September 25, 2019

From Mary Sepulveda, Trauma Informed Care Specialist, Virginia Garcia Memorial Health Center

It was trauma that inspired the opening of the first Virginia Garcia Clinic in Cornelius, Oregon. In 1975, six- year-old Virginia Garcia and her farmworker parents traveled from their home in Mission, Texas to California and Oregon to work in the fields.  Along the way, Virginia cut her foot and by the time they reached Oregon it had become infected. Due to economic, language, and cultural barriers to healthcare, Virginia died from what should have been an easily treatable wound. Within a month of her death the community rallied together to open the first Virginia Garcia Memorial Health Center (VGMHC) in a three-car garage, determined to prevent similar tragedies from happening.

Since this beginning, VGMHC has been dedicated to serving those who need it most, meeting patients where they’re at, and understanding the physical and emotional consequences of a lifetime of hardship.  As the concept of Trauma Informed Care (TIC) began to spread across the state, VGMHC immediately recognized it was a concept that was at the heart of their founding and mission and worked with the Oregon Health Authority to develop a Trauma Informed Services Policy and Plan.

In 2019, VGMHC implemented the strategic initiative of becoming a Trauma Informed Organization.  This initiative was to begin with an organizational assessment followed by a training and sustainability plan informed by the assessment findings.

We conducted the initial assessment informally, through a series of strength-based interviews at our 18 clinic sites as well as across our various administrative departments.  The results were not surprising; VGMHC staff had a wide range of levels of knowledge and skills around the concepts of trauma and TIC.  It was clear from this initial assessment that we would benefit from beginning with a foundational training to create a shared language and understanding of the shift we were making.

Training Efforts

We implemented a Trauma Informed 101 training in the summer of 2018.  This training rolled out across the organization over the next 12 months and we added additional trainings at our pilot clinic in Yamhill County (VG McMinnville).

Our TIC 101 training is a broad overview of trauma and TIC; covering the basics of the ACEs study, neurobiology, epigenetics, equity, and secondary/vicarious trauma and resilience.  Most importantly, the TIC 101 training de-emphasizes the idea that trauma and adversity happen “out there” and instead shines a light on the fact that many of us, working in this organization, bring our own lived experience of trauma and adversity with us each day.  Turning the lens to look at our own experiences and responses has proved an effective method for engaging folks in this work.  When we begin to see ourselves (and our co-workers) as survivors, it changes the lens through which we view our patient population and our organizational culture.

As of July 2019, over 450 of our 600+ staff have received the 101 training and new employees at VGMHC receive the training as a part of their onboarding. Pre- and Post-Training Surveys show a marked increase in knowledge and confidence around trauma and TIC, click here to see the box plots.

Following the initial TIC 101 trainings, we collaborated with experts in the field to offer a deeper dive into the ACEs study, Neurobiology, Culturally Responsive Trauma Informed Care, and Secondary/Vicarious Trauma with a focus on building resilience.  Initially, the plan was to bring these trainings solely to our pilot clinic in McMinnville; however, the interest generated by the TIC 101 was so great that we expanded our offerings to our administrative building and other clinical sites. Additionally, we developed role specific trainings for our front desk and HR staff so that they could begin to bring trauma-informed (TI) practices into the specialized work they do.

In July 2018, we held an all-day training at our administration building.  We began the day with Dr. Teri Pettersen discussing the ACEs study and providing tools for connection with patients. Dr. Julie Rosenzweig then presented on the Neurobiology of Trauma, helping folks to connect the dots between trauma and behavioral adaptations.  After lunch, we dived right back in with Tori Lopez LCSW, discussing Culturally Responsive Trauma Informed Care.  Tori’s presentation resonated deeply with the audience, as many of our patients, as well as employees, are from culturally specific communities and/or are immigrants to this country. Because talking about trauma for an entire day can be emotionally and, physically draining, we decided to end the day with Dr. Alia Zelder presenting on Secondary/Vicarious trauma and offering tools for building resilience and maintaining safety in our work.  We had an overwhelmingly positive response to this training and so we have scheduled a second session for October of this year.

Finding protected time for medical providers and staff to attend trainings has been challenging and so in October of this year we will pilot an early morning session, with a Zoom option, for medical providers to practice skills for working and talking with patients through a TI lens.  Dr. Amy Stoeber will lead this training.

Beyond Training

Although all of this is a good start, you cannot train your way out of trauma and so we have developed additional pathways to infusing this information across the organization. Some of the strategies we use to keep folks thinking about and practicing TIC are:

  • A TIC “library” at each clinical site as well as the admin building. Each site has copies of the following books available for staff:
  • “Resilience Toolkits” at each clinical site as well as Admin. The toolkits contain coloring pages and markers, The 90 Day Gratitude Journal, blank journals, mindfulness tools, and various fidget toys. Each clinical site has customized their basket and added items that work best for them.
  • Monthly TIC “tidbits” in our newsletter, The Vine
  • A photo contest featuring SAMHSA’s Six Principles of Trauma Informed Care. Winning photos are published in our newsletter and our intranet site and winners receive a VGMHC water bottle.
  • A weekly TI “Best Practice” meme each Friday in an all-staff email, see example below.

All of this work has been supported by a generous grant from The Cambia Health Foundation. This grant funding has allowed VGMHC to take a multi-faceted and innovative approach to realizing the goal of becoming a Trauma Informed Organization.

Our work continues as we develop workgroups at each of our clinical sites, examine our policies and procedures from a TI/Equity lens, and continue to learn about the effects of trauma and opportunities for growth.

Best Practices for Providing Trauma Informed Care #120

Practice suggestive or invitational language instead of instructive language.

For example, instead of, “Take a deep breath and relax,” you could use, “Some people find it helpful to take a deep breath to relax during this part of the examination,” or, “I invite you to take some deep breaths and relax during this part of the exam if that feels comfortable to you.”