Creating change within emergency department

One of the important parts of the trauma-informed care story is that we not only provide better care for our patients (better engagement, better retention, better outcomes), but that we also reduce provider secondary stress and burnout and reduce staff turn-over.  These are the issues that upper management should care about. Please let me know if you have any other questions.

I have also worked in the emergency department as a child life specialist, my sole purpose was to provide psycho-social support.  I found the best ways to advocate for trauma informed practices was present pulling for research and theories and to use modeling in my ever day interactions.  For presentations and since I was working with children, I focused on things like stress-appraisal/responses, child development, resilience theories, and any support I could find about the impact of trauma on development.  With the said, I found it most effective to make it relateable to them.  How does it benefit them, not just the patient.  How can it make their job easier, reduce costs, save time, improve patient satisfaction scores.  Leadership will be most driven by those factors.  Make it as tangible for their every day work experiences as possible.  Do they want to reduce the number of behavioral health codes? Get patients out the door faster by improving compliance and reducing use of medication? 

Secondly, with the front line staff, I found modeling was the best teacher.  I used family centered, trauma informed practices in every single interaction.  Someone would notice a difference and ask me about it.  Then they would start doing it and it just snowballed from there.  If a staff member was strongly apposed to utilizing a certain method or technique and they had more "power" than me, I just had to roll with it.  I still showed them respect, but I always advocated for what was best.  Some slowly, over time, began to shift their ways; some did not.   Again, my information was targeted towards pediatrics, so that may change your approach.  However, these strategies worked well for me. Getting buy in from leadership is really the best way to create system wide change. 

Hi Katie,
I think you are on to something big! Thank you for taking the leap and demonstrating leadership in this area!
While every community, clinical site, and work culture will differ, there do seem to be recurring themes when looking at a few of the articles hyperlinked below. (Click on the title to open documents). 
In the near future, I suspect the questions and issues you are raising now - will be standard considerations and possibly even built into performance metrics that are linked to reimbursement. 
While I don't have any specific answers - hopefully someone else here on ACEs Connection will ... OR your question may be what is needed to get folks thinking about this issue. 
Either way - thank you for bravely bringing forth such an important question! 
Karen

ACEs Connection Clip TIC and the ER 4-min

Does trauma-informed care belong in the emergency department?

Trauma-Informed Care Needed for Victims of Violence in the ED

Trauma-Informed Care for Violently Injured Patients in the Emergency Department.

How Trauma-Informed Care Can Help During Behavioral Health Emergencies

In Focus: Recognizing Trauma As a Means of Engaging Patients 

Hi Katie - Thank you for taking on this important topic.  The February edition of The Permanente Journal includes an article I wrote from the perspective of a patient. It includes a rather humorous anecdote about an emergency department doctor that may help you make your case. The article can be accessed online at this address. https://www.thepermanentejourn...020/winter/7305.html

I also speak and do workshops for staffs of agencies or hospitals that want to better understand the connections between ACEs and adult mental health.  Please feel free to contact if you want to follow up.  Bonnie Armstrong  armstrongjoy2@gmail.com

Hi Katie

You are working on a PowerPoint. I have some images that may be fun to use. 

And under the factor for every major disease ( according to the CDC ) 

This is some data. Not ACEs data but based on ACEs. 

The 2015 National Survey on Drug Use and Health (NSDUH) collects information on the reasons people misuse prescription psychotherapeutic drugs. NSDUH is an annual survey of the U.S. civilian, noninstitutionalized population aged 12 years or older and is the primary source for statistical information on illicit drug use, alcohol use, substance use disorders, and mental health issues for this population. One of NSDUH's strengths is its large sample size, which allows for examinations of prescription drug misuse and the reason for that misuse.

https://www.samhsa.gov/data/si...hortReport-3210.html

• PRESCRIPTION PAIN RELIEVERS                                                              91.8 million
• PRESCRIPTION TRANQUILIZERS                                                              38.2 million
• PRESCRIPTION STIMULANTS                                                                      4.8 million
• PRESCRIPTION SEDATIVES                                                                          18 million
• SELF DESCRIBED BINGE DRINKERS                                                           65 million
• COMBINED TOTAL ALCOHOL AND PRESCRIPTION DRUG USE              209.8 million

Note: This does not take into account the 553,000 + homeless Americans we now have. The numbers are likely to be higher than 66% of living Americans.

Years Loss Of Life ( YLOL )

To put this data in a way that my mind can grasp it the CDC states that people will lose 10 years of life if they have an ACEs score of 4> and 20 years loss of life if their ACEs score is 5> .  So let's look at Years Loss Of Life.  This is not easy to see as it happens at the end of life say from an expected life of 80 to be reduced to 70 years old at death.

To compare from 1950 the U.S. Military Has Killed 20-30 Million People since World War II in 37 victim nations.  Years Loss of Life ( YLOL) is 25 million x 42years ( median age) =1,050,000,000.  1 billion 50 million years loss of life from all the US involvement in wars from 1950 till now.

In this same amount of time because of ACEs we in America have YLOL at -10 years each of 2/3 of 157 million Americans = 1,053,400,000 ( 1 billion 53 million YLOL )

Based on ACEs science this current generation is 209.8 million Americans “The 2015 National Survey on Drug Use and Health (NSDUH)” have potential Years Loss of Life at 10 years each = 2,098,000,000 ( 2 billion 98 million YLOL )

The word holocaust fits the facts. We are in a slow but deadly holocaust. An invisible holocaust.  I am almost 70 now and can say the golden years are the best years of life. We are losing our elders in their golden years from not seeing the impact that unresolved Adverse Childhood Experiences have on a person's life. This cuts across all economic and educational backgrounds.

I would be careful not to seem too annoying to admin if you have little clout.   You want to keep your job.  Some of these health systems are just about the bottom line ($) and the doctor is just another cog on the wheel these days. Many of them have little clout too. 

Hi Katie,

I am a physician and my clinical practice is in out-patient reproductive health, but occasionally we have emergencies that require me to transfer a patient to the Emergency Department. When I do, I often accompany the patient, and am able to sneak back to the trauma bay with them and "doula" them through that experience. Boy, do I know exactly what you are talking about!

The other big part of my work is providing trauma-informed care education to medical professionals and students of the medical professions. It is such an uphill battle!

I have long hoped that some ED doc or trauma surgeon would take this up as a research project, since evidence is the only thing that drives change in healthcare delivery these days. If there is an interested physician at your institution who has the ability to conduct research, I'd love to work with them (and you) on designing a simple study that would, undoubtably, show improved outcomes and patient satisfaction, when basic trauma-informed measures are implemented. 

In the meantime, make yourself a point of safety and connection when you are able. Each one of us has the power to make a terrible experience a little bit less terrible.

Hang in there!

Carmen

I would suggest looking through ACEs Connection's resource list of trauma-informed guides and tools. Hope this helps!