Trauma-informed approaches in clinic & community settings - - PowerPoint PPT Presentation

Trauma-informed approaches in clinic & community settings

January 30, 2020 Katy Davis, PhD, Director of Trauma-Informed Care Initiative, University of California San Francisco Women’s HIV Program Michelle Adyniec, RN, Clinical Manager for Care Management Initiatives, Camden Coalition of Healthcare Providers

• Introduction – Rebecca Sax, National Center for Complex Health and Social

Needs

• Housekeeping – Rebecca Sax
• Presentation:
• Katy Davis, PhD, Director of Trauma-Informed Care Initiative, University of California San Francisco

Women’s HIV Program

• Michelle Adyniec, RN, Clinical Manager for Care Management Initiatives, Camden Coalition of

Healthcare Providers

• Q&A
• Wrap-up & next steps – Rebecca Sax

Agenda

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• This event will be recorded
• Please keep yourself on mute (by phone or Zoom platform)
• All questions should be submitted through the Q&A feature

Housekeeping

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Trauma-informed approaches in clinic and community settings

4 Michelle Adyniec, RN Camden Coalition of Healthcare Providers Katy Davis, PhD, LCSW Women’s HIV Program at UCSF

Trauma-Informed Health Care at UCSF Women’s HIV Program (WHP)

Photo by Lynnly Labovitz; used with artist and patient permission

The National Center for Complex Health and Social Needs Thursday, January 30, 2020 Katy Davis, PhD, LCSW Director of Trauma-Informed Care University of California San Francisco Women’s HIV Program

Project Team

WHP Clinical Implementation Team:

Esther Chavez Beth Chiarelli, LCSW Jennifer Cocohoba, PharmD Katy Davis, PhD, LCSW Rosalind De Lisser, MS, PMHNP, FNP Edward Machtinger, MD Ericka Perez, RAS Lealah Pollock, MD Janeen Rojas, NP Michelle Spence

Peer Empowerment Team:

Rhodessa Jones

Medea Project: Theater for Incarcerated Women

Naina Khanna

Executive Director, Positive Women’s Network-USA

Partner Organizations in Clinic:

Rita Da Cascia/ Catholic Charities

Intensive Family Case Management

South Van Ness Adult Behavioral Health Services

Psychiatry and Therapy Services

WHP Research Team:

Yvette Cuca, PhD, MPH Carol Dawson- Rose, PhD, RN Martha Shumway, PhD

WHP Administrative Team:

Al Paschke, RN Vishalli Loomba

Overview

• Why the focus on Trauma-Informed

Health Care?

• Brief Background of WHP and our

evolution toward TIHC

• The case of Linda as an illustration of

TIHC

• Evolving response to trauma

Photo by Lynnly Labovitz; used with artist and patient permission

The Women’s HIV Program at UCSF

Among first programs in country for women living with HIV Female-focused services provided in a “one-stop shop”

Patients

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Mean age=51 (range 20-76)

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49% African American/Black

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20% White (non-Hispanic)

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9% Asian/ Pacific Islander

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7% Hispanic/Latina

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2% Native American

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9% Multi-ethnic, 4% other

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10% transgender

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Primary care

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Pharmacy program

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Ob/GYN

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Therapy / Psychiatry

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Social work

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Case management

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Partner agencies

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Breakfast

Trauma and Substance Use

Trauma

– 96% with childhood, lifetime, and/or recent trauma – Adverse Childhood Experiences (10 items) ➢Mean 4.2, 58% had 4+ ACES ➢Mean 6.6 experiences of trauma on THS

Substance Use

– 41% used illicit substances in the past 3 months

Mental Health

– 27% PTSD, 70% Depression, 57% Anxiety

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2017 Machtinger, E.L., Cuca, Y.P., Davis, K., DeLisser, R., and Dawson-Rose, C. “Addressing Substance Use within a Trauma-Informed Primary Care Framework.” The Medical Management of HIV/AIDS and Hepatitis Annual Meeting, December 7-9, 2017, San Francisco, CA.

Implementing TIHC

1) Establishing Trauma-Informed Culture

– Foundation – Environment

2) Establishing Trauma-Informed Patient Care

– Education – Inquiry – Response

A PATIENT’S STORY

Trauma-Informed Patient Care

• Education on link

between trauma and substance use

• Response of onsite

interventions and community partnerships

Health Empowerment Recovery Services (HERS) Integrated Treatment for Substance Use and Trauma

Stages of Change for Substance Use Phases of Trauma Treatment

Intervention Elements Precontemplation Contemplation Preparation Pre-Phase 1: Engagement Ongoing Assessment / Social Support 1.Harm-Reduction and Motivational Interviewing 2.Case Management and Linkage Services 3.Drop-In Support , Mindfulness, and Walking Groups Action Phase 1: Safety and Stabilization Behavioral Health Support 1.Psychiatric Evaluation and MAT 2.Ongoing Motivational Interviewing

• 3. WRAP Group

4.Seeking Safety Group ( 5.Linkage to Residential, Detox, or Intensive Outpatient Phase 2: Trauma-Focused Treatment Intensive Trauma Intervention 1.Skills Training in Affective and Interpersonal Regulation (STAIR) 2.Individual Trauma-Focused Therapy 3.Expressive Therapy: (Medea Project) 4.Peer-led Trauma-informed Leadership Intervention Maintenance (Recovery) Phase 3: Empowerment/ Post-Traumatic Growth Ongoing Recovery / Maintenance Support 1.Drop-In Support and Mindfulness Groups 2.Ongoing Medication Monitoring 3.Linkage to Job Training and Employment Programs 4.Linkage to 12-Step and Other Community Programs 5.Peer Leadership Roles in Clinic

Trauma-Informed Organizational Culture

• Safe and welcoming

environment

• Multidisciplinary team-

based care

• Training, supervision, and

support for staff

SAMHSA's Concept of Trauma and Guidance for a Trauma-informed Approach. 2014 http://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdf.

Thank you!

Trauma-informed care (TIC) in the community setting

Michelle Adyniec, RN, Clinical Manager for Care Management Initiatives, Camden Coalition of Healthcare Providers

• Our programs seek to work with people in Camden experiencing medical

and social complexities

• We meet with participants weekly in their homes, at appointments, and a

variety of other community settings

• Participants set their own goals and care team members provide support,

guidance, and resource connection to assist in achieving those goals

• Pilot initiatives for specific populations like pregnant women living with

substance use disorder and individuals involved with the criminal justice system

Community-based care

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• Supporting participants as they navigate systems that do not engage in

trauma-informed practices

• Supporting participants in managing their anxiety and fear in order to move

their care plan forward

• Supporting participants who have heightened reactions

What TIC can look like in community spaces

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• Whenever possible prepare yourself and your clients
• Non-judgmental listening and use of silence
• Therapeutic use of self and humor when appropriate
• Be ready with redirection and grounding techniques
• Be aware of boundaries and boundary testing behavior

Practical strategies for putting TIC into practice

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• Influence community partners by modeling TIC
• Connect TIC to mutual goals
• Use strength-based approaches with both clients and other providers

Practical strategies for putting TIC into practice

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• Know your strengths and weaknesses
• Bring your authentic self
• Balance empathy with boundaries
• Take time for reflection and processing

Reflections and lessons learned

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Questions?

Submit your questions through the Q&A feature

• National Center for Complex Health and Social Needs:

nationalcenter@camdenhealth.org

• Katy Davis: katy.davis@ucsf.edu
• Michelle Adyniec: madyniec@camdenhealth.org

For more information

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Share resources,

• pportunities, and

questions among peers Join today!

http://bit.ly/complexcareresourceexchange

Complex Care Resource Exchange LinkedIn group

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We want your feedback!

An evaluation survey will be sent

• ut after this webinar

Camden Coalition of Healthcare Providers

National Center for Complex Health and Social Needs An initiative of the Camden Coalition of Healthcare Providers

www.nationalcomplex.care @natlcomplexcare 800 Cooper St., 7th Floor Camden, NJ 08102

Thank you!