From Diane Yatchmenoff, Ph.D, Director, Trauma Informed Oregon
Good news in healthcare
I recently went for a checkup to the eastside Portland Clinic (formerly Portland Family Practice) where I’ve been a patient for years, though I’m highly irregular about preventive routines so don’t get in very often. As I waited to be called back to the exam room, I noticed a Suggestion Box in the waiting room, with a pad of short patient feedback questionnaires sitting next to it, questions like: ‘Were you able to make an appointment at a time that was convenient for you?’ ‘Was the receptionist friendly and helpful?’ ‘Did your visit with the provider meet your needs?’
There might be some additional or different questions to address the sense of physical and emotional safety, empowerment, and relationship that can help trauma survivors engage with their healthcare providers, but I thought it was a great step.
It gets better.
In the exam room, after the medical assistant had done the usual (blood pressure, pulse, checking on current medications, etc.), she showed me the gown (and, blessedly, told me how I was supposed to wear it). And then she said, without a trace of condescension:
‘But I know you haven’t met yet, so if you would rather wait to put on the gown until you’ve had a chance to talk with him, that would be fine.’
In that simple acknowledgement of possible anxiety (or for some, a significant trigger) was a world of understanding and respect. It communicated something important: We understand that you may be uncomfortable here and we will do our best to lessen that discomfort.
Small things can make a big difference. We call that low cost, high impact.
And in the schools
Earlier this week I drove out to Gladstone to meet with Wendy Wilson, principal of John Wetten Elementary School. As I approached the school, I noticed a line of parents and children forming outside, despite the fact that schools there don’t start until the day after Labor Day. Chatting with a few of them and with teachers who had turned out also, I learned that they were there to make sure all of the children are registered and have paperwork completed this week so that none of that has to happen on the first day of school. The evening shifts are wild, they told me, with many working parents who can’t make it during the day. But it’s worth it – helps to make a smooth start to the year.
It was a beautiful morning, and spirits were high. Most noticeable was the conscious effort to ensure that children and their families feel welcome at the school and are excited to come back.
Several years ago, Wendy and others from the district heard a presentation by Vincent Fellitti (ACE study researcher from Kaiser Permanente) and Chris Blodgett, who has studied the prevalence and impact of ACEs in school settings. What they learned about ACEs resonated with their growing concerns about the mental health needs of children in the district. With the support of Superintendent Bob Stewart, they acquired a small grant from Care Oregon with a focus on creating a Community of Care for all the children at John Wetten. As Wendy put it, “Our job is to make sure the children can access their education. To do that, they need classrooms that feel calm and safe, and where teachers have the skills to support self-regulation, relationship and reason.”
Wendy did some research on what schools around the country were doing and created a plan, starting with a Trauma Sensitive School Checklist, developed at Lesley University. The John Wetten teachers completed the checklist, which provided a place to start in setting priorities. Teachers also gathered data on signs and symptoms of trauma in the classroom, helping to engage staff and build motivation and buy-in. Working with a trauma-sensitive version of the Positive Behavioral Intervention and Supports model, this year they will focus on staff development of knowledge and skills, supported by classroom-level coaching for the early grades. Wendy will be sharing more information about the process and progress at John Wetten at our September 10 meeting in Portland.
From the Beaverton schools
With a growing concern about unaddressed mental health needs of students in the Beaverton Schools, Danielle Sheldrake, executive administrator for student services, and other district personnel conducted an informal survey last fall of school staff who work with students inside or outside the classroom. They found startling results: in a 30-day period, there were 462 mental health incidents in the elementary level and 1289 at the middle and high school levels. The younger children with mental health issues were absent an average of 4.5 days out of 72 and secondary students with mental health issues missed an average of 12 days out of 72. This was no surprise to overloaded counselors, principals, teachers and other staff who found themselves regularly seeing students who showed signs of depression, anxiety, anorexia or self-injury, or who said they had considered suicide.
Data from the survey supported the district’s decision this year to hire five social workers to help connect children in crisis and their families with needed care. Five social workers for the entire district is not a lot, and no one assumes it will be enough. The district is exploring additional options, with a long-term goal of partnering with providers. In the meantime, however, troubled children, youth and families in the Beaverton schools will have access to a little more help.
Upcoming from Trauma Informed Oregon
September 10. With a focus on early and middle childhood, Trauma Informed Oregon is co-sponsoring a working meeting with Oregon Pediatric Society and Project Launch in Portland on September 10 to look at emerging practices to address the impact of adversity and trauma. A panel of providers will briefly present their work and participants will have an opportunity to meet in discussion groups to learn more, share their own experiences, and talk about what is needed. Panelists include:
John Stirling, MD, Director – Center for Child Protection, Santa Clara Valley Medical Center
Terry Ellis, LCSW, Clinical Director – Youth and Family Services, Native American Rehabilitation Association (NARA)
Wendy Wilson, Principal – John Ettinger Elementary School
Erin Fairchild, Director – Defending Childhood Initiative
Lisa Butler, Regional Director – Oregon Family Support Network
Maggie Bennington-Davis MD, MMM, Chief Medical Officer – Health Share of Oregon
September 18. Focusing on adults in the mental health system, Trauma Informed Oregon is offering a day-long training on trauma informed care on September 18 in Salem, with an emphasis on challenges in residential care and community-based mental health treatment services.
October 5. Trauma Informed Oregon (TIO) is returning to the North Coast!! We are excited to have Laura Porter from ACE Interface joining us in the morning to discuss the ACE study, NEAR science and how we can help overcome ACEs by building community resilience through competencies and supports that enable us to respond to, withstand, and recover from adversity. After lunch Trauma Informed Oregon will facilitate break-out sessions to hear from attendees about the work folks are doing, what hotspots are in their community, and hear about what they need from Trauma Informed Oregon.
Coming soon. The TIC Standards of Practice workgroup has met to review the most recent draft, which is also currently being piloted by a few of our partners in mental health, housing, addictions, and other service sectors. Once the feedback and suggestions have been incorporated, the proposed Standards of Practice for implementation of Trauma Informed Care will be posted on the web for comments from the entire Collaborative. We will also be working in small groups at regional forums throughout the year to further pilot test and refine this tool.
Over the year. Trauma Informed Oregon (TIO) will head out around the state again over this next year to provide training, combined with the opportunity for new partners and new communities to hear about TIO, to share their work and to have input into the resources we’re developing as well as plans and priorities for this biennium. These events will be posted as they are scheduled.