Only within the past two years have ACEs gained public recognition in North Carolina sparking program development to address and increase resiliency. Overall, North Carolina’s ACEs ranking is 30th out of 50 (WOCMH, 2017). It appears that little is being done in the medical field in NC to assist medical providers in becoming trauma-informed. By educating patients that childhood trauma may be an underlying cause of their health conditions, they can begin to heal by removing self-blame (Machtinger, Cuca, Khanna, Rose, & Kimberg, 2015). Providing trauma-informed care can allow providers to create a more conducive treatment environment for patients, viewing them in a more holistic manner and avoiding possible re-traumatization. This program aims to address the absence of TIC in primary medical practice and emergency rooms in Eastern North Carolina.
Project Activities
Grant funding will lead to the development of a workshop curriculum that will teach local providers methods of trauma-informed care and ACEs screening methods when applicable. Additionally, a curriculum will be developed for these providers attending the workshop to bring back to their offices and implemented among their staff. Two hundred primary care physicians and urgent care physician and 100 office managers, heads of emergency personnel, and emergency care providers such as EMTs and paramedics, will be invited to 2-day skills workshops across the state that will inform and teach methods of trauma-informed care. These individuals will be provided materials to take back to their workplace and share the information. The first day of the workshops will consist of education and guest speakers regarding methods of TIC, and its importance among the community and potential resources that can be utilized. The second day will include demonstrations and scenarios for the participants to act out and begin to develop the skills in action.
Social Ecological Model
This program aims to address the organizational, community, and public policy levels in the McLeroy Social Ecological Model in the hopes that the benefits will trickle down to the lower levels (Mcleroy, Bibeau, Steckler, & Glanz, 1988). We feel this combination has tremendous potential to reach the most people. While we want to make a difference ultimately on the individual and interpersonal levels, it would be too costly and too time-consuming to direct efforts in this way while only exhibiting minimum change. Instead, we hope that by targeting higher levels in the model, it is possible to make a more significant change over a broader spectrum of people. The community level will include the actual development of the program and implementation through the workshops. From these workshops, additional teaching can be done at the institutional or organizational level, expanding the knowledge to the office and support staff, which will later be evaluated though post-tests. Upon completion of the workshops, depending on effectiveness, we will reach up to the policy level in requiring this training to be done at all doctors’ offices, emergency personnel, and new hires.
Trauma-Informed Principles
The workshops will be based on teaching safety, trustworthiness and transparency, empowerment, voice and choice, and cultural, historical and gender issues. In order to avoid re-traumatization, providers will be required to demonstrate methods to instill feelings of safety with their patients and openness to build trust. A significant focus will be on the autonomy of the patient, ensuring they are well aware of all options and allowing them to have a choice in their treatment. While this is often addressed in a provider’s schooling, it is rarely practiced (Sonfeild, 2005; Williams & Quill, 2004). During the first day of the workshops, speakers will deliver a talk on the sensitivity of cultural, historical, and gender issues within this community that needs to be taken into consideration while improving care.
Public Health Framework
The goal of this program is not to address each who experienced ACEs but to create a system to put into place that will promote the proper care and treatment for these individuals through a community and policy approach (Feuer-Edwards, O’Brien, & O’Connor, 2018; Georges, 2019). It addresses both tertiary and secondary prevention level approaches by aiming to minimize the harmful effects of past traumatization and promote healing (tertiary) while implementing screening and prevention practices to inhibit re-traumatization or further traumatization from the healthcare setting. This doubles a secondary level of prevention as we implement these practices and incorporate screening to narrow down an appropriate treatment approach. Depending on the success of the original program, the training will be expanded to include non-medically health-related constructs in the community such as soup kitchens, homeless shelters, and churches who also contribute to the more substantial infrastructure of minority population health. The idea of scaling up these programs to involve more of the community is a critical component of a public health approach, but only once the intervention has been shown effective in this community (Violence Prevention Alliance, 2011).
Project Outcomes
Healthcare providers will be able to recognize the signs of an individual who need a more sensitive approach to care and be capable of providing that care. Care includes, but is not limited to, explaining reasons for performing an exam or diagnostic test that may seem invasive, asking the patient’s preference gender of provider, nurse, and assistant, and providing choices to the patient within the exam to provide a sense of control (Raja, Hasnain, Hoersch, Gove-Yin, & Rajagopalan, 2015; Tello, 2018). Eventually, this training will lead to region-wide required training for all medical professionals before or within the first month of working and become something as familiar as universal precautions (Raja et al., 2015). This type of care will become similar to universal precautions but instead of against transmissible pathogens, against trauma.
References
Sonfeild, A. (2005). Rights vs. Responsibilities: Professional Standards and Provider Refusals. Guttmacher Institute, 8(3). Retrieved from https://www.guttmacher.org/gpr...nd-provider-refusals
Feuer-Edwards, A., O’Brien, C., & O’Connor, S. (2018). Trauma-Informed Philanthropy. Retrieved from http://www.philadelphiaaces.or...InformedPhilanthropy
Georges, B. (2019). What is Public Health? Retrieved March 22, 2019, from American Public Health Association website: https://www.apha.org/what-is-public-health
Machtinger, E. L., Cuca, Y. P., Khanna, N., Rose, C. D., & Kimberg, L. S. (2015). From Treatment to Healing: The Promise of Trauma-Informed Primary Care. Women’s Health Issues, 25(3), 193–197. https://doi.org/10.1016/j.whi.2015.03.008
Mcleroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs. Health Education & Behavior. https://doi.org/10.1177/109019818801500401
Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma Informed Care in Medicine. Family & Community Health,38(3), 216–226. https://doi.org/10.1097/fch.0000000000000071
Violence Prevention Alliance. (2011). The public health approach. Retrieved March 22, 2019, from WHO website: https://www.who.int/violencepr...ch/public_health/en/
Williams, G. C., & Quill, T. E. (2004). Physician Autonomy, Paternalism, and Professionalism: Finding Our Voice Amid Conflicting Duties. Virtual Mentor, 6(2). https://doi.org/10.1001/virtua....2004.6.2.msoc2-0402
Wisconsin Office of Children’s Mental Health. (2017). Adverse Childhood Experiences (ACEs) and Trauma-Informed Care (TIC) Information Sheet. Retrieved from https://www.pacesconnection.com...08789154224721/North Carolina ACEs TIC Info Sheet Final1.pdf
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