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

Agenda - 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 2

Housekeeping - 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 3

Trauma-informed approaches in clinic and community settings Katy Davis, PhD, LCSW Michelle Adyniec , RN Women’s HIV Program at Camden Coalition of UCSF Healthcare Providers 4

Trauma-Informed Health Care at UCSF Women’s HIV Program (WHP) 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 Photo by Lynnly Labovitz; used with artist and patient permission

Project Team WHP Clinical Implementation Partner Organizations in Clinic: Rita Da Cascia/ Catholic Charities Team: Intensive Family Case Management Esther Chavez South Van Ness Adult Behavioral Health Services Beth Chiarelli, LCSW Psychiatry and Therapy Services Jennifer Cocohoba, PharmD Katy Davis, PhD, LCSW WHP Research Team: Rosalind De Lisser, MS, PMHNP, FNP Edward Machtinger, MD Yvette Cuca, PhD, MPH Ericka Perez, RAS Carol Dawson- Rose, PhD, RN Lealah Pollock, MD Martha Shumway, PhD Janeen Rojas, NP Michelle Spence WHP Administrative Team: Al Paschke, RN Peer Empowerment Team: Vishalli Loomba Rhodessa Jones Medea Project: Theater for Incarcerated Women Naina Khanna Executive Director, Positive Women’s Network -USA

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” Primary care Social work ✿ ✿ Pharmacy program Case management ✿ ✿ Ob/GYN Partner agencies ✿ ✿ Therapy / Psychiatry Breakfast ✿ ✿ Patients Mean age=51 (range 20-76) ✿ 49% African American/Black ✿ 20% White (non-Hispanic) ✿ 9% Asian/ Pacific Islander ✿ 7% Hispanic/Latina ✿ 2% Native American ✿ 9% Multi-ethnic, 4% other ✿ 10% transgender ✿

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 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. 9

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 Phases of Trauma Treatment Intervention Elements Substance Use Ongoing Assessment / Social Support Precontemplation 1.Harm-Reduction and Motivational Interviewing Pre-Phase 1 : Contemplation 2.Case Management and Linkage Services Engagement Preparation 3.Drop-In Support , Mindfulness, and Walking Groups Behavioral Health Support 1.Psychiatric Evaluation and MAT Phase 1 : 2.Ongoing Motivational Interviewing Safety and Stabilization 3. WRAP Group Action 4.Seeking Safety Group ( 5.Linkage to Residential, Detox, or Intensive Outpatient Intensive Trauma Intervention 1.Skills Training in Affective and Interpersonal Regulation (STAIR) Phase 2 : 2.Individual Trauma-Focused Therapy Trauma-Focused Treatment 3.Expressive Therapy: (Medea Project) 4.Peer-led Trauma-informed Leadership Intervention Ongoing Recovery / Maintenance Support 1.Drop-In Support and Mindfulness Groups Maintenance Phase 3 : Empowerment/ 2.Ongoing Medication Monitoring (Recovery) Post-Traumatic Growth 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

Community-based care • 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 19

What TIC can look like in community spaces • 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 20

Practical strategies for putting TIC into practice • 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 21

Practical strategies for putting TIC into practice • Influence community partners by modeling TIC • Connect TIC to mutual goals • Use strength-based approaches with both clients and other providers 22

Reflections and lessons learned • Know your strengths and weaknesses • Bring your authentic self • Balance empathy with boundaries • Take time for reflection and processing 23

Questions? Submit your questions through the Q&A feature 24

For more information National Center for Complex Health and Social Needs: • nationalcenter@camdenhealth.org Katy Davis: katy.davis@ucsf.edu • Michelle Adyniec: madyniec@camdenhealth.org • 25

Complex Care Resource Exchange LinkedIn group Share resources, opportunities, and questions among peers Join today! http://bit.ly/complexcareresourceexchange 26

We want your feedback! An evaluation survey will be sent out after this webinar 27

Camden Coalition of Healthcare Providers Thank you! National Center for Complex Health and Social Needs An initiative of the Camden Coalition of Healthcare Providers www.nationalcomplex.care @natlcomplexcare 800 Cooper St., 7 th Floor Camden, NJ 08102