Making The Link鈥擳rauma & High-Needs Consumers
Open Minds; Monica E. Oss, 6/30/2015
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Recently I listened in on a听conversation with a care coordinator听working with a targeted group of consumers with听complex support needs.听His听statement that caught my attention:听鈥淢any bad things have happened to these people and that won鈥檛 be undone in any short period of time.听To help them, I need to get to know them.鈥
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That seemed听to be听trauma-informed care in action – a subject getting more attention in care management programs.听The effects of听trauma have听been better understood with more understanding of听epigenetics – that what you do and what happens to you can change your genetic make-up听(see ).听 Specifically, research has shown that both adults and children听who are frequently exposed to traumatic episodes have changes听in how their听brain functions and听their genetic make-up听(see ).
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Beyond this very basic science, we have validation of the concept through the Adverse Childhood Experiences Study (ACE) which found that certain experiences are major risk factors for the leading causes of illness and death, as well as poor quality of life (see and ).听The study authors听also developed听a trauma scoring system, referred to as the ACE score, that tallies types of childhood abuse and neglect on a 0-to-10 scale (see ).
As a result,听鈥渢rauma-informed care鈥 approaches have been developed, defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) (see ) as:
…adherence to six key principles rather than a prescribed set of practices or procedures. These principles may be generalizable across multiple types of settings, although terminology and application may be setting- or sector-specific: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and, cultural, historical, and gender issues.
How to apply this new knowledge?听A recent briefing paper, , from Center For Health Care Strategies (CHCS), outlined six service models that show promise:
Addiction & Trauma Recovery Integration Model (ATRIUM) – This model targets homeless populations, correctional populations, jail diversion programs, AIDS programs, and survivor support programs. It provides peer support, psycho-education, interpersonal skills training, meditation and spirituality training, and community action (see ).
Prolonged Exposure Therapy (PE Therapy) – This model targets adults with previous experiences of trauma and posttraumatic stress disorder (PTSD). It provides PTSD education, breathing retraining to reduce physiological experience of stress, exposure practice with real world situations, and talking through trauma (see ).
Eye Movement Desensitization and Reprocessing (EMDR) – This model targets adults with previous experiences of trauma and PTSD. It provides spontaneous associations of traumatic images, thoughts, emotions and sensations, and dual stimulation using either bilateral eye movements, tones, or taps (see ).
Sanctuary Model – This model targets residential treatment for children, public schools, domestic violence shelters, homeless shelters, and group homes. It provides a supportive, collaborative, and healing environment that improves trauma treatment, building cross-functional teams, and improving staff morale and retention (see ).
Seeking Safety – This model targets individuals experiencing trauma, PTSD, or substance use issues. It provides safety as the overarching goal, through integrated treatment of trauma and substance abuse, ideals, cognitive behavioral interpersonal and case management skill sets, and attention to clinician processes (see ).
Trauma Recovery and Empowerment Model (TREM) – This model targets adult and young adult trauma survivors, particularly those with exposure to physical or sexual violence. It provides cognitive restructuring, psycho-education, and coping skills training (see ).
For new approaches to 鈥渨hole person鈥 centered care coordination to work, addressing听the unique characteristics of individuals is key 鈥 and screening for and addressing trauma is an important ingredient.听For more, check out 听and .听Let鈥檚 hope this isn鈥檛 one of those areas that takes the field seventeen years to go from knowledge to action.