Communities (MARC) project, funded by The California Endowment and the Robert Wood Johnson Foundation. As the backbone organization for the MARC project, Harmonium was award $100,000 each year to manage the project by supporting the current activities of the SD-TIGT, coordinating the evaluation process, managing funds, and developing promotional and educational tools for the project.
Lozada hopes the SD-TIGT will continue to move the needle forward in creating system change in this county of over three million people.
“Sometimes, moving in the right direction is more challenging when you don’t have well established systems believing in the effort and advocating at all levels,” she says. “We have to own and understand the power we have to make change and help support the well-being of communities.”
Lozada thinks that the MARC project is a testament to her idea that San Diego County is “not alone” in the effort to create a trauma-informed, resilience-building community. The project will allow communities to come together, celebrate their successes, learn from each other, and most importantly, reflect on the “sprinkles” of change happening around the country to continue to build on that momentum.