Ep. 26 – Reality Check – Laura Berlinger (Children’s Bureau of New Orleans)

Good afternoon and welcome to Reality Check. Hi Ashley. .....Hi Serena. I'm happy to have you here with us today. We're talking to

Hi Serena.

Laura Berlinger who is a clinical social worker by training and the program manager of Youth.

Bureau in New Orleans. And we're super excited to have her here today. Laura has been an ally of Epic and Calm for many, many years and has helped many young people in our community connect to our services. So if you can start by talking a little bit about how you got to be where you are at Children's Bureau.

you.

you

I noticed a trend of a lot of trauma and really a desire to connect and a desire to heal and a desire to meet requirements and move forward in life, but just a lot of barriers. And I felt like there needed to be more done in the community to address trauma symptoms in young people of that age. And it just so happened that Children's Bureau got funding to develop what at the time was called a transitional youth.

program for 18 to 24 year olds who had experienced trauma. so it was new funding, it was a new program and I was lucky enough to be hired to develop that program and I was providing full-time clinical care in the community at that time and just kind of helping figure out the best model for us to adopt. And over time the program has grown and we are now a team of clinicians and peer support specialists that we call community mental health workers.

and I am the manager of the program. I still do a little bit of the clinical work, but I'm able to manage our great community partnerships and a wonderful team of clinicians and peer support specialists.

Well, congratulations on 10 years of doing this amazing work and 10 years with Children's Bureau. We're on the same anniversary timeline. I didn't realize. Uh-huh.

Wow, that's great.

Yeah, I was,

I had thought we overlapped at Children's Bureau a little bit, but I guess we didn't

was reminded that you spent some time at Children's Bureau. Your name came up on a record. I was like, oh, that's right. But I don't think we overlapped.

Mm-hmm.

You

We had some Tulane child psychiatrist there for a while,

Well, it's funny that I'm putting together now that Epic started at the same time as your program. But I mean, it makes good sense in that the overlap that or the need for more services that you were seeing when you were working the Orleans defenders

Yeah.

we all started doing this work at the same time and it was fortuitous because each of our clinical services needs the other and work better together. So can you tell us a little bit about what you're currently doing at Children's Bureau, what your program offers and how it connects to the work we're doing at Epic.

Yeah.

Yeah. So we focus on evidence-based treatment for grief and trauma related symptoms. So what that looks like day to day is primarily treating, most often we're treating PTSD and adjustment disorders, also major depressive disorder, generalized anxiety disorder, can be panic disorder, but we're looking at symptoms that are tied to a trauma exposure. It can be recent, it can be distant in childhood or a loss can also be any kind of loss.

we provide those services in community locations. So we have wonderful partnerships with Cafe Reconcile, for example, Youth Empowerment Project, other organizations that are providing non-clinical but supportive services, oftentimes with, you know, an aim towards vocational support, workforce development, education. And our population size or population age has expanded to 16 to 24, which is now called Opportunity Youth Population.

We've added in the peer support component, which has been so beneficial. And so now what we have is at each site, each partnership site, we have a designated day and time of day where a clinician and a peer support specialist or community mental health worker are paired together and they provide, collaboratively provide care. The community mental health workers are able to provide a wider array of services. They can serve young people who are not necessarily coming in with an identified trauma related need.

but day-to-day life stressors, relationship dynamics, and things like that. But they also provide a lot of support in identifying clients that would be a good fit for the trauma treatment that our clinicians provide. And they provide support through the process of therapy engagement, check-ins between sessions, and things like that.

That's great. That reminds me of kind of how our peer support specialists operate alongside the clinician, but helping with the day-to-day stuff that's usually just as challenging to navigate.

Yes.

Yeah, and we actually had a recent beautiful example of one of our health workers talking to one of your peer support specialists and collaborating around a shared client that we've been transitioning over to Epic Services. just that the two of them bringing their peer lenses together and collaborating to...

support this client in overcoming some barriers, even just hearing about it secondhand right after the call. was like, this is such a sweet spot for this kind of work because it's so important and it so supports clinical engagement and long-term outcomes.

for sure. it's illustrative of the collaborative work that you do. And I remember when you all were getting your peer support or your peer workers and you were talking to us about how we started our program or integrated them into our clinical work. And now here we are many years later with them in communication with each other.

Yeah.

Yeah.

So I think the reality is that the work that's done at Children's Bureau is so needed in our community, right? Where there is a lot of trauma and not enough services to support young people. And then when that work becomes complicated by psychotic symptoms, that's when the referrals are made over to Epic in a very thoughtful and a very clinically astute kind of way.

Yes.

I

think that's another thing that's super important to illustrate to our listeners and our watchers is that you and your clinical team that you lead, take the time to really think through the symptoms that are presenting on the patient end, client end, and make a thoughtful referral often in consultation with people on our clinical team. And there's that conversation, the pause, the conversation that happens before sending someone

who's in a really vulnerable place over to a whole new clinical team. And there's that warm hand, what we like to call warm handoff, so that someone's just not right sort of left to write in an unknown environment while feeling unwell, but they're sort of guided over and supported as they make that transition.

Yes,

I

wanted to pause for a second just if you could give our listener watchers, a, I think trauma, the word trauma is like thrown around today. Like we don't even know, sometimes we don't even really know what we're talking about. Could you give just like a brief?

description of, you know, the little C trauma, complex PTSD, first PTSD, and sort of, because I know we have patients that have both, but I think it's really important to sort of contextualize what we're talking about, especially as we get into talking about the, when there's intersection with emerging.

psychotic disorders.

Yeah. So at Children's Bureau, we really do take a wide view of trauma and really allow it to be by the impact that it's had on the client. I'll say, know, diagnostically, right, for PTSD, there's this, you know, there's got to be like a clear event and, you know, clear threat and things like that. And we do get a lot of cases like that. We get a lot of, you know, exposure to violence, loss due to violence and abuse and assault and things like that.

Additionally, if there are, I think, traumatic patterns in a person's life, such as ongoing exposure to sexism, racism, discrimination, poverty, that are just as impactful on the person's life, but may not be boiled down to a single event or a series of events, many, many events over time, right? And so you have that chronic trauma.

that does ultimately often constitute a physical threat and threat to safety. But some clinics and in some spaces might not be as easily defined. We see the impact that it has and we recognize the impact that that has. And so we include that in trauma exposure. We do get a lot of cases with chronic, not only chronic, but complex trauma where you have layers of trauma. have,

maybe something that occurred during childhood, then you had maybe like a period of abuse, and then maybe an adult incident or several adult incidents of exposure. And so there are complex layers to the way trauma presents, which is why we're not only treating PTSD, we are treating resulting mood disorders, anxiety disorders, adjustment disorder, grief as well.

really treating what comes and working with what presents first and what the client identifies as the most predominant need. And there are some cases that we find not to be the best fit for us. When psychosis is the predominant need, we need to get that person into the right level of care as quickly as possible. And so we want to support that. beyond it being outside of our scope really to treat, then we're flexible in how we work with.

what they perceive as loss or trauma

Yeah,

I think that's important in the topic of discussion at this moment in time, specifically with social media and with TikTok therapists and everything that, know, they're, what we see, or what someone experiences because of...

they're difficult in what they define as difficult experiences or exposures that the treatment approach might be variable. you are with a good therapist, they're able to, even if it has not evolved into a complete PTSD picture, they're able to almost be preventative of the development. Because PTSD, and it's like,

Yes.

pure quote unquote sense takes a long time. It takes a long time for you know, your physiology to become like that. And when I worked in a juvenile justice center, that's what was fascinating because we had oftentimes these like multiple traumas where, you know, loss of life loss of was, they were in imminent danger.

but it was right after, you know, and so when we would start working with them, I always wondered like, is there a part of this that could be preventative of this becoming full-blown PTSD? And then you'd see the kids where you watch it and you just like watch it evolve into that over time while they were there, because they're in an environment that's just re-traumatizing on a day-to-day basis. But that people out there can get

Right.

treatment for what they feel is a traumatic experience, even if they're not sort of meeting criteria for PTSD, you know, that it does manifest differently and hopefully your, you know, your clinician will have a individualized approach. And if that's not happening and you're kind of dismissed because maybe you're not meeting a specific definition of trauma, then you should probably be looking elsewhere.

for care.

Right, right. Yeah. Yeah,

and we also think about the detrimental effects of even chronic stress, even if it's not something that we consider to be, even if we're not using the word trauma, but something that is a chronic stressor where the person's never able to let down and relax. We know that that has a detrimental effect on the nervous system, on, know, physiology and psychology. so recognizing, looking at

Mm-hmm. Right. Yeah.

of therapy, is to help someone live the life that they want to live, help the person continue to develop, especially in young adulthood, to develop into, who am I? Who do I want to be? How do I want to engage with this world? And so we want to support that process, both through therapeutic intervention and also through peer support, without needing to get too stuck on definitions and criteria. Yeah.

Definitely. And

actually though, when we think about it, that's why it is called the trauma and stressor related disorder chapter. It's not like actually just trauma. It is stressor related.

Right.

Just trauma. Yeah. Well,

Yeah.

I...

If we think about all this and then where you all do your work and the fact that you're co-located in these different organizations across the city, right? You're in a place in space, say Cafe Reconcile, where young people are being trained to work in industry. They have support there in the form of a clinician and a peer worker. Can you talk a little bit more about how that works and what

Yeah,

as maybe a success you've seen.

it's so great to work embedded in these partnerships because we know that it's hard for pretty much anyone to add a weekly appointment into their week. It's hard to go out of your way in the course of your day. But when you add in starting a job training program, doing something big like that, maybe for the first time, when you talk about other barriers, there might be from transportation to maybe

environmental needs like childcare needs or other expectations within your family, we really wanna make it easy for young people to receive these services, people who aren't already engaging on their own, who aren't making it to appointments at an outpatient clinic where they have to take an extra step in their day. And so we wanna make it easy for young people to access. We also love working on a multidisciplinary team and find that it's really effective. And so...

know, at Cafe Reconcile, it's a great example. They were our first partnership in this program, so we're hitting the 10-year mark with them as well as a partnership. And, you know, they have multiple case managers. They have, I mean, they have a lot of mental health professionals on staff who are not providing hour-long therapy sessions, but they're providing excellent case management. They're providing alumni support and engagement, psychoeducation, know, emotional support, support with crisis.

And so we fit into their team as treatment providers and peer support specialists, offering something that they don't have on their team, but they have a lot of other things to offer. And they have, you know, wonderful trainers that are training in different, you know, soft skills and on the job skills, culinary skills. So we're able to collaborate with other helping professionals who really care about the same young people. And we all work as a team together. And, you know, we're not there every single day.

So also, we trust and know that there are other support staff, other supportive individuals that are there looking out. If there's a safety plan that we need a couple of other eyes on or hands on deck, there are other people checking in on the young person. I find it's very effective to work in an environment where you have a multidisciplinary team like that.

Yeah, for sure. I think that's, I mean, one of our huge strengths at Epic too is having this small to disciplinary team. And that is both clinic and community based. And we can go out and be in the community, but we can't always be in these places that can be difficult or stress provoking for our patients. And I think about how so many of them go out into the world and get jobs, but have the challenge of managing them given, right?

in customer service, right? That can get tricky and heated and people, customers can be in bad moods and that can trigger our patience. And then they are stuck, right? In stress mode and or stuck in not knowing what to do and to be able to have support there. Like you said, maybe not every day, but in the form of many different humans who are all on their team wanting them to succeed. That's awesome. Like if only we all had that on a daily basis.

Right,

right?

yeah, yeah, exactly. It's something that really we, that everybody needs. And, you know, I think a lot of young people who have, the opportunity youth population are young, it's defined as 16 to 24 year olds who've been disconnected from work or school. And so it does take, you know, additional support to wrap around somebody who has somehow, you know, been cut off from opportunities along the way.

to really wrap around and be welcomed into a really a sense of community. it lasts beyond the training, a lot of these agencies that last beyond the training period, it lasts beyond maybe the, if we do an evidence-based intervention that lasts a certain number of sessions, it extends beyond that time where you have, there's still a community available. That's a beautiful thing to be a part of.

thought

as a little bit of an introverted human

myself, that we've experienced challenges with this over time. It's certainly not the main story, but the individuals that have trouble with the so many people because of, well, not always because of, but it's just difficult to connect.

Hahaha

especially at the pace of some of our programs where it's like you walk in the door and you meet multiple different people and it can be a lot. And then confidentiality has come up in some of my patients where there's a known connection with outside community-based resources where there's also other people their age and sort of the

Yeah.

New Orleans is sort of a small town. And in some of our neighborhoods, everybody knows about each other. They know each other's business. know if family members have been arrested. They know all these things and they know of their trauma. And I was just wondering how, in our clinical setting, it usually revolves around paranoia. So I think it's a little bit.

maybe more straightforward than thinking about confidentiality with the work that you all do. And I'm wondering, number one, for the people that might be like, yeah, it sounds great, I need help, but it sounds like a lot of people, you know, one time, but then also like protecting privacy and how you guys navigate that.

That's a great question. We talk about that a lot with our clients and it

really, it depends so much on the individual. You know, there are some individuals, young people that will, you know, excitedly greet their therapist in the middle of programming, in the middle of a crowded room and let everybody know how much they're being helped by the service or how much they're engaging with the service, you know? And there are others that are like, could we keep this really, really, really quiet? And for some, even to the point of like, could we not do it here? So I would say for a majority,

young

people, it works best to do it on site. That's what works best. It's convenient. We're in a tucked away area at most of our partnership sites, so there's some privacy. And we don't just go and announce to the room, like, I'm calling so-and-so for their therapy session. We have systems in place where somebody else pulls, or maybe the young person keeps track of their schedule. There's a more discreet way of being pulled for that hour-long session.

Right.

And we work with the partnership organizations on that. But there have been times that a young person will say, we actually do this like right when I get home from programming via telehealth? Or can I actually, I think I could make it to your office. Could I do that on a day that I'm not here or at a time that I'm not here? And so we work that out, you know, case by case with the client and really talk transparently about it. Voice in voice is huge in trauma services. But at the very least, we are seeking to not re-traumatize anybody and to not make anyone feel unsafe. So.

Mm-hmm.

Yeah.

That is huge. And I think it's, yeah, it's really leaning in with curiosity to what the young person's preferences are going to be because sometimes it's surprising. It's not maybe not something that we've heard before in terms of exactly. And it might be because my cousin is in this cohort or because I know this or that person. Sometimes there are other elements of layers like that.

All right.

Mm-hmm. Yeah.

Yeah. Sometimes I feel, or sometimes we forget to directly address that. And I think it is, you know, while we were talking, making me think about how intentional and enlightening conversation that could be with each of our individuals that come in to get their perspective about, while we're excited.

Hmm.

Yeah.

Yeah.

to like do everything for them. It can be a little much sometimes.

beautiful to offer such a community feel and it's also, yeah, it can be complex. Yeah.

Thank

Mm-hmm.

Right.

And especially when community has been compromised, I can go back to what we were saying before, Laura, about so many of the people you see have been cut off from community, then they're in lies of vulnerability, right? And so people are gonna be cautious. They're gonna have their guard up, understandably so, to protect themselves. And so, right, they're gonna want to, and we wanna encourage them to be thoughtful and mindful and cautious about recreating community,

way.

Yeah.

So we're doing this work together in New Orleans and we have these cross referrals that happen over time and there's far more need in the community than either of us can provide. What are some of the other organizations and or pathways to care that you found really helpful for the young people that you serve?

Thank

Well, this is honest and not just convenient because we're all talking. Honestly, having Epic available as a resource has been huge. mean, it's interesting to reflect on us having been around for the same amount of time. I think it took me a little bit of time in my program development at Children's Bureau to recognize and see the need for an ongoing referral pathway.

And to learn how to really recognize psychosis when it was coming up on my caseload, I think, Epic to me is a really groundbreaking treatment model and a really groundbreaking type of clinic that not every community has access to. And so being able to know there is a really safe and competent resource to provide to young people who if they've come on our clinical radar, then they also have

some sort of trauma or loss, right? And so when you add that on top of the presenting symptoms of psychosis, we wanna make sure that we're connecting people to a resource we can really trust. And so I think the collaboration and the referral pathway with Epic has been one of the biggest assets in terms of community resources that I've found. it's so valuable to be able to have community resources where there can really be a dialogue, where it's not just,

fill out this form, send it over and, you know, we'll call them. It's more when we can really make the warm handoff. As one of you had said, I think that really makes an impact. You know, I've been able to accompany clients to their first appointment over at Epic, which I think people feel a lot safer because it's scary to go to a new clinic for the first time. mean, that's, it's scary to go to a new dentist for the first time. You know, these are things that can be unnerving for lots of people. And so I think.

there are so many great resources to connect with. I will say that because we, do have such great partnerships with organizations who have excellent case management services, a lot of the case management and collaboration, we, we make recommendations, but we lean a lot of times on the case managers at these agents to use their connections when it comes to housing resources, when it comes to,

you know, a higher level of care or maybe just a community, community-based psychiatrist. I think, we sort of as I find that as social workers and community-based social workers and counselors, we often have those one-off relationships where it's like, know the psychiatrist over at St. Thomas and I'm just going to text that person and see if they have an opening, you know, so there's that, networking that is so crucial for connecting.

young people to additional wraparound care, I just think we're really lucky to have immediate access to a lot of case management support.

No, it's a good shout out to case management. feel like case managers work so hard or is so essential to the mental health, to mental health services at large. And I'm glad we're able to shine a light on them.

Yeah.

Yeah.

I was just remembering, sorry, this speaking of warm handoffs and referrals being out in the community with you up by the river years ago. I mean, maybe this was almost 10 years ago when you referred a young person to us and we met in the community with that person who was very hesitant to come over to our services due to their symptoms of paranoia. Yeah, it's a good memory and a good reminder of how, right, those transitions.

yes!

Mm-hmm.

can look so many different ways.

I just

remember that being the most casual, relaxed conversation. Just the three of us sitting down and just talking allowing that just to kind of settle in of like, here's a new person associated with this whole force that I've mentioned. That was a really beautiful moment of connection. Yeah, I agree. Yep. Yeah.

I was just thinking before we, wanted to talk a little bit about this reality that psychotic disorders can coexist with trauma and stressor related disorders. you were in a vulnerable age group for both.

On our end, get a lot of clinicians that jump to the conclusion that psychotic symptoms are traumatic in nature. no, they usually are, but it's related to a trauma exposure. yes, psychosis itself can be traumatic. And I think that there's sometimes a...

Hmm.

a desire maybe to see it as related to a specific trauma versus emerging schizophrenia. But approaches to the psychosis could be very different in each different setting. And just how careful we have to be with, I had several patients where the psychosis was thought to be a trauma related.

Right.

symptom and then they start trauma based therapy, not like go south and essentially, you know, and then the reverse can happen. But just when people are, you know, seeking help and when they are getting to know their agency, their people in their community that can provide help to really make sure

that they're being heard and that there's consideration. I mean, I realize that there's not trauma specialists and psychosis specialists all over the place, but just the having someone and listening for your clinician, considering, like considering could this be this, this could be this, and not diving and seeing.

next

test.

you know, seeing things through a silo. Cause we have to do, we have to do the same all the time, especially with our clinical high risk population. But you know, that it's a, you want your person that's going to be taking care of you in your life to be considering of, of the multiple things that can be going on because it really does drive treatment approaches.

Yeah.

Yeah.

You're making me think of just the value that I've learned over time doing this work of really slowing down with clients to listen and try to understand. And you'd mentioned a success story or something that comes to mind is meeting a young person where I was unsure how much what I was seeing was a trauma reaction versus possible early psychosis symptoms. And we really leaned on

Mm-hmm. Yeah.

our peer support model at first with that young person just to allow there to be a safe relationship with, know, the way our model works is the clinician is always available as a backup and a thought partner with the peer support specialist. So they're never on their own. We didn't want to rush into a treatment model with someone who was already pretty hesitant to fully trust. And yeah, we didn't want to make things too cut and dry before we really felt we could do that and recognize that the first thing that needed to happen was just starting a relationship.

And with the one relationship that we knew could last regardless of which direction we went because our peer support folks can work with a wide array of clinical presentations. But we know we can't duplicate clinical services, right? So start sometimes slowing down and really just listening and getting to know somebody without rushing to treat something that you aren't quite sure you totally understand yet. And that's something that I value about our collaboration is that I find that

Epic has that curiosity as well of like, let's explore this together. And that's the way I aspire to be as a clinician as well. It's not jumping 10 steps ahead of where I've got the to assume that I know where this is headed or where this is coming from, but that I'm building a clinical impression in my mind through the relationship and trusting the client, trusting what the client sharing with me.

Right.

Yeah. I have a, I remember the first time I had young man who had a pretty significant PTSD. yeah, I would say kind of in its like most classical form, whatever that might be. And he also had schizoaffective disorder and he was, you know, he had been through a lot of trauma focused CBT and had been through a lot.

psych, first episode psychosis treatment. And he was very clear about what was his paranoia related to psychosis versus like distress at reminders, hypervigilance. And I remember just being like, could you come, I think I said to him, can you come and teach our residents and fellows like that people know, like if you take them through and.

Hmm.

Okay.

Yeah.

help them, you know, cause he would be like, is this a risk at all moment or is this a, I need to do some breathing skills and like check my environment kind of moment. Very clearly. It was so fascinating. Yeah. Total, total insight. And like people can have that insight. It just takes time.

That's me.

Yeah.

Such insight. Yeah. Yeah.

Yeah, absolutely. Yeah.

Yeah.

Yeah.

No, I so appreciate the idea of taking time of leading with curiosity, leading the clinical work with curiosity. And I think circling back to something we talked about at the beginning is just asking questions. And for all of us, know, new clinicians, seasoned clinicians being willing to say, I don't know, or I'm confused by what I'm seeing and to tap a colleague and ask questions. And you've done that so gracefully over the years, Laura. I've really, really appreciated it.

Mm. Yeah.

And I think it is led to write like much more like a streamline of referrals like that match, right? The services that we can provide. And then the other thing I think you've done is you've in your own clinical curiosity have brought in training like you've brought us in to do a training for your clinicians. And so I just say that out there to our listeners and watchers that that's something that can happen if you're clinically

and

curious, we can provide a training. And do you all provide trainings at Children's Bureau around trauma or?

have, we have, and we certainly do. That's part of our partnership model as well, is that we'll come in and we train on our trauma-informed model with our partnership staff. But certainly, in terms of area of specialty, mean, grief and trauma is our everyday, all day, every day. And

you know, definitely would encourage people to reach out if there's an interest in training because it's something that I think ebbs and flows in terms of our capacity to deliver. But I think it's a really important thing for the community of mental health providers and the community at large to not get isolated and limited in, you know, benefiting from the knowledge that's out there. It was so great to bring Epic in for a training because, you know, I found that some of my colleagues were

Like, I think I might be seeing this with a client, but I just like, can't even wrap my head around this. I don't know a whole lot about this. This is the first time I'm seeing this. And that can be so overwhelming to feel like you're really out of your depth. so training each other and learning from each other is huge. It's again, part of slowing down too, right? Rather than just racing through the tasks of the day, but stopping for training is really important for helping professionals. Yeah.

Mm-hmm.

Yeah, yeah,

And I love that we've been collaborating, educating and training each other for 10 years now. Yeah, yeah, I know, right? Well, thank you so much for joining us today. I love that we joined at this 10 year mark and here's to 10 more years of serving the community and working together.

Yeah, I know it's amazing. And it flew by. Yeah.

Wow.

You

Yes.

Thank you both so much for the opportunity and for the work that you're both doing. was great to talk.