Trauma informed hospital system

I'd love for you to post any replies you get more generally -- while a few have tried to have this started in New Zealand, and posted articles about it over a decade ago, NOTHING has really happened. Whereas in Australia, where I come from, at least some "segments" of health services, such as some of Queenslands Alcohol and Other Drug Services for younger people now incorporate such measures.

I'm not certain about using aces for screening, but a psych hospital unit for people with ptsd or dissociative disorders that is trauma informed - owned by isstd member Joan Turkus, is a until called The Center, in the Psychiatric Institute of Washington, in W, DC. 

Also Christine Courtios, PhD, incest and complex ptsd expert, was hired a couple of years ago by Elements Behavioral Health to bring their hospitals up to speed on state of the art trauma informed practices - so hospitals owned by Elements Behavioral Health would be a good bet - http://www.elementsbehavioralh...m/treatment-centers/   Though again, these are mental health hospital options.

see attached -- now an old article -- from a MH Nursing perspective, which has generally NOT been followed up -- in a couple of places there's been some "attempts" to provide "training" for MH nurses in trauma-informed practices, but these haven't, IMHO, kept up with the literature, and don't offer much of a realistic, or "helpful" perspective; and in my personal experience, haven't had much impact on practices even in the same city where the training has been conducted in the first place (Auckland, by Deb Lampshire -- if people know the work by John Read, co-authored by Ms Lampshire).

I work at Crittenton Children's Center in Kansas City, MO. We are a trauma informed facility and started the Head Start Trauma Smart Program. We screen patients for ACEs.

Hello Katie, 

I am working with our group on trauma informed schools and would like to know this 

"Trauma Smart helps preschool children, and the adults who care for them, calmly navigate difficult life challenges. We pair practical, hands-on tools with effective coping strategies and bring them into the places where kids learn and play every day."

What very specifically are the "Practical, Hands-On Tools?"  

Thanks

Check out the work of Dr. Nadine Burke Harris and her team at the Center for Youth Wellness (SF, CA) http://www.centerforyouthwellness.org/about/ . This link describes their clinical programs http://www.centerforyouthwelln...g/clinical-programs/

Hi Dr. Hahn,

Avis Smith, who started the program, can give you a lot more information on the specifics than I can. Her email is ahsmith@saint-lukes.org

Katie

Katie Thanks a Bunch.  I will do that.  

Tina

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Hi Dr. Hahn,
Avis Smith, who started the program, can give you a lot more information on the specifics than I can. Her email is ahsmith@saint-lukes.org
Katie

Would love to hear if anyone knows of a clinic or hospital that routinely screens adults for ACEs

I would also encourage you to talk to Rahil Briggs.  They screen parents early on when they have babies and even have the conversation about how to keep that child's score lower.

I see this as a problem in medicine and every field... 

We seem to have gone into a speciality after medical school -- but even during our training we were siloed.  We did and were graded on our "performance" in gynecology, in pediatrics, in psychiatry, in neurology, in surgery, in internal medicine... etc....

However a person is not siloed.  

A person is a person..... as an example the patient is a person who becomes pregnant but also has a seizure disorder and is 14 years old who by the way happens to develop "psychotic depression" and then gets appendicitis (who's pregnancy was conceived by her father and she doesn't want anyone to know), pretty complicated to decipher who this "kid" belongs to...

Is it peds/ob/fp/im/neurology/surgery/ social work????  Bottom line, all of us need to be involved!!!!  The problem is we aren't all involved.  Often times we look and think "is this my patient or the neurologist's now?"  Seen it all the time in medicine and I bet others have too.... 

When I worked in Rochester, MN I had several mom's who had been my patients and they were still teens.  Our policy was "you had a baby, move on to IM or FP" even if the parent was only 14 years old.  I broke the rules several times and the inflexible system didn't like that.  I would see them both for colds (mom and baby)..... I didn't think and don't think these rules make any sense.. just because a 14 yr old girl gave birth does not mean she is not a pediatric patient..... at least not to me...

So it is all complicated.. 

I would love to continue to learn about how to make a hospital system trauma informed... am moving on to a new practice... where I will be the only ped .. so I get to decide.......

So thanks for all the information and learning..... 

this list tends to be mostly "listened to" by those in child and educational settings, but for those interested in adults -- I couldn't agree more, Tina, but don't give up. I used to work (am retired now) as a clinical and forensic psychologist, with an enduring interest in Substance Abuse Treatment, and was constantly frustrated by this lack of awareness and "appropriate attention" by "The System" to patients' "real needs". Someone who might know about such health systems is Ruth Lanius, Psychiatrist / Professor, Uni Western Ontario, who wrote "The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic" (2010 - Amazon http://goo.gl/PR92Ck ). It's crucially important in adult MH and addictions -- see Kate Mills work of a couple of years ago, finding "almost all" of those presenting to acute psychiatric facilities with suicidal ideation and Substance Abuse histories had suffered some form of childhood interpersonal trauma -- attaching a link to the radio broadcast -- reveals more than the academic articles.

I'm retired now but when working in AOD once each year I'd ask such services if any were geared up for this sort of ACEs screening -- none were, but a couple said they were "thinking about it".  ACEs in female AOD clients are very high, in males not as high, but both much higher than in the general community. When one considers such women often end up presenting for admission to general hospitals for SU-related physical complaints while still in their 30's (men in their 40's -- relative incidence 70%/40% of such patients) one can gain some inkling of the severity and scale of the problem -- most often, never asked about, never told to anyone, and never addressed.

And what are we learning "these days" -- people often don't "grow out of it", or "get over it", but that elements of such concerns live for as long as the patients do -- their whole natural lives, into later years, affecting their care with dementia, and their dying days.  It is certainly NOT just a problem for pediatricians. 

People haven't "connected the dots", yet, but that's what we're re-learning from the latest research on Vietnam vets with PTSD arising from 40 years ago -- many of whom had histories of childhood trauma,  re-exposed to trauma in the war, and now with "intractable" disorders  --- but now such individuals are identified much earlier, and screened out of serving, so far as I know from Downunder.

The field has been saddled (crippled) by an over-identification with traditional ideas of PTSD due to only particular types of events, now we're realising that for people experiencing ACEs the types of events / experiences can be much broader and much more complex to understand (McDonald's paper), and that for some it can sensitise them to the effects of later adversity, and only for a few, IMHO, will they be able to enjoy "posttraumatic growth" --  It'll take at least another 5-10 years for medicine to catch up, costing  health care systems billions along the way, for "inadequate and inappropriate treatment". It's not for no good reason that van der Kolk has called childhood trauma the biggest public health problem (NOT just the biggest childhood mental health problem).

Good luck, best wishes

Sorry, Russel, using acronyms probably isn't a very trauma informed practice.  It stands for Alcohol and Other Drugs - now I am mostly seeing SUD for substance use disorders. 

You're VERY, very right, Grace, on both counts -- to do a decent job for patients we urgenty need to re-name, re-think, and re-frame what we do. It's bizarre that AOD was considered to be such an "advance", though it rightly acknowledged how important, and how grave, may be the consequences of "alcohol use disorders", certainly as serious, if not more so, than other drugs  -- I've no excuse. To some extent, we are all the products of the systems from whence we came, fortunately not irrecoverably so.  In the hospital-based service in which I last worked, we were all AOD Clinicians. Now it's called the MHAIDS -- MH, Addictions and Intellectually Disability Service -- also not "trauma-informed". Indeed, the official name of the NZ association for counsellors in the field is DAPAANZ, though now offficially called The Addiction Practitioners' Association, Aotearoa-New Zealand, it comes, curiously enough, from Drug and Alcohol Association of Aoteroa, New Zealand. Even compared to Australia, there are national differences in how serious are what drugs are viewed as  "problematic" -- alcohol being the major one here, though we've got a much less "serious" approach to drink driving (again the Downunder term for Drunk Driving -- again, reflecting the, until recently, view of alcohol as being THE drug most often impairing driving, and hence our very poor IMHO approach to helping repeat drink drivers.

Again, it's very much viewing things as "the substance" that's problematic, not natural, human processes, and people's struggles with those -- Michael Twohig and colleagues have an interesting, new, approach to one such  that's often problematic -- but it's very much in its early days, too   http://goo.gl/Q13uzy Or the multi-factorially determined "self-medication" of early trauma-related suffering -- the responses to the main article are freely available, and an interesting outside-in look into the overall conceptualisation process, and of how much we all need others in approaching such matters  https://goo.gl/E0YkHH

During Vermont's 2013 Legislative session, House Bill 762 proposed to require ALL Vermont Health Care providers (I'm assuming that includes hospitals), to screen ALL patients, regardless of age, for ACEs. One of our ACEs Connection members was involved in addressing the wording of Vermont's ACE screening tool, if not related tasks.