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Trauma Informed Services

August 5, 2010

Earlier I wrote about the extent of trauma in the lives of American Indian children and the resulting issues it causes during adulthood. 33% of American Indians have 4 or more Adverse Childhood Experiences, many of them quite severe. Various studies in particular show the extreme sexual abuse (repeated) taking place in many of our homes. The complex trauma this causes is difficult to assess, but it is important to do so.

Dr. Vincent Fellitti and Dr. Robert Anda caused the ACES to happen because of the dropout rate Dr. Fellitti observed among his obese patients who were doing extremely well until the dropout behavior. In their video discussing the ACES, a number of participants spoke about their experience with finding out about the trauma they experienced and the behaviors they exhibited. One woman’s comment struck me in particular. When seeking help for medical issues, she had never been asked whether she suffered any type of abuse as a child. Physicians treat medical conditions that have their genesis in childhood trauma, but never consider it in their treatment.

Chugachmiut began certain types of behavioral health screening in the past year: for depression, smoking and substance abuse. We are looking at screening for domestic violence. However, we may have missed a critical step, as have most medical care providers, and that is trauma informed medical care. This system has, according to the literature, a number of prerequisites for creation. It needs to be safe, trustworthy and provide choice for the patient. It must minimize retraumatization while providing a path to supportive services. It must empower the client. And the model must be collaborative. Physicians provide about half of counseling services to patients, according to a 1999 Surgeon General’s Report on Mental Health. So trauma informed care must of necessity find its way into the Physicians office.

Trauma informed care has a number of steps for proper development, and we must rely on those experts who have spend considerable amounts of time studying and researching best practices. One source is the Ohio Legal Rights Service for People with Disabilities. Their advice on developing trauma informed services is described as follows:

“Components of a Trauma Informed Treatment Program”

“A program that provides Trauma Informed Treatment is made up of the following components, or parts:

  • Treatment and care providers who understand the dynamics of trauma and violence.
  • Staff training about trauma and violence issues, and how to provide treatment and care to individuals who have experienced trauma or violence.
  • Treatment and care providers understand and recognize that the use of seclusion and restraint and the forcing of intramuscular shot medications is retraumatizing.
  • Assessment of an individual’s experiences with trauma and violence prior to admission to the program.
  • Treatment planning that facilitates consumer choice, control, and participation in: treatment, program/policy development, and evaluation.
  • An environment that is physically and practically designed to avoid retraumatization.
  • An environment that is safe and nurturing.
  • An environment that is empowering.
  • An environment that is culturally competent.

Trauma Specific Treatment Services can and should be provided in all treatment environments.”

As we seek to help our potentially large number of trauma impacted patients and clients, we are seeking advice and counsel on how to best provide appropriate services. And we will seek partnerships with those who can help us develop and provide those services. We know that both our medical practice and our clinical behavioral health practice must become trauma informed and develop the type of services that bring our patients to good health-holistically.

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