Curriculum written by Stephanie S. Covington, Ph.D., LCSW Training provided by Carol Ackley, LADC Text Box: Beyond Trauma: A Healing Journey for Women •Childhood •Adolescence •Adult •Street (workplace and community) •Consumer Culture •Media •War •Planet Text Box: Levels of Violence •Natural •Created Text Box: Two Kinds of Suffering The diagnostic manual used by mental health providers (DSM IV-TR) defines trauma as, “involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.” (American Psychiatric Assoc. [APA] 2000, pg. 463). Text Box: Definition of Trauma “The person’s response to the event must involve intense fear, helplessness or horror (or in children, the response must involve disorganized or agitated behavior).” (American Psychiatric Assoc. [APA] 2000, pg. 463). Text Box: Definition of Trauma (cont.) Violence against women is so pervasive that the United Nations has addressed and defined violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life.” (United Nations General Assembly, 1993). Text Box: Violence Against Women Gender-Responsiveness Creating an environment through site selection, staff selection, program development, content, and material that reflects an understanding of the realities of the lives of women and girls and that addresses and responds to their strengths and challenges. (Covington & Bloom) Text Box: Gender-Responsive Services The theories related to gender and substance abuse (and any other relevant treatment services) that create the framework of thought for program development. This is the knowledge base that creates the foundation upon which the program is developed. Text Box: Theoretical Foundation The approaches used in the program that create the therapeutic process. These are the ways in which theory is operationalized(how theory is applied). Text Box: Treatment Strategies •Shame and Stigma •Physical and Sexual Abuse •Relationship Issues •fear of losing children •fear of losing partner •needing partner’s permission to obtain treatment Text Box: Women’s Issues: An International Perspective Text Box: Women’s Issues: An International Perspective •Theory of Addiction •Holistic health model •Chronic neglect of self in favor of something or someone else •Theory of Women’s Psychological Development •Relational–Cultural Model (Stone Center) •Theory of Trauma •Three Stage Model (Herman) •Upward Spiral –A Transformational Model (Covington) • Text Box: Helping Women Recover: A Comprehensive Integrated Approach Text Box: Voices: A Program of Self-discovery and Empowerment for Girls Trauma Theory Sandra Bloom, M.D. Mary Harvey, Ph.D. Judith Herman, M.D. Peter Levine, Ph.D. et al. Integrates cognitive-behavioral, expressive arts, guided imagery, and relational therapy. Text Box: Beyond Trauma: A Healing Journey for Women •Attachment: a culture of belonging •Containment: a culture of safety •Communication: a culture of openness •Involvement: a culture of participation and citizenship •Agency: a culture of empowerment (Haigh) Text Box: “Therapeutic culture” has these elements •Substance Abuse •Mental Health •Trauma Text Box: Three Critical and Interrelated Issues Some women use drugs: •To maintain a relationship •To fill in the void of what’s missing in a relationship •To self-medicate the pain of abuse in relationships (Covington & Surrey, 1997) Text Box: Relational-Cultural Theory •These are services that are provided for problems other than trauma but require knowledge about violence against women and the impact of trauma thereby increasing their effectiveness. Text Box: Trauma-informed Services Trauma-informed services: 1.Take the trauma into account. 2.Avoid triggering trauma reactions and/or traumatizing the individual. 3.Adjust the behavior of counselors, other staff and the organization to support the individual’s coping capacity. 4.Allow survivors to manage their trauma symptoms successfully so that they are able to access, retain and benefit from the services. (Harris & Fallot) Text Box: Trauma-informed Services Principle 1. Trauma-Informed Services Recognize the Impact of Violence and Victimization on Development and Coping Strategies Text Box: Ten Principles of Trauma-Informed Services Principle 2. Trauma-Informed Services Identify Recovery from Trauma as a Primary Goal Text Box: Ten Principles of Trauma-Informed Services (cont.) Principle 3. Trauma-Informed Services Employ an Empowerment Model Text Box: Ten Principles of Trauma-Informed Services (cont.) Principle 4. Trauma-Informed Services Strive to Maximize a Woman’s Choices and Control Over Her Recovery Text Box: Ten Principles of Trauma-Informed Services (cont.) Principle 5. Trauma-Informed Services Are Based in a Relational Collaboration Text Box: Ten Principles of Trauma-Informed Services (cont.) Principle 6. Trauma-Informed Services Create an Atmosphere That Is Respectful of Survivor’s Need for Safety, Respect, and Acceptance Text Box: Ten Principles of Trauma-Informed Services (cont.) Principle 7. Trauma-Informed Services Emphasize Women’s Strengths, Highlighting Adaptation Over Symptoms and Resilience Over Pathology Text Box: Ten Principles of Trauma-Informed Services (cont.) Principle 8. The Goal of Trauma-Informed Services Is to Minimize the Possibilities of Retraumatization Text Box: Ten Principles of Trauma-Informed Services (cont.) Principle 9. Trauma-Informed Services Strive to Be Culturally Competent and to Understand Each Woman in the Context of Her Life Experiences and Cultural Background Text Box: Ten Principles of Trauma-Informed Services (cont.) Principle 10. Trauma-Informed Agencies Solicit Consumer Input and Invoice Consumers in Designing and Evaluating Services Elliot, D.E.; Bjelajac, P.; Fallot, R.D.; Markoff, L.S.; Reed, B.G. Trauma-Informed or Trauma-Denied: Principles and Implementation of Trauma-Informed Services for Women. Journal of Community Psychology, July, 2005., 33(4): 461-477. Text Box: Ten Principles of Trauma-Informed Services (cont.) Text Box: Trauma Specific Services The following statistics illustrate how pervasive interpersonal violence is in the lives of women and girls. •The strongest risk factor for being a victim of partner violence is being female. (APA, 1996) •Approximately 1.5 million women are raped or physically assaulted by an intimate partner each year in the US.(Bureau of Justice Statistics [BJS], 2000). Text Box: Statistics •Violence against the woman occurs in approximately 20 percent of dating couples (APA, 1996). •Women age 16-24 experience the highest per capita rates of intimate violence (19.6 victimizations per 1,000 women)(BJS, 2002). •Violence within the family is traumatizing to most women. (APA, 1996). Text Box: Statistics •While both male and female children are at risk for abuse, females continue to be at risk for interpersonal violence in their adolescence and adult lives. (Covington & Surrey). •In 1998, over 1,800 murders in the US were attributed to intimate partners.Three quarters of the victims were women, accounting for 33% of all murders of women and 4% of all murders of men. (BJS, 2000a). Text Box: Statistics •More female than male adolescents have been sexually assaulted. (Commonwealth Fund, 1997). •An estimated 67 of every 100,000 females in the United States were reported rape victims in 1998. Despite a decline in the nation’s crime rate, over the past decade, reported rates of rape and sexual assault did not decline.(FBI, 1999). Text Box: Statistics •Only 22 percent of rapes are committed by someone the victim does not know. (Kilpatrick, Acierno, Saunders, Resnick, Best, & Schnurr, 1998). •While relationship violence happens to women of every race and ethnic background, African-American women are physically assaulted at a rate that is 35% higher than Caucasian women, and about 2-1/2 times the rate of women of other races. (National Coalition Against Domestic Violence, 2000). Text Box: Statistics •1/3 of women in state prison and 1/4 in jails said they had been raped (BJS, 1999). •Women in prison reported childhood abuse at a rate almost twice that of men; abuse of women as adults was eight times higher than the rate for men (Messina et. al., 2001). •Between 23-37% of female offenders reported that they had been physical or sexually abused before the age of 18 (BJS, 1999). Text Box: Statistics Text Box: Sexual Assault Graph Bureau of Justice Statistics Text Box: Sexual Assault Graph Text Box: Process of Trauma Text Box: TRAUMATIC EVENT Overwhelms the Physical & Psychological Systems Intense Fear, Helplessness or Horror Text Box: PAINFUL EMOTIONAL STATE Text Box: RETREAT Text Box: SELF-DESTRUCTIVE ACTION Text Box: DESTRUCTIVE ACTION Text Box: ISOLATION DISSOCIATION DEPRESSION ANXIETY Text Box: SUBSTANCE ABUSE EATING DISORDER DELIBERATE SELF-HARM SUICIDAL ACTIONS Text Box: AGGRESSION VIOLENCE RAGES Left Side of BrainRight Side of Brain •Analytic•Intuitive •Logical•Emotional Text Box: Brain •Recurrent and severe emotional abuse •Recurrent and severe physical abuse •Contact sexual abuse Growing up in a household with: •An alcoholic or drug-user •A member being imprisoned •A mentally ill, chronically depressed, or institutionalized member •The mother being treated violently •Both biological parents notbeing present (N=17,000) Text Box: ACE Study (Adverse Childhood Experiences) Results ACEsstill have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness. •Smoking •Alcoholism •Injection of illegal drugs •Obesity (Felitti, V.J.: Origins of Addictive Behavior: Evidence from the ACE Study. 2003 Oct:52(8): 547-59. German. PMID: 14619682 (PubMed-indexed for MEDLINE). Text Box: ACE Study (Adverse Childhood Experiences) CJ 21% .5+ (before age 16) HMO 13% .5+ (before age 18) Greater exposure to CTE’s increased likehoodof 14 out of 20 health–related outcomes. (Messina & Grella, 2005) Text Box: Childhood Traumatic Events Women in CJ System Text Box: Childhood Traumatic Events CJ Women •Psychotropic medication •Mental health treatment •Attempted suicide •Traumatic stress (Messina & Grella, 2005) Text Box: Childhood Traumatic Events Largest Effect-Mental Health Text Box: Childhood Traumatic Events Largest Effect-Mental Health •Management •Health Care •Mental Health Issues Text Box: Implications – CJ System Three Modules: Violence, Abuse and Trauma The Impact of Trauma on Women’s Lives Healing from Trauma Integrates cognitive-behavioral, expressive arts, guided imagery, and relational therapy. Text Box: Beyond Trauma: A Healing Journey for Women •Learn what trauma/abuse is •Understand typical responses •Develop coping skills Text Box: Key Elements (Staff and Clients) Text Box: Disorders Related to Trauma and Substance Abuse in Women’s Lives •Re-experiencing the event through nightmares and flashbacks. •Avoidance of stimuli associated with the event (for example, if a woman was raped in a park, she may avoid parks, or if she was assaulted by a blonde man, she may avoid men with blonde hair). •Estrangement (the inability to be emotionally close to anyone) Text Box: Post-traumatic Stress Disorder •Numbing of general responsiveness (feeling nothing most of the time) •Hyper-vigilance (constantly scanning one’s environment for danger, whether physical or emotional) •Exaggerated startle response (a tendency to jump at loud noises or unexpected touch) (DSM –IV) Text Box: Post-traumatic Stress Disorder (cont.) Three Symptom Clusters: •Re-experiencing •Numbing and Avoidance •Hyperarousal Text Box: Post-traumatic Stress Disorder (cont.) •Depression •Anxiety •Panic disorder •Phobic disorder •Substance abuse •Physical disorders Source: Davidson, J. (1993) “Issues in the diagnosis of posttraumatic stressdisorder.” In American Psychiatric Review of Psychiatry, Vol. 12 Text Box: Disorders Related to Post-traumatic Stress Disorder Source: Herman, 1992, 1997 Syndrome Stage One Stage Two Stage Three Hysteria (Janet 1889) Stabilization, Symptom-oriented treatment Exploration of traumatic memories Personality reintegration, rehabilitation Combat trauma Scurfield(1985) Trust, stress-management education Re-experiencing trauma Integration of trauma Text Box: Trauma: Stages of Recovery Source: Herman, 1992, 1997 Syndrome Stage One Stage Two Stage Three Complicated post-traumatic stress disorders Stabilization Integration of memories Development of self, drive integration Text Box: Trauma: Stages of Recovery Source: Herman, 1992, 1997 Syndrome Stage One Stage Two Stage Three Multiple personality disorder (Putnam 1989) Diagnosis, stabilization, communication cooperation Metabolism of trauma Resolution, integration, development of post-resolution coping skills Traumatic disorders (Herman 1992) Safety Remembrance and mourning Reconnection Text Box: Trauma: Stages of Recovery Source: Herman, 1992, 1997 Text Box: Trauma Three Group Models Source: Herman, 1992, 1997 Text Box: Trauma Three Group Models Source: Herman, 1992, 1997 Text Box: Trauma Three Group Models A trigger is something that is an external stimulus that sets off a physical or emotional reaction in a person. The stimulus can be a sound, another person, a place, a smell, a behavior…almost anything that consciously or subconsciously reminds the woman of the past trauma. Text Box: Triggers Grounding techniques are strategies to help a person who is dissociating (“losing time”, emotionally absent) “come back” into current reality and feelings. Grounding techniques can help women realize that they are in the here and now and that what they are experiencing is In the past and it is not happening now. Text Box: Grounding •She is able to use some safe coping skills •She has no major current crises or instability (e.g., homelessness or domestic violence) •She is willingto do this type of work •She can reach out for help when in danger •She is not using substances to such a severe degree that emotionally upsetting work may increase her use Text Box: When is a Woman Ready for Trauma Processing? •Her suicidality has been evaluated and taken into account •She is in an ongoing system of care that is stable and consistent, with no immediate planned changes (e.g., discharge from inpatient unit or residential program) Text Box: When is a Woman Ready for Trauma Processing? •Compassion fatigue •Burnout •Vicarious traumatization Text Box: Secondary Traumatic Stress (STS) •Safety •Empowerment •Connection (Aloneness) •Normal reactions (Shame) •Mind-body connection •Substance abuse •Woman-centered Text Box: Beyond Trauma Themes The following qualities in a facilitator will help to ensure a positive group experience: •Trustworthy •Credible •Available •Reliable, consistent •Hopeful •Warm, compassionate •Emotionally mature Text Box: What Makes a Good Facilitator? •Healthy boundaries, respects confidentiality •Committed to and interested in women’s issues •Multi-cultural sensitivity and responsiveness •Appropriate gender -a female should facilitate the all-female groups Text Box: What Makes a Good Facilitator? (cont.) •If trauma survivor, she needs to feel confident that she is at a place in her own recovery that will allow for healthy and positive outcomes for herself and the women in the group. •Content expertise, if possible •Skills as a facilitator Text Box: What Makes a Good Facilitator? (cont.) •Begin and end on time •Maintain structure of the group •Move the group through the content of each session •Lead by example by having appropriate boundaries and containing your feelings •Allow each woman to have her own experience of the group Text Box: Role of the Facilitator Session 1Connections between Violence, Abuse & Trauma Session 2Power and Abuse (10 activities) Text Box: Module A: Violence, Abuse, and Trauma Beyond Trauma Module A Session 1 Connections between Violence, Abuse & Trauma •Impacts Inner Self –It can impact our inner life…our thoughts, feelings, beliefs, values. For example, some women believe that “you can’t trust anyone”, and “the world is a very unsafe place.” Text Box: Inner Self & Outer Self •Impacts Outer Self –It can impact our outer life…our outer life consists of our relationships and our behavior. Many women who have experienced trauma struggle with their relationships –families, friends, sexual relationships. Text Box: Inner Self & Outer Self (cont.) Trauma can take many forms: •Emotional, sexual or physical abuse, •Extremely painful and frightening medical procedures •Catastrophic injuries and illnesses •Rape or assault •Muggings •Domestic violence •Burglary Text Box: Traumatic Events •Witnessing murder •Automobile accidents •Immigration •Natural disasters (hurricanes, earthquakes, tornadoes, fires, floods, volcanoes) •Abandonment (especially for small children) •Terrorism such as September 11, 2001 •Witnessing violence such as a parent harming another parent Text Box: Traumatic Events (cont.) •Loss of a loved one and severe bereavements (even of a pet) •Combat/war •Torture •Kidnapping •Intergenerational (cultural) trauma Of all these forms of trauma, women are at greater risk of interpersonal abuse than men. Text Box: Traumatic Events (cont.) Text Box: Trauma & Abuse Text Box: Sexual abuse Physical abuse Emotional abuse Domestic violence Witnessing abuse/violence Stigmatization Incarcerated women Women of color Poor women •Internal Internal safety is how we take care of our emotions and feelings. If we feel overwhelmed, sad, angry, lonely or frightened, we need to have ways to take care of ourselves when we are stressed. Text Box: Safety •External External safety issues involve actions we take in our surroundings. We may lock our doors, choose not to go out alone at night, or un-list our telephone number. We do things to try and keep ourselves physically safe in our environment. Text Box: Safety Beyond Trauma Module A Session 2 Power and Abuse Text Box: From the manual In Our Best Interest: A Process for Personal and Social Change. Available through Domestic Abuse Intervention Project, 206 W. 4th St., Duluth, MN 55806 Session 3 Reactions to Trauma Session 4 How Trauma Impacts our Lives (7 activities) Text Box: Module B: The Impact of Trauma on Women’s Lives Beyond Trauma Module B Session 3 Reactions to Trauma •Fight •Flight •Freeze Text Box: Biological Reactions to Trauma •Hyper-arousal –this is the most common reaction. It includes difficulty breathing (panting, shallow, rapid), increased heart rate, cold sweats, muscular tension, tingling, racing thoughts, worry. •Constriction –this alters breathing, muscle tone and posture. It constricts blood vessels in the skin, arms, legs, and internal organs, and tenses muscles. Hyper-arousal and constriction describe a physical response. Text Box: Symptoms of Trauma •Dissociation –your mind disconnects from the event or physical reality of what is happening. This is a mind-body split. This feels like “losing time”and can include loss of memory. •Denial –this is like dissociation only not as severe. A woman ignores or fails to acknowledge a feeling or situation or acts as though it is unimportant. Dissociation and denial are part of the psychological response. Text Box: Symptoms of Trauma (cont.) •Exposure to trauma can create a PTSD response in the limbic system •The PTSD response can become complex and chronic. Text Box: Trauma and the Brain •Trauma disrupts the chemistry of the brain and can predispose a women to alcohol and drug use, eating disorders, self-injuring behavior and mental health problems. •When trauma occurs in childhood, it can have lasting effects on brain development. Text Box: Trauma and the Brain •Physical reactions are automatic and are not controlled by us. •Brain reactions are also automatic. •The body stores reactions. Then the body reacts as though it is back re-living the traumatic events of the past Text Box: Reactions Child Adolescence Adult Event Life before the event Life after the event Overall impact of the event: Text Box: Trauma History Beyond Trauma Module B Session 4 How Trauma Impacts Our Lives Women report the following: •“Losing control”of life •Re-experiencing –can’t concentrate •Self-image changes •Depression •Relationship problems •Sexuality issues Text Box: Trauma and its aftermath •Idealizing or overvaluing relationships •Fear of commitment •Self-imposed isolation •Triangulating with others •Humiliating interactions Text Box: Relationship Problems might include: •Involvement in abusive or criticizing relationships •Difficulty trusting self/others with intimacy •Tolerating abusive or excessive neediness patterns •Emotional and physical care-taking of others at expense of self Text Box: Relationship Problems might include: •Avoidance/fear of sex •Approaching sex as obligation •Negative feelings with touch •Difficulty with arousal, sensation •Vaginal pain •Emotional distance during sex (spacing out) •Disturbing sexual thoughts and images •Compulsive or inappropriate sexual behavior •Difficulty in intimate relationships Text Box: Sexual Issues might include: Session 5 The Addiction and Trauma Connection: Spirals of Recovery and Healing Session 6 Grounding and Self-Soothing Session 7 Abuse and the Family Session 8 Mind and Body Connection Session 9 The World of Feelings Session 10Healthy Relationships: Wheel of Love Session 11 Endings and Beginnings (29 activities) Text Box: Module C: Healing from Trauma Beyond Trauma Module C Session 5 Spirals of Recovery and Healing Often women believe that alcohol and other drugs help them in a variety of ways to: •Make connections with others •Comfort themselves •Manage or avoid feelings •Escape physical pain •Ease social withdrawal •Feel comfortable with sexual intimacy •Create distance Text Box: Women , Substance Abuse and Trauma •Build courage •Increase hope, the world seems better •Forget the past •Increase a sense of vitality •Deal with a violent partner •Dissociate (altered state) •Feel numb •Rewire the brain •Maintain the status quo Text Box: Women , Substance Abuse and Trauma Text Box: Self-Care Scale Text Box: Self-Care Scale Beyond Trauma Module C Session 6 Grounding and Self-Soothing Grounding techniques are strategies to help a person who is dissociating (“losing time”, emotionally absent) “come back”into current reality and feelings. Grounding techniques help the person become aware of the here and now. Grounding techniques can help women realize that they are in the here and now and what they are experiencing is in the past and it is not happening now. Text Box: Grounding Alone With Others Daytime Night Time Text Box: Self - Soothing Beyond Trauma Module C Session 7 Abuse in the Family Text Box: Sexual Abuse in Families The single most powerful and effective way to step safely out of rigid childhood roles and heal the wounds of the past is to reparentyourself. It is a critical part of self-healing that will allow you to know and love yourself and have healthy intimate relationships in the future. Text Box: Reparenting •To do this you must be attuned to your inner child’s feelings and needs. •Attunement to your inner child can be the first step toward love and healing. •Be empathetic, understanding and gentle; validate the child’s feelings and address them openly. Text Box: Reparenting (cont.) •You may feel comfortable reaching out to a close friend or partner, with whom you can be open and vulnerable, to allow this inner child to be held, loved and nurtured. •Without meeting the needs of your inner child, it can be difficult to meet your adult needs and the needs of those around you. Text Box: Reparenting (cont.) Beyond Trauma Module C Session 8 Mind and Body Connection 1.Sense having a feeling. 2.Locate feeling in the body. 3.Name the feeling. 4.Express feeling appropriately 5.Ability to contain feeling. Text Box: Emotional Wellness •Slow Down. Stop. •What am I feeling? •Does the intensity of the feeling match the situation? •How old am I…as I have this feeling? Text Box: Emotional Wellness Text Box: Body-Mind Connection Beyond Trauma Module C Session 9 The World of Feelings •Anger •Loss •Shame Text Box: Common Feelings Beyond Trauma Module C Session 10 Healthy Relationships: Wheel of Love Text Box: Relationship Wheel Respect Respect is the appreciation of someone’s values and it begins to happen when we see their integrity. We often earn respect when we are willing to do the right thing or take the “right action,”particularly when the choice is difficult. Text Box: Respect, Mutuality, Compassion Mutuality Mutuality means there is an equal investment in the relationship. Each person has a willingness and desire to see the other, as well as being seen; to hear the other, as well as being heard; and to be vulnerable, as well as respecting the other’s vulnerability. Mutuality also means that there is an awareness of the “we,”not a sole focus on two “I”’s. Text Box: Respect, Mutuality, Compassion Compassion Compassion is similar to empathy but it occurs on a deeper level. Empathy is understanding another’s feeling and being able to feel with them. Compassion means that we go a step further and join with them in their struggle or pain. When we are compassionate we lend our selves to another’s process –we give of ourselves in order to be with them emotionally. Text Box: Respect, Mutuality, Compassion •Similarities •Ability to Deal with Change •Compatible Values •Effective, Open Communication •Effective Conflict/Anger Resolution •Effective Negotiation •Firm Personal Boundaries •Healthy Sexual Expression •Shared Quality Time •Friendship (Covington & Beckett, 1998) Text Box: Steps to a Healthy Relationship Text Box: From the manual In Our Best Interest: A Process for Personal and Social Change. Available through Domestic Abuse Intervention Project, 206 W. 4th St., Duluth, MN 55806 Text Box: Relationship Wheel Text Box: Wheel of Love Beyond Trauma Module C Session 11 Endings and Beginnings •What I appreciate about the other women in the group. •What I appreciate about the group. Text Box: Appreciation One definition of spirituality is oneness, wholeness, connection to the universe; belief in something greater than yourself, trust in a higher or deeper part of yourself. Text Box: Spirituality •Quiet time •Prayer •Meditation •Centering activities such as singing, music •Being out in nature •Keeping a journal Text Box: Spiritual Practices •Attending church, synagogue, mosque, temple •Helping others in need •Creating personal altars.. •Learning from others. •Celebrations! Text Box: Spiritual Practices (cont.) •Safety •Empowerment •Connection (Aloneness) •Normal reactions (Shame) •Mind-body connection •Substance abuse •Woman-centered Text Box: Beyond Trauma Themes Working on multiple levels: •Individual •Political •Spiritual Text Box: Women Healing •Stephanie S Covington, Ph.D, LCSW Email: Sc@stephaniecovington.com Websites: www.stephaniecovington.com www.centerforgenderandjustice.org •Carol Ackley, LADC Email: Ackley@riverridgetreatmentcenter.com Text Box: For More Information