Making The Link—Trauma & High-Needs Consumers
Open Minds; Monica E. Oss, 6/30/2015
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Recently I listened in on a conversation with a care coordinator working with a targeted group of consumers with complex support needs. His statement that caught my attention: “Many bad things have happened to these people and that won’t be undone in any short period of time. To help them, I need to get to know them.”
That seemed to be trauma-informed care in action – a subject getting more attention in care management programs. The effects of trauma have been better understood with more understanding of epigenetics – that what you do and what happens to you can change your genetic make-up (see What Is Epigenetics?). Specifically, research has shown that both adults and children who are frequently exposed to traumatic episodes have changes in how their brain functions and their genetic make-up (see Traumatic Consequences).
Beyond this very basic science, we have validation of the concept through the Adverse Childhood Experiences Study (ACE) which found that certain experiences are major risk factors for the leading causes of illness and death, as well as poor quality of life (see The Adverse Childhood Experiences (ACE) Study and Relationship Of Childhood Abuse And Household Dysfunction To Many Of The Leading Causes Of Death In Adults. The Adverse Childhood Experiences (ACE) Study). The study authors also developed a trauma scoring system, referred to as the ACE score, that tallies types of childhood abuse and neglect on a 0-to-10 scale (see What’s An ACE Score?).
As a result, “trauma-informed care” approaches have been developed, defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) (see Trauma-Informed Approach & Trauma-Specific Interventions) as:
…adherence to six key principles rather than a prescribed set of practices or procedures. These principles may be generalizable across multiple types of settings, although terminology and application may be setting- or sector-specific: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and, cultural, historical, and gender issues.
How to apply this new knowledge? A recent briefing paper, Trauma-Informed Care: Opportunities For High-Need, High-Cost Medicaid Populations, from Center For Health Care Strategies (CHCS), outlined six service models that show promise:
Addiction & Trauma Recovery Integration Model (ATRIUM) – This model targets homeless populations, correctional populations, jail diversion programs, AIDS programs, and survivor support programs. It provides peer support, psycho-education, interpersonal skills training, meditation and spirituality training, and community action (see Addiction & Trauma Recovery Integration Model (ATRIUM)).
Prolonged Exposure Therapy (PE Therapy) – This model targets adults with previous experiences of trauma and posttraumatic stress disorder (PTSD). It provides PTSD education, breathing retraining to reduce physiological experience of stress, exposure practice with real world situations, and talking through trauma (see Prolonged Exposure Therapy For Posttraumatic Stress Disorders).
Eye Movement Desensitization and Reprocessing (EMDR) – This model targets adults with previous experiences of trauma and PTSD. It provides spontaneous associations of traumatic images, thoughts, emotions and sensations, and dual stimulation using either bilateral eye movements, tones, or taps (see Eye Movement Desensitization and Reprocessing).
Sanctuary Model – This model targets residential treatment for children, public schools, domestic violence shelters, homeless shelters, and group homes. It provides a supportive, collaborative, and healing environment that improves trauma treatment, building cross-functional teams, and improving staff morale and retention (see Sanctuary Model).
Seeking Safety – This model targets individuals experiencing trauma, PTSD, or substance use issues. It provides safety as the overarching goal, through integrated treatment of trauma and substance abuse, ideals, cognitive behavioral interpersonal and case management skill sets, and attention to clinician processes (see Seeking Safety).
Trauma Recovery and Empowerment Model (TREM) – This model targets adult and young adult trauma survivors, particularly those with exposure to physical or sexual violence. It provides cognitive restructuring, psycho-education, and coping skills training (see Trauma Recovery and Empowerment Model).
For new approaches to “whole person” centered care coordination to work, addressing the unique characteristics of individuals is key – and screening for and addressing trauma is an important ingredient. For more, check out Models For Developing Trauma-Informed Behavioral Health Systems And Trauma-Specific Services and A Treatment Improvement Protocol: Trauma-Informed Care In Behavioral Health Services. Let’s hope this isn’t one of those areas that takes the field seventeen years to go from knowledge to action.