Integrating Trauma Informed Services into Primary & Behavioral Healthcare Settings Changing the discourse for all service providers S. Michele Cohen, PhD, LPC, LCPC Bread of Healing Clinic Choice Consulting Services, LLC drsmichelecohen@gmail.com (262) 208-5359 Good Vibrations? According to quantum physics, all matter is energy existing as vibration..one of the most amazing traits of the heart is that it generates an electrical field with an amplitude 60 times greater than the brain. The physical antenna that is able to pick up these waves is the elaborate sensory apparatus of our whole body if the antenna is tuned in. Hubert (2007) 1
What is trauma? Trauma refers to extreme stress (e.g., threat to life, bodily integrity or sanity) that overwhelms a person s ability to cope. The individual s subjective experience determines whether or not an event is traumatic. Traumatic events result in a feeling of vulnerability, helplessness and fearfulness. Traumatic events often interfere with relationships and fundamental beliefs about oneself, others and one s place in the world. (Giller, 1999; Herman, 1992) Trauma Informed Care What is it, exactly? Definition Mental Health Treatment that is directed by: 1) a thorough understanding of the profound neurological, biological, psychological, and social effects of trauma and violence on the individual and 2) an appreciation for the high prevalence of traumatic experiences in persons who receive mental health services. Jennings, 2004 2
Trauma Comes in Many Forms Abuse or assault (sexual, physical, emotional, psychological) Neglect Domestic violence Witnessed violence Deprivation due to extreme poverty Repeated abandonment or sudden loss Natural disasters Traumatic brain injuries Combat experiences/military sexual trauma (35% of women in the military) Adverse Childhood Experiences (ACE) Study Examines the health and social effects of ACEs throughout the lifespan among 17,421 members of the Kaiser Health Plan in San Diego County. Childhood abuse, neglect, growing up with domestic violence, substance, abuse or mental illness in the home, parental, discord, and crime. The ACE Study reveals the relationship between emotional experiences as children and physical and mental health as adults as well as the major causes of mortality in the United States. 3
The Lower Brain Cortex Limbic Mid brain Brain Stem Dr Perry -CTA Adverse Childhood Experiences (ACE) Study Center for Disease Control & Prevention Household dysfunction Kaiser * WI ** Substance abuse 27% 27% Parental separation/divorce 23% 21% Mental illness 19% 16% Violence between adults 13% 16% Incarcerated household member 5% 6% Abuse Psychological /Emotional 11% 29% Physical 28% 17% Sexual 21% 11% Neglect Emotional 15% Physical 10% * Center for Disease Control and Prevention 1995-97 ** http://wichildrenstrustfund.org/files/wisconsinaces.pdf 4
The ACE Score and the Prevalence of Severe Obesity (BMI >35) Percent obese (%) Dr Anda -CDC ACE Score ACE Study (1997) ACE Score and Drug Abuse Dr Anda -CDC Ever had a drug problem Ever addicted to drugs Ever injected drugs ACE Study (1997) 5
Physical Effects of Trauma Trouble falling/staying asleep (insomnia related psychosis) Feeling agitated, anxious or in a heightened state Getting startled by noises Feeling shaky/sweaty Having heart pounding or trouble breathing Impact of Trauma Over the Life Span ACE Study - effects are neurological, biological, psychological and social in nature, including: Changes in neurobiology Social, emotional and cognitive impairment Adoption of health-risk behaviors as coping mechanisms Severe and persistent behavioral health, physical health, social problems, and early death (Felitti, V. et al., 1998) ACE Study (1997) 6
Safety for Our Patients Reducing the Risk of Retraumatization Medical Settings Medical trauma Medically marginalized Diagnostic labeling Resistant Non-compliance Behavioral Health Settings Prior experience with BH Dis- empowered Diagnostic labeling Resistant Non-compliance Think about a dentist visit Think about hospital settings Behaviors Are Symptoms Trauma informed service providers recognize that behaviors may be symptoms of a larger problem Chronic medical conditions Self injury Substance abuse Violence toward others Trauma informed services shift the focus from: What is wrong with the patient? to What has happened to the person? 7
SAMHSA Center for Integrated Health Solutions There are six suggested levels of integrating care: 1. Coordinated Minimal Collaboration ( nobody know my name, who are you? ) Basic Collaboration at a Distance 2. Co-Located Basic Collaboration Onsite ( I help your consumers. ) Close Collaboration Onsite with Some System Integration ( I am your consultant. ) 3. Integrated Close Collaboration Approaching an Integrated Practice ( We ae a team in the care of consumers. ) Full Collaboration in Transformed/Merged Integrated Practice ( Together, we teach others how to be a team in care of consumers and design a care system. ) (Heath, Wise Romero, & Reynolds, 2013) Guiding Values of Trauma-Informed Care 8
Shifting the Perspective: What Happened? Safety and security are first considerations Recognizes impact of trauma on worldview Understands the whole person, not just the problem/symptoms Collaborative Develops healthy coping strategies (gives survivors power and belief that they are experts in their own life) Goal is to return control Strengths based Qualities of a Trauma-Informed System of Care Understand that trauma impacts many people s lives. Provide services that are trauma-sensitive. Respect and collaborate with consumers. Place priority on the consumer s safety, choice and control (Wisconsin Trauma Summit, 2007) 9
Planning/Collaborating with Consumers Focused on consumer involvement/choice Services happen WITH the consumer, consumers are informed on what is happening What does the consumer need/want Provides sanctuary Mutual trust Outcomes of Collaborative Planning Better quality of life for consumers Greater consumer satisfaction Greater chance of recovery Reduced chance of consumer re-traumatization Lower rates of consumer and staff assault and injury Lower rates of staff turnover and higher morale 10
References Adverse Childhood Experiences Study (1997). Retrieved from http://www.acestudy.org. Giller, E. (1999). What is Psychological Trauma. Sidran Press. Retrieved from http://www.theannainstitute.org/what%20is%20psychological%20trauma.pdf? contentid=88. Heath, B., Wise Romero, P. & Reynolds, K. (2013). A Standard Framework for Levels of Integrated Healthcare. Washington, D.C.: SAMHSA-HRSA Center for Integrated Health Solutions. Herman, J. (1992). Trauma and Recovery. New York: Basic Books. Hubert, B. (2007). Bal-A-Vis-X: Rhythmic Balance/Auditory/Vision exercises for Brain and Brain-Body Integration. Retrieved from http://www.bal- a.vis.com. Jennings, A. (2004) Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services. U.S. Department of Health and Human Services. Retrieved from www.theannainstitute.org/mdt.pdf 11