In February of 2020 while working for a regional healthcare system as the Trauma Informed Administrator, the last in-person training session I conducted before COVID 19 impacted public gatherings, was for all of the staff of the Sullivan County Regional Health Department (SCRHD). In the winter of 2022, as organization doors began reopening from the pandemic, SCRHD Director Gary Mayes learned I was now doing this work as a national trainer, organizational coach and consultant, so he reached out asking for my help.
As a passionate advocate of this work, I've realized that implementing ACEs/PACEs science and trauma informed practices involve much more than training. As someone who has presented on this topic to over 50,000 professionals in diverse sectors in the past 8 years, I've seen champions emerge and organizations who have implemented inspiring programs, while others leave trainings and much to my dismay, carry on business as usual.
When Director Mayes reached out asking for my help in moving them organizationally beyond trauma aware to where this understanding was embedded into their culture, I knew it was a great opportunity especially having leadership buy-in from the top. In April, we will conclude working together for nearly a year and I could not be any more proud of this team and what they've accomplished. Recently I had the privilege of interviewing Director Mayes and his key leadership about our journey.
Sullivan County Regional Health Department Leadership (left to right) Dr. Stephen May, Regional Medical Director; Becky Haas, Consultant; Hannah Taylor, Director of Operations; Gary Mayes, Regional Health Department Director.
Please introduce yourself and tell your role at the Sullivan County Regional Health Department.
Gary Mayes - I am the regional Director of Sullivan County Regional Health Department, and have served in this role since 2000. Previously I was the System Director at Wellmont Health Systems overseeing risk management & safety. I have a bachelor’s of science from East Tennessee State University, am a licensed paramedic, and certified healthcare safety professional.
Hannah Taylor - I am the Director of Operations at Sullivan County Regional Health Department and have been an employee since January 2021. I have a background in nursing, having earned my BSN from East Tennessee State University. My nursing background is in cardiac care and long-term care. In addition, I have an MBA in Healthcare Administration from King University.
Dr. Stephen May - I am the Regional Medical Director of the Sullivan County Regional Health Department. I graduated 1978 summa cum laude graduate from ETSU, and a 1983 graduate of the UT Center for the Health Sciences with a degree in Medicine and then completed a Family Practice residency in Huntsville, Alabama and a Fellowship Degree in Family Practice. I returned to my home town of Elizabethton, TN in 1986 and was in a busy family practice with my father for 26 years. I've held many hospital leadership positions and served on a Regional Board for the local healthcare system. Since 1999, I've served as the Regional Medical Director/ Public Health Officer for the Sullivan County Regional Health Department along with Assistant Medical Director for Sullivan County EMS as well as been the TN Emergency Preparedness Medical Director for the TN Department of Health and an Examiner for the TN Center for Performance Excellence. I'm humbled to have received multiple community awards through the years that include the Christian Servant Leadership award, Health Care Hero award and recognized for his Public Health service to the Sullivan County community during the 2020 COVID Pandemic
Gary, can you give some background on Sullivan County related to challenges of health needs, addiction, poverty, crime, etc. that you as a health department are working to address.
Gary Mayes: Like many areas in the United States, Sullivan County has been hit hard by the opioid epidemic, as well as other forms of substance abuse, which can lead to overdose, chronic health problems, and other negative health outcomes. Mental health issues are also a growing concern in Sullivan County. Chronic diseases such as heart disease, diabetes, and cancer are major public health concerns as well as tobacco use remains a significant public health issue regionally.
How did each of you first hear about trauma informed care/ACEs? Why did you think this science was relevant to services provided by SCRHD?
Gary Mayes: My first exposure to Trauma Informed Care was at a conference in Johnson City where you presented. I knew immediately that it was something we needed for improving our care of for patients and our employees.
Hannah Taylor: I first heard about ACEs and trauma informed care early on in my employment at SCRHD. After doing my own research on the topic it was clear to me this was something not only other health care professionals needed to know about, but also the community. Sullivan County has a high level of opiate abuse and poverty impacting our community. I reasoned, could that could be prevented or reduced if we only changed the way we thought about people? What would happen to our community if we could change the focus from “what is wrong with you?” to “what happened to you?” After seeing data from various sources, including the original ACEs study conducted at Kaiser Permanente, it was clear that there was a correlation between a higher ACE score and negative health outcomes. Working in public health, it was evident we needed to help our community lower their individual ACE scores which in turn would produce better health outcomes.
Dr. Stephen May: Trauma Informed Care was first introduced to me during the learning process for and in treating drug addiction in women focusing on understanding addiction in pregnancy and Neonatal Abstinence Syndrome. This concept had further growth and development after attending a regional ACE’s Summit expanding the concept and research on ACE’s and how Trauma Informed Care could impact patient care in July 2019.
Hannah - can you describe your role in leading this project. Who have you enlisted help from in forming the implementation team? Please describe a few of the trainings, use of environmental scans, and other tools Becky has provided for staff and how they have been beneficial to the team.
Our partnership with Becky began with a kick off event where Chuck Price (Blue Collar Consulting) shared his experience in leading the Waupaca County DHHS to becoming trauma informed. Following this, at Becky's leading, I invited our organizational leaders to form an implementation team. For the past 10 months, we have met monthly with Becky leading the conversation at those meetings. I have received help in this project from multiple staff members, not only internally but also externally. The nursing supervisors have been a huge help in this process. They are responsible for direct patient contact on a daily basis and have been able to identify ideas for implementing trauma informed care and bring those to the implantation team meetings. Our Public Information Officer has been active serving on the implementation team and is now posting resources on social media and has added related content to the website. General staff members have volunteered to participate on the implementation team. They bring a different perspective to the group. The Basics of Trauma, ACEs, Resilience and Using a Trauma Informed Approach training that Becky provided to the entire organization as we began this journey in June of 2022 was what really sparked an interest in the staff to participate in this group. Multiple employees expressed their interest after watching the story of Healing Neen and how she connected addiction and crime to her own traumatic past, staff expressed wanting to help our patients to do the same.
Becky led our team in conducting an environmental scan of facilities in both Blountville and Kingsport. Items we identified were then shared with the implementation team and sparked facility and grounds changes which we have now made within the organization. On the Blountville campus we have changed landscaping to make the overall facility more inviting. Excessive signage has been removed or wording has been changed to make the environment more hospitable and welcoming. In the lobbies, we added essential oil diffusers that release lavender and eucalyptus scents and make the environment more relaxing. TV monitors in the waiting areas have been changed where now they offer internal and community resources and the faces of the providers patients will be seeing upon their visit. Bulletin boards are being updated regularly with community resources. We have added information on our public website with education and resources for the community related to trauma informed care and ACEs. In addition, regularly there are social media posts about trauma and ACEs.
Becky provided a number of trainings throughout the months of working with us. She provided a 5-hour Train the Trainer for the Basics course as well as training on Workplace Wellness- Caring for Me is Caring For You, and Creating Trauma Informed Multidisciplinary Teams as Best Practice. We now have in-house trainers who are focused on community outreach. In an effort to support workplace wellness, staff are encouraged to take walking breaks as needed and many are getting outside for fresh air and exercise through the day. Staff are allowed to light their work areas with lamps vs. using fluorescent lighting if they wish. We have educational resources and recordings that are on our internal webpage for staff to access at any time for continuing education. Staff are encouraged to participate in peer support and talk to administrative staff about any ideas or suggestions they have for the organization moving in a trauma responsive direction. Many managers now have “open door policies” or “virtual office hours” to change the thinking within the organization to functioning as a whole, and not just siloed by departments.
In addition to our established staff receiving training, every new hire now watches a short video during orientation on the Basics of ACEs. They are required to complete a 3-hour educational course before their first 6 months of employment. We have embedded TIC in our job descriptions, stating that preferred candidates are those having a knowledge of trauma and its effect on individuals. Staff surveys are sent out to new hires at 2 weeks, 1 month, and after 3 months of employment to touch base with the employee and gather any suggestions or improvement areas for the organization.
Taking this science out into the community has been a high priority for the health department as a whole. We have been to the YWCA in Bristol providing women’s health services, we go in the local jail, DIS staff go to various recovery clinics and our health education staff are going into schools and various other facilities to provide education and services using a trauma informed approach. We plan to continue outreach in the community on a long-term basis. Outreach allows us to meet people where they are and meet the need they have in a convenient way for them. Doing this by using a trauma informed approach allows patients to feel more comfortable coming into our clinics and are showing greater levels of trust with their care. We have worked closely with the Branch House Family Justice Center to change procedures and policies when now identifying victims of sexual or domestic violence in the clinic.
Sullivan County Regional Health Department team leaders. This group met monthly serving as the implementation team.
Dr. May - can you describe the CHANT program and how you saw it as a resource being underutilized?
Dr. May: CHANT stands for Community Health Access and Navigation program. CHANT is a statewide program that replaced HUGS, CSS, and TnCare Kids program since 2019. It is a navigation program with 19 focused pathways that now includes ACE screening incorporated with family evaluations and Evidence Based Healthy Families Home Visitation programs. Prior to working to implement trauma informed care, we were having difficulties as an agency in making referrals to CHANT resources.
Dr. May - can you share about the new screening tool that is now streamlining referrals for service?
With staff input, we have developed a new screening tool and algorithm. The logistical algorithm and screening tool are designed to focus on needs identification and responding to those needs immediately through available Health Department services and/or other referrals to Unite Us.
Director Mayes can you describe your strategic planning session and what is your long term goal for sustaining a trauma informed culture at SCRHD?
Gary Mayes: We assembled our core leadership team for a full day dedicated to selecting key strategic elements. This resulted in producing a three-year work plan. During this planning process we used SAMHSA six pillars as guiding principles from the framework Becky had shared with us along with other ideas for implementing trauma informed care in a sustainable way. We included training staff on the effects of trauma, creating trauma-sensitive environment, and rewriting job descriptions to include a focus on trauma informed care. Our goals are establishing a trauma informed organizational culture. Becky’s training focused on understanding the impact of trauma but now strategically we want a safe environment that promotes this approach with our patients and all services we provide. Our long term plan includes regular facility assessments along with policies, and procedures that will prioritize TIC.
Director Mayes how would you best describe working with Becky as an organizational coach and trainer?
Working with Becky Haas as a trauma informed organizational coach and trainer has been very rewarding. When working with our team, she clearly has the skills that promote collaboration and the exchange of ideas. Sullivan County Regional Health Department has learned from her not only as a subject matter expert but from her experience in helping organizations move from being trauma aware to trauma competent. She is a partner and colleague that has clearly helped us advance in our TIC journey. Working with Becky has not only been an enriching experience for our department but will help improve our service to the citizens in Sullivan County for many years to come.
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