Executives of most organizations providing services for consumers with mental health or cognitive disabilities that would say they provide trauma-informed care. But if you are one of those executives or a health plan manager or a family member, how do you know if trauma-informed care is more than lip service? More than policies and procedures?
That was the focus of the session, Making Trauma-Informed Care An Operational Reality: The Leadership Challenges, by Kevin Ann Huckshorn Ph.D., MSN, RN, CADC, ICRC, author of Principled Leadership in Mental Health Systems and Programs; and Former Director of the Delaware Division of Substance Abuse and Mental Health, at the 2015 OPEN MINDS Executive Leadership Retreat. She offered a structured approach to assuring that services delivered are trauma-informed – as well as some metrics for measuring the impact of trauma-informed care.
From a structural perspective, implementing trauma-informed care has three components:
- Safety and Stabilization – Assuring that the treatment service experience – from admission to discharge – is caring and comfortable for consumers.
- Processing of Traumatic Material – Providing a context for consumers to acknowledge, experience, and normalize the emotions and cognitions associated with the trauma in a safe way and at a safe speed.
- Reconnection and Reintegration – Supporting the consumer in developing a “new sense of self”.
But, assuming you follow that structure, how can you measure whether trauma-informed care is actually being delivered? Dr. Huckshorn suggested some “big picture” outcome measures that are the result of trauma-informed care practices. These included fewer adverse events and client injuries, shorter length of stay, better consumer engagement and satisfaction surveys, lower number of staff injuries, and lower workers compensation costs.
But on a more practical level, I thought some of her “checklist” attributes for delivering trauma-informed services would also be good measures – albeit measures that would come from a “mystery shopper” approach to assessing care delivery. Those attributes on her checklist included items like a friendly and personal greeting of consumers; pleasant admission space and admission experience; use of peer support specialists in the admissions process; trauma assessments as part of the admissions process; little or no use of coercive interventions like seclusion, restraints, and forced medications; and staff training in basic customer service and consumer engagement.
And, speaking of mystery shopping research and the consumer experience, I was struck by just how much trauma-informed care seems to parallel good customer service for any organization. Dr. Huckshorn said, “If you spend time in many community mental health centers, you will find that the consumers are ignored, they’re patronized, they don’t receive proper education on their illness, and they are not involved in their care plans. We infantilize them. We don’t give them the choices and options they need to make informed decisions.”
Trauma-informed care, on the other hand, is focused on a delivery system that meets the needs of the consumer and their experience. If you’re going to implement trauma-informed care, then you have to focus on customer service. You can’t have rules that are built around staff convenience or practices that are about anything other than serving your consumers. Just as Disney or Marriott hotels have developed service-oriented organizations that focus on training their staff to be customer service representatives, health care organizations also must focus on meeting the needs of their consumers in a way that is customer-centered (see No Customers Without Customer Service and Customer Service Is A Leadership Issue). Changing your organization’s culture to one that is trauma-informed requires the executive team to examine every aspect of the organization – from the building and rooms where you serve consumers, to the way staff greet and follow-up with consumers, to the way clinical staff talk to and treat consumers. This may mean opening your system to criticism from consumers and family members and advocates – and listening to their feedback.
My takeaway from the session is that trauma-informed care leads to the better outcomes (aka the “Triple Aim”) that every organization is looking for – and consumer engagement and customer service are the key to making that care delivered effectively. And, if that is the case, then the emerging best practice model for health care service delivery will likely be clinical professionals with fabulous engagement and customer service skills who are equipped with technology-enabled decision support tools that can be used with consumers to develop science-based, consumer-preferred treatment plans. My question – is this what is happening at the service level in most health and human service organizations? And, is this what clinical professionals are learning in their academic training?
For more on trauma-informed care, check out:
- National Council for Community Behavioral Healthcare: Is Your Organization Trauma-Informed?
- Making The Link – Trauma & High-Needs Consumers
- Trauma-Informed Care In Behavioral Health Services
- Traumatic Consequences
- A Treatment Improvement Protocol: Trauma-Informed Care In Behavioral Health Services
And for more on the best practice models and decision support, join me on October 27 and 28 at the 2015 OPEN MINDS Technology & Informatics Institute, for the session The Evolution Of Population Health Management: Using Data & Predictive Analytics To Improve Outcomes by OPEN MINDS Senior Associate Joseph P. Naughton-Travers, Ed.M. and Tina Esposito, Vice President, Center for Health Information Services, Advocate Health Care; and the session, Leveraging The Power Of Analytics To Shape Medicaid Policy & Practices For Complex Consumers: The Experience of Pennsylvania’s Medicaid Program, by David K. Kelley, M.D., M.P.A., Chief Medical Officer, Office of Medical Assistance Programs, Pennsylvania Department of Human Services.