In the early 2000s, Julie Warren’s daily habits included alcohol, Xanax, marijuana and 750 milligrams of Vicodin, the latter 5 to 10 times per day. By 2014, she had added methamphetamine to her daily mix, using day and night.

Warren was skin and bones. She weighed roughly 80 pounds as a 26-year-old mother of two.

This is the condition Warren was in when Child Protective Services (CPS) knocked on her door one August evening in 2015 with a court order to remove her children, then 8 and 4 years old. Soon after, Warren entered now-retired Judge Carole Clark’s drug court — the Smith County Family Preservation Court in Texas. 

At first, Warren solely went through the motions. 

“I just remember having the mentality of ‘I’m trying to get this done and over with,’ ” Warren said. 

But, in Clark’s court, “Game sees game,” Warren said. While at first, she quit using drugs to check boxes, Clark’s court looked past the symptom — addiction — and targeted the root cause — trauma — to ensure sustainable recovery. 

Clark had routinely seen recidivism and generational cycles in the cases appearing in her drug court, specifically on her CPS docket. So, Clark did away with the traditional handling of the CPS docket and searched for a solution to the issues that required state involvement in the first place. 

The solution, she found, required children and parents healing from their trauma. 

Today, Warren is more than 5 years clean — 2,505 days as of May 7 to be exact. She regained custody of her children and obtained her bachelor’s degree in 2016. Now she is a case manager at Youth and Family Enrichment Centers, serving adolescents who are in state care through the child welfare system. 

Her path was not easy nor straightforward, but she credits where she is today to Clark’s court, which uses a systematic approach to complex trauma called Trust-Based Relational Intervention. TBRI is a therapeutic model that trains caregivers to provide effective support and treatment for at-risk children.

In addition to courts, it has been applied in places such as churches, schools, orphanages, residential treatment facilities, group homes, as well as foster and adoptive homes.

This is the model Ashland Juvenile and Probate Court Judge Karen DeSanto Kellogg, along with other community partners, intends to bring to Ashland County’s juvenile division.

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Clark’s trauma-informed practices involve doing more than the minimum required by law, and intentionally using practices to not re-traumatize people that go through the court system.

The goal of this approach is to improve outcomes for children and families, lower recidivism rates within the child welfare system and reduce the intergenerational pattern of child abuse.

Clark and her team often refer to their court as a drug court, or a family treatment court. Overall, the trauma-informed approach is applied to cases where children are removed from their caregiver because of an addiction issue, which is comparable in Ashland to abuse, neglect and dependency cases. 

Drug courts in Texas and Ohio differ. In Texas, drug courts are a type of intense supervision, which is mandatory in counties with more than 550,000 people; whereas in Ohio a drug court is a specialized docket that courts can adopt. 

Ashland County does not have a drug court, nor any specialized dockets. Nearby counties — including Richland and Knox Counties — have drug courts as well as other specialized courts, such as mental health and re-entry courts.

DeSanto Kellogg said she sees a need for a specialized drug docket in her juvenile court. When it comes to other divisions, the candidates for county common pleas judge disagree on whether to start a drug court, or other specialized courts.

Regardless of the official label, DeSanto Kellogg said she already has a drug court, because she sees drug cases in her court almost every day.

Drug courts in Ohio and trauma-informed courts have many of the same practices, and those practices can be adopted through what the Supreme Court of Ohio calls a specialized docket or through a judge’s case managing.

DeSanto Kellogg has been taking the case management approach so far. For example, she has begun making court appearances more frequent for abuse, neglect and dependency cases.

There are statutes that dictate the minimum requirements for these types of cases, when it comes to meeting frequency and sunset dates, but judges can choose to do more than the minimum. 

“My position is, in those cases, if that’s all we do and do well — that is not enough,” DeSanto Kellogg said.

Further changes in Ashland are forthcoming, using information gleaned from a multidisciplinary training in April from Clark and her court team.

Assess safety risk → address trauma → reunify

I.

Clark’s court team were the first people to tell Warren they were sorry about how she was treated, Warren said. 

“You could see in (the therapist’s) eyes that she cared and she heard me and she wasn’t labeling me as a bad parent or anything, she just saw my hurt,” Warren explained. 

Warren’s addiction stems from childhood trauma.

Warren said she grew up in an abusive home and both of her parents struggled with substance use. Her mother died when she was 5-years-old from acute alcoholism and emphysema. Warren was raped in sixth grade, and her father moved the family from Arkansas to Texas shortly after. Warren had to start over completely. 

Above all, she said, her childhood lacked family connection and love. She resorted to drugs and alcohol to numb the pain. 

The first phase of Clark’s trauma-informed court process involves assessing risk. The risk assessments used in Clark’s court system helped Warren acknowledge her own trauma as well as helped the court develop an individualized service plan. 

When people such as Jennifer Gregory — who has done everything from case management, social work, parent education, and individual and group counseling for the Smith County court system — complete risk assessments, she said sincerity and honesty is key. 

“When applicable, I would say ‘If I were you and I had the same history, the same coping skills, the same support, I would use meth too.’ And I meant it because I would have. I couldn’t say I can’t. I don’t know that,” Gregory said. “So I’d say, ‘it’s highly likely if I was in the same equation. I’m just like you are. We’re human beings, and we’re just trying to survive. ’And they’re like, ‘Really? Is she being for real?’ 

“‘Absolutely — so how about we change it? Aren’t you tired?’”

Risk assessments are completed by a trauma-informed clinical social worker, licensed professional counselor or drug counselor. At minimum, these assessments include Substance Abuse Subtle Screening Inventory, Adverse Childhood Experiences questionnaire and an interview to identify history of trauma.

The SASSI questionnaire is used to identify substance use problems, and the ACEs questionnaire is used to identify childhood trauma. A high ACE score, signifies higher risk for health, social and emotional problems.

Ashland’s juvenile division currently has a partnership with Appleseed Community Mental Health Center for ACEs assessments for children and parents, but DeSanto Kellogg is looking to incorporate more than ACEs, to align with Clark’s approach. 

The court system, as it has long operated in Ashland and elsewhere, has looked for periods of compliance, failing to address why the people seen by the court make the decisions they do. 

A focus on the “why” means the court system is working to treat the person, not the behavior, said Elizabeth Watkins, Family Justice Director at the Williamson County Attorney’s Office in Georgetown, Texas, who began her career as an investigator with the state’s CPS.

Behaviors will manifest in many different ways, Watkins added. 

“There’s no quick fix to the ingrained, dynamic and generational toxic stress that our clients have experienced,” Watkins said. “We have to remember that their behavior is a symptom and not the true potential of the individual.”

People may not be ready to receive information the first time the court system touches them.

Clients dealing with substance use issues often have not developed the means for internal regulation, so they need external regulation, Watkins said. External regulation can involve co-regulation — responsive interactions to provide coaching to the client — and keeping a consistent schedule.

Education level and the effects trauma has had on a client’s ability to receive and digest information should be considered when communicating and setting goals, Watkins said.

It’s important not to overwhelm people “who can barely plan the next meal with a service plan that is 10 pages long with no order to what needs to be done and expect them to figure it out.”

Watkins said assumptions on emotional or intellectual ability should not be made based on age and physical appearance, because trauma can stunt growth. The same can be true of assumptions about people’s motivations.

An attorney from the Texas court team, James Carter, said he often hears lawyers or others in court systems say, “I’m not going to care more than they care,” when talking about drug use cases.

But Carter said, “Well, guess what? You have to care more than they care, at the beginning. Because they don’t have the capability. They’re compromised. They’re compromised emotionally. You’re not.”

Clients who are addicted to drugs will manipulate you, he said, because that is often how they have survived. 

“They have to know ‘Is Dad in this mood, or what do I have to say to not get beat, what do I have to say so this bad thing isn’t going to happen to me?” Carter explained. “When you spend your formative years having to do that, you’re going to have a skill.” 

Warren agreed, using the misnomer she has often heard “Mom loves the pipe more than the kids.”

During the first phase where risk is being assessed, supervised visitation with children is allowed. Clark’s court maintains it should always be allowed to maintain the parent-child relationship, unless it is unsafe for the child’s well-being. 

When it comes to the children in these cases, a trauma-informed court gives them a voice in the process. 

Attorneys meet with the children personally, rather than relying on reports from CPS, so the children’s needs are a factor in the court’s decision-making process.

“The only way this works is if that child has a voice — a voice that speaks for them, not about them,” Carter said. 

II.

While Clark’s court identified Warren’s history of trauma in phase one, addressing that trauma required much more time. Phase two of Clark’s court does this through individual counseling and trauma group sessions, which can only begin after the parent completes drug treatment.

These services in Clark’s court range from training on trauma-informed approaches, such as TBRI and an attachment theory-based intervention called Circle of Security that teaches caregivers to become responsive to their children’s needs, to group therapy sessions.

Throughout Warren’s time in court, the team praised her for accomplishments, through small gestures such as verbal praise or larger gestures such as sharing cake or a meal out. 

These acts of praise have been a key criticism of Clark’s court. Opponents say these celebrations indicate Clark is too soft or lenient. 

When asked why praise works, Warren said, “It’s very simple. I was still a child.”

Acts of praise do not take much effort, Warren argued, but they meant everything to her as she had not previously been supported in that way. 

Warren also said positive reinforcement from Clark made her feel personally connected. Warren did not want to disappoint Clark, she said, and that personal relationship remains clear today as Warren refers to Clark as “grandma.”

While court staff praised Warren for progress, they also held her accountable.

Clark’s court tasked Warren not simply to get clean but to “surrender to the process,” a phrase Clark uses to signify people are truly invested in recovery. At first, Warren did outpatient treatment for three months, but she said she was not surrendering, which sent her back to phase one.

Clients also pay for their own treatment, which Warren experienced first-hand.

After outpatient treatment did not stick, Clark sent her to a sobriety house, a seven-month stay she did not want at the time but in the end was on the hook to pay for herself.

In this particular facility, residents could not leave for a certain period of time. However, over time clients are permitted to earn income outside of the home in order to pay for the services. 

Clark added, “This is not welfare. This is about how parents live. We’re teaching them how responsible parents live.”

While client’s pay for treatment such as sobriety living, funding is needed to offer other facets of treatment, such as the assessments and trauma-related trainings.

Clark’s court used drug-court grants, private donations, scholarships and other means to secure these programs. 

DeSanto Kellogg said she does not intend for added programming to cost Ashland County more money. She said she will be looking internally, at staff already qualified or who could be qualified to run these programs. 

“There are a lot of things that I do, or could do, that aren’t really about costing more money, and that’s going to be the first place the court starts,” she said, adding there are also grants available.

Another facet of a trauma-informed court is that everyone works together.

Carter stressed a team concept, rather than an adversarial approach, which he said is the “normal system.” Under a team concept, all participants work to achieve the same purpose, which is to maximize the outcomes for families. 

This team includes the judge, trauma and substance abuse evaluators, psychological evaluators, CPS supervisors, CPS attorneys, parent attorneys, children’s attorneys, CASA volunteers, mental health providers and substance abuse providers. In Clark’s court, these stakeholders meet at least once per month. 

While CPS typically has all the control in custody cases, for example, Carter said in his Texas court that is not the case. He argues it should never be. 

“In our court, everyone’s a team,” Carter said. “I started understanding that the team concept doesn’t mean you partner with CPS … the team concept simply means that everybody has the same goal and everything you do, you do for the same purpose.”

In order to work as a team, trust is also needed, Carter said. He does not condone trials by ambush or “gotcha.” Without trust, litigation becomes punitive and counterproductive, he said. 

While the Texas team said the goal is to work as a team across sectors of a case, there has to be some level of confidentiality. For example, the Texas team hosts trauma group sessions, and currently CPS is present, which often means parents will withhold information for fear of punishment, said Jennifer Gregory. She has done everything from case management, social work, parent education, and individual and group counseling for the Smith County court system. 

“While you want to be a team, there does need to be some boundaries for true progress, for true transparency,” Gregory said. 

III.

Warren remembers the day she got her children back and they moved into a new apartment. They did not yet have a table, so they ate pizza on a box. The lack of furniture was not a concern, though. Her children were safe in her care.

“We were so happy,” she recalled. “They were so happy.”

During the third and final phase of Clark’s drug court, the court orders a monitored return of a parent’s children — if it believes the child can be returned safely. Court staff does in-home coaching at this point.

When people first enter Clark’s court, they often do not have the means for internal regulation. Now, the regulation for Warren came from within.

She had a clear plan on how to remain clean, but also on what parenting strategies she can use to provide a safe home for her children.  

“Building those coping skills, the repetition, preparing for stressors in drug court — that was so stressful doing all that stuff … I was able to work two jobs, take care of my kids and get my master’s degree,” Warren said.

“Drug court will prepare you for the hardest battles in life, for sure. I think that’s what helped me to see I have more purpose in life. Yes, this is something happening to me, but I’m more than this situation. I can overcome it.”

In retrospect, Warren says her life trajectory changed the day she stepped into Clark’s courtroom. But, at the time, all she wanted to do was be with her children, because she was scared, she said. 

“I’m all for family reunification, all of that, but I definitely had to heal years and years and years of trauma on my own without my kids present,” Warren said. “Because I would come back from trauma group just completely disorganized, and so there’s a lot of things I’m glad they didn’t see during the process of me getting well.”

Does it work?

Overall, Smith County — the county Clark and her team worked in — experienced lower rates of revictimization of children returning home or receiving in-home CPS services with the Texas Department of Family and Protective Services.

Smith County had the lowest percentage of reconfirmed victims when compared with the five-year outcomes of children in DFPS care in four comparable Texas counties, specifically with the most similar numbers of children in care. The compared counties included Potter County (22.4%), Tom Green County (20.4%), Johnson County (15.8%); Webb County (14%); and Smith County (9.4%).

In terms of reconfirmed victims, Smith County had the lowest percentage when compared with the two Texas counties most similar in child population, also based on the same five-year outcomes. Smith County had  9.4% reconfirmed victims, whereas Jefferson County had 20.7% and Brazos County had  18.9%. 

Clark and her team also view fewer jury trials as an indicator of success, specifically because it indicates a collaborative rather than an adversarial approach to handling cases. Clark did not have any jury trials between 2008 and July 2018, and contested hearings in most cases reduced in most cases. 

It is important to note this would not be a measurable factor in Ohio, as CPS jury trials are largely not permitted. 

The Smith County data was not gathered in a controlled study. Other factors could be at play. Clark and her team said the exact effects of implementing TBRI in their court are difficult to quantify, and their approach was not effective 100% of the time. 

“I don’t want anyone to get a misconception here — everybody who goes to this program isn’t successful,” Carter said. “We have people who walk away. We have people who won’t participate. We have people who give up.”

Clark said while they offer the tools, the client has to pick them up for it to be effective. 

Clark and her team said they continuously asked for stakeholder feedback, and they often learned by trial and error.

One recurring problem was finding trusted providers and counselors. Before finding Gregory, they had gone through several other assessors, and once they had her, the team needed to expand its base of providers to keep up with court needs. 

Others can learn from the challenges the Texas court overcame, but sustainability remains a concern.

The Texas court is no longer using all the facets of the trauma-informed system it had under Clark since she retired in 2018. 

In both Texas and Ohio, judges run for election and are not appointed, therefore continued community support of a trauma-informed court system — and the election of a judge who shares that support — would be needed for continuation.  

Sustainability has yet to be proven. But for people such as Warren, the effectiveness is clear.

“I learned skills that I was not showing growing up,” Warren said, “and now I can implement it with my children, with the children I work with, with co-workers, with church members or strangers.

“(Clark’s court) saved my life, and it’s just so great in return I get to help others. It’s a ripple effect.”