Trauma Informed Care - Episode 3

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Transcript

SPEAKER_00 0:00

You're listening to Vital Signs, a podcast for Sentera providers. Welcome to episode three 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 0:35

Hello and welcome to Vital Signs, a podcast for Sentera providers. I'm your host, Tommy Bateman, and we're going into part three of our trauma-informed care series, part three of four. And we're here again with Austin Alderman, LPC of Sentera Health Plans, who is our expert on trauma-informed care. Now, in part one, we introduced the topic, what it is, uh the prevalence, and in part two, we talked about core principles of trauma-informed care. And towards the end of that last episode, we started looking at what it looks like when an organization adopts these principles. So let's continue on with that conversation, Austin. Let's talk about putting this into practice. What does it look like when a practice implements it? You already said, you know, it's not just asking trauma questions like we do at PHQ 9, like this is the section we're getting on. It is a core principle that we inculcate into our entire practice, it sounds like.

SPEAKER_02 1:35

Yeah, absolutely. So, you know, that implementation, uh, it's going to begin with those principles that we discussed previously. But those, if you notice those principles are all things that are daily behaviors, they can be policies or just environment changes, right? They're about shifting how we interact and communicate and structure those services so that that safety, trust, and empowerment can guide everything that we're doing.

SPEAKER_01 2:00

Um, so again, it's go ahead. Interesting, interesting. What what is a policy, a trauma-informed care provider office policy look like?

SPEAKER_02 2:10

Yeah. So some of the policy things is really how we're gonna reword our what policies we have as an organization, right? In the sense that what are the expectations, what are we expecting from the patients when they come into our office, making those clear to them, and then also what we're gonna do for them. Like not only what we need for them to be, we obviously need them to be active participants, but what are we gonna do for them? What limits are there? How what limits around that? What are things that we're gonna be okay with? Because I think one of the things I always stress when I've done this with school systems is it's not trauma, isn't just a pass for the child to mistreat the teachers or administration, right? It doesn't just give them a pass to react. And I think it's the same for patients, right? There has to be, when they're in our office, you know, there has to be a level of safety for our staff as well. And so it's being clear with them, letting them know during the intake, what what policies do we have that are going to be mindful of their trauma that we know you might um have a grievance at some point, you might not agree with things, but here's what we're gonna do. Here's how we're going to handle any things that come up. And then here's the limits to that, right? Like at some point, they might not be uh at a place where they could be in our practice or um someone that we can see at the time if we're in a clinical thing. So again, it comes back to that transparency piece and again the the safety of we need you to do those things, these things, X, Y, and Z, and I'm gonna do these things as your provider to make sure we come together and we're working collaboratively to get your your goals met.

SPEAKER_01 3:51

So it's like, you know, we say this in relationship counseling too, how important boundaries are and uh applying this to the practice. And what I really liked about that, Austin, is that um a lot of times when people consider, oh, that person's uh dealing with trauma, or that's a trauma traumatized kid, we put our kitty gloves on and let them get away with murder, the traumatized individual, you know, or person dealing with trauma. And um, that's not the case. You're not saying that.

SPEAKER_02 4:20

Right. No, I think a lot of it comes to like, you know, like from times being clinicians with some of those non-compliant patients or anything. I think the way we approach those things, I feel like we always use maybe like a softer tone when we communicated with them, right? We we were the stable person for that person who was out of control or was reacting in a way, right? Like we have to be the stable object for them so that they can regulate themselves, right? So it's how we're going to approach them knowing that they have trauma. Um, but I think the big piece with trauma informed, knowing with how prevalent it is, if we approached everyone from that lens, I don't think you could ever go wrong, right? Like if I talk to you in a calm tone and you never experience trauma, I don't think you're gonna get offended because I'm not coming in and dictating something to you, right? Like it's so it doesn't matter, you don't necessarily have to know someone's trauma to handle them from a trauma-informed lens so that if they have trauma, because sometimes people haven't identified it yet, right? Like they they can't name it. They know something's off, something's happened to them, but they have not been in a place where they can name what's happened to them. So it's operating from those daily things that we're already doing, uh again to build that safety, trust, and empowerment back.

SPEAKER_01 5:38

Yeah, I and I'm I'm thinking of yeah, the safety and trust, the the transparency of the policies, the transparency of our boundaries. Uh I always felt when you know, when I worked with kids too, especially once they had those type of experiences. Um, and I don't know how helpful this is to the to everybody, but I imagine myself as, you know, within this, within the walls, you know, fair, you know, everything is fine, but that wall is is thick and tall, and we're not gonna, you're not gonna get over that boundary, you know. And if you try to climb that boundary, I'm just gonna make the wall taller at that point. And sure enough, it there seemed to be a calming effect of even strongly enforcing that boundary uh for the um for the people I work was working with.

SPEAKER_02 6:22

Yeah, yeah. And I think you know, the trauma-informed piece from an organization standpoint is like not not necessarily not necessarily seeing that individual as their symptoms, right? Like how many from a mental health standpoint have you heard, oh, that person's bipolar or that person's borderline, right? Like where we identify them as their diagnosis or symptom versus a human, right? Like we we kind of dehumanize them because we're identifying them based off of the symptoms they're exhibiting versus coming from that place of uh curiosity instead of judgment, right? So if we can adopt the trauma-informed practices, it it the goal is to improve outcomes, which means our patients are gonna stay engaged longer with us. They're gonna feel respected. And then we know if they come to their their sessions and their appointments with us, their health outcomes are gonna improve. And that that's gonna be the main goal for a lot of us is to get them that like you said, that bottom line to where they're doing better, feeling better, uh, and having those better health outcomes.

SPEAKER_01 7:23

So let's say we're we're, and I know you know, I was beating around the bush earlier, but let's say we're implementing these policies, where do you start? Who do you go to first?

SPEAKER_02 7:34

Yeah. So I would say that there's um there's two ways that I I think work well in the ways that I've done it. So there's like a clinical level, like us as the clinicians providing the work, things that we need to implement, but then as an organization level, um, and I will say I've I've done this uh training of trauma-informed care for quite a few school systems, quite a few community partners. And I think the ones where it really did well, it started from the top down. Like the superintendent said, I want me and my school school office, school board office staff to participate in this. And then I want you to go do this with the schools, and then I want you to go do this with the bus drivers and the cafeteria workers and the custodians. Like those are the systems where from the very top all the way down to front office staff got this training because the goal is for everyone to do it. And I think you have to have that leadership buy-in if you want to see the the change around it into the culture. Because it's hard to say treat your students this way or treat your patients this way, but the people above you don't even treat you in the way that they're asking you to treat others, right?

SPEAKER_01 8:46

Starting from the top, get that leadership buy-in and kind of have that trick trickle down affect uh everybody else. And as you said, I mean, a lot of the clinicians probably already are well trained and versed in some of this stuff, but having the organization itself from front desk staff to the custodian, as you said, knowing it is an important thing to really model the model trauma-informed care within an organization, right?

SPEAKER_02 9:11

Absolutely. Yeah, and I think sometimes, you know, when someone enters our buildings, they don't usually see the doctor right away, right? So knowing that the person at the front door who says hello to them and acknowledges them, it it starts there. It starts from when they enter the building and everyone they encounter that's part of our practice to all the way to their appointment, right? It it there's so many opportunities for someone to intervene and give them that positive smile or that interaction to help them feel safe so that when they enter the exam, they're they're not as defensive, right? And maybe they can be a little bit more vulnerable with their caregiver or the their provider to give them really what they need and what their needs are.

SPEAKER_01 9:55

Yeah, that the yeah, I can tell you, front desk, they have they could set the tone for the entire visit. I I I don't know how many reviews I've looked on Google where you know they said, Oh, the doc was great. Um, front desk staff, this is why they're getting one star right now. And I'm never going back. Uh doctor, yeah, healed me up, did what exactly what I needed, listened to me. It was wonderful. But forget that front desk staff. And so I'm not coming back. And I personally have dropped um um a dentist in my experience when the front desk, front desk staff changed, I'm like, well, I'm out. You know, yeah, absolutely.

SPEAKER_02 10:29

And I I think, you know, and looking at it from a context too, like with the children that I've worked with, right? Like when a child comes to school tardy, right? Like he comes in and when the front desk staff says, Oh, you're late again. Okay, I'm gonna write you a pass to go to class. Like, why aren't you on time? You know, giving them a hard time, then that child who's already late, who's already probably feeling rushed, is now entering the classroom after kind of getting scolded by the front desk versus the school that I worked at that made such, I think made a lot of progress was the person checked in late and they're just like, oh, I'm so glad to see you. Let me get you a breakfast. Did you have breakfast? Let me get you a bag, like you can take it to class with you and eat on the way, right? Like the the idea of how welcoming those two different interactions could be to set the tone for the day for that child, right? And if we don't set the tone for the child to be successful, they're gonna go to class and they're gonna disrupt, and then the teacher is gonna be calling us for help, right? Like, I need I need assistance down here, so and so is not following the rules, they're throwing things, right? So it's making sure that from the get-go, from when they enter the building, that they start feeling that trust and they start being up, feeling like they're a part of that environment and that the people in that environment care about them.

SPEAKER_01 11:43

And they could still do the in the school's case, the core mission of education. Of course, having punctuality, though those ethics are important, sure. Um, but the core mission is education. We shouldn't comp do anything to compromise that. And same thing with in healthcare. The core mission is the wellness of our patients, not uh um not making sure that they fill out the forms correctly or whatever it is, you know. So um, so speaking of, so we do have our internal biases. I don't like being late. Um, I I like to make sure my my I's are dotted and T's are crossed. Um but uh uh uh I also understand I can't bring those biases into uh my practice all the time, but I can understand those can bring a barrier. Uh so what type of barriers are you experiencing when it when uh it comes to implementing trauma-informed care or that ethic into uh a practice?

SPEAKER_02 12:37

Yeah, absolutely. And I think that the first question I always ask myself when, especially when they rub rub into my bias on the same, punctuality is is pretty important to me. Um, but when it doesn't seem to be a high value for that person, I'm I always get to a point where I have a relationship where I just ask, like, what's going on? Like, why is there something happening? Does this time not work for you? Is there a better day or time right like coming from that place of curiosity versus you're late again? Here's here's a cancellation fee, or I'm gonna cancel at the point, right? You know, I think that comes back to also the policy of like someone who's chronically late, they don't get to just continue to be late. Like we need our policies and limits around that, right? Like how many times are they allowed to cancel or no show before we have to do something different as a provider? But at the same time, I think as providers, we have to have those conversations and open the door versus just say, oh, you're you're late again. Sorry, you know, not not seeing you versus, hey, I maybe not be able to do your full session, but can we figure out is this day and time not good? Can it like what happened? Is there a barrier that I need to help address? You know, is there a bus ticket that we need to get you connected with or a bus system if transportation's a problem? But coming from a solution-focused mindset versus just the the punishing mindset, right? Like how can we give you the tools that you need to get here on time? And what does that need to look like?

SPEAKER_01 14:03

Excellent. And um, I can hear you know some business owners going, well, that does affect my bottom line. Um, so you know, when you have talked to organizations in the in in the past about adopting these practices, you know, what what are common things that that have, I don't know, prevented them from implementing trauma-informed care principles uh or stopped it in its tracks or things that were hurdles to overcome within an organization?

SPEAKER_02 14:33

Yeah, I think there's a lot of I think hurdles for trauma-informed care. And I think one of the biggest things is like that we talked about in a previous part of that people think that it's extra work, right? That they think it's going to be adding extra tasks. Um, but it's really just making sure that people understand that trauma-informed care is more about how we do the work that we're already doing and making those small shifts in language and transparency and the difference. Um, one of the other hurdles, I think, is probably my the biggest one that I've done these trainings is the lack of leadership buy-in. And I know we touched on it earlier, but without that leadership buy-in, I think trauma-informed care efforts, they kind of stall out. Um and like I said, I've been I've been fortunate enough to do this for various uh community partners and school systems and organizations. I feel like the ones that it wasn't just kind of a check on the box, like, hey, I gave my staff trauma-informed care, check the box, moving on. Um, the ones that really adopted these principles, like I said, did it from the top down. The superintendent of the school system participated in the trainings before they were ever implemented to the school. And, you know, they also implemented um a teacher, it was kind of like a teacher work group where they revisited this. Like, is it working? Is it not working? Are there other training, many trainings or refreshers that we need to do? You know, not making it just that one time a year, check the box, we're done. We did trauma-informed care, but it was part of like a regular discussion. It became very normal for their culture to have a work group that regularly visited it. And that's where they came up with the idea of like if a child comes tardy, we're gonna offer them a breakfast. Because chances are if they're tardy, they probably didn't get breakfast. And I don't want them to come to my classroom hungry, you know, because then back to Maslow Hierarchy of Needs, how are they gonna learn if if they're hungry? Right. So, you know, they they implemented a lot of things that the front office staff would do, right? And they would do um instead of their little tardy slip they had to hand the teacher, it was like a smiley face of you came today, right? It was things, it was just changing the language so that the teacher knew they were tardy, but the child didn't have to be shamed for it. Because there's also times it's out of their control, right?

SPEAKER_01 16:51

So it does sound like there is some upfront work to do. It's not just training, it's not just sitting in front of Austin and listening to what trauma-informed care is. There's also some effort in, hey, maybe we should, like some people with diversity and inclusion, they review their policies and procedures and go, hey, is this in line with what we're trying to do as an organization? Um, so you know, I are has have the have the places you work with, do they review their policies and go or procedures and go, well, is this trauma-informed? Um, is there something we can start moving in that direction uh, you know, to help uh you know be more in line with those principles?

SPEAKER_02 17:30

Yeah, yeah, absolutely. And I and I agree with you. I think they're again the the trauma-informed listening to me is a very small percent of adopting the culture. Um and I think making sure you review all of your policies and is this trauma-informed? Is it not trauma-informed? Is it is it punitive? And I to your point, Early, but I think providers, it it does having people not show up for their sessions is going to affect the bottom line for sure. Right. So you have to have some sort of limit as a provider, what you want that to look like, of how often that can happen or much. But it's one of the again, going back to that is instead of just hitting them with the no-show, sorry, see you next time, but opening the door of what happened? What can I do? Is there something I can do different on my end? Because also for bottom line, if they start coming to the sessions on time, participating in the service, they're gonna have better health outcomes, which is then gonna also improve other areas as well, not just um for us as the business owner.

SPEAKER_01 18:33

And I like that that curiosity too, uh, a policy of curiosity. Uh, you know, that that tardiness or that no-show could be diagnostic all its own to help point out to the real problem that we're experiencing. You know, they're showing up for for you know heart problems, but man, there might be something else that that can actually help solve that heart problem. Cardiologist, you you tell me.

SPEAKER_02 18:55

But um, yeah, I was gonna say, I think it goes to the, you know, we talked in the other parts too of what we think is their primary concerns or primary needs isn't what it really is, right? Like they're coming to the appointment for their cholesterol, but before they got there, their child got suspended from school or they, you know, they've missed too much work, and so now they're at risk of losing their job. So they couldn't leave on time, right? They had they had to stay over, right? So making sure we come from that curiosity, understand where they're coming from to see if there's things that we can do as a provider to support them and not not be a burden onto them. So if they come and come to us and they they seek the help that they need, and we're not an unnecessary burden that they see us as a a tool to get better.

SPEAKER_01 19:40

Yeah, I love this. And again, just to kind of recap those two common barriers, man, it's we need that uh leadership buy-in. We don't have leadership buy-in. Things tend to fall apart because it really does need to be a change in culture completely in many ways, but that doesn't mean we're adding extra work. Uh, it is just not changing the work, or excuse me, not adding to the work, it's changing how we do the same work. So, Austin, thank you so much for for this talk about implementation and barriers. And our last part, we're going to talk about well, what's the payoff? What do we get out of it? Um, so we'll go there about measuring impact. Again, thank you guys for listening to part three, and we'll see you at part four.

SPEAKER_00 20:22

Thank you for joining us. Be sure to keep an eye out for episode four 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 credit. That's it for now, but we'll be back soon with another episode of Vital Signs, the podcast that delivers evidence based education for physicians and healthcare providers on the go.