March 30, 2018

From Dr. Michelle Homer Anderson, Trauma Informed Care Enthusiast

I have to thank TIO for asking me to explore the kinds of trauma informed care (TIC) work taking place in the world of healthcare in Southern Oregon. I have connected with people and programs doing amazing things to understand trauma and build resilience in individuals and the community. Here are a few of the people and stories I heard . . .

I first reached out to William North the Chief Executive Officer of Rogue Community Health who was willing to chime in. As I discovered, William is definitely a TIC champion!

Rogue Community Health

Rogue Community Health is a nonprofit patient-centered medical home that offers medical, dental, behavioral health, pharmacy, lab, and integrated health services to people of all ages and backgrounds.

William let me know that one of the first “aha moments” for his agency happened when his entire staff was first introduced to the Adverse Childhood Experiences study (ACEs). Through that training they began to realize how much staff was impacted by ACEs and the traumatization that can occur as they are taking care of patients.  They initially began to look at what it means to create a safe environment. They also asked “what can we do to de-escalate situations and make sure staff are trained to handle them”?

As is common when people begin to learn about ACEs they resonate with the information in ways that cause them to ask “What can I do?” or “What next?”

Rogue Community Health made the decision to move their entire organization to a trauma informed positioning and practice. They began working with an external expert to navigate the dynamics related to this decision.  They have developed a trauma informed development team, have worked with their board to create and implement an agency inclusion statement, and are in the process of working through their transition and transformation by implementing a project plan through 2018.

As we ended our correspondence William said “If you haven’t contacted them already, La Clinica is working on some of this as well.”

So off I went. Through a series of handoffs, I connected with Kim Oveson the Integrated Behavioral Health Coordinator at La Clinica.

La Clinica Health Center

La Clinica strives to improve the quality of life for the diverse communities they serve by providing culturally appropriate, accessible, and affordable quality health care and offers services through seven neighborhood health centers, 10 school-based clinics, and a mobile health center. Their social services and outreach programs provide a safety net for our most remote and vulnerable community members.

Kim explained to me that La Clinica began its TIC journey about six and a half years ago. They put together a workgroup that is comprised of staff from each of their clinics and they meet regularly. They are currently working on a TIC strategic plan that will guide their next three years of work. They have hired a consultant who is working to help them get more organized and to implement deeper TIC practices that are “beyond the nice music and just training for front end staff.”  An “aha moment” was that they have realized that this takes time and that it is not an overnight process.

La Clinica staff are engaging in the work through trainings on ACEs, mindfulness and deeper ways of communicating. They are currently focusing on leadership development using personal effectiveness seminars so that leaders know how to “be with their staff.” They are also working to find ways to bring this information and these skills to patients as a “way to get after the social determinants of health.”

Two years ago La Clinica was working on plans to build a new clinic and they had a student from the north end of the state (Portland State University—Go Vikings!) doing some work for them. Through her amazing contributions and the insight of staff at La Clinica the plans shifted and that clinic became a wellness center.  In addition to quality medical and dental services, patients have access to complementary services such as physical therapy and acupuncture and wellness coaches who work as part of care teams and are available to help patients make choices to set their lives on healthy paths. They offer a variety of classes, from mindfulness to healthy eating to Zumba. They have incorporated a community kitchen and exercise and meeting space into a medical office.

Kim let me know that their organization now asks for TIC consultations whenever they are making any changes or are planning any remodels and that they continue to look through a trauma informed lens no matter what committee or council or initiative they are working on. She said that sometimes people want to revert to “old ways” but that they have held steady and it is making all the difference; she said becoming trauma informed “has to be like smoke—it has to permeate everything.”

In reflecting on what William and Kim said and thinking about other TIC work I am aware of, I better understand that as agencies and people work towards truly integrating trauma informed approaches it is definitely helpful to understand that it takes time, thoughtfulness, commitment, and the willingness to hold steady in the vision.

With that in mind I ventured on to see what else is happening in my backyard and discovered an innovative project that is being implemented at Asante’s Rogue Regional Medical Center (RRMC).

Rogue Regional Medical Center

RRMC is home to our region’s only neonatal intensive care unit (NICU) which is the department where Hillary Handelsman MSN, CNM, WHNP-BC Perinatal Clinical Practice Advisor works her magic with mothers and babies who are recovering from opioid addiction.

Hillary spent an hour talking me through the project which is based on an initiative to “Improve the Quality of Care for Infants with Neonatal Abstinence Syndrome (NAS)” started by Dr. Matthew R. Grossman, MD from Yale.

Many of us know there is an opioid epidemic in our country. What people may not be as familiar with is that every 25 minutes a baby is born suffering from opioid withdrawal (NAS) from exposure in utero. Southern Oregon is not untouched by this epidemic.

Babies who are experiencing withdrawal are typically separated from their mother and placed in the NICU where they undergo morphine treatment for 30 or more days.

RRMC is implementing a new program for mothers choosing recovery and they focus on keeping babies with their mothers and out of the NICU. They stay in the hospital for four to five days to observe for symptoms of withdrawal, which does not always occur immediately, and staff use the time to help families build the skills necessary to care for their babies while in a nurturing and supportive environment.

Babies experiencing the effects of withdrawal typically have difficulty with eating, sleeping, and being consoled because of how opiates in utero affect their central nervous systems and their gastrointestinal systems. Staff work with the families to create an environment that will support the baby being able to eat, sleep, and be consoled. Skin-to-skin contact between a parent and the baby, a low stimulus and soothing environment (dim lights, quiet), and being fed on demand have been shown to decrease withdrawal symptoms.

The focus is on these three areas because if a baby can’t eat, sleep, or be consoled AND the family does not learn the skills to help their baby there is an increased risk of child abuse (shaken baby) and neglect (failure to thrive).

All staff are trained in ACEs and non-pharmacologic interventions; from the nurses working with mother and baby, to the occupational therapists who assist with feeding issues, to the cadre of volunteers who come in to help cuddle babies who have difficulty being consoled.

This was an amazing and inspiring conversation and full of so much hope for families. RRMC is addressing an epidemic social issue through innovative medical care and I am looking forward to further conversations about the impact they are making.

Here is a short YouTube Video about the program:

Southern Oregon Success/Southern Oregon Pediatrics

I know there is even more work being done in the healthcare arena as evidenced by the following excerpt I read in a report done by Peter Buckley, the director of Southern Oregon Success whose organizational aim is to “Bring together the talent, expertise, and resources of the entire community to promote the health, academic, and life success of our children, youth, and families.”

At Southern Oregon Pediatrics the physicians and staff began to implement trauma-informed practices based on the [ACEs] trainings, their research and staff discussions. One simple and profound change was to add a question to a new mom when she brings her baby in for the first check-up: ‘And how were things for you when you were growing up?’ By adding that question, they provided an opportunity to talk about trauma, and to follow up with discussions on how the new mom’s baby might be protected and nurtured.

These four agencies are just a few of the healthcare agencies involved in TIC work in Southern Oregon. It has been an enlightening adventure in a week’s time, one that has been inspiring and rejuvenating. I am thankful for the opportunity to have stepped out of my day-to-day work to reach out to others who were so willing to share. It has left me in a state of awe and wonder and with an increasing sense of hopefulness.