This story was reported in partnership with the Springboard Project at Type Investigations.
Antonio Caballero Villa, 47, was an onion farmer in Mexico before he was shot. He looks haunted as he recalls the day he says he remembers vividly. He remembers being tailed by members of a cartel while in his car with his father, brother, and cousin. When they stopped to confront them, shots rang out.
His memories from this point remain fuzzy. He was told that EMTs revived him on the scene of the shooting. He was taken to the hospital, where he later learned that he was the only survivor.
In the days after the shooting that injured him and killed members of his family, he couldn’t sleep for almost a month. Two years have passed since his shooting, but he remembers waking up feeling like he was dreaming.
“I want to scream loudly, to free myself from this nightmare,” he said in Spanish. “But it’s not easy.”
He struggled with staying motivated in recovery, he said. He thought about giving up but kept pushing forward for his family, especially his wife and five kids, three of whom live with him in southern California. After relocating to California from Mexico, he got some physical therapy but not much more medical help. It was eventually his sister and circle of support who encouraged him to seek support last year at the Olive View Trauma Recovery Center.
“A lot of people won’t admit when they feel bad,” he said. “I’d never done therapy in my life before what happened to me and before we came here. Initially, I thought, ‘No, therapy isn’t good for anything,’ but I see I was wrong and that it helps a lot.”
More than half of American adults have experienced gun violence or cared for someone who has, and gun-related crimes leave many of these survivors forgotten, untreated, and left to pick up the pieces of their lives without the support they need. This often means navigating life with an additional trauma: a wound or disability or grief, depression, anxiety, and post-traumatic stress.
Recovery for many is difficult and costly. Going through public legal or criminal legal systems to obtain financial support and mental healthcare can mean jumping through challenging hoops when survivors are at their most vulnerable. In this landscape, trauma recovery centers serve as a rare, and underfunded, safety net of comprehensive case management and mental health services to survivors of violence for free.
Trauma recovery centers, or TRCs, offer a relatively new approach in care for survivors recovering from a violent crime, with 54 trauma recovery centers in 13 states and more on the way. TRCs are increasingly co-located in community centers and hospitals and family justice centers across the country. Nearly half of these centers are in California, where the model was first created in 2001, thanks in large part to an amendment passed a decade ago that sought to use funds from prosecuting white collar crime to create development grants for these types of centers.
A decade later, 24 additional trauma recovery centers were created in the state and found relative success, with most located in the Bay area and Los Angeles County. Estimates are that nationally, therapy and case management at these providers help about 20,000 people every year who wouldn’t otherwise have the access to care after a violent trauma starts to heal, and they return to work and pick up the pieces of their lives.
As of this year, though, many trauma recovery centers in California are losing a significant amount of grant funding from the state — anywhere between 30% and 60% of their total budgets. That’s because these grants depend not on tax dollars but on a combination of the state’s savings from reduced incarceration, victim restitution funds, and money the state collects from the prosecution of white collar crimes. When these savings dip and fewer cases are being prosecuted and fined at the state and federal levels, the drop in available dollars disrupts crucial care for victims of violent crime for the foreseeable future.
“This is care delivery,” said Breena Taira, administrative director of the Olive View Trauma Recovery Center in Sylmar, Calif. “There are so many people who have been victims of crime [who] can benefit from TRC services, both the mental health aspect and the wraparound case management, that it can be very disruptive to not have a stable budget and to not know how the funding might be sustained into the future.”
How trauma recovery centers help
Survivors of violent crime are often not reached by victim service providers, according to the Alliance for Safety and Justice, and too many still don’t get the help that they need. Most adults coming to TRCs are economically stressed, but the centers allow them to receive a variety of free therapeutic treatments and case management to help them heal. Gena Castro Rodriguez, executive director of the National Alliance for Trauma Recovery Centers (NATRC), said the trauma recovery center model takes a more sympathetic, trauma-informed approach, helping people from the start of their journey to recovery.
People usually find out about TRCs from their doctors, local community organizations, family members, or police departments, but unlike some victims services, clients do not have to engage with the criminal or legal system to get assistance from TRCs.
Services begin with an “intake” where a case manager or counselor checks in with a new client about how they’re doing in the moment and identifies where the client needs support based on their situation. They then help clients with their most immediate needs, like relocating to a new home or applying for disability benefits or victim’s compensation. The Olive View TRC even offers legal services for clients to handle issues such as normalizing immigration status.
Then counselors identify a therapeutic treatment plan for clients. Participants receive up to 16 weeks of free therapy with a counselor, with sessions held at the TRC or wherever is safest for a client to meet. It’s at this stage that clients begin the work of recovering mentally from their traumatic experiences.
This model has shown promise over the years. The handful of research on TRCs reports reductions in PTSD symptoms, improved mental health, decreased alcohol use, decreased homelessness, and increased filing of victim compensation claims for clients who complete the program.There are a few studies on the impact of these programs, and what they tend to find is that this model is a cost-saving measure: Its approach costs about a third less than comparable therapeutic services. More importantly, it’s been found that many crime survivors had better access to housing and food, and were able to return to work.
When clients enter the office of Felicia Cantu, a trauma therapist for 10 years, they see a couch, blankets, stuffed animals, and textured pillows; side tables with stress balls, PlayDo, and kinetic blocks. Even fidget toys.
“I love a bunch of fidget toys,” Cantu said. “Nobody is too old for fidget toys! Or stuffed animals.”
For the last two years, Cantu has worked at the University of California, San Francisco General Hospital’s Trauma Recovery Center (SF TRC), where the TRC model was born. Like other TRCs, SF TRC supports and advocates for the needs of clients coming in — sometimes in a crisis — with physical and, more often, emotional wounds to heal. This could be for a variety of causes: domestic violence, sexual assault, physical assault, and gun violence.
“Essentially, we are [for] anyone [who] has been a victim of a violent crime,” said Cantu. “That could look like treating people [who] have experienced traumatic loss… [like] a homicide, meaning someone was killed or murdered. That actually extends to any family member, so a parent, sibling,” or, she added, others.
The UCSF TRC is connected to the Level 1 trauma center at UCSF, and Cantu is part of a program that sends her to victims’ bedsides to explain how they support victims of trauma and connect them with the center’s mental health services.
According to Cantu, combining case management — coordinating services needed — with therapy helps clients feel stable by meeting urgent and important life needs before beginning therapy. One of her past clients had experienced a gunshot wound and was living on the streets. His primary goal was to get bowel surgery to remove the ostomy bag doctors attached during surgery for his gunshot wound. Cantu said that even though he had PTSD and other severe symptoms to grapple with, the injury was a major source of trauma, depression, and shame for the client, and getting the surgery was his top priority in treatment. Cantu supported this goal, recognizing that improving the client’s physical health and quality of life was likely to have a significant impact on their mental health and ability to engage in further trauma processing.
Case management is just as important as traditional therapy, Cantu said: “If people can’t get their basic needs met, how are they going to manage any of their symptomatology?”
Trauma is complicated. We need systems that get that.
Memory loss, depression, sleepless nights. These are just some of the signs of a traumatic experience. According to Iris Cruet Rubio, director of the Miracles Counseling Center in the South Bay region of Los Angeles, trauma can live in the most unexpected places. Sights, sounds, and even smells can take clients back to the moment of the trauma and trigger their symptoms.
“When we experience a trauma, all of our senses turn on, so it’s not only what they see, it’s what they hear,” she explained. “Were there any particular sounds? Was there a song playing? They’ll say, ‘I could hear a radio far away.’ And there was this song, this particular song playing, so now, when they’re going about into the world and they hear this song, and it’s the same exact song, it’s going to trigger. And they don’t even know what’s triggering them.”
Trauma makes it difficult for many people to navigate the requirements of criminal and legal systems to get assistance. Being able to access TRC services without having to jump through legal hoops removes a huge obstacle to getting help.
Cruet-Rubio said that by the end of 16 weeks of sessions, their clients are in a better position to continue what she calls their “healing journey.”
Antonio Caballero Villa applied for disability benefits and enrolled in Medi-Cal, California’s Medicaid program, but he had a lot of doubts when asked about starting therapy. It would be his first experience with therapy and he said he wasn’t sure it would be good for anything. But he said he was glad he tried it.
“There are moments where I really struggle, when I’m remembering what happened to me, but I remember what the therapist said — that there’s no other way through it aside from processing what happened, to not give up. To give it your best,” he said.
He said the four months of therapy helped him manage the painful memories of his shooting and the shooting of his father, brother, and cousin. He said his treatment has also had a positive impact on his family: His healing helped reduce the weight on his family.
While there’s no definitive measure of how much it costs individuals or families to get the help they need to navigate life after a violent event, trauma therapy costs are already out of reach for many families. Nationally, it’s estimated that gun violence alone costs about $7.79 million every day in the U.S. to cover healthcare costs, including immediate and long-term medical and mental health care. This doesn’t include an estimated $147.32 million paid daily for work missed due to injury or death.
The U.S. Department of Justice estimated that the country had about 3.5 million victims of violent crime in 2022. The Alliance for Safety and Justice estimates that a trauma recovery center would have to be available per 100,000 people to adequately meet the needs of victims of crime in the United States. Trauma recovery is a public safety issue, said Sandy Felkey Mullins, a senior researcher at the NYU Marron Institute of Urban Management.
Public safety commands much more tax money: a proposed $26 billion in California for 2024–25. If the roughly $20 million spent annually on TRCs came out of public funds, it would be a drop in the bucket — less than 0.1% of spending.
“Just the focus on trauma and healing … is not something you see much in the criminal justice system,” said Mullins. However, this is seen now through TRCs, she said. “I think it really has become very central to communities as a place of safety, where you can go and get what you need .… I think they really are a shining example of the direction we should be moving.”
Were you a victim of a violent crime? Have you been through the TRC experience? We’d like to hear from you.
An uncertain future for TRCs
If everyone agrees that the model works, then why is the funding dwindling?
One reason goes back to how TRCs, and victim services more broadly, are funded. Federal victim’s services funds depend not on public health dollars but on fines collected from prosecuted crimes. This is also how funds work federally via the Victims of Crime Act (VOCA). In California, Prop. 47’s passage a decade ago takes a fraction of dollars from cost savings from reduced incarceration and applies them to the development of TRCs.
“It’s not very consistent dollars, one because that fund goes up and down, depending on the savings from that year, and two, it’s a competitive process every two years,” said Castro Rodriguez.
Grants for trauma recovery centers in California run on a biannual cycle, and how much TRCs receive in allocated funds depends on how their grant applications are graded, which is not necessarily a measure of whether they have provided services effectively or met community needs. The grant applications are reviewed and administered by the California Victim’s Compensation Board (CalVCB), which uses a point system to tier the applications that come in for TRC funding. Each applicant is placed in a tier — first, second, or third — and the board decides how much of the requested funds each applicant gets. With a smaller state pot of money available, getting into a high-enough tier can make the difference between another survivable two years and a struggle to stay open for victims.
“The whole concept of having this funded on a grant basis fundamentally doesn’t make a lot of sense,” said Olive View’s Taira. “Just like medical services or mental health services in general, [TRCs] need to be available on a long term and sustained basis because we don’t anticipate that the need is going to go away.”
Most TRCs around the country surveyed by the NYU Marron Institute of Urban Management run on shoestring budgets for the services they offer: The median was just $1.1 million annually, and 93% reported concern that financial constraints might mean a reduction in future services, longer waitlists, and service delays for clients and their families.
“I didn’t expect that the funding lines would be as slim as they were, and that they were cobbling together,” said Angela Hawken, a researcher at the Marron Institute who surveyed TRCs across the country. Her survey found that only 14% of TRC respondents are confident they can maintain their current level of service over the next five years. “They’re just surviving year to year,” she said.
Despite the increase in the number of TRCs in the state, the number of grants given has remained the same, creating unwanted competition between TRCs.
Taira said that CalVCB suggested seeking out other funding sources and donors, but for most TRCs that don’t have the fundraising infrastructure to seek out grants, that’s just not feasible.
“We’re just trying to hold it together,” she said. “With how short-staffed we are, survival of the center is more at the forefront.”
The future of funding for victim care should include supporting the existing trauma recovery centers that are doing the work, but the priority has been to fund new TRCs, Taira said. While she and other TRC directors agree that more centers are needed, their issue stems from existing ones needing to compete for their survival with more new centers for the same limited pool of money.
Supporting new TRCs “obviously needs to happen,” she said, “but it shouldn’t be at the expense of the other TRCs that are already in existence.”
Some funds focused on victim services are earmarked for research, or other areas that don’t help centers provide services, Taira said. Only a few grants exist to help, like a separate three-year grant that Olive View has to assist people in a crisis with emergency services. She said that as long as TRCs are funded without regard for the ongoing needs that exist, they are going to continue to struggle.
“It’s a reflection of their experience of grant writing,” she said of the funding process. “I think we’re really lucky we have a UCLA affiliation … but that shouldn’t be what’s necessary to provide trauma recovery services.
“In the optimal setting, it would be ‘let’s fund all the TRCs that already exist based on the needs in their communities’ and ‘let’s also look at the communities that don’t have them and see if we can fill that need as well. That’s a lot of money, but it is the next step that needs to be done if this model is to be sustained.”
All applications are reviewed and scored using the same criteria, said the California Victim’s Compensation Board in a statement to the Amsterdam News. “TRCs can provide data in their grant application responses that is considered in the scoring. A final recommendation for grant funding goes to the three-member Board for approval.”
Caballero Villa completed therapy more than a year ago, and while he says he could use more, his sessions equipped him with tools that he uses every day to manage. He makes and sells small bracelets in his neighborhood. Aside from sales, he said he enjoys getting to interact with people.
“I like to sell these bracelets that I learned how to make so that I can bring in extra income,” he said. “It’s not much I bring back, but it’s something.”
Solving the funding dilemma
Despite the constraints, more trauma recovery centers are being founded across the country. Castro Rodriguez from the National Alliance for Trauma Recovery Centers said federal dollars are being used to start new centers in states like Arizona and Michigan, although they are likely to face similar long-term funding issues as California-based TRCs.
“It’s great because they’re gonna get dollars to start them, but it’s only short-term funding, like three years, two years,” she said. Without a dedicated federal funding stream, they’re going to have to figure out how to keep these centers funded after the initial grants run out, she added.
Trauma recovery centers have recently made their way to the East Coast. New York State has five that were created in 2023, with four in New York City. Late last year, the New York City Council approved between $600,000 and $800,000 each for four centers. Including TRCs in the city budget could provide funding that is less subject to change than in California, assuming the council maintains it as a priority.
“Trauma recovery centers should be a pillar of our public safety infrastructure to support underserved crime victims and communities harmed by the trauma of violence inflicted in our neighborhoods,” said City Council Speaker Adrienne Adams in a statement. “The Council is proud to have funded the creation of New York State’s first TRCs, which will provide comprehensive services for survivors of violence in our city who fall through the cracks of traditional victim services.”
A new Brooklyn TRC recently signed a lease in East Flatbush. Lead counselor Stephanie Menyhay is excited about finally having a place for future clients to come in the door. In Coney Island, the Jewish Community Council of Greater Coney Island (JCCGCI) TRC is also one of the latest to open its doors. Director Dulande Louis said that most of their caseload already involves clients with gun violence trauma.
“This is a community that has been plagued by gun violence for far too long and I think bringing this work and so this community is really, really, really timely, and it’s quite needed,” she said.
Louis said trauma-informed care isn’t easy for participants but plays a crucial role in improving safety and wellness. “If you’re not engaging in the healing process, you will meet violence with violence. I tell people, I get it, but it’s honoring you as a being to engage in that work. And once we start collectively to do all [that’s needed] to engage in the work, we are creating a safer community for the next generation, and they deserve it.”
Noy Thrupkaew and Martin Macias Jr. also contributed to reporting this story.