The Intersection Between Trauma-Informed Care and Integrated Care

The Intersection Between Trauma-Informed Care and Integrated Care

TODAY S PRESENTERS Diana Camacho Senior Project Manager Kaiser Permanente Crispin Delgado, MPP Consultant Kaiser Permanente Karen Johnson, LCSW Director of Trauma-Informed Services National Council for Behavioral Health

ACKNOWLEDGEMENT The work outlined in this presentation was generously funded by Kaiser Permanente National Community Benefit, Safety Net Partnerships. 2

TRAUMA-INFORMED APPROACHES IN PRIMARY CARE INITIATIVE (TIPCI) All good relationships begin with intentional conversations What did the field need to know? Where to begin? The process Where do we go next?

THE ADVERSE CHILDHOOD EXPERIENCES STUDY

Adverse Childhood Experience Study The #1 Chronic Health Epidemic in the United States The impact of ACEs can now only be ignored as a matter of conscious choice. With this information comes the responsibility to use it (Anda and Brown, CDC)

TRAUMA-INFORMED APPROACHES IN PRIMARY CARE Minimize reaction to triggers Improve non-adherence to treatment and use or overuse of services Help people understand how trauma impacts their current health Connect people with appropriate resources It s good medicine! Trauma-Informed Care is Now the EXPECTATION, NOT the Exception!

SCOPE OF TIPCI Defining trauma-informed care for primary care 14 primary care sites chosen from 8 Kaiser Permanente Regions through diligent application process Cohort of patients chosen Deep dive into 5 Domains of Primary Care

14 TIPCI ORGANIZATIONS California Community Medical Centers Neighborhood Health Care Venice Family Clinic Wellspace Health Colorado Clinica Family Health Services Colorado Coalition for the Homeless Georgia Whitefoord Hawaii West Hawaii Community Health Center Maryland Chase Brexton Health Care Community Clinic, Inc. Oregon The Native American Rehabilitation Association Virginia Community Health Care Network Washington Lummi Tribal Health Center Washington, DC Bread for the City

Be respectful Take time Build rapport SENSITIVE PRACTICES IN HEALTH CARE SETTINGS Share information Share control Respect boundaries Foster mutual learning Understand non-linear healing Demonstrate awareness and knowledge of trauma

DOMAINS OF A TRAUMA-INFORMED PRIMARY CARE SETTING Domain 1: Early Screening & Comprehensive Assessment of Trauma Domain 2: Patient Voice, Choice & Collaboration Domain 3: Workforce Development & Best Practices Domain 4: Safe & Secure Environment Domain 5: Data Collection & Performance Improvement

IDENTIFIED COHORTS 100% of patients were identified as having a serious, chronic, and poorly managed health condition Identified cohorts included patients with uncontrolled diabetes depression obesity chronic pain comorbid conditions

BARRIERS AND CHALLENGES Time Constraints Difficulty in Choosing a Screening and Assessment Tool Data Collection Competing Initiatives Challenges in discussing trauma with patients

Increased TIC practice KEY ACCOMPLISHMENTS Knowledge dissemination Workforce engagement and development Client engagement Interdisciplinary collaboration Implementation advancement Sustained TIC practice Expansion of TIC practice Increased advocacy Enthusiasm for the Learning Community model Hunger to learn more about TIC

KEY ACCOMPLISHMENTS Reported high adherence (at least 70%) to treatment Some improvement in monitored health indicators One clinic reported by the end of TIPCI, 75% of the initial cohort was no longer identified as being highrisk as their diabetes came under control

PRE- & POST-ORGANIZATIONAL SELF ASSESSMENT BY DOMAINS FOR ALL AGENCIES

RESOURCES DEVELOPED FOR COHORT

The Change Package

PRACTICE TRANSFORMATION TEAM Diverse group of national experts Leaders from primary care and trauma-informed care Researchers Educators Advocates Safety net representatives Federal agency representatives Reflective of Kaiser Permanente footprint

PRACTICE TRANSFORMATION TEAM AND A LEARNING COMMUNITY Practice Transformation Team Feedback Content Development Learning Community

CHANGE PACKAGE Agreed upon Trauma-Informed Care components Screening Tools/Processes Outcome Measures Trauma-Specific Interventions Implementation Practices Evidence-based Scalable Sustainable

DISSEMINATION TO THE BROADER SAFETY NET FIELD & BEYOND National Council will work with key partners to distribute Change Package to broader Healthcare Field Resulting in INCREASED TIC COMPETENCY NATIONWIDE

PROJECT GOALS AND OUTCOMES Project Goals Recruit and select PTT Convene PTT for content development Pilot change package Finalize change package Disseminate change package Expected Outcomes Engage key leaders willing and able to inform the dissemination of key practices in TIC Change package addresses components of successful implementation of TIC in primary care 7 Organizations implement TIC impacting up to 15,000 individuals Finalized TIC Change Package provides clear guidance on standardized implementation of TIC in the primary care practice setting Change package is used in a variety of primary care practice settings within national healthcare audience Long term goal - Up to 300 FQHCs and other primary care settings implement Trauma-Informed Approaches

RESOURCES Infographic (National Council shareable page)it.ly/1q86xco Hope Beyond Hurt Poster http://bit.ly/1szwq14 SAMHSA/HRSA Trauma http://1.usa.gov/1etquux ACEs Connection http://www.acesconnection.com/ ACEs Too High http://acestoohigh.com/ Kaiser/National Council Partnership http://bit.ly/1zamqxl

STAY CONNECTED If you would like more information about this initiative, or to stay connected, please contact: Karen Johnson karenj@thenationalcouncil.org National Council for Behavioral Health www.thenationalcouncil.org