Putting Trauma-Informed Care Into Practice Series .
Advancing innovations in health care delivery for low-income AmericansPutting Trauma-Informed Care into Practice SeriesImplementing Trauma-InformedCare into Organizational Cultureand PracticeOctober 30 2017, 12:30-2:00 pm ETFor Audio Dial: 888-395-3240Passcode: 427216Made possible through support from the Robert Wood Johnson Foundationwww.chcs.org @CHCShealth
Questions?To submit a question, please click the question markicon located in the toolbar at the top of your screen.Answers to questions that cannot be addressed due to time constraints will beshared after the webinar.2
Multi-year initiative supported by the Robert WoodJohnson Foundation Objective: Understand and spread practical strategiesfor implementing trauma-informed approaches acrossthe health care sector.» Two-year multi-site pilot demonstration and learningcollaborative with six leading health care organizations» National dissemination of project lessons to spread emergingbest practices» Implementation analysis conducted by the Urban Institute3
What is Trauma-Informed Care? Takes the individual’sexperience of trauma intoaccount Instead of asking“What’s wrong with you?”asks “What happened to you?” Must occur at clinical ANDorganizational levels-Sandra Bloom, MD,creator of the Sanctuary Model4
Key Ingredients of Trauma-Informed CareORGANIZATIONALCLINICAL1. Lead and communicateabout the transformation process7. Involve patients in thetreatment process2. Engage patients inorganizational planning8. Screen for trauma3. Train clinical as well asnon-clinical staff members4. Create a safe environment5. Prevent secondary traumatic stressin staff6. Hire a trauma-informed workforce59. Train staff in trauma-specifictreatment approaches10. Engage referral sources andpartner organizations
Today’s Speakers and AgendaBuilding a Trauma-InformedOrganizational CultureKen Epstein, PhD, LCSW, Director of Child, Youth, and Family System ofCare, San Francisco Department of Public HealthImplementing Trauma-Informed Care Acrossa Health SystemRahil Briggs, PsyD, Director of Pediatric Behavioral Health Services,Montefiore Medical Group6
Trauma Informed SystemsA Model For Promoting A Healing Organization
Trauma Informed Systemsprinciples and practices supportreflection in place of reaction,curiosity in lieu of numbing, selfcare instead of self-sacrifice andcollective impact rather thansiloed structures.”- Epstein, K, Speziale, K, Gerber, & Loomis, B (2014): SF DPH TIS (Trauma-InformedSystems InitiativeConnecting communities to compassionate systems. Reclaiming Bay Area futures.8
Relational Leadership“I've learned that people will forgetwhat you said, people will forget whatyou did, but people will never forgethow you made them feel.”Maya Angelou9
History: Stress and Trauma arePublic Health Issues Stress linked to 6 leading causes of death‒ Heart disease, cancer, lung ailments,accidents, cirrhosis of the liver, and suicide Trauma impacts more than just theindividual‒ Ripple effect to others Some communities disproportionatelyaffected‒ Racism Urban Poverty Trauma Toxic Intergenerational transmission of trauma Systemic, preventative approach needed10
ONSTAFFTrauma affects organizations andsystems as well as communitiesand individualsCLIENT11
Initiatives12
Impact of RacismHistoricalUnresolved GriefDisenfranchisedGriefInternalized Oppression13
Client needsVs.HMO modelsof careStaff andbudget ms, taskdriven vs.relationalFeelingunsafe withco-workersStaff turnoverTraumaticeventsviolence,suicide,deathsNot enoughtime forcollaborationor supervisionTrauma-Organized Systems: Chronic Stressors and Collective Trauma14
GOVERNMENTTHE TRAUMA ORGANIZEDTRAUMA INFORMED Reactive/OrganizationalHyperarousal (Crisisdriven) Reliving/Retelling Fragmentation/Us vsThem Interpersonal Conflict/Silo OrganizationalDisassociation/Amnesia Avoiding/Numbing Authoritarian Leadership Shared Language FoundationalUnderstanding of Traumaand Healing Understanding of thenature and impact oftrauma Understanding racialdisparities and insidioustraumaTRAUMA INDUCINGTOHEALING ORGANIZATION Reflective Collaborative Culture oflearning/Curiosity Making meaning out ofthe past Growth and PreventionOriented (Conflict OK) Relational LeadershipTRAUMA REDUCING15
TraumaUnderstandingSystem &ServiceTrust biology&DevelopmentCollaboration &EmpowermentCultural Humility& ResponsivenessResilience &Recovery16
Innovations do not benefit those who never experience them.–Fixsen, D17
Trauma Informed System:Conceptual FrameworkLeadershipEngagementORG LeadersMiddle ManagementTraining:Trauma 101EvaluationEmbeddedPolicy andPracticeJimtrainers18Champions
Cultural humility &ResponsivenessRacial/cultural equityPracticesTraumaUnderstandingTIS 101EvaluationCompassion &DependabilityReflectiveSupervisionOrganizational HealingResilience &RecoveryMindfulnessPolicyCollaboration &EmpowermentParticipatoryDecision Making19
Evaluate & AlignTRAUMA-INFORMED SYSTEM:TIS 101Evaluate20
Questions?To submit a question, please click the question markicon located in the toolbar at the top of your screen.Answers to questions that cannot be addressed due to time constraints will beshared after the webinar.21
Montefiore Medical Group:Trauma Informed Care Rahil Briggs, PI (rabriggs@montefiore.org)Miguelina German, Project DirectorBrittany Gurney, Project ManagerDana Crawford, Katie Dumpert, Alissa Mallow, Content TeamTrauma Informed Multidisciplinary Team members: nurses,pediatrician, family medicine doc, administrators, front desk,psychologists, social workers
Agenda Why embark on this TIC journey? How to proceed?– Leadership buy in– Learning collaboratives/Online learningmodules/In-person trainings– Screening– Critical Incident Management (CIM)
Why? How? Existing integrated behavioral health service (BHIP) How to get leadership buy in– How to identify a champion– Importance of aligning with institutional goals
Learning Collaboratives April 2016:Introducing TIC – UnderstandingStress & Trauma June 2016:Manifestations of Trauma Sept 2016:Secondary Traumatization Dec 2016:Reactions to Trauma March 2017: Resilience, Recovery & Commitmentto Change
LC#2: Manifestations of Trauma
Triggers: Traumatic Beliefs1) I am not safe.2) People want to hurt me.3) If I am in trouble, no onewill help.4) The world is dangerous.
LC# 3: Secondary TraumaCompassion Fatigue “The cost of caring” The gradual erosion of all the things that keep usconnect to others in our caregiver role– Empathy– Hope– CompassionNot only for others,but also for ourselves
LC#3: Secondary Trauma You didn’t experience the trauma, but you learnedabout the trauma and it impacts you Can lead to PTSD Can be the result of hearing a patient story ordebriefing with a colleague Symptoms that are similar to those of patients withtrauma experiences
Vicarious Traumatization
LC# 4: Reactions to TraumaRemember the acronym, PEARLS :Support:“Let’s work together.”“That sounds frustrating.”“I am sorry that happened.”“You have gone through a lot.”“I understand why you’re upset.”“Let’s see what we can do.”
The Avoider (moving away) WithdrawRefers patient elsewhereSilence patients/colleaguesHumor?
The Superhero (moving toward) Exaggerated sense of responsibility Excessive advocacy Over-sharing
The Critic (moving against) Anger and irritability Heated arguments Sarcastic remarks
LC #5: Resilience, Recovery andCommitment to Change
Solutions PEARLS920-CALMDeep BreathingMindfulnessCalm spacesWalking routesBuddyEAPCIM
Trauma Informed Care Screening MMG practices universally screen for depressionacross the lifespan (from pediatrics to geriatrics).
Questions to think about .1) How can you assess if your practice is ready tobegin conducting PDSAs to screen for ACEs withyour patients?2) What types of training and support will yourpractice staff need to build competency andcomfort in administering the ACEs?
But how can screening adults forchildhood ACEs help?
The expectation that we can be immersed insuffering and loss daily and not be touched by itis as unrealistic as expecting to be able to walkthrough water without getting wet.-- Naomi Rachel Remen
Critical Incident Management Exposure to traumatic events can cause a heightened ‘emotionalstate’ or ‘crisis’ which generates emotional turmoil. Evidence Based Practice Model – International Critical IncidentStress Foundation Designed to assist individuals exposed traumatic critical incidentshelping to prevent post-traumatic stress. Crisis reactions can be lessened and rapid return to adaptivefunction can be achieved if appropriately trained crisisinterventionists utilize this EBP model.
Critical Incident Management atMMG The violent and unexpected death of an associateemployed at the site A mass casualty event that the center responds to Violence of a catastrophic nature in the center either bya patient or an associate which results in life-threateningharm and/or death to a patient or associate
Elements of Critical IncidentManagement Small group Crisis Management Briefing(CMB) Rest, Information, Transition Services (RITS) Defusing Debriefing
Lessons Learned Importance of shared language and attention to TIC Challenge of large institution and diffused reportingstructures IT ACEs screening across the lifespan Champions* * *What can you do tomorrow? Reflect on the importanceof TIC, Commit to the change, and find yourchampion(s).
Questions?To submit a question, please click the question markicon located in the toolbar at the top of your screen.Answers to questions that cannot be addressed due to time constraints will beshared after the webinar.45
Visit CHCS.org/Trauma-Informed-Care/Learn about CHCS’ AdvancingTrauma-Informed Care projectDownload practical resourcesfor adopting trauma-informedapproaches to care, such as: Key Ingredients for Successful TraumaInformed Care Implementation Strategies for Encouraging Staff Wellnessin Trauma-Informed Organizations Understanding the Effects of Trauma onHealthSubscribe to CHCS e-mail andsocial media updates to learnabout new programs and resources46
Putting Trauma-Informed Care into Practice Series Implementing Trauma-Informed Care into Organizational Culture and Practice October 30 2017, 12:30-2:00 pm ET For Audio Dial: 888-395-3240 Passcode: 427216 Made possible through support from the Robert Wood Johnson Foundation
Laying the Groundwork for Trauma-Informed Care . By Meryl Schulman and Christopher Menschner, Center for Health Care Strategies . IN BRIEF Adopting a trauma-informed approach to care has the potential to improve patient health outcomes as well as the well-being of providers. While becoming a trauma-informed health care organization can be time .
The assessed content included prima - ry survey, secondary survey, airway and ventilation, circulation, shock, thoracic trauma, head/spinal trauma, abdomen/pelvis trauma, musculoskeletal trauma, paediatric trauma, geriatric trauma, obstetric trauma, trans - fer of care, and other course specific inclusions.
life course and research, practice, and training for caseworkers and supervisors from a trauma-informed framework is crucial. Join us for this interactive, foundational training on a trauma-informed framework for APS supervisors. We'll learn about a trauma-informed care approach from biological, programmatic, and policy levels.
Historical trauma - Cumulative emotional and psychological wounding from massive group trauma across generations, including lifespan Historical trauma response (HTR) is a constellation of features in reaction to massive group trauma, includes . historical unresolved grief (similar to Child of Survivors Complex re: Jewish Holocaust survivors and
Behind the Term: Trauma Prepared in 2016 by Development Services Group, Inc., under contract no. HHSS 2832 0120 0037i/HHSS 2834 2002T, ref. no. 283– 12–3702. 1 Behind the Term: Trauma Related terms: complex trauma, historical trauma, human-caused trauma, naturally caused trauma, trauma,
categories of trauma as a framework for trauma assessment. “Little t” trauma “Big T” trauma Complex trauma “Little t” Trauma “Little t” trauma involves events that we encounter day to day that can make life difficult but are not out of the ord
Trauma-informed ServicesTrauma-informed Services Trauma-informed services: 1. Take the trauma into account. 2. Avoid triggering trauma reactions and/or traumatizing the individual. 3. Adjust the behavior of counselors, other staff and the organization to support the individual’s coping capacity. 4. Allow s
ASME Section IX, 2019 Edition As published in the Welding Journal, September, 2019 (with bonus material. . .) UPDATED 12-19 Prepared by Walter J. Sperko, P.E. Sperko Engineering Services, Inc 4803 Archwood Drive Greensboro, NC 27406 USA Voice: 336-674-0600 FAX: 336-674-0202 e-mail: sperko@asme.org www.sperkoengineering.com . Changes to ASME Section IX, 2019 Edition Walter J. Sperko, P.E. Page .
