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