Trauma Informed Care - Episode 2

Sentara is accredited by the Southern States CME Collaborative to provide continuing medical education for physicians. 

Sentara designates this enduring material for a maximum of .25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Sentara Continuing Medical Education adheres to ACCME Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of an accredited activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

To Claim Credit for listening to this episode:

1. Click here and enter 18508 as the Activity ID (number).
2. Then go to the MY CME tab and complete the evaluation.
3. Credit hours will be reflected on your transcript, or you may download your certificate.

For more information, click here.

Transcript

SPEAKER_00 0:00

You're listening to Vital Signs, a podcast for Sentera providers. Welcome to episode two of the Trauma Informed Care Series. In today's episode, we're joined by Tommy Batum, Director of Clinical Practice Management, and Austin Alderman, licensed professional counselor. Before we turn things over to the team, here are a few important CME announcements. This episode is accredited for AMA PRA Category 1 credits. For full accreditation, designation, and disclosure information, please refer to the show notes. And now, here are Tommy and Austin.

SPEAKER_01 0:34

Hello, welcome to Vital Signs, a podcast for Sentera Providers. Again, I am your host, Tommy Bateman, and we are talking about trauma-informed care with Austin Arm and LPC with Sentera Health Plans. In the previous episode, we kind of talked about uh the uh basic definition of trauma, its prevalence, uh, what it looks like, what it doesn't look like, some of the you know cultural phenomena that are happening since we have been studying the prevalence of uh trauma and uh you know adverse to childhood experiences. And in this one, we want to kind of start drilling down to some of the more core principles of trauma and trauma-informed care. So Austin, now that we kind of understand the need, what are what are these core principles?

SPEAKER_02 1:22

Yeah. So building off kind of what we discussed in the last one, so SAMHSA does a really good job laying out what they consider are like six foundational principles that really guide trauma-informed practice. And really, this is kind of getting to the meat of like the action steps, right? What we can do as community partners. Um, and they first have number one is safety. Uh, number two is going to be trustworthiness and transparency. Number three is that peer support. Four is going to be collaboration and mutuality. Five is empowerment, voice and choice. And number six is that cultural, historical, and gender issues.

SPEAKER_01 2:00

So let's walk through it. Let's start with safety first. What is that defined as a principle?

SPEAKER_02 2:06

Yeah. So the safety, the reason why this is their number one is people need to be physically and emotionally safe before any healing or growth can occur. And so what this could look like for us as providers is making sure we have clear explanations of what's going to happen in their session or exams, making sure when they walk into our office it's calming, it's welcoming, it's nothing that um is is bright light, you know, very sterile environments. Um, and then making sure that we have predictable routines and that we as the providers are using respectful language. Um and once we can establish that, we can kind of move into the their number two one, which is like that trustworthiness and transparency, like making sure that we're consistent because we got to rebuild trust, right? The people who are coming to us with their trauma, they've lost that power and control and they're not going to be very trusting of everyone or all the situations they encounter. So for providers, we want to make sure we're following through on commitments. We want to explain why we're asking certain questions. I know it's really common now for people to do trauma screenings or PhQ depression screenings or even substance use screenings, right? Like we need to explain why that information is helpful to us. Like, what's the point of us gathering that data? How is it going to help us help them? Um, and being honest about what the expectations are with our practice and what limits exist, right? Like thinking about on our therapeutic day treatment summer camps, right? The the most successful days was when we were able to have those rules, be clear about our expectations, and also make sure that there was safety too. Like there was also limits of behaviors that were allowed and not allowed and like kind of consequences that came with choices that they made. So, but it should have never been a surprise, right? It's ongoing conversations that we have throughout with them. So to build that transparency and that trust with them.

SPEAKER_01 3:58

And you know, it's it's funny, a lot of a lot of the children uh in those settings chafe at rules, but it's exactly those rules that make them feel safe because a lot of them don't have rules at home, right? And you know, the those that complete lack of rules, and and this is me, I'm jumping into my clinical brain saying that complete lack of rules kind of tells them I don't know where safety is, right?

SPEAKER_02 4:23

Yeah, I one of them in very beginning before I even decided mental health was where I wanted to go, I worked at a juvenile detention center as just staff there. And you know, we had uh we had a lot of kids who were repeat offenders, right? They come in, spend a couple months, do their time, go home, and a few weeks later, they're back. You know, they're back for their and I finally, and there's one kid who stands out to me where I was like, why? Like what is going on? Like, why do you come here? And he said to me, and I'll never he's like, you all care about me. You all have rules. And if I break that rule, there's a consequence. But if I do what you guys asked me to do, there's rewards. There's a whole token economy system within that environment. And like you said, they they might chave at it at times, but they also that's what they're seeking. They're seeking caring and again the transparency, right? Like they those kids knew what the rules are, they knew what the consequences were for not meeting those expectations. And for the most part, they they enjoyed having that sense of responsibility themselves as well.

SPEAKER_01 5:24

Yeah, and so you heard it here first, or probably for the 50 millionth time, parents' rules, expectations is loving loving on your children. So very good stuff. Yeah, it's funny. I worked in an adult correctional facility, and I heard much of the same response that uh they felt safer and and um their mental health was better when they were incarcerated, some of them, which was which was an interesting thing. But not to dwell on that too much, what's peer support? What what is that principle?

SPEAKER_02 5:55

Yeah, so you people heal in communities, right? So having shared experiences helps reduce that shame and isolation of thinking that it's something that doesn't happen to others. So as a provider or organization, like making sure we offer support groups, uh, linking our patients or clients to peer recovery specialists or mentorship programs, uh, peers can model that resilience and provide that validation. I'm I don't think I can say enough good things about peer recovery services. And I think that's also been a growing trend in the past decade or two. But being able to connect someone who has experienced similar trauma and has lived that and is also healed from that, I think it's so helpful to our clients and patients to connect them to someone so that they see someone who's walked in there in their shoes and that they've come out on the other end better and that they've been able to heal from it.

SPEAKER_01 6:52

Yeah, I mean, I've noticed in my own practice that people that experience trauma tend to isolate, right? Absolutely.

SPEAKER_02 7:00

Absolutely, yeah. So connecting them and getting them uh in front of people, and then they get to realize, like, oh, this it wasn't just me or what it wasn't something I did wrong. This happened to so many people around me as well. And and also gives them the I hope the place to set goals, right? Like they can look at the other person in that support group and it's like, wow, look at this person and how far they've come. I want to be like them, that they don't feel like it's not a goal that they can reach.

SPEAKER_01 7:29

Excellent. And so it kind of leads into the next one. And I mean, the other ones, the other principles were kind of obvious on their face when it came to the I could probably guess the definition, but this one collaboration and mutuality. Tell me more about that one.

SPEAKER_02 7:42

Yeah, so this it goes into like encouraging those clients to set goals, right? Like, what are they coming to the sessions for? What are they coming for the exam? Like, what is their goal? Um, and it kind of goes back to the collaboration is you know, the counseling 101 of allow that client to be the expert in their life, you know, listen to what their primary concern is. Because I think sometimes as providers, we hear what their concern is, but then we have our laundry list on the other side of things of like, but here's what I want you to actually do, right? Like you want this one thing. I need you to do these 10 other things instead. But it's like if we can't get that one way, one thing out of the way for them that they see is their primary need, they're never gonna get to the place where they'll do the other areas, right? So it's like making sure we let them guide us in the treatment and that we're meeting them where they're at. Um, and the other thing for organizations is like listening to feedback from those people who are getting services, right? Like if we're missing the mark, we got to be honest with ourselves on that and and make changes. And then if we're doing things well, you know, doubling down on those things and making sure we continue the things that people are telling us is working for them.

SPEAKER_01 8:50

And you know, it it's I'm thinking about how that shows up in the real world. So as a counselor, of course, you one of our things that we do is we do an ISP where a service plan where we set goals collaboratively with the client and come up with uh what they want to do, and and there's agreement between clinician and client, and and we move forward. Um and and of course, behavioral health, there is a bit of subjectivity to it where the the patient experience and client experiences is very important. But I'm thinking, what about you know, in the medical field where cholesterol is cholesterol, right? Overweight obesity is um obesity. How can how can we have collaboration and mutuality and um something a little bit more concrete, like some of the medical fields?

SPEAKER_02 9:40

Yeah, I I like to think in the medical fields, we can still offer choice, right? Like if their cholesterol is the problem, what are the treatment options for them to address it, right? Say, you know, giving them A and B, and let's start with one, right? Instead of saying we're gonna watch what we eat, we're gonna monitor our cholesterol levels, you know, like giving them a choice. But I think as the experts in the field, I think we also get to guide that treatment as well, but giving them the choices when they're available, right? Like how do how do we want to handle it? Are we gonna start exercising first or are we gonna start eating healthier meals and then we're gonna revisit it, you know, in 30 days and then climb something on? I think as providers, that's something we sometimes miss the mark on. And even in treatment planning, right? With uh mental health, is they come up with like 10 goals. And we're like, sure, let's do all 10. But we know realistically we need to do something small. So let's we know change is hard. So starting with small, measurable changes is going to be the goal. And you know, I think in the medical profession, that can translate over with how we address certain medical needs if there are different ways to approach it and then doing it in small increments instead of saying, here's here's the list that I need you to do all these things by the next time I see you. We know most people leave that office and that piece of paper goes to the side, right? So it's like, what's the one thing I'm gonna? What's the one piece of homework we can ask from them that we're gonna follow up on next time?

SPEAKER_01 11:06

So, you know, we have our best practices, we have our um, you know, research-backed interventions, but if the patient or client is not on board, then that's not the best practice in that moment, it sounds like.

SPEAKER_02 11:21

Yeah, yeah. And I think there's been a lot of improvements that I think with um that integrated health care, right? Is in making sure that you know, cholesterol might be the members or our our viewpoint as the doctor, their number one concern is getting that cholesterol under control. But to that patient sitting in front of us, their number one might be an unmet food need or unmet housing need, right? So it's like, okay, can I link you now to a social worker or a case manager that can maybe give you those resources that you're in a better mindset, that then we can address cholesterol, right? Like I think I think our health needs usually fall to the wayside when our um SDOH needs, our social detrimental health needs aren't being met, right? There, there's a we need that Maslow hierarchy of needs before we can get there.

SPEAKER_01 12:08

Yeah, and if we threw a statin, and geez, I'm I'm going way out of my field, but if we threw a statin at somebody that you know is in a food desert, you know, and only being able to access to junk food and high stress, um we're we're we're not doing, we're not really solving the problem in in the end. So and I think we already hinted at this. Um we we empowerment, voice, and choice is the fifth of the principles we're talking about today, but I think we already hinted around that. Can you elaborate more?

SPEAKER_02 12:36

Yeah, I absolutely I think we definitely have. So it, you know, I think we know trauma involves that loss of power control. So the trauma-informed care piece is trying to give that power back, right? Like again, going back to offering those options rather than mandates and making sure that we're always highlighting strengths. And I think we've all had those clients or patients where like finding the strength, like we're digging deep. Like they're they're a tough, tough one for us to work with, but sometimes reminding ourselves that they showed up for their session or even their scheduled appointment, that's that's a strength, right? Like they chose to come in when they could have canceled or no showed us, right? So they have realized that this is something they need. So making sure we build on any strengths that we can find.

SPEAKER_01 13:19

Interesting. And and and that's I I think uh them showing up and being an active participant in it. That I mean, not only are we talking about better, better patient care and potentially better patient outcomes, but hey, this is hitting the bottom line at this point, too, right? Um that's very important to understand. We we have to have sustainability. Um, and that's that's very interesting. So the last one, uh cultural, historical, and gender issues. Let's walk through that one real quick.

SPEAKER_02 13:48

Yeah. So, you know, trauma trauma doesn't just occur in a vacuum. There's social context, and these things matter. So making sure that we're culturally responsive, that we are aware that people's cultural beliefs and backgrounds are going to impact uh how they approach the services and the care that they are seeking. Um and just having that awareness that historical trauma, such as racial violence, is is going to pop up. So that that individual may not have directly experienced a traumatic event, but they have been grown grown up in a household where others have. So it's like that generational trauma is going to continue until we can get them to a place of safety.

SPEAKER_01 14:26

Yeah.

SPEAKER_02 14:26

Um, and then just making sure our gender-sensitive policies, that we are mindful and seek that humility and that we show respect for lived experiences.

SPEAKER_01 14:37

You know, and there are you know cultural differences between uh, and I'm remembering um our discussion earlier about adverse childhood experiences. Um, there's cultural differences of what that definition may truly be. I I could think of one example of uh corporal punishment. You know, some think you know, spanking is about as far as we can go, and others go back, oh yeah, no, my parents wore me out, and they don't consider that a traumatic experience at all. Um, you know, because that's culturally, all the kids got wore out by their parents, you know, over there, wherever that is, you know, and and um and so that that is something to to really be aware of and think about. And so very good. Now, when a provider office you know adopts these principles, what changes uh there? I know we already mentioned that you know we may have better client or patient buy-in and that they're showing up more. Um, what other things tend to shift within that office environment when we start adopting trauma-informed care?

SPEAKER_02 15:43

Yeah, I think, you know, well, for you know, the goal, right, is to make sure that we put these in into practice. We can sit and talk about them, but it's like, okay, now now we got to have the rubber meet the road and actually do something about it. And I think the biggest shift that providers will see when they start operating from these principles is is the minds is the mindset shifts, right? That that the phrase comes up again instead of what's wrong with you, asking what's happened to you, right? Giving us a sense of a better understanding of the person sitting across from us versus that place of judgment. Um and I think it shows up in just how we document, how we talk to the patients, how we structure our services, and even from the top down as an organization, like how does leadership treat staff? And that's going to translate to how staff treat clients. Um, and it it just need it needs to become a shared culture, not not just kind of a checkbox. And I think that's one of the things I stress a lot when I've done these trainings for organizations is I think a lot of people, employees, they're doing everything they can. Like the idea of adding something more to the plate is at sometimes asking a lot from staff. Um, and so I the way that I always like to phrase trony for cares, it's not we're not adding something new. We're just changing how the how we're already doing things, right? Like you're already having to communicate to the client, you're already having to document your sessions. So it's changing the lens that we look at those from. So it's not extra work, it's things that we're already doing, but making sure that we uh do it in a sense that's going to be safe, safe, and trusted, giving all those six principles back to the member or the client to be able to feel safe and make those positive changes.

SPEAKER_01 17:27

I really like that. And I think what you just did, Austin, is give a sneak peek to part three where we talk about implementation. So, with that, folks, stay tuned and get ready for part three of our next talk on trauma-informed care. Thank you again, Austin.

SPEAKER_00 17:43

Thanks. Thank you for joining us. Be sure to keep an eye out for episode three of the trauma-informed care series. You've been listening to Sentera Vital Science, a podcast created for Sentera providers. As a reminder, please check today's show notes for details on how to claim your continuing education credits. That's it for now, but we'll be back soon with another episode of Vital Science, the podcast that delivers evidence based education for physicians and healthcare providers on the go.