When fear starts to rise up in Dakota Johnson's chest and tears well up in her brown eyes, she tries to remember to take a breath and whisper to herself: "It's not that deep. It's not that deep. It's not that deep."
Dakota is 8 years old. Math and art are her favorite subjects. She likes painting and drawing and playing with slime.
In the middle of one night in November she woke up in her dad's North Philadelphia apartment to screams, smoke, and fire. A man living on the floor below had left a cigarette burning on a mattress. Flames spread throughout the building. She and her father tried their front door, but the smoke was too thick. So he led her to the kitchen window, three stories up, and lowered her onto a second-floor roof, several feet below. A police officer happened to be driving by and was able to reach up and grab her, pulling her to safety. Firefighters helped her dad down.
The fire that burned up her Pocahontas doll, her school uniform, and her Legos also took away Dakota's sense of safety and security.
After that, she needed to know where her dad was at all times, for fear his new home had also caught fire.
Sirens made her shudder. Late at night she cried.
"I didn't know what to do," said Dakota's mom, Sheena Holbrook. "She wouldn't go to her grandma's house because her grandma lives on the seventh floor, and she didn't see an easy way out."
A school counselor recommended they try a new, community-based, cognitive behavioral therapy program in North Philadelphia. The Joseph J. Peters Institute (JJPI), which opened its doors in January with a $200,000 grant from the Pennsylvania Commission on Crime and Delinquency, brings trauma-informed counseling to kids in one of the city's neighborhoods that needs it the most.
The 22nd Police District in North Philadelphia has one of the city's highest rates of violent crime. It's also one of the poorest areas in the city. In 2016 the median household income there was $21,805, far below the city's median of $39,770, and beneath the national poverty line, which is $26,104. Kids grow up with day-to-day stresses related to poverty.
"Within the neighborhood, unfortunately a lot of people have become desensitized," said Natalie Dallard, JJPI's director of community outreach. "Experiencing community violence, seeing people getting robbed or people fighting in the neighborhood, this is just life where I live. They don't realize that this is something that's actually having long-term effects on them."
Every Thursday, Dakota's mom takes her to see therapist Levi Lee in a classroom in the basement of the Church of the Advocate. It is one of the only programs of its kind in the community, Dallard said. JJPI opened with hopes of serving 120 kids, ages 3 to 17, in the 22nd Police District. Most sessions last between 16 and 20 weeks.
"Sometimes I think children's lives are way worse than adults'," Lee said. "They just have so many rules and so many expectations, but they can't control how people talk to them. They're carrying around so much in these tiny bodies."
The kids who come into the Church of the Advocate for the program have stress related to having incarcerated parents and exposure to violence or abuse. Three of the 10 clients have been involved in house fires.
The Philadelphia Fire Department responded to 2,700 fires in buildings last year, an average of seven a day. Asked for a breakdown by neighborhood, the department said it didn't have the "analytical capacity to compile and share that data." With aging housing stock and more than a quarter of the population living below the poverty line, some in unregulated rooming homes, fires are a consistent problem in Philadelphia.
"House fires were the last thing I was thinking about when we started this work," Dallard said. "But if you live in a blighted neighborhood, or an area where housing is old and not up to code, they happen, and that can be traumatic for a young child."
Dakota wrote about her rescue to help her cope with stress. She has a "toolbox" of strategies to use when she's overwhelmed, which include breathing exercises, repeating the phrase "It's not that deep" three times, and then explaining why she realizes that danger is really at bay.
"Because I'm safe," she told Levi during a recent session. "Because the oven is off. Because no one is smoking."
"Excellent. How's your stress level right now?"
"Like a 1?"
When JJPI staffers first came to the neighborhood, they did a "world tour" of schools, barbershops, and community centers.
"Not one person told us our services weren't needed," Lee said. He thinks it's a sign the stigma surrounding mental health is fading. Philadelphia has long acknowledged the trauma that poverty breeds.
It's been nearly eight years since the city set up an institute dedicated to trauma care, both to train providers and partner on programs. The city has close to 20 partners, including Pew, Drexel, and CHOP.
According to the Adverse Childhood Experiences Survey, 80 percent of children in Philadelphia have been exposed to at least one potentially traumatic experience. Forty percent of Philadelphians reported experiencing or witnessing violence growing up.
"It's a conservative estimate that approximately 30,000 youth will need evidence-based trauma treatment," said project director Arturo Zinny, of the Philadelphia Alliance for Child Trauma Services.
Fires are one of the more physically obvious disasters children face, Zinny said. "What we see the most and with much more prevalence is the impact of interpersonal trauma, community violence, domestic violence, emotional, physical, sexual abuse, neglect, and the impact of the deep poverty," he said. "A lot of our kids are living in this constant adversity and having to bounce back from multiple traumatic events."
Lee sees about 10 kids a week. There is already a wait list. While his work focuses on children, he often asks parents to sit in on sessions and sometimes that opens up something in them.
But it can be tricky getting the right care. Holbrook, who works in behavioral health with adolescent girls, knew Dakota needed counseling, but she tried several places that didn't offer the kind of general therapy her daughter needed. Having insurance made qualifying for programs harder.
Pennsylvania offers a broad menu of behavioral health services for patients on Medicaid, but the options on the private insurance side are much slimmer, said Dr. Kamilah Jackson, the city's deputy chief medical officer for Child and Adolescent Services at Community Behavioral Health.
"The narrative is very clear that most people who have a need, don't actually get services," Jackson said.
Holbrook says her daughter has made improvements since starting the program. She goes to her grandma's house now, and she doesn't break down as much.
On Dakota's eighth visit last month, Lee gave her a book of fire safety tips to read:
"Keep the bedroom door closed." "Don't cook in loose fitting clothing."
She read it aloud before handing it back to him. He told her it was hers to keep.