and reach thousands of daily visitors
Listen to thisAs I was working on yesterday’s briefing on the importance of addressing trauma in care management programs for the many consumers with chronic conditions and complex support needs (see Making The Link – Trauma & High-Needs Consumers), I closed with a reference to the seventeen-year science-to-service lag in health care field – and the hope that applying this research wouldn’t take that long.
In an interview on NPR on March 2, 2015, Can Family Secrets Make You Sick?, Dr. Rob Anda, author of the Adverse Childhood Experiences Study (ACE), expressed surprise that when he and Dr. Vincent Felitti first published their results in the late 1990s, the response from the medical community was less than enthusiastic. “I thought that people would flock to this information,” Dr. Anda said, “and be knocking on our doors, saying, ‘Tell us more. We want to use it.’ And the initial reaction was really – silence.” In fact, it took a long time to even get the study published. A number of top medical journals rejected the article according to Dr. Anda “because there was intense skepticism.”
Despite the somewhat frosty initial reception, we are seeing the use of these research findings make their way to practice. How do I know? When I reached out to our OPEN MINDS senior advisors, I got some great examples of “on the ground” use of trauma-informed care.
* * *
I’ve used trauma-informed approaches to care in both my work in Milwaukee
County and in Fairfax, Virginia. As the administrator for Milwaukee County’s
Crisis Services, I was also the team lead for Crisis Stress Debriefing. In
Milwaukee, we studied the impact of trauma on those consumers who did not
seem to respond to traditional treatment and had more co-occurring substance
use. We found significant exposure to sexual abuse from early childhood, as
well as exposure to murder and other violent crimes. We altered our
treatment to address these issues based on what we knew at that time (the
mid-1980’s). Additionally, the city of Milwaukee police were among our major
clients, where we found a significant correlation to trauma exposure and
dysfunctional responses to dangerous situations, including the entire time
that the Jeffrey Daumer case was taking place (the late 1980’s/early
1990’s).
As the executive director of the Fairfax Falls Church Community Service Board (CSB), we found that in our substance use programs, trauma was a factor in 60% of adolescents. In addition to the six approaches listed in the CHCS briefing (Trauma-Informed Care: Opportunities For High-Need, High-Cost Medicaid Populations), we also used Dialectical Behavioral Therapy (DBT) trauma victims, especially those with chronic suicide behavior and self-abuse. (Trauma-Informed Care in County Mental Health Systems – George Braunstein, OPEN MINDS, Senior Associate)
As a just-retired chief executive officer of Adult and Child Center, the largest provider of child welfare (including foster care) services in Indianapolis, I contributed to the initiation of trauma-informed care (trauma-focused CBT) for youth in the child welfare system. Children involved in the child welfare system have universal experience with trauma. Unfortunately, experiences preceding involvement in the child welfare system are generally chronic and in multiple forms including physical, sexual, verbal abuse, neglect, and exposure to family violence. When this trauma is followed by a possible removal from family, friends, and school for an undetermined period of time, additional trauma results.
As the ACE study, and other studies, have substantiated, there are severe consequences when children are subject to traumatic events. Organizations providing foster care and other child welfare services are well aware of the consequences of trauma including physical, behavioral, and social problems. Child welfare involved children too frequently exhibit physical problems, such as stomach pain and headaches, great fear (especially the younger children), distrust, depression, anxiety, poor performance in schools, and substance abuse.
State child welfare systems and providers of child
welfare services increasingly recognize the need to serve children, and
their stakeholders – including parents, care givers, judges, case workers – from a trauma informed perspective. This perspective requires routine trauma
screenings/assessments, education on the effects of trauma on a child, and
provision of evidence-based trauma-informed practices that maximize the
child’s sense of safety, help the child to develop coping strategies, and
increase resilience.
(Robert Dunbar, OPEN MINDS, Senior Associate).
As the former National Director of Autism Services for Providence Service Corporation, I learned that bringing trauma-informed care (TIC) to an organization requires a charismatic “champion” to lead it. Through a partnership with the National Council, our “champion,” Dr. Allison Jackson, kicked off Providence’s initiative with a retreat that gave us all a good core understanding of TIC and more than a few good clinical and fiscal reasons to embrace it.
At first I struggled to apply TIC to the population of consumers I was responsible for, those with autism, and their families. But as I learned more, I realized:
• Many children with autism have or will experience physical restraint (something I’ve spent a good portion of my career teaching people how to replace with positive behavioral approaches). As we have regrettably witnessed lately in the news, the physical restraint of a human being by others is dangerous, and the experience of either being restrained or doing the restraining is not one that leaves people unchanged.
• Experiencing a diagnosis of autism is traumatizing to most families. With three words—“your child has autism”—dreams are shattered, lives change, roles change, and people struggle to understand their new reality.
• Some individuals with autism who have not benefited from effective treatment may be aggressive toward family members, staff and others. Family members in particular who have experienced this tell of the shock and trauma this violence perpetrated by their child inflicts upon their heart and soul.
Becoming a trauma-informed organization is a cultural shift requiring buy-in from everyone. The first thing everyone thinks is, “Oh no, not something else to do” while we’re all trying to do more with less. But here’s the good news, and the secret to being truly trauma informed – it isn’t something else to do, it’s how you do what you’re already doing. How different is it from our current expectations to teach staff to deliver effective, efficient, timely, respectful, and person-centered services sensitive to the likelihood that the person served may have a history of trauma? How much more time does it take to conduct daily operations in an environment reflecting safety and security through softer lighting, warm paint colors, multilingual reading materials, and a friendly professional in reception who smiles? Fifty-one percent of the general population have experienced trauma in childhood, and 98% of people served in behavioral health have experienced trauma (see Is Your Organization Trauma-Informed?). Being trauma informed isn’t just good science. It’s good business, and reflects the kind of culture we, who help people achieve physical and mental health, are already invested in.
With increased pressure on reducing the health care
spend by a small proportion of citizens (see The Marketing Challenge Of The
5% & The 95%), the focus on how to best incorporate the findings of the ACE
study and the use of trauma-informed care will increase. These are examples
of how to make that happen.
(Lora Perry, OPEN MINDS, Senior Associate).
https://www.openminds.com/market-intelligence/executive-briefings/trauma-informed-care-action.htm/
