Healing neen trauma informed care

Tonier “Neen” Cain is a renowned expert on trauma-informed care. She also spent nearly two decades addicted to crack cocaine and in and out of the criminal justice system. For this Discussion, you consider her powerful story of recovery and consider the awareness her experiences can bring to care of women and trauma survivors.

To Prepare (Please See Attachment)

Watch the video, “Healing Neen,” in the Learning Resources.
Reflect on the circumstances in Tonier “Neen” Cain’s life that contributed to her choices, criminal activity, and involvement in the criminal justice system.

Post by Day 4 of Week 8
-Describe Neen’s relationship with her children and mother, drug activity, prostitution, and experiences with the criminal justice system.
-Reflect on how the experiences for females in the criminal justice system are different from those of males. How was ---Neen’s experience uniquely female?
-How might her experiences have been different if the criminal justice system had provided evidence-based treatment specifically for female offenders?

I'm about to go back into the Maryland Correctional Institution for Women to do a presentation for the inmates

here. Just four years ago, I was an inmate here. It's good to be on this side. It's good to be on this side.

I heard about Tonier through the different partners that we have in the community. Her name is out there. She's

known by lot of people for the positive work that she's doing. And you wonder how could someone be so happy

and jovial and have gone through all of the trauma that she's gone through in her life?

Hello. OK, so this is D building. This is the very last housing unit that I was in. Just four years ago, this was my

home.

In 1989, I remember the first time I was here. I went through the jail system. Thefts, prostitution, prostitution,

prostitution, possession of CDS, possession of open container.

I'm coming into work at the National Association of State Mental Health Program Directors.

My mother had a way which she hit you. She would hit you with a belt, and she would hold the strap or the belt so

the buckles would hit you. And she would hit you in your face and your head with it. So we often got a lot of scars

from the belt buckles.

And this is my mama's birthday.

This was in '94. And this point, I was homeless, sleeping underneath a bridge, eating out of trash cans. I couldn't

go in anybody's house, including my mother's.

He brought me down here to get with him. He'd say, no, don't sleep in bus stops no more.

A lot of times I was beaten.

These-- these two houses were crack houses.

Scrunch down here and take a hit of crack right here.

This is a very secure building.

And this is my office. I have a office.

I have scars. I have a scar right there.

Right here, I have-- you can't really tell-- two black eyes and a busted lip.

Thank you for receiving us here in El Paso. My name is Tonier Cain.

I was molested, I was raped. I was raped, I was beaten, I was raped.

And I was like, this is how it's supposed to be for me. I am nothing. I'm never gonna amount to anything, and this

is how it is. And I'll stay here. I die just like this. And I had become comfortable with that.

Please join me in welcoming Ms. Cain here to MCIW.

[APPLAUSE]

Good evening, ladies, and thank you so much for coming out and spending a little time with me tonight. I'm so

thrilled to be here, to be able to stand in front you beautiful, wonderful women and just help you to understand that

it's all about you. So I'm telling you. I'm standing before you with 83 arrests and 66 convictions. They say I was

going to spend the rest of my life in jail or die in the streets. And I'll tell you today, not so. Not so.

[APPLAUSE]

And you know, I end up with a drug addiction. I'm 19 years. But you know, I don't have to tell you about what it is

that goes along with drug addiction, do I? I really don't. But what I want to tell you, that it wasn't using drugs that

was the problem. It was what happened to me as a child.

My mother would entertain a lot of different men. She would be partying, and you would hear her singing and

laughing. But when the music stopped-- [SHATTERING GLASS] I knew I was gonna start hearing the footsteps

come towards our bedroom door. And at age 9, I positioned myself in front of the bedroom door to protect my

brothers and sisters, but in the event, it made me available to the men. I brushed my teeth because I thought

maybe I could brush away the smell of the men when they did the acts to my mouth.

My mother's an alcoholic. She's always been an alcoholic. And sometimes she would leave the household two and

three days at a time.

Well, finally at age 11, somebody thought that something was truly wrong in the household. Because we were

always looking out the windows, but we weren't allowed to play. My mother wouldn't allow us outside, because she

did not want anyone to know what was going on in that apartment.

Well, somebody thought that was wrong, and they called the Department of Social Services. And when Social

Services came into the household and seen the conditions we were living in, they immediately removed us from

that household and put us into foster care. Well, we ended up going to court.

And I remember the court date. I was excited, because I would see my brothers and sisters. And we were on a

pew. And in the front, my mother was there. She was crying, she was really upset. And sitting beside her-- y'all, I

don't know where they found him at-- was my father.

He was sitting there, not to say, I'm gonna take my kids home with me, but to give reasons why he wasn't. So nine

family members was allowed to choose each and every one of us. And I end up with my cousin. And she was a

nurturing and good person.

This is my cousin. She's actually my second cousin, but when I was growing up, I always thought she was aunt,

because the older generation was like aunts. But when I came into your household, and you guys gave me so

much love, and you showed me how to take care of myself.

And it was a good time, because I was getting up there in aging. Because I never knew how to wash myself or

wipe myself. Barbara didn't teach me that. So you taught me all of that stuff. I remember you being in the

bathroom with me.

Just showing her--

Showing me how to take care of my hygiene, because I didn't know. And talking to me. I mean, patiently talking to

me. I wasn't used to being like a normal kid, because the living situation I came out of.

My mother came to the household where I was living. And she called me-- Neen. Because that's what my mother

calls me. So I ran downstairs and I opened up the door and I ran and she hugged me, and she said, I love you. I

want you to come back and live with me. She told she loved me, the words that I'd been dying to hear from her.

I was crying 'cause I knew I was knew I was miss you. But I was crying, and you were born to her, where you

going to stay, and going back home to your mother. And I just kept praying on the inside that everything was

going to be OK.

Within a week, she severely beat me in the middle of the street for trying to go to school. By then, she had had

more kids. I realized she wanted a babysitter. She didn't want me back 'cause she loved me.

That's my mother over there, in the white.

Aaahhh.

I know, I'm just saying.

I know you-- [INAUDIBLE].

I've desperately needed my mother to love me. Sometimes I would be tired, don't want to get hie, but she wanted

to get high, so I would go out and prostitute so she could get high. Just so she could love me.

I thought that I had to earn her love. I mean, I thought if I go and prostitute for the drugs, she'll be proud of me.

And she would use the drugs and get mad 'cause there's no more. But that's how I always ended up with her.

How much? How much you need?

What're you gonna give me? $10. I don't know.

Yeah. I'm going to go get me--

I know what you're going to get.

A beer. A big one, this time, 'cause I'm going out later.

Well, I didn't know how to live without my mother, 'cause I knew I couldn't live with her. So I remember taking the

overdose. I remember waking up in the emergency room. I remember when nobody asked me, what happened to

you? I remember them telling me, you're going back home with your mother, and being terrified.

So she had came up with this great idea that one of her drinking buddies who thought I was cute-- he was 24, I

was a child, basically-- wanted to marry me. What was that? An opportunity to make my mother proud of me once

again. I jumped on it.

I'm walking down the aisle. She signed the papers. I didn't even have to be there, because I was a minor.

So I moved, so I'm married. I'm married, and my mother's living with me, and my husband would come home and

he would do like this. And if there was dust on his finger, he wanted to know, what was I doing all day long that I

could not dust his house? There was many beatings because I didn't dust his house.

Age 19, somebody came to me and said, try this. And it was crack cocaine. I didn't get no beating from dusting the

house no more, because after one hit of crack, I cleaned my house, I went upstairs, cleaned the neighbor's

house. I was outside washing everybody's cars.

Shoot, I didn't get beating no more. But you know what? Using crack cocaine introduced me to the criminal justice

system.

All right, give me a hug.

All right. I love you.

I'm gonna go over here, 'cause they wanted me.

Hi, sweetie.

[INTERPOSING VOICES]

Nice to meet you.

I was prostituting and I lost five children to the system. But this time-- (WEEPING) this time--

She was triggered.

Yeah.

I was wondering, is it possible she could be in the group tomorrow? Just to--

Yeah. Absolutely. Did you-- did you just--

So you ladies was chosen because we think that your story, you collaborating with my story, and sitting here, just

doing this focus group, just talking about where you been, and how things feel for you now, and then where we

want to go.

My parents were heroin addicts. In the county where I'm from, it was heroin addiction. Foster care systems,

psychiatric facilities, I went through all of that.

I never told my mother that my brother used to molest me. This is the first time I'm telling that now.

Well, my mother not just getting high. Her friends get high. People on her job get high. They get together and

have a party and get high.

My father would beat my mother all the time, so I saw that. And I ended up going through it myself. Every

relationship I've ever had has been abusive. And if they're not abusive towards me, I'll be abusive towards them,

because I feel that's how they show me love. They don't care about me if they don't put their hands on me when I

do something to hurt them.

My mother sacrificed me for the sake of keeping a man. And my first time being molested, I was four years old.

My mother took my hand and gave it to him, and told me, you're going with him to play with his nieces.

But when we got to where we was going, wasn't nobody there but me and him. And I remember it being really,

really dark. But when I came back, I felt different. And I remember looking at my mother, and it seemed like she

didn't see anything wrong.

And I remember when she took me in the room that night to put me to bed, I wondered why she didn't notice I

didn't have on the same panties. Even now, I'm 37 years old, and I sleep with the covers tucked under me for

security.

80% of our population has been traumatized. The trauma is the underlying reason and the basis that leads to the

self-medication, the drug use, and then eventually landing in jail.

But I didn't know how not to come back. I didn't know how to stay clean. And something inside of me just-- I didn't

have the motivation to want to be sober. Because I went back to my reality-- homelessness, putting myself in

harm's way, staying with people that was going to beat me and hurt me and stuff. Like-- you know, so it was easy

to just drink and drug. And unfortunately, it landed me right back here really quick.

I spent many, many years working in the state mental health system. I mean, I started volunteering when I was a

kid, 14 years old, in the state hospitals. So I spent close to 15 years at the maximum-security hospital at Clifton T.

Perkins, and then I went on in the state of Maryland to be director for special populations, where I had the

responsibility for services to people who were incarcerated, people who were homeless, people who had

substance use issues. I've kind of done everything from the clinical work to the administrative work, to now looking

at promoting what my passion is-- trauma-informed care and the understanding of trauma in the lives of those that

we serve.

Up to 90% of individuals who are in the public mental health system have been victims of trauma. About 85%, we

know from the Department of Justice, of girls in the juvenile justice systems have been the victims of early physical

or sexual abuse. About 97% of homeless women who have mental health issues have been the victims of trauma

while they were on the streets. 87% have been the victims of early childhood abuse. Over 50% of women in

substance use programs report histories of incest. I mean, it's just-- it's just universal.

And so this is the ACE study, matching in this very middle-class population, a population that is exactly half

women, half men, by chance. 80% white, including Hispanic, 10% black, 10% Asian. 74% have been to college. In

no way is this some dismissible group, you know, that yeah, maybe those people across town, et cetera. This is

basically you and me. And what we found was extraordinary. A, the prevalence of these ten categories, and B, the

remarkable effect that they had 50 years later.

28% of the women have a history of childhood sexual abuse. I mean, who the hell would know that? In terms of

injection drug use, a person exposed to any four of those categories was 1,350% more likely to become an

injection drug user at some point later in life. If you go to ACE score six, exposure to any six of those categories,

you're wildly off the scale, because now it's a 4,600% increase in the likelihood that an ACE score six individual will

become an injection drug user, as compared to an ACE score zero individual.

I mean, so you know, I mean, the epidemiologists at the CDC told me, look these are numbers that we see once

in a lifetime as an epidemiologist. Once in a career. So the numbers are of extraordinary magnitude.

Dr. Felitti, hi.

Hey.

Hi.

How are you? Nice-- nice to see you.

It's nice to see you. Thank you so much. I'm so thrilled. How was your travel in?

Pretty easy. It was interesting, coming in yesterday, because the city's changed a great deal. In some ways for the

better and some ways for the worse.

I met Tonier Cain several weeks ago at a conference here in Baltimore, when this sensible young woman came

up and looked me dead in the eye and told me that she had an ACE score of 10, that she had experienced all 10

of the categories that I was talking about.

I don't spend a lot of time around my mother, because like I said, she's still abusive. But I go to pay her bills and

all, make sure she has food in the house and everything. Because she's not only alcoholic now. She's a crack

addict.

You know, I looked at her, and I could see the sadness. She was sober, you know, 'cause she was just getting up

in the morning. And I just-- I wanted so badly to reach out and hug her. But she wouldn't allow that. My mother

won't allow us to do that. We're not even allowed to call her Mom. We call her Barbara.

Any thoughts why?

I know. You know, I never really thought about it.

Well, maybe being called mother imposed a responsibility that she didn't feel up to.

Yeah. Yeah, that's true.

[ENGINE REVVING]

[TIRES SCREECHING]

Well, this is one particular day, I had made a deal with these two guys. And they had had, like, a massive amount

of crack. And I went to them, I said, well, you know, they was trying to talk to me to get me to some sexual things. I

said, well, you give me this amount of drugs, I'll do this, this, this, and this.

Well, I thought I was a good negotiator, but I guess I wasn't. 'Cause when when we were going behind this

building, they started to talk among themselves, and when we got back there, they were saying, well, we're not

going to give you anything, but you're still going to do this, this, this, and this. And after they did that, they beat me

really bad. They spit on me. And when I-- and then left.

You know, when I was able to get up and get around here, there was a officer standing against his car. And when

he seen me, I was walking to him and I was in a lot of pain. And I was-- when he seen me, he was like, Ms. Cain,

we've been looking for you. Because I had a failure to appear warrant.

I was trying to tell him that these two guys that's walking past us laughing at me just did this to me. He thought I

was trying to-- I guess you thought I'd run off, and he thought I was resisting, so when he grabbed me, he

grabbed my arm and put it behind my back and threw me against the car, which cracked my nose open.

I'm not angry with them, because people that do things like that-- I mean, we're talking about two guys that's

caught up into their street world, and all they know is hurt and violence, 'cause that's what they grew up with. And

my only hope is that they're not doing that to anybody else. Because they think it's OK, 'cause they haven't

acknowledged it. You know?

But I see people that hurt me all the time, that raped me. I see them all the time. You know? Annapolis is very

small.

Tell me something about cocaine. What's the good part of it?

What's the good part about crack cocaine? It's a number. It absolutely, positively numbs out any feeling you have.

Only for a few seconds. That's why you gotta keep doing it again, to get-- but there is no concern.

I mean, I used to take a hit of crack cocaine, and I used to get high on the fact that I had it in my hand. It didn't

even get in my system yet. But because I knew in the next three seconds I'm gonna be somewheres else, and I

don't have to deal with reality.

An effective treatment.

An effective treat--

And that kind of forces the question, treatment of what?

Right.

Which is kind of uncomfortable for a lot of people to hear. And I think I had mentioned to you about crystal meth,

and how pretty much everybody knows that's the most commonly sold street drug in the country. And no one

seems to know that the first prescription antidepressant medication, introduced in 1940, was methamphetamine.

That's amazing.

And it was the main prescription antidepressant for the next 20 years.

That is amazing.

So does that mean something? Yeah, well, then you get to think, well, it's a lot easier to say to somebody, my kid's

on crystal meth because of the damn drug dealers in the neighborhood, than it is to say, my kid's buying

antidepressants on the street.

Right, right, right.

I couldn't use drugs and alcohol, 'cause I was in jail, so I had to find something to help me cope. And that's what

helped me cope. I just-- I would fight, I would argue, I would cuss. I'd go on lock, and I'd get off lock, I'd do my lock

time, and, you know, oh well. See you all later. I'll be back. I'll be back.

And I would mutilate myself. My thighs, my neck had cuts, my arms. And it wasn't to kill myself. Just to get the pain

out. That was just a way to express the trauma.

I felt helpless. I felt powerless. And being a woman in a powerless situation, it brought trauma, because the

trauma came from those situations where though I was taking advantage of it, I felt powerless.

Would you mind-- Christine, do you mind if I see where you would hurt yourself? Can I see that? 'Cause I know

you showed before. What did you use?

I would take and bust the glass out in my room, and take the pieces of the glass and cut myself up. Cut my neck.

I'm would break the toilet seat, break the glass out the doors and the windows.

Or I'd take a staple. I'd take the staple out the bed. Or I'd take a-- I took an eggshell one time, the hard on the

eggshell, and yeah-- just to get that pain out.

Being locked in that room, nobody would want to deal with me, nobody-- it's the environment, too. Trauma, the

Being locked in that room, nobody would want to deal with me, nobody-- it's the environment, too. Trauma, the

environment. You know, environment is like the core, is like the set-up for trauma. And being in that environment

and being locked in that room, small as a bathroom, behind that door 23, 24 hours a day, already having trauma

issues, it didn't help at all.

In the detention center I had suicide watches. And because I wouldn't stay on my medication that the psychiatrist

prescribed to me, they would put you in segregation. Then they stripped me down, because you're suicide.

You're nude, so you had the male officers coming around, flashing the lights while you were in here nude. No

mattress. No clothes. And you had male officers that's coming in, checking, laughing at you.

Lay down, spread your legs open. And that was my experience at the county jail. Or they would do things like--

you had a couple of them that would open up the slot and they would put their penis through so you could give

them some head. And they would give you like a cigarette or something.

So the men was able to do things if I was being watched, and they could hear the door open. So they would put

their penises through, through the little slot, and say, give me some head, I'll give you a cigarette. Give you some

gum. Yeah. Oh, I know, girl, but it's just--

Give her some tissue.

And that was one of the earliest experiences of my incarceration. And you did things because-- and not only, you

know, if it was because they was promising you cigarettes or nothing, but just because somebody was there for a

moment. You know? Thank you.

So yeah. Yeah. That was the whole experience of being in seclusion, for the hole, at the jail. That's all the things

that came with that. And there wasn't any therapy, because even when the psychiatrist come, he'd just give you

more and more medication.

Yeah, why is there no trauma treatment? You know, I think there's not a whole lot of people trained to do it. But

then you have the non-believers and some of the old guard, that still thinks, you know, you can just give

somebody a pill and it's all going to be better.

The issue of the public health paradox is really what forces one to recognize, if you wish to think seriously about

this at all, that so-called trauma-informed care really becomes essential. Trauma-informed care is understanding

how the thing that you're dealing with is the problem, really is also someone's attempted solution to traumatic

experiences in life, usually-- not always-- but usually in childhood, overwhelmingly unrecognized, and further

protected by deep shame, by secrecy, and by social taboos against exploring certain areas of human experience

that are just terribly uncomfortable to explore.

Trauma-informed care is an entire culture shift. It takes traditional practice and flips it upside down. It isn't just

teaching someone, you know, what is trauma and why is it so important to address it? It really forces the system

to totally, totally redo and rethink all of their practice. And coercion and all of those practices-- seclusion and

restraint, coercive practices, level systems-- I mean, there's so many practices that need to be flipped upside

down.

Sleeping on the streets, underneath the bridge, eating out of a trashcan. Not even having the desire to live

anymore. Five years ago, I didn't think anybody could help me.

And this is the bridge. This is the bridge. I'll go down and see. Hi. How y'all doing? [? Jay ?], we're about to come

down here and do some filming, so you might not want to be doing what you're doing.

Home for so long. For so many years. I just remember, just hearing the cars, the cars going over top of me. That

would brought memories back, because I would lay here and I'd hear the car. And in a way, that gave me some

peace, because you know that people is there, up there. It was like, you know how you hear crickets, some people

hear crickets at night and it gets them soothed, it soothes them and put them into a peaceful sleep? I would hear

the cars.

It just was all just mud and sand. And they put these bricks here, I guess to stop people from sleeping underneath.

And now they have nowheres to go.

But just a little less than five years ago, I was sleeping under here. Taking a hit of crack. Pass it to you. When it

comes a point when we feel safer underneath a bridge, a filthy, bridge, where we're exposed to violence and

rapes and everything, when it's safer out here, there's a problem there. There is a problem.

I felt safer right here than anywheres else, this and jail. And that's sad. For 19 years.

What's today [INAUDIBLE]?

We going to Mama. Oh my god.

Thanksgiving Day?

Yes. That--

What are you thankful for?

Mommy.

What?

There you go, you did it. It won't turn. See? You did it.

Let me try now. I did it. Come on, let's go.

We're in Newtowne 20, in Annapolis, Maryland. It's one of the highest crime-rate areas, project communities. It's

where my sister Tonya lives.

Happy Thanksgiving to you, too. Hey, Teli.

What's up? And I'm telling you now, something's always gonna end up. Somebody's going to be mad at

somebody, or there's gonna be an argument.

This is my sister Tonya.

I know, she's leaving us.

Where you going?

Yeah, she's moving to Georgia. She's going down south.

Yes, I am, and I cannot wait. You guys want to go?

Don't take-- I didn't ask you to take them out the pack.

Get your [INAUDIBLE] up. I can't take-- this is stressful.

Put 'em back in the pack.

Why am I putting it back in the pack?

Nobody's eating them.

Hello, hi, everybody.

This is my sister Shannon.

Hi!

Y'all remember Shannon.

If she's not ready, call, or if she's not ready, just come back here. We'll get her when we get her. All right. My

mother is so intoxicated that she can't get it together. So this is a really, a nice Thanksgiving Day.

[CHILDREN LAUGHING AND PLAYING]

Yay, Alandra!

[LAUGHTER]

[KIDS SHOUTING]

Mama!

No, nothing but the homegrown.

Hey, ma.

That I made today. That I made today, the chitlins.

Hey, Happy Thanksgiving.

Thank you.

Hey, Happy Thanksgiving.

Whew. Here we go.

Who's drinking, besides me?

[CHILD WAILS]

Who fell? Brandon?

This is every Thanksgiving, every Christmas, everybody.

I just want to make sure I had enough food for everyone to eat, get full, and take a plate if they want.

[ALL TALKING]

Are you guys [INAUDIBLE]? mad at him.

[ALL TALKING]

Grandma, Grandma.

Neen makes salad like, like y'all do-- lettuce, tomatoes.

I make salad like I like. It don't have nothing to do with the color.

It's gross as shit.

Oh my god!

Put that bottle down.

(SHOUTING) No, you! That's why I'm leaving.

Put that goddamn bottle--

I bet you that's why-- Because of her is why I'm moving. Just because, just because, and I love her to death.

Anytime she ever, ever, ever, ever need me, I'm gonna be there. But right now, she don't need me. She wanted to

do her and be her, so I'm gonna go and do me.

I'm 59 years old. I'm tired of drinking. I drink a lot. I drink beer. I'm tired of it, tired of it.

[ALL SHOUTING] But I don't need no-- I don't need to go to rehab because I don't need no-- I just drink beer, you

know? I don't even know why I drink. Right now, right now, puzzle. But I want to stop. Don't even know how I can

stop.

[SOBS] I'm a good woman. I live on Social Service, give me money, food stamps. They never came to me and

said, Barbara, come here, hug me, kiss me. All they wanna do is make me pregnant.

I love all my kids. I got ten daughers-- I got six daughters and four kids. Sons-- four sons.

I'm getting out of here. I am--

And you know what? I love all them. But you know, I won't pretend to be best mom, I would-- I was never-- I was

never the best mother in the wild world. I did my kids wrong. They got taken from me. It's emotional.

There's my son. Come here, come here, baby. This is my youngest son. His name's Monterae. I love you, gimme