1. Twin Valley Behavioral Healthcare TIC Implementation 2008- present Lisa Gordish, Psy.D. LICDC-CS Liz Smith, Training Officer Central Ohio Regional TIC Meeting February 27, 2015

2. The Early Years Precursors to TIC: – Restraint Reduction initiative and Safety Guidelines (2005-2008) – Identified Trauma Informed Care as a vehicle to restraint reduction – Formed a TIC workgroup with ties to R/S reduction committee – Review of literature and available models (Harris and Fallett, Bloom- Sanctuary, NCTIC) – Dare to Transform Conference, Washington DC 2008

3. Initial Steps Decision to train all staff with assistance from NCTIC in the following areas: – What is Trauma and Why is it Important – Neurobiology of Trauma – Trauma & Recovery- Peer Advocate – Personal Comfort Plans and Interventions All staff trained over 6 month period

4. Staff Training session With Dr. Joan Gillece National Center for Trauma Informed Care 2009 Staff Training Session With Dr. Joan Gillece National Center for Trauma Informed Care- 2009

5. Specific Action Steps Personalized Comfort Plans with Admissions Comfort Boxes on the units Safety Plans for acutely aggressive situations – ID Triggers and Warning Signs, individualized targeted interventions TIC Training in Orientation Trauma Specific Training for Licensed Clinicians- Seeking Safety Staff Self- Care/Vicarious Trauma training

6. Maintenance Good Results, reduction in S/R, fewer injuries Integrate purchase of comfort box items into standard ordering of supplies Patient worker for inventory and filling boxes Comfort Items at admissions Review and monitoring of Safety Plans within Behavior Therapy Committee Standardize Safety Plan template and add to shared-drive for easy access upon re-admission

7. Long-term maintenance- Life Happens Changes in leaders, fiscal issues, increased admissions, increased staff stress and workload, opiate epidemic Lost ground, S/R went up, staff morale went down Clear that we needed to pay more attention to concept of parallel processes Performance Improvement Group Identified need to address organizational challenges and organizational culture- Reaching Safety Together

8. Parallel Processes All staff organizational survey – Respect, Clear Leadership & Expectations, Workload Management and Personal Growth and Expectations All staff Cafés’- Leadership staff interacting and listening to direct care staff

9. Parallel Processes Central Office training from NCTIC with strong focus on organizational dynamics Hospital training and consultation from Raul Almazar, RN NCTIC Developed goals for organizational improvement and one direct care goal – disciplinary process, staff appreciation and support, staff assault response, TIC training needs and patient recovery tool kits.

10. Future Work- Are We There Yet? Current leadership has integrated TIC into TVBH strategic plan (not an initiative, but foundational) Time for re-training staff to keep the ideas fresh and support TIC focused staff to patient interactions Continue focus on Prevention, Pre-crisis and crisis responding in a trauma informed manner Provide staff with knowledge, ideas and tools for their own emotional regulation and well-being

11. Thank you! Lisa.Gordish@mha.ohio.gov (614) 752-0333, ext 5633 Liz.Smith@mha.ohio.gov (614) 752-0333 ext. 5451 Twin Valley Behavioral Healthcare 2200 W. Broad St. Columbus, Ohio 43223