John R. Kasich, Governor Tracy J. Plouck, Director John L. Martin, Director
1
Developmental Disabilities Mental Health and Addiction Services
What is Trauma?
Individual trauma results from an event, series of events, or a set of circumstances
that is experienced by an individual as physically or emotionally harmful or
threatening and that has lasting adverse effects on the individual’s functioning and
physical, social, emotional, or spiritual well-being
(SAMHSA)
2
Prevalence of Trauma
Exposure to trauma is widespread
• Trauma can occur at any age • Trauma can affect individuals from all
walks of life
3
What is Trauma?
The individual’s experience of these events or circumstances helps to determine whether it is a traumatic event. The long-lasting adverse effects on an individual are the result of the individual’s experience of the event or circumstance.
4
Prevalence of Trauma
Exposure to trauma is especially common among individuals with mental illness, substance use disorders and developmental disabilities
5
Trauma Affects…
Over one out of three females with mental health disorder; and About one out of five males with mental health disorder in Ohio
Source: Client Self-Reported Experiences of Trauma, SFY13, Ohio Behavioral Health Module
Trauma Affects Ohioans with Developmental Disabilities…
Ohio Department of Developmental Disabilities 2013 MUI Data
2 out of every 10 individuals with Developmental Disabilities experience trauma each year in Ohio
Individuals with Developmental Disabilities and Trauma
Increased risk for abuse as compared to the general population (Gil, 1970; Mahoney & Camilo, 1998; Ryan, 1994) • Over four times as likely to be victims of crime as
the nondisabled population (Sobsey, 1996)
• Two - ten times more likely to be sexually abused than those without disabilities (Westat Ind., 1993)
• Often experience rejection and loneliness (Pitonyak)
8
Trauma Affects Ohioans with Developmental Disabilities…
According to the World Health Organization: Children with disabilities are 4 times more likely to be exposed to trauma than children without disabilities Adults with disabilities are 1 ½ times more likely to be exposed to trauma than adults without disabilities
Jones, et. al., 2013 (Children) Hughes, et. al., (Adults)
Interaction between DD and Trauma Bi-directional effects
• Abuse and neglect have profound influences on brain development. The more prolonged the abuse or neglect, the more likely it is that permanent brain damage will occur.
• Not only are people with developmental disabilities more likely to be exposed to trauma, but exposure to trauma makes developmental delays more likely.
-Joan Gillece, Ph.D.
10
DD, MI and trauma
• Cognitive and processing delays that interfere with understanding of what is happening in abusive situations
• Feelings of isolation and withdrawal due to their differences, which may make them more vulnerable to manipulation because of their increased responsiveness to attention and affection.
-Joan Gillece, Ph.D.
11
Cost of Trauma
• Trauma is a major driver of medical illness, including cardiac disease and cancer
• Addressing trauma can positively impact the physical, behavioral, social and economic health of Ohio and Ohioans
12
What is “Trauma Informed”?
A program, organization or system that is trauma-informed: • Realizes the widespread prevalence and impact of
trauma • Understands potential paths for healing • Recognizes the signs and symptoms of trauma and how
trauma affects all people in the organization, including: • Patients • Staff • Others involved with the system
• Responds by fully integrating knowledge about trauma into practices, policies, procedures, and environment
• Not the same as treatment for PTSD 13
Outcomes with TIC
• Improved quality of care and impact of care • Improved safety for patients and staff • Decreased utilization of seclusion and restraint • Fewer no-shows • Improved patient engagement • Improved patient satisfaction • Improved staff satisfaction • Decreased “burnout” and staff turnover
14
Ohio’s Trauma Informed-Care (TIC) Initiative
• Many mental health, addiction treatment and DD serving providers have already provided training and consultation in trauma informed practice
• Many clinicians are trained in Trauma-Focused
Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization training (EMDR); Dialectical Behavioral Therapy (DBT) and other treatment modalities
15
Ohio’s Trauma-Informed Care (TIC) Initiative
• There continues to be a need for training for staff/facilities and community system partners
• The ability of all communities and providers to organize
trauma trainings internally is often beyond their finances, time and capabilities, yet the need of persons served has not changed
• The initiative will seek to provide additional resources
for agencies and programs in Ohio who may need this support
16
Ohio’s Trauma-Informed Care (TIC) Initiative
• Since Summer of 2013, an interagency workgroup comprised of leaders from Ohio MHAS and Ohio Department of Developmental Disabilities (DODD) has been meeting to formulate plans to expand TIC across the state
• A portion of the “Strong Families, Safe Communities” funds
from the Governor’s Office have been earmarked for this purpose
• The National Center for Trauma-Informed Care
(NCTIC)/SAMHSA and Ohio Center for Innovative Practices (CIP) have also consulted formally
17
Ohio’s Trauma-Informed Care (TIC) Initiative
Vision: To advance Trauma-Informed Care in Ohio Mission: To expand opportunities for Ohioans to receive trauma-informed interventions by enhancing efforts for practitioners, facilities, and agencies to become competent in trauma- informed practices
18
Ohio’s TIC InitiativeTrauma-Informed Care • The TIC model assesses a service delivery system and makes
modifications based on the basic understanding of how trauma affects the life of an individual (those served and those providing the service)
• TIC means that every part of an organization or program understands the impact of trauma on the individuals they serve and promotes cultural and organization change in responding to the consumers/clients served
• This is not a service; rather it is an approach to interpersonal interactions that takes into account the potential scars of a person’s past experience
• The TIC Initiative is not about endorsing particular trauma-informed practices, treatment models, screening or assessment instruments or processes and takes an across-the lifespan approach
19
Trauma-Informed Care (TIC) Promotes Cultural Change
20
“What’s wrong with you?”
“What has happened to you?”
TIC Planning Framework
Interdepartmental Team (OhioMHAS and DODD)
Statewide Trauma Informed (TIC) Propagation Plan For MH, DD and AoD
TIC Training/Summit for Clinical and Administrative Leaders
Regional TIC Collaboratives
Community Agencies CO Partners , Specialty Groups
(Children, older adults, DD)
Internal Departmental
Implementation (Hospitals/community
support network, developmental centers,
therapeutic communities)
Collaboration with other departments
and agencies
Technical Support
Organization(s)
Advisory Committee
TIC Project Coordinator
OhioMHAS and DODD Leadership
Ongoing communications/Training for Regions, Boards, Agencies and
Providers
Interdepartmental Leadership Team
22
• Dr. Mark Hurst, OhioMHAS, Co-Chair
• Kathy Coate-Ortiz, OhioMHAS
• Jody Lynch, OhioMHAS • Angie Bergefurd,
OhioMHAS • Trudy Sharp, OhioMHAS • Dr. Lisa Gordish, Twin
Valley RPH • Dr. Kraig Knudsen,
OhioMHAS • Latonya White, OhioMHAS
• Pam Berry, DODD, Co-Chair • Sarah Lawson, DODD • Patrick Kanary, CIP, Case
Western Reserve University • Joyce Starr, OhioMHAS • Dr. Tammy Collins,
OhioMHAS • Jackie Doodley, OhioMHAS • Dr. Afet Kilinc, OhioMHAS • Rob Robbins, DODD • Kim Kehl, OhioMHAS,
Project Coordinator
TIC Planning Framework
Interdepartmental Team (OhioMHAS and DODD)
Statewide Trauma Informed (TIC) Propagation Plan For MH, DD and AoD
TIC Training/Summit for Clinical and Administrative Leaders
Regional TIC Collaboratives
Community Agencies CO Partners , Specialty Groups
(Children, older adults, DD)
Internal Departmental
Implementation (Hospitals/community
support network, developmental centers,
therapeutic communities)
Collaboration with other departments
and agencies
Technical Support
Organization(s)
Advisory Committee
TIC Project Coordinator
OhioMHAS and DODD Leadership
Ongoing communications/Training for Regions, Boards, Agencies and
Providers
Framework for Ohio’s TIC Initiative
Progress so far: • June 2013: Initial training of ODMH/MHAS Central Office and
Regional Psychiatric Hospital (RPH) leadership in TIC • On site training of clinical and support staff at all RPHs, with
participation of DODD Developmental Centers, as available • Regular consultation with NCTIC on next steps • Plans for subsequent visits and consultation from NCTIC • Launch of TIC research study in collaboration with OSU
College of Social Work
24
Framework for Ohio’s TIC Initiative
Progress: Statewide • November 2013: TIC Project Coordinator started (Kim Kehl) • Advisory Group formed (Co-chairs: Dr. Julie Gentile and Dr.
Patrick Palmieri) • Endorsed “Fundamentals of TIC” approach • Serve as “ambassadors” of TIC
• Submitted application to NCTIC for technical support in December 2013
• Train-the-trainers model • System infrastructure and infiltration
• Updated TIC Website: • http://mha.ohio.gov/traumacare
25
TIC Advisory Committee:
• Survivors of Trauma • DODD • Ohio Hospital Association • Medicaid • PCSAO • OACBHA • Ohio Council • OACCA • ODH • Hamilton County Board of DD
• Wright State University :MI/DD CCOE
• Depart of Aging • Human Trafficking Commission • CIP • ODJFS • ODYS • Ohio Women’s Network • Board of Regents • Center for the Treatment and
Study of Traumatic Stress • Ohio Provider Resources
Association (DD)
26
TIC Planning Framework
Interdepartmental Team (OhioMHAS and DODD)
Statewide Trauma Informed (TIC) Propagation Plan For MH, DD and AoD
TIC Training/Summit for Clinical and Administrative Leaders
Regional TIC Collaboratives
Community Agencies CO Partners , Specialty Groups
(Children, older adults, DD)
Internal Departmental
Implementation (Hospitals/community
support network, developmental centers,
therapeutic communities)
Collaboration with other departments
and agencies
Technical Support
Organization(s)
Advisory Committee
TIC Project Coordinator
OhioMHAS and DODD Leadership
Ongoing communications/Training for Regions, Boards, Agencies and
Providers
Framework for Ohio’s TIC Initiative
TIC Summit June 26, 2014 • Thematic fundamental training for clinical and
administrative leaders • AM session: Didactic by leaders from NCTIC • PM session: Regional breakouts to advance TIC locally
• Identify strengths, weaknesses, needs, champions • Identify initial plan to proceed, with support from
departments for communication, facilitation, etc. • Sustainability
Regional Collaboratives • Progressively transmit TIC and increase expertise within
regions • Topical workgroups (prevention, DD, child, older adult, etc.) • Department(s) continue to support, facilitate, communicate 29
Athens Region
Lawrence
Meigs
Gallia
Washington
Monroe
Scioto Adams
Brown
Hamilton
Butler Warren Clinton
Highland
Jackson
Ross Vinton Athens
Preble Greene
Fayette
Madison Clark
Miami
Darke Champaign
Franklin
Pickaway Fairfield
Hocking
Mercer Auglaize
Shelby Logan
Union
Hardin Allen
Van Wert
Paulding Putnam
Hancock
Wyandot
Marion
Delaware
Morrow
Seneca
Sandusky
Ottawa
Lucas Fulton Williams
Henry Wood Defiance Erie
Huron
Lorain
Wayne
Medina
Cuyahoga
Summit
Knox
Holmes
Licking
Coshocton
Muskingum
Tuscarawas
Guernsey
Perry Morgan
Noble
Belmont
Harrison
Carroll
Columbiana Stark
Portage
Mahoning
Trumbull
Ashtabula
Geauga
Lake
Crawford
Twin Valley
Region
Lawrence
Gallia Scioto
Adams
Hamilton
Pike
Jackson
Vinton Athens
Madison
Miami Darke
Fairfield
Hocking
Mercer Auglaize
Shelby Union
Hardin Allen
Putnam Hancock
Wyandot
Marion
Delaware
Seneca
Sandusky
Ottawa
Lucas
Wood Erie
Huron
Holmes
Guernsey
Perry Morgan Noble
Belmont
Harrison
Clermont
Jefferson
Richland Crawford Ashland
Montgomery
Lower Northeast
Central
Southeast
Upper Northeast
Southwest
Northwest
TIC Regional Collaboratives
Framework for Ohio’s TIC Initiative
Sustainability: • Based on the passion of those involved in the initiative • Encourage use and repurposing of existing resources • Technical support: NCTIC and deliverables of CCOEs • Encourage regions and state to develop internal expertise and
learning communities to transmit, maintain and advance our ability to respond to those with trauma needs
31
TIC: Why is this important?
32
TIC: Why is this important?
“What Happened to You?”
33
34
• Ohio Department of Developmental Disabilities • National Center for Trauma-Informed Care • OhioMHAS Office of Research • Public Children’s Services Association of Ohio • Ohio Human Trafficking Commission • Ohio Department of Health • Ohio Domestic Violence Network • SAMHSA • Ohio MHAS Trauma Website:
http://mha.ohio.gov/traumacare
35
Dr. Mark Hurst, M.D., FAPA Medical Director, OhioMHAS
30 East Broad Street, 36th Floor, Columbus, OH 43215 (614) 466-6890
Pamela Berry Senior Policy Advisor, Ohio Department of Developmental Disabilities
30 East Broad Street, 12th Floor, Columbus, OH 43215 (614) 301-2992
Kim Kehl TIC Project Coordinator, Office of the Medical Director
OhioMHAS 30 East Broad Street, 36th Floor, Columbus., OH 43215
(614) 644-8442 [email protected]
Top Related