Q&A with Alisha Moreland-Capuia, M.D.

You are an expert in trauma-informed systems change and have interacted with numerous and varied aspects of the criminal justice system, training judges, probation officers, and district attorneys. Why is it so crucial that the judicial system applies a trauma-informed lens, especially when dealing with people who experience mental and substance use disorders?

We know from literature and practical experience that a large proportion of individuals who become entangled with the law also have significant trauma histories. We know these individuals have experienced higher rates of post-traumatic stress disorder, childhood trauma, poverty, and lack of education.

We realized that if the system itself did not account for these things, we really couldn’t get to the optimal system outcome, which is to reduce recidivism and to guide people onto a path of healing. So, it seemed like a natural thing to do to help every member of the system—including judges, lawyers, police officers, and parole officers—have a shared understanding and a shared language about what might be happening to individuals within the context of their system. I help people understand that you can place humanity at the center of what you do and still hold people accountable if the system’s goal is to help people get better.

Finally, I struggle with the notion of rehabilitation because it assumes that individuals who become entangled with the criminal justice system have the set of skills that they needed to survive in the first place. It is a profound assumption. So, one of the things that I have been doing with justice system partners is to get them to think about this idea of habilitation. Habilitation focuses on helping individuals acquire skills so they can thoughtfully participate in society and not become re-entangled with the criminal justice system.

While in residency training, you built Healing Hurt People–Portland (HHP), a hospital-based, trauma-informed, community-focused violence prevention program serving people of color ages 10 to 35. What was it like to build buy-in for a program focused on violence prevention in the hospital setting?

First, it was modeled after a lot of the work that was done by the great and amazing Dr. Sandra Bloom. She’s at Temple University and is the mother, if you will, of the sanctuary model, which looked at helping to reduce the use of seclusion and restraint in inpatient behavioral health settings. That really did become the birthplace for all of us thinking about how trauma-informed care looks. She also supported the inception of the Healing Hurt People program in Philadelphia, Pennsylvania, which I modeled my program after.

HHP–Philadelphia had exceptional success with a model of moving into the trauma bay and doing what is understood as “golden moment work.” We have a social worker and a peer with lived experience meet with the individual and their family. So, you start the work right at the peak of vulnerability, shift that narrative immediately, and provide some resources. We got significant results—90 percent of the folks in our program were able to stay away from the criminal justice system, got into an educational program, or were able to start a job, and were then also enrolled in some form of counseling or support. From a culturally specific standpoint, folks struggled with the word “therapy,” but they resonated with the word “support.”

The program has an advisory council composed of the mayor’s office, community members, police, the hospital, social workers, and a local community behavioral health agency. It’s still up and running, and it is operated by the Portland Opportunities Industrialization Center and Legacy Emanuel Hospital, one of two level-one trauma centers in Oregon.

You are the former Executive Director of the Avel Gordly Center for Healing, one of the few practices in the Northwest that focuses on culturally sensitive care for the African and African American communities. You are now Director of the Program for Culturally and Trauma-Informed Community Outreach at McLean Hospital in Boston, Massachusetts. What are some examples of how behavioral health care can be tailored to be more culturally responsive? 

I’m very proud of the work we did at the Avel Gordly Center, where I was director for nearly 7 years. The Center is named after Senator Avel Gordly, one of the first African American legislators in Oregon and someone who understands the mental health and criminal justice systems.

Under her leadership, a group of African American leaders in Oregon came together to conceptualize what a center would be. They paid attention to things like the name, realizing it would not be helpful to use the words “mental health” or “behavioral health,” but just a center for healing and wellness. Seventy-five percent of the staff is African American.

I think that the main way that behavioral health could be more culturally responsive is if organizations are really adhering to what it means to be trauma informed, not just the basic principles, but putting things into play and centering safety. Most of the time, we’re dealing with folks who feel very traumatized and marginalized and do not feel seen, heard, valued, and respected. The very nature of being trauma informed includes addressing all of those feelings.

We know that Black/African American people are disproportionately represented in the criminal justice system. How could we better address this concern when tailoring services to be more culturally responsive?

When I train, I help people make the connection between fear and trauma. I talk about the neurobiology of both, and I help people recognize that everyone has been afraid of something. Then I help them understand what it must be like for someone to have their threat response turned on 24/7, 365 days a year. Once we reach what I call the “point of convergence,” someone will say, “Well, now I understand why someone would come into my office, and I’m asking them to do their homework, and they haven’t done the homework.” We become more culturally responsive when we become more thoughtful about our own humanity.

As we move towards a public-health approach to mental illness and substance use disorders, how can we better support relationship building between criminal justice and behavioral health stakeholders?

I say to every single system that “public safety is public health.” If you believe that framework, it changes our approach because now we’re thinking about prevention, containment, management, and treatment. One good example is in Multnomah County, Oregon, where we adopted the Law Enforcement Assisted Diversion (LEAD) program. So, if we think about things like racism, substance use, mental health, or mental wellness, all of these things are public health and safety matters. Using this context, we can actively think about reconstructing or re-evaluating how systems operate and what resources we provide. This includes who should be at the table, who should help make decisions, and how we support individuals, families, and communities.



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