The Journal of the Arkansas Medical Society Issue 5 Volume 115 | Page 13
AFMC: A CLOSER LOOK AT QUALIT Y
and Mental Health Services Admin-
istration, a program, organization or
system that is trauma-informed will
be able to:
• Realize the prevalence of trauma
and understand potential path-
ways for recovery
• Recognize signs and symptoms of
trauma in clients, families, staff and
others involved in the system
• Respond by fully integrating
knowledge about trauma into its
current policies, procedures and
practices
• Actively resist re-traumatization
by exposing individuals to triggers
without providing the proper sup-
port or sensitivity 7
Health care providers should
adopt TIC practices on both orga-
nizational and clinical levels. Orga-
nizational culture must change to
include a focus on amending policies
that have the potential to cause
trauma for patients and staff, while
clinical approaches work to address
trauma’s effects on individual
patients. 6
The Center for Health Care
Strategies (CHCS), a nonprofit policy
organization dedicated to improving
the health of low-income Americans,
is leading a national initiative to
advance TIC in the clinical setting.
CHCS developed the following key
organizational and clinical ingredi-
ents for TIC:
ORGANIZATIONAL INGREDIENTS
FOR TIC 6
Engage patients in organiza-
tional planning. Provide opportuni-
ties for patients who have personally
experienced trauma to join a patient
engagement committee and help
guide efforts for implementing TIC.
Train clinical as well as non-
clinical staff members. Create a
welcoming, trusting, nonjudgmental
environment by training nonclinical
staff, including security guards and
front-desk workers, on the impact
that trauma can have on behavior and
how to de-escalate tense situations.
Create a safe physical and
emotional environment. Reduce
noise levels in waiting rooms and
clinical areas to provide a calm, quiet
environment. Develop policies and
procedures to ensure that patients
feel respected.
Prevent secondary traumatic
stress in staff. Train staff on how
their own ACEs or traumatic expe-
riences can be triggered while
interacting with patients and how to
perform self-care to reduce burnout.
Hire a trauma-informed work-
force. Use behavioral interviewing
techniques to look for qualities in job
candidates such as empathy, non-
judgment and collaboration.
CLINICAL INGREDIENTS FOR TIC 6
Engage patients in the treatment
process. Empower patients by involv-
ing them in decision-making and
development of their care plan, rather
than telling them what will be done.
Screen for trauma. Use validated
screening tools such as the Life Event
Checklist (www.integration.samhsa.
gov/clinical-practice/life-event-
checklist-lec.pdf ) or the Abbreviated
PCL-C PTSD checklist for civilians
(www.integration.samhsa.gov/clini-
cal-practice/Abbreviated_PCL.pdf ).
Train staff in trauma-specific
treatment approaches. Identify and
train staff using an evidence-based
model that best meets the needs of
your organization’s care model and
population served.
Engage referral sources and
partner organizations. Work with
community partners and within a
system of care to develop a robust
trauma-informed referral network.
The Arkansas Adverse Childhood
Experiences and Resilience Work-
group, a cross-sector collaboration
working to prevent and address the
negative impacts of ACEs, is develop-
ing trainings for providers interested
in adopting TIC in their practices. For
more information, contact Janie Gin-
occhio at [email protected]. s
Ms. Ginocchio and Ms. Gaulden are
program and policy analysts at AFMC
and coordinate the Arkansas Adverse
Childhood Experiences and Resilience
Workgroup.
REFERENCES
1. Sacks, V., & Murphey, D. (2018). The prev-
alence of adverse childhood experiences,
nationally, by state, and by race or ethnicity.
Bethesda, MD: Child Trends.
2. Centers for Disease Control and Prevention.
(2017). 2016 Behavior Risk Factor Surveil-
lance System. Atlanta: CDC.
3. Felitti, V., Anda, R., Nordenberg, D., William-
son, D., Spitz. . .Marks, J. (1998). Relationship
of childhood abuse and household dysfunc-
tion to many of the leading causes of death
in adults. American Journal of Preventive
Medicine, 14(4): 245-258.
4. Anda, R., Felitti, V., Bremner, J., Walker, J., Whit-
field, G., Giles, W. (2006). The enduring effects
of abuse and related adverse experiences in
childhood. European Archives of Psychiatry
and Clinical Neuroscience, 256(3): 174-186.
5. Kalmakis, K. & Chandler, G. (2015). Health
consequences of adverse childhood expe-
riences: A systematic review. Journal of the
American Association of Nurse Practitioners,
27(8): 457-65.
6. Martin, L., & Menschner, C. (2017). Key Ingre-
dients for Making Trauma-Informed Care
a Standard of Care. Retrieved from https://
www.chcs.org/key-ingredients-making-trau-
ma-informed-care-standard-care/.
7. Substance Abuse and Mental Health Services
Administration. (2018). Trauma-Informed
Approach and Trauma-Specific Interventions.
Retrieved from https://www.samhsa.gov/
nctic/trauma-interventions.
AFMC WORKS COLLABORATIVELY WITH PROVIDERS,
COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO
PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH
EDUCATION AND EVALUATION. FOR MORE INFORMATION
ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
CALL 1-877-375-5700 OR VISIT AFMC.ORG.
NOVEMBER 2018
NUMBER 5
NOVEMBER 2018 • 109