November 16 , 2006

Trauma Recovery Center in it for the Long Term

By Gina Poggi
Special to the Neighborhood Newswire

When a patient doesn’t show up for a counseling session at the Trauma Recovery Center (TRC) it’s not unusual for staff members to search them out at a Tenderloin hotel, homeless camp or other non-traditional home. This assertive approach has helped the Center identify and treat more than 4,800 mostly low-income victims of violent crime since it opened in 2001.
The TRC is a nationally-recognized program that helps violent crime victims by providing free services ranging from medical and mental health support, safe housing in cases of domestic violence and sexual assault, help filing police reports and communicating with the District Attorney’s office.
The TRC has treated victims of sexual assault, domestic violence, shootings and stabbings, as well as family members of homicide victims. Many of the Center’s clients are poor, uninsured, live in high-crime neighborhoods and have suffered an average of five other serious traumatic events in their life. Homeless women experience repeated sexual assaults, children witness multiple instances of domestic violence, and those with mental health issues are frequently robbed and/or physically assaulted.
“One of the things that distinguishes this Center is that we’re really focused on public sector patients,” said its founder, Dr. Alicia Boccellari, director of the Division of Psychosocial Medicine at San Francisco General Hospital. “We’re focused on practical needs and we’re the first in the country to also do research on this population in terms of what does it take to heal from cumulative trauma.”
The TRC takes a proactive approach to finding and treating its patients. Center staff perform “sweeps” of San Francisco General Hospital’s emergency room looking for crime victims, visit patients at bedside while they recover from physical injuries in the hospital, offer practical help, and establish relationships with their clients that frequently lead to much-needed mental health treatment.
The Center’s staff consists of social workers, psychologists, psychiatrists, nurse practitioners, and outreach workers, who are referred to as “trackers” — trained non-clinical people who go into homeless encampments to find crime victims and encourage them to get treatment.
It’s a technique that’s proven to be highly successful. Before the TRC existed, only six percent of sexual assault victims who came to SF General received mental health treatment; with the TRC’s help, 71 percent now receive care. And the number of victims who return to employment is 56 percent higher among the TRC’s clients as compared with those who do not receive their services.
Much of the Center’s success is attributed to their non-judgmental attitude. Many of the TRC’s clients who experience violent crime don’t have a support system to lean on and are without a lot of resources. The TRC provides a caring environment, in some cases the only one available to them.
“We really make sure that [our] staff is compassionate and that they really treat people with respect. A lot of the people that we see are not used to being treated well by anyone in their lives,” said Dr. Boccellari.
The program has received awards from the San Francisco District Attorney and the San Francisco Board of Supervisors, as well as the National Association of Public Hospitals’ National Safety Net Award for Patient Services — the TRC being one of two programs in the country to receive this prestigious award. But despite these accolades, it’s been an uphill battle to keep the program funded.
In 2005, Governor Arnold Schwarzenegger vetoed a bill that would have provided funding to the Center through the state’s Victim Compensation Fund (VFC), which “was established to assist all victims of crime by providing reimbursement for out-of-pocket expenses” and currently has a $96 million surplus. In his veto message the governor said that funding an organization instead of individuals is an incorrect use of the VCF “even for a program as successful as the Trauma Recovery Center.”
Last October, State Assemblyman Mark Leno and the Public Safety Committee sponsored another funding bill which, after being approved by two-thirds of the State Senate, the governor signed. However, Schwarzenegger limited the Center’s funding to one year. 
In the meantime, Dr. Boccellari has advocated for state legislation that would open five more centers like the TRC throughout California. Although her perseverance is unrelenting, the task is both time-consuming and daunting. “It’s hard to run a program when there’s no certainty of the permanence of the funding,” said Dr. Boccellari. “To spend all this energy focused on getting legislative bills passed instead of seeing patients, instead of putting my energy into improving the program and improving the quality of care — it’s very frustrating.”