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

Transcription

1 Lessons from the Front Lines: Insights into Trauma-Informed Care for Medicaid s Complex Populations June 22, 2015 Call-in Number: ; Passcode: Supported by Kaiser Permanente Community Benefit. Alexandra Maul, MPH Program Associate

2 Questions? To submit a question, please click the question mark icon located in the toolbar at the top of your screen. 2

3 Agenda I. Welcome and Introductions II. III. IV. Overview of Trauma and Trauma-Informed Care for Complex Populations Developing a Trauma-Informed Workforce: Lessons from the Health Resilience Program Questions V. Community-Wide Systems Change: Creating a Trauma- Informed Community in Camden VI. Questions VII. Closing Remarks 3

4 Welcome and Introductions Alexandra Maul, MPH Program Associate Center for Health Care Strategies Laurie Lockert, MS, LPC Health Resilience Program Manager CareOregon Victoria DeFiglio, RN, BSN Clinical Director, Cross Site Learning and Workforce Development Camden Coalition of Healthcare Providers 4

5 About the Center for Health Care Strategies A non-profit health policy center dedicated to improving the health of lowincome Americans 5

6 CHCS Initiatives To Advance Trauma-Informed Approaches to Care 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 6

7 Agenda I. Welcome and Introductions II. III. IV. Overview of Trauma and Trauma-Informed Care for Complex Populations Developing a Trauma-Informed Workforce: Lessons from the Health Resilience Program Questions V. Community-Wide Systems Change: Creating a Trauma- Informed Community in Camden VI. Questions VII. Closing Remarks 7

8 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 8

9 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 retraumatizing individuals 9

10 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? 10

11 Agenda I. Welcome and Introductions II. III. IV. Overview of Trauma and Trauma-Informed Care for Complex Populations Developing a Trauma-Informed Workforce: Lessons from the Health Resilience Program Questions V. Community-Wide Systems Change: Creating a Trauma- Informed Community in Camden VI. Questions VII. Closing Remarks 11

12 CHCS Building a Trauma Informed Workforce: A Work in Progress Laurie Lockert, MS, LPC Manager Health Resilience Program CareOregon June 22, 2015

13 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 retraumatization. (SAMHSA) 3 Central principles of TIC: Create safety Restore power Value the individual 13

14 What TIC doesn t mean 14 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. 14

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16 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 16

17 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! 17

18 In the Beginning Create Safety 18

19 Learning from Weekly Huddles Gathering the stories and their impact on staff 19

20 Learning how to hire for the work And the workflows 20

21 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 21

22 2014 HRP Engagement Level Distribution Engagement Level Our Team Fully Engaged 32% Engaged 68% Somewhat Engaged 0% Disengaged 0% CareOregon Annual staff engagement survey in which employees identify their most critical needs in the workplace environment 22

23 Continuing to build a TIC Culture Fostering a Learning TIC Leadership organization Tell the stories Transparent Management style Incorporate meditation & gratitudes 23

24 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 24

25 The Health Resilience Team 25

26 Agenda I. Welcome and Introductions II. III. IV. Overview of Trauma and Trauma-Informed Care for Complex Populations Developing a Trauma-Informed Workforce: Lessons from the Health Resilience Program Questions V. Community-Wide Systems Change: Creating a Trauma- Informed Community in Camden VI. Questions VII. Closing Remarks 26

27 Questions? To submit a question, please click the question mark icon located in the toolbar at the top of your screen

28 Agenda I. Welcome and Introductions II. III. IV. Overview of Trauma and Trauma-Informed Care for Complex Populations Developing a Trauma-Informed Workforce: Lessons from the Health Resilience Program Questions V. Community-Wide Systems Change: Creating a Trauma- Informed Community in Camden VI. Questions VII. Closing Remarks 28

29 Trauma-informed care in the context of vulnerable populations June 2015

30 THE WHAT Camden Coalition of Healthcare Providers 30

31 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 Camden Coalition of Healthcare Providers 31

32 Camden Hospital Cost Curve Camden Coalition of Healthcare Providers 32

33 Complexity NOT Disease State Traditional Intervention Paradigm Hotspotting Intervention Paradigm Camden Coalition of Healthcare Providers 33

34 THE HOW Camden Coalition of Healthcare Providers 34

35 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 Camden Coalition of Healthcare Providers 35

36 Key Organizational Tenets Core Values Servant Leadership Communication & Collaboration Compassion & Respect Innovation Data-driven Practice Diversity & Inclusion People Principles Development Balance Sustainability Health & Wellness Family Continuous Feedback Performance REINFORCED THROUGH: Management structure and informal representations of values Camden Coalition of Healthcare Providers 36

37 It s not What s wrong with you? It s What happened to you? Patient Case: Elizabeth Camden Coalition of Healthcare Providers 37

38 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 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 Incorporation of ACEs & deepening TIC Camden Coalition of Healthcare Providers 38

39 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 Camden Coalition of Healthcare Providers 39

40 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 Camden Coalition of Healthcare Providers 40

41 Camden Healing 10 We expect to impact over ⅓ of Camden s children and families in a given year Camden Coalition of Healthcare Providers 41

42 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 Camden Coalition of Healthcare Providers 42

43 Agenda I. Welcome and Introductions II. III. IV. Overview of Trauma-Informed Care for Complex Populations Developing a Trauma-Informed Workforce: Lessons from the Health Resilience Program Questions V. Community-Wide Systems Change: Creating a Trauma- Informed Community in Camden VI. Questions VII. Closing Remarks 43

44 Questions? To submit a question, please click the question mark icon located in the toolbar at the top of your screen

45 Visit CHCS.org to Download practical resources to help improve the quality and efficiency of Medicaid services. Subscribe to CHCS 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. 45