square bulletImplementing Trauma Informed Care in a Rural Health Clinic

May 25, 2016

From Stephanie Sundborg, MS, Consultant, Trauma Informed Oregon

Trauma Informed Care Added to Comprehensive Approach

Across Oregon, health care professionals are working to implement Trauma Informed Care in their clinics and organizations. Through Trauma Informed Oregon, I’ve had the pleasure to work with a rural clinic in Central Oregon and would like to highlight their experience.

La Pine Community Health Center is a Federally Qualified Health Center serving approximately 7,500 individuals per year from five clinic sites in rural areas of Central Oregon. Person centered care has always been a priority with this clinic and they offer a wide range of support services such as case management, health education, and community outreach on topics including nutrition, stress management, smoking cessation, and lifestyle coaching. In collaboration with other community partners, these support roles are offered free of charge as a way to provide comprehensive care.

Last fall, due to the vision of Dr. Laura Pennavaria, Chief Medical Officer at La Pine Community Health Center, the clinic added Trauma Informed Care (TIC) to its comprehensive approach. Recognizing that many patients have complex situations, including histories of trauma, the clinic management felt that this perspective would help staff better understand root causes involved in many of the social and health outcomes experienced by the patients.

Following an all-staff training in October, the clinic formed a workgroup that represents the diversity of roles in the clinic. This group has eagerly embraced TIC and is taking on the role of modeling and advocating for it within the clinic. Focusing on open communication and transparency was an early priority for the workgroup. They have established a regular monthly update to keep staff informed of TIC progress and have worked to get regular feedback from staff.

Efforts That Have Had the Most Impact

According to the work group members, the two efforts that have had the most impact include the addition of behavioral health support and services and the clinic’s focus on a trauma informed crisis response. The clinic has been experiencing a fair number of crisis incidences since we’ve started the TIC effort. The TIC lens has helped the group pay attention to staff wellness and support as these incidences can be triggering or traumatizing for everyone in the clinic. The following are some examples of how they’ve made this process trauma informed:

  • Incidence response protocols are used so that staff are informed and feel able to handle the situation and the potential for traumatizing patients in the clinic is minimized. One example is that law enforcement is asked to enter in the back door rather than alarming patients by walking through the lobby. They have also scheduled de-escalation training for all staff to build skills for everyone.
  • The Behavioral Health (BH) Consultant and clinic management debrief staff after an incident, and gather feedback about what might be done better/differently (giving staff voice).
  • The Behavioral Health Consultant follows up with staff that may have experienced stress related to these situations.
  • Clinic management staff circle back with patients that may have been affected to ensure they are doing OK (i.e., feeling safe).

The Need for a Safe Environment

The clinic seems especially mindful of the need for a safe environment built on trust, relationships, and open communication. I think the TIC effort has helped them understand how trauma affects both staff and patient engagement with the clinic. I can see the TIC perspective in how they approach their work. They are very collaborative and are paying attention to the support and wellness of each other. For example, at a recent work group meeting, they were checking in with the BH Consultant (which is a new position since January) to see how they could support her and ensure that she doesn’t feel overwhelmed by the demand, especially because a focus on TIC mean she gets pulled in frequently. As one solution, the clinic is adding another behavioral health consultant to help meet the need. In another example, staff were talking about a youth who was feeling depressed and came into the office experiencing possible suicidal thoughts. As part of the discussion, a TIC work group member reminded everyone about the importance of giving patients a choice and the opportunity to collaborate about next steps.

While the clinic recognizes that creating a trauma informed culture takes time, their commitment to this approach has been inspiring. It has been fun working with such an enthusiastic group and watching how they incorporate TIC principles into the clinic practice.