April 5, 2018

From Mandy Davis, LCSW, PhD, Director, Trauma Informed Oregon

The Impact

I was visiting my 97-year-old grandmother recently. She resides in a continuing care retirement community and is at the highest level of care. She needed assistance getting up so I pushed the call button because I can’t lift her and she can’t stand safely. While we are waiting for assistance my grandmother was getting upset and kept trying to stand while I told her she couldn’t but that I was trying to get help. I felt helpless and useless. I go to the hall to find help and I see Jane who was moving down the hallway by herself in her wheelchair. There was a provider pushing a cart down the hall and the wheels were in dire need of maintenance because they were making the most awful screeching sounds. Jane yells out, “What is that awful noise?” Now this was not in a calm voice but in an I-just-heard-fingernails-on-a-chalkboard voice. The provider casually continues pushing the cart past the woman and says, “What noise?” By the time someone came to help my grandmother I did not have a calm voice either.

A person I know suffers from several physical ailments including chronic pain that can be contributed to a life of significant adversity. Her body has literally been surviving since birth and through her young adult years. She has had multiple providers and her current provider is concerned about her use of pain medications. Because her provider wants her to taper off, Kiesha cannot get another prescription until she sees a pain specialist. That appointment is three weeks away—well past the time the amount of pills she has will last. She is scared and worried and as she tries to reduce the pain medications she feels pain. When she calls to report this, she is told to wait it out and take ibuprofen until the pain appointment. When she calls for medical transport, because of a system problem, her insurance has been cancelled until she can bring in a social security card and birth certificate. Now she is in pain and feeling helpless.

When my second child was three weeks old he developed a rash and a high fever. There was concern that it might be meningitis. I don’t remember the drive from urgent care to the emergency department (I was told to drive there immediately). I do remember showing up in a daze and having a team of folks waiting to take him while asking me questions and getting us prepped in a room. I can remember the lights in the room and sensing both slow motion and being rushed simultaneously. I was asked to consent to a spinal tap because they needed to get moving on the procedure ASAP. I froze. I remember standing there with the paper and pen and not moving. Some part of me was thinking, What are you doing? Of course you are not going to sign this without doing research or getting a second opinion. And another part of me was thinking, What are you doing? Sign this and get him better! Then a physician touched my hand, looked me in the eye, and said she had a child of a similar age. I breathed. She talked and I could listen and then I could sign. As I handed over my child she said, “I will take the best of care of him.”

I think about the impact of toxic stress, trauma, and adversity for each person in these situations. Does Jane feel dismissed/unheard or worse does it cause her to question her grip on reality (something she is questioned about often). Did the provider not hear the wheels because he has tuned them out as well as the call button sounds and loud TVs that are on all day? Does the prescriber in example two worry about a dependency on pain medications but doesn’t know what else to do when Kiesha calls crying in pain that has no identifiable medical reason? I needed my son’s physician to have exceptional medical skills but in that moment I also needed humanity and connection. What allowed the physician to provide both?

The Efforts

This newsletter is highlighting trauma informed care (TIC) efforts in healthcare. In the past few months I have had the opportunity to talk with several healthcare providers and I heard clearly that it is not getting easier—providers are asked to do more with less (I also heard a lot about electronic medical records). Will applying trauma-informed practices or knowing about adverse childhood experiences ease this burden? Knowing the impact of adversity and toxic stress may not change prescribing a medication for an infection but it will change how you provide the prescription and instructions for better long term success. TIC also helps us understand when current methods are unsuccessful. For example, if you understand the vulnerability experienced in a dental chair you might recognize why it is one of the medical procedures survivors are least likely to attend. I understand that the provider pushing the cart probably does not make a livable wage, has an impossible caseload caring for people who can afford a continuing care retirement community and who likely gets complaints more than compliments. So much about healthcare is about nurturing—nurturing people and nurturing environments. How are we supporting or hindering this?

Many of us know that connections matter and supportive relationships are healing. Providing connection could mean hiring community health workers and peer support specialist or on a more basic level saying, “That noise is the cart,” “I have a child of a similar age I know this is scary,” “We will be with you until your pain appointment.” We talk about integrative care and how you can’t separate caring for the physical body from the mind—we need all on board as we strive for wellness for patients, caregivers, and providers. I think TIC in healthcare is about identifying ways the system is preventing integrative approaches because of billings practices, treatment protocols, job descriptions, and interpersonal relationships.

TIO is committed to supporting TIC in healthcare. We have recently finalized the Standards of Practice for Trauma Informed Care—Healthcare Settings as a tool to identify what you are doing well and where you may focus efforts to implement TIC practices. We have learned from medical providers throughout the state. If you have practices to share please do!

I am aware of the complexities of healthcare and I am so HOPEFUL after reading the stories of our contributors. In each blog I see the integration of medicine and humanity and how we can shift systems to support nurturing.

Helpful Blog Posts

What’s Going on at TIO

  • Our sloth mascot has been named! Please meet Finn Sid Scout Wyatt Flash, who we’ll just call Finn. They may pop up in various places hopefully as a reminder to slow down, smile, or just as a cute brain break.
  • I am so excited to have Lea Ann Holder of Generations of Healing working with TIO as a tribal liaison. Some of you may know her from her work as the Assistant Director of the Child Welfare Education Program at Portland State University. Those of you who know Lea Ann know how amazing it is to have her consulting with TIO as we strive to be more responsive and listen to the voices of tribal communities. We will keep you posted as this work progresses.
  • Our forums are happening! We will be visiting three regions around the state. In the Columbia Gorge Region we’ll be in The Dalles, for the Southeast Region we’ll be in Lakeview, and for the Northeast Region we’ll be in Enterprise.
  • We completed our retreat in February and the time was well spent. Look for upcoming metrics resources, implementation templates, and training plans.
  • On ACEs Connect there is an “Oregon: ACEs Initiatives and Actions” document available that highlights what’s going on in Oregon.

Where We’ve Been

Since the last newsletter I had the opportunity to present at the Oregon Law and Mental Health Conference. It was a great gathering that combined voices of providers and those with lived experience. The key note speaker was Judge Lerner-Wren and you can access many of the sessions at olmhc.org.

I also had the honor to share the stage at the Oregon Suicide Prevention Conference with two youth from the Oregon Trauma Advisory Committee (OTAC), Lauren Conn and Viktoria Rosqvist. They talked about the resources OTAC has developed.

To Do List:

  • Listen to the inSocialWork Podcast Series. This podcast discusses the challenges and barriers to promoting and sustaining trauma informed policies and practices.
  • Fill out the following survey about your interest in webinars, research, and more.
  • Take a look at our online Discussion Forum and participate in the discussion.