Trauma-informed approaches in clinic & community settingsJanuary 30, 2020

Katy Davis, PhD, Director of Trauma-Informed Care Initiative, University of California San Francisco Women’s HIV ProgramMichelle 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

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Michelle Adyniec, RNCamden Coalition of Healthcare Providers

Katy Davis, PhD, LCSWWomen’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 NeedsThursday, January 30, 2020

Katy Davis, PhD, LCSW Director of Trauma-Informed Care

University of California San FranciscoWomen’s HIV Program

Project Team

WHP Clinical Implementation Team:Esther Chavez Beth Chiarelli, LCSWJennifer Cocohoba, PharmDKaty Davis, PhD, LCSWRosalind De Lisser, MS, PMHNP, FNPEdward Machtinger, MD Ericka Perez, RASLealah Pollock, MDJaneen Rojas, NPMichelle Spence

Peer Empowerment Team:Rhodessa JonesMedea Project: Theater for Incarcerated Women

Naina KhannaExecutive Director, Positive Women’s Network-USA

Partner Organizations in Clinic:Rita Da Cascia/ Catholic CharitiesIntensive Family Case Management

South Van Ness Adult Behavioral Health ServicesPsychiatry and Therapy Services

WHP Research Team:Yvette Cuca, PhD, MPHCarol Dawson- Rose, PhD, RNMartha Shumway, PhD

WHP Administrative Team:Al Paschke, RNVishalli 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 UCSFAmong first programs in country for women living with HIV

Female-focused services provided in a “one-stop shop”

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

✿ Primary care✿ Pharmacy program✿ Ob/GYN✿ Therapy / Psychiatry

✿ Social work✿ Case management✿ Partner agencies ✿ 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

PrecontemplationContemplationPreparation

Pre-Phase 1: Engagement

Ongoing Assessment / Social Support1.Harm-Reduction and Motivational Interviewing2.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 MAT2.Ongoing Motivational Interviewing3. WRAP Group4.Seeking Safety Group (5.Linkage to Residential, Detox, or Intensive Outpatient

Phase 2: Trauma-Focused Treatment

Intensive Trauma Intervention1.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 Groups2.Ongoing Medication Monitoring3.Linkage to Job Training and Employment Programs4.Linkage to 12-Step and Other Community Programs5.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, opportunities, and

questions among peers

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Complex Care Resource Exchange LinkedIn group

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We want your feedback!

An evaluation survey will be sent out after this webinar

Camden Coalition of Healthcare Providers

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

www.nationalcomplex.care@natlcomplexcare

800 Cooper St., 7th FloorCamden, NJ 08102

Thank you!