Presentation on theme: "Next Steps Towards a Trauma-Informed System of Care"— Presentation transcript:
1Next Steps Towards a Trauma-Informed System of Care Presented By:Douglas E. Patrick, JD, LCSWManager, Children's Behavioral Health SystemChildren's Behavioral Health ServicesDepartment of Health and Human ServicesArabella Perez, LCSWDirectorTHRIVE InitiativeSarah Krichels Goan, MPPEvaluatorHornby Zeller Associates , Inc.Jennifer McLaughlinYouthYouth M.O.V.E.Michelle LaPointeFamily MemberG.E.A.R. Parent Network
3What Research Tells UsEstimated 3 million children and adolescents in the United States are exposed to serious traumatic events each year.Nearly one out of three adolescents have been physically or sexually assaulted by the age of sixteen. (Boney-McCoy & Finkelhor, 1995)Violent crime victimization among youth found to be twice as high as the rate for adults. (Hashima & Finkelhor, 1999)High-rates (between 50% and 70%) of Post-Traumatic Stress Disorder in child/adolescent and adult public service users. (Macy, 2002, Kessler, 2000, Switzer, et al., 1999)PTSD rates among Medicaid enrollees found to be highest among children 5-12 years (609.5 per 1000). (Macy, 2002)Child/Adolescent trauma survivors found to have higher rates of mental health service use and to use more acute mental health treatment services, including: inpatient hospitalization, crisis services, and residential treatment services at higher cost. (Frothingham, et al. 2000; Macy, 2002, Newmann, et al., 1998; NTAC, 2003)Select a few to chat about
4Implications for the System When service systems do not appropriately assess, identify, and effectively address the underlying trauma-related needs of these children and families, the result is often that services are:more expensiveineffective and overwhelming to the child and familyre-traumatizing for the childResulting in poorer treatment outcomesGiven the pervasiveness of traumatic experiences among children/youth receiving public mental health services and the potential long-term costs to individuals, service systems, and society, these findings underscore the importance of trauma screening and identification early in the treatment process and the need for establishing and testing more trauma-informed approaches to service delivery and treatment.
5A Systemic ApproachDue to pervasive nature of trauma, systems of care need to take systemic approach to traumaA Trauma-informed system includes:Universal trauma screening, assessments and service planning – integrating all components;Focus on recovery, resiliency, strengths-based, and skill building;General awareness and understandings of all stakeholders of trauma, its effects and potential triggers;Changes in policy and practice to support a trauma sensitive approach throughout the system and participating agencies to reduce incidences of re-traumatization; andCrisis Management from a trauma informed perspective.
6Why Develop a Trauma Informed System of Care Approach in Maine Data collected and analyzed by Dr. Jay Yoe, Ph.D. of DHHS showed clearly that compared to others, children and youth trauma survivors in Maine:Were at greater risk of significant harm;Were likely to experience co-occurring challenges physically, developmentally and with substances;Had significantly greater challenges in the areas of child/youth and parent/caregiver acceptance and engagement with service providers;Were more likely to use mental health services and high-end services for greater periods of time; andHad 73% higher mental health service expenditures and 51% higher overall treatment expenditures.Doug
7State perspectiveSix years ago Maine was awarded a six year grant by the Federal Substance Abuse and Mental Health Services Administration to develop and implement a System of Care for Children that would be:Trauma-InformedFamily DrivenYouth GuidedCulturally and Linguistically Competent
9Overview of System of Care and Trauma Theory Understanding System of Care principles and Trauma-Informed Approach
10Legislatively initiated in 1992 Comprehensive Community Mental Health Services for Children and Their Families ProgramLegislatively initiated in 1992Goal: Develop community-based systems of care for children with serious emotional disturbance and their familiesCharged to implement the goals and recommendations of the New Freedom Commission and transform children’s mental health services.Arabella
11Systems of CareA system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. A system of care helps children, youth and families function better at home, in school, in the community and throughout life.ArabellaGary Blau, Child, Adolescent and Family Branch, CMHS, SAMHSA
12System of Care Values Family Driven Youth Guided Cultural and Linguistic CompetenceTrauma-Informed
13Definition of Family Driven Care Family-driven means families have a primary decision making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation. This includes:choosing supports, services, and providers;setting goals;designing and implementing programs;monitoring outcomes;managing the funding for services, treatments and supports and;determining the effectiveness of all efforts to promote the mental health and well being of children and youth.Osher, Federation of Families for Children’s Mental Health and Child, Adolescent and Family Branch, CMHS, SAMHSA
14Definition of Youth Guided It is when young people have the opportunities to achieve positive development, assist in their successful transition to adulthood, and develop a deeper connection to their community and peersIt occurs when:The voice and actions of youth are valuedYouth are engaged from start to finishYouth are utilized as a resource in the development of themselves and their communitiesYouth are provided with an environment where they feel safe to voice opinions and won’t be judge based on experience nor age
16Title VI, Section 601, Civil Rights Act of 1964 Linguistic Competence: Legal Mandates, Regulations, Guidance, and StandardsTitle VI, Section 601, Civil Rights Act of 1964Non- Discrimination based on Race, Color, National Origin, Age, Disability, SexU.S. Department of Health & Human ServicesU.S. Department of EducationThis slide need to be changed and needs to add State of Maine Mandates- Arabella was to check with LucU.S. Department of JusticeSlide Source: National Center for Cultural Competence, 2010
17Maine Human Rights Act §4552. Policy To protect the public health, safety and welfare, it is declared to be the policy of this State to keep continually in review all practices infringing on the basic human right to a life with dignity, and the causes of these practices, so that corrective measures may, where possible, be promptly recommended and implemented, and to prevent discrimination in employment, housing or access to public accommodations on account of race, color, sex, sexual orientation, physical or mental disability, religion, ancestry or national origin; …….[2005, c. 10, §1 (AMD).]
18What is Trauma and Why Does it Matter? The personal experience of interpersonal violence including sexual abuse, physical abuse, severe neglect, loss, and/or the witnessing of violence, terrorism and/or disasters. (NASMHPD, 2004)Historical Trauma, Stigma Trauma and Intergenerational TraumaWe care clinically but what about as a system?Evidence – Adverse Childhood Experiences and local researchPreventable health and human event with enormous societal cost
19What is Trauma-Informed Means understanding the role that violence and victimization play in the lives of large numbers of children and familiesProviding services and supports in a manner that is welcoming, respectful and appropriate to trauma survivorsA trauma informed organization makes every effort to avoid re-traumatizing individualsArabellaLecture: A trauma Informed approach focuses on the core relationship. The relationship must be open and genuine collaboration between provider and consumer at all phases of the service delivery system. Allowing for consumers to choose where, how and when services are provided.
20Trauma-Informed Theory Instead of asking “what is wrong with you?”a trauma-informed approach asks“what has happened to you?”Roger Fallot and Maxine Harris, Using Trauma Theory to Design Service SystemsUniversal precautionary approach…..What is Trauma-informedArabella: Roger Fallot and Maxine Harris Book 2 minutes to review this informationUsing Trauma Theory to Design Service Systems
21Trauma Informed Principles/Philosophy SafetyTrustworthinessChoiceCollaborationEmpowermentLanguage Access and Cultural Competence
22SafetyBecause trauma inherently involves a physical or emotional threat to one’s sense of self, families and youth are often especially attuned to signals of possible danger.It is essential then, that service organizations prioritize safety as a guiding principle in order to become more hospitable for trauma survivors and to avoid inadvertently re-traumatizing people who come for services.This holds true for staff as well.
23TrustworthinessSurvivors of trauma report a violation of boundaries resulting in a justified inability to trust others; especially those in power and authority.A trustworthy organization is one that demonstrates appropriate boundaries, task clarity, clear and consistent policies and reasonable expectations for providers, families, and youth.The trauma-informed organization recognizes how trust has been violated and seeks to earn trust.
24Choice Maximizing family and youth choice and mutuality. Allows family and youth to choose where, how and when they will receive services. They also have an active voice in selecting a provider and determining treatment.
25CollaborationPolicies, practices and relationships that encourage empowerment, partnership, and participation, as well as strength based and community-based approaches.Having the ability to share power and value both perspectives:Collaboration with family and youth allows for very specific insight. Only they know their responses, their needs and history better then anyone else does.
26EmpowermentIt is the state of feeling self-empowered to take control of one's own destiny.To become aware that one’s experience can enhance service systems and promote change.Program opportunities to develop skills and enhance knowledge of the consumer.
27Language Access & Cultural Competence Extent to which policies, procedures, staff, services and treatment are sensitive to family and youth:culturestraditionsbeliefsThe agency’s policies and procedures acknowledge that behaviors and responses to trauma are influenced by culture.Ensure language access through:policytrainingreimbursement
28Achieving System of Care Goals There is a need for common understanding about basic principles and this webinar is a step toward achieving the goalProviders are critical in implementing these principlesAn assessment of providers was needed to determine strengths and needs –this was the Trauma Informed Agency Assessment that was to be taken by all agency staff and a percentage of family and youth served by the agency.Data specific to agencies could be used to assist agencies in making change according to the unique strengths and needs of each agencyAgencies will implement Continuous Quality Improvement activities with the support of Children’s Behavioral Health Services, Thrive and other organizations
29Overview of the Trauma- Informed Agency Assessment: Development, Implementation, Scoring and Validation
30Goals of the TIAA ToolProvide agencies a mechanism to identify areas where they are successfully trauma-informed, and pinpoint areas where they want to improve.Guide the CQI process for making the system even more trauma-informed.Support data-driven decision-making!Help agencies gauge whether CQI efforts were successful.
31Development PhasesPlanning: created conceptual framework, method for data collection, involved key stakeholdersPilot Testing: implemented pilot tests, made revisions based on resultsImplementing: statewide assessment and response monitoringDiscuss steps,
32The Domains Children, Youth and Families Physical and Emotional Safety Youth and Family EmpowermentTrustworthinessCommitment to Trauma-informed PhilosophyCultural CompetenceTrauma Competence
33(total potential score/total actual score)*100 How is it Scored?Standards for each core trauma domain have been established.Questions correspond to a domain.Each question uses 5-point scale.Total potential score = number of questions that comprise the domain multiplied by 5Total actual score = summation of given responsesFinal score =(total potential score/total actual score)*100
34Internal Consistency & Reliability Tool ValidationCronbach’s AlphaTests on the domains fall within acceptable rangesExploratory Factor AnalysisGroupings make senseEach question contributes meaningfully to domain resultsInternal Consistency & Reliability
35State Expectations For Continuous Quality Improvement : Developing a CQI PlanRe-administering the assessment
36States Expectations and Continuous Quality Improvement By January 2011, agencies will have completed a CQI Plan required by contracts regarding issues identified in the Trauma Informed Agency AssessmentAgencies have been provided with resources including training opportunities, such as this web based training, and a detailed Guide to Trauma-Informed Organizational DevelopmentAgencies have been provided with the results from the assessment and many agencies did not obtain the number of responses needed to provide dataAdditional detailed reports can be accessed by contacting Sarah Krichels Goan at Hornby Zeller Associates.
37State Expectations Continued Agencies that did not obtain the number of responses needed will re-administer the assessment in Part of their CQI Planning would be to identify how to obtain more responses.There will be a re-administration of the assessment in 2012 for all staff who interact with children/youth for all agencies.Agencies will continue to refine their CQI Plans in the future toward the goals of Maine having the first fully Trauma Informed System of Care!
38State Expectations Continued Continuous Quality Improvement Plan - System of Care requirementsAt least one goal from two separate domains in the assessmentRequired Goal: Agencies that did not fully complete the first administration of the assessment must include a goal regarding completion of the next administration of the assessment. This must include objectives and action steps specifically addressing how the agency will ensure that assessment is completed.Goals may be developed by referring to the “Key Question” section in each domain in the “Guide to Trauma- Informed Organizational Development.”Objectives, action steps and outcomes may be developed using the “Best Practice Standards” in each Domain.
39ResourcesTechnical Assistance Partnership for Child and Family Mental HealthNational Child Traumatic Stress NetworkThe National Center for Trauma-Informed CareNational Institute for Trauma and Loss in ChildrenChildren’s Mental Health Initiative
40Resources Child Welfare League of America www.cwla.org National Center for Mental Health & Juvenile JusticeTraumatic Stress Institute-Klinberg Family CentersTraining Center of the Jewish Board of Family and Children’s ServicesJoyfields Institute