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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.
Questions?
To submit a question, please click the question
mark icon located in the toolbar at the top of your
screen.
2
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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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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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?
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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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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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
26
Questions?
To submit a question, please click the question
mark icon located in the toolbar at the top of your
screen.
27 27
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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Trauma-informed carein the context of vulnerable populations
June 2015
Camden Coalition of Healthcare Providers
THE WHAT
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Camden Coalition of Healthcare Providers
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 Coalition of Healthcare Providers
Camden Hospital Cost Curve 32
Camden Coalition of Healthcare Providers
Complexity NOT Disease State
Traditional Intervention Paradigm Hotspotting Intervention Paradigm
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Camden Coalition of Healthcare Providers
THE HOW
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Camden Coalition of Healthcare Providers
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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Camden Coalition of Healthcare Providers
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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Camden Coalition of Healthcare Providers
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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Camden Coalition of Healthcare Providers
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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Camden Coalition of Healthcare Providers
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 Coalition of Healthcare Providers
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 Coalition of Healthcare Providers
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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Camden Coalition of Healthcare Providers
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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I. Welcome and Introductions
II. Overview of 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
43
Questions?
To submit a question, please click the question
mark icon located in the toolbar at the top of your
screen.
44 44
Visit CHCS.org to …
Download practical resources to help improve the quality and efficiency of Medicaid services.
Subscribe to CHCS eMail Updates to be notified about new programs and resources.
Learn about cutting-edge state/health plan efforts to improve care for high-risk, high-cost beneficiaries.
www.chcs.org
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