lessons from the front lines: insights into trauma ... · trauma informed care “trauma-informed...

www.chcs.org

June 22, 2015

Call-in Number: 1-800-310-6649; Passcode: 799834

Alexandra Maul, MPH

Program Associate

Lessons from the Front Lines: Insights into Trauma-Informed Care for Medicaid’s Complex Populations

Supported by Kaiser Permanente Community Benefit.

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I. Welcome and Introductions

II. Overview of Trauma and Trauma-Informed Care for Complex Populations

III. Developing a Trauma-Informed Workforce: Lessons from the Health Resilience Program

IV. Questions

V. Community-Wide Systems Change: Creating a Trauma-Informed Community in Camden

VI. Questions

VII. Closing Remarks

Agenda

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Alexandra Maul, MPH Program Associate Center for Health Care Strategies

Laurie Lockert, MS, LPC Health Resilience Program ManagerCareOregon

Victoria DeFiglio, RN, BSNClinical Director, Cross Site Learning and Workforce

Development Camden Coalition of Healthcare Providers

Welcome and Introductions

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About the Center for Health Care Strategies

A non-profit health

policy center

dedicated to

improving the

health of low-

income Americans

• Complex Care Innovation Lab

• Advancing Adoption of Trauma-Informed Approaches to Care

• Resources:► Trauma-Informed Care issue brief

► CareOregon blog

► Today’s webinar

► Look for more resources in the future

CHCS Initiatives To Advance Trauma-Informed Approaches to Care

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IV. Questions


VI. Questions


Agenda

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Why Trauma Matters

• What is trauma?

• Childhood trauma is common and has lifelong consequences

• Exposure to adverse experiences can lead to greater risk of serious health problems, detrimental social outcomes, and increased costs to social service systems

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What is Trauma-Informed Care?

• Instead of asking “What’s wrong with you?” asks: “What happened to you?”

• Recognizes that trauma has effects on physical health outcomes, behavior patterns, and the physiological ways that information gets processed

• Acknowledges that many “problem” behaviors survivors exhibit are actually coping mechanisms

• Guides systems in how to avoid re-traumatizing individuals

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Trauma and Complex Populations

• The experience of trauma crosses gender, socio-economic, ethnic, and racial lines, but . . .

• Many “complex” Medicaid beneficiaries display symptoms associated with trauma:

• Higher disease rates

• Higher rates of substance use and behavioral health disorders

• Poorer social outcomes

• Is Trauma-Informed Care a way to successfully engage them?




IV. Questions


VI. Questions


Agenda

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CHCS Building a Trauma Informed

Workforce: A Work in Progress

Laurie Lockert, MS, LPCManager Health Resilience Program

CareOregonJune 22, 2015

Trauma Informed Care

“Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization.” (SAMHSA)

3 Central principles of TIC:

Create safety

Restore power

Value the individual

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What TIC doesn’t mean14

• It doesn’t mean excusing or permitting/justifying unacceptable behavior.

o Supports accountability, responsibility

• It doesn’t mean just being nicer

o Compassionate, yes, but not a bit mushy/patronizing

• It doesn’t ‘focus on the negative’

o Skill building, empowerment

o Recognizing strengths

Bottom Line: People are not trying to be “difficult.” They are doing the best they can with what they’ve got.

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Serving CareOregon’s, complex, high-risk clients, whose avoidable use of Acute Care Services is

significantly driven by complex psychosocial issues

1 Manager + 3 Supervisors

1 Program & Data Specialist

2 Triage coordinators

29 HRS’ (Includes: Housing, Respiratory, Addiction Specialists)

Contracted: 8 Peer Support Specialists

Embedded in 27 Clinics

4 counties

# Clients served: over 1,940

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Trauma Meets Trauma: Patients with trauma histories being served by a

traumatized health care system

Results thus far…

o Frequent “No shows”

o Disengagement from care

o Not following through with treatment plans

o Re-traumatizing each other

o Emotional reactivity

o Provider burnout

o Hopelessness…… For Providers & Patients/Clients!

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In the Beginning…

Create Safety

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Learning from Weekly Huddles

Gathering the stories and their impact on staff

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Learning how to hire for the work

And the workflows

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Training for HRS’s• Neurobiology of

Trauma &TIC

• Motivational Interviewing

• Substance abuse treatment options

• Domestic Violence

• Housing Resources

• Ins Benefits

• SSI/SSD –

• Cultural trainings

• Trauma Stewardship

• Palliative Care Programs

• Pain Management

• CHF, Liver Health: Disease and Care

• Diabetes Understanding and Care

• Pulmonary Conditions

• Asking the staff what they need

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2014 HRP Engagement Level Distribution

Engagement Level Our Team

Fully Engaged 32%

Engaged 68%

Somewhat Engaged 0%

Disengaged 0%

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CareOregon Annual staff engagement survey in which employees identify their “most critical” needs in the

workplace environment

Continuing to build a TIC Culture

Transparent Management

style

Fostering a

Learning

organization

Tell the stories

Incorporate meditation &

gratitudes

TIC Leadership

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Learnings along the way

• One person cannot make the cultural change

• Trauma-Integrated Clinical Supervision

*(Rosenzweig, J., 2015)

• Organizational Self Assessment for TIC

• Organization has TIC Policies and Procedures

• Core trainings on MI, Trauma Informed Care&Vicarious Traumatization

• Behavioral interviewing

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The Health Resilience Team

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IV. Questions


VI. Questions


Agenda

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Questions?



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IV. Questions


VI. Questions


Agenda

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Trauma-informed carein the context of vulnerable populations

June 2015

Camden Coalition of Healthcare Providers

THE WHAT

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Overview of Camden Coalition• 79 full-time-equivalent staff, $9.02-million annual budget

• Mix of foundation & federal grants, technical-assistance & care-coordination

contracts, and hospital support

• Membership organization with 22-member board; incorporated non-profit

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Camden Hospital Cost Curve 32


Complexity NOT Disease State

Traditional Intervention Paradigm Hotspotting Intervention Paradigm

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THE HOW

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Care Philosophy• We see trauma informed care as a part of a broader care philosophy that

has roots in:

• Harm reduction

• Unconditional positive regard

• Motivational interviewing

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Key Organizational Tenets

People Principles

• Development

• Balance

• Sustainability

• Health & Wellness

• Family

• Continuous Feedback

• Performance

Core Values

• Servant Leadership

• Communication &

Collaboration

• Compassion & Respect

• Innovation

• Data-driven Practice

• Diversity & Inclusion

REINFORCED THROUGH: Management structure and

informal representations of values

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Patient Case: Elizabethhttp://www.marketplace.org/topics/health-care/diagnosis-camden/when-your-symptoms-dont-

tell-whole-story

http://www.marketplace.org/topics/health-care/diagnosis-camden/when-your-symptoms-dont-tell-whole-story

It’s not “What’s wrong with you?”

It’s “What happened to you?”

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Incorporation of ACEs & deepening TIC

Current Structure

• CCHP does not administer the ACE

survey

• Care plans are established under

the assumption that all patients

have experienced early childhood

trauma

Lean start-up pilot, Spring 2015

• 9 patients were assessed via the

Philadelphia Urban ACE survey

• Average ACE Score: 5.6

• Average time to complete the

survey: 15 minutes

• Staff reported the patient-provider

relationship was benefited

• Engaging in Seeking Safety training

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http://www.instituteforsafefamilies.org/philadelphia-urban-ace-study


Domains of Care Planning

• Addiction

• Advocacy and Activism

• Benefits and Entitlements

• Education and

Employment Connection

• Family, Personal, and Peer

Support

• Food and Nutrition Support

• Health Maintenance,

Management, and

Promotion

• Housing and Environment

• Identification Support

• Legal Assistance

• Medication and Medical

Supplies

• Mental Health Support

• Provider Relationship

Building

• Transportation Support

• Reproductive Health and

Internatal Care

• Patient-specific Wildcard

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Camden Trauma Summits• Hosted by Hopeworks ‘N Camden

• Attendees from multiple disciplines including the police department,

healthcare, Camden school district, and a host of other non-profits

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Camden Healing 10

• We expect to impact over ⅓ of Camden’s children and families in a given

year

• http://healing10.org/camden-healing-10-city/

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Where we’re headed…• We have signed a data-sharing agreement with the local police

department to cross match health care high-utilizers with arrest/jail

records. We found 200 overlapping individuals.

• We are in discussions with the Camden School District to obtain data

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II. Overview of Trauma-Informed Care for Complex Populations


IV. Questions


VI. Questions


Agenda

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Questions?



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lessons from the front lines: insights into trauma ... · trauma informed care “trauma-informed...

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