Last week, my colleague Tressell Carter took a look at how the court system is evolving to consider trauma and other behavioral health issues through the use of “trauma-informed” and “problem” courts (see Judging, Not Judging: Trauma-Informed Courts). As I read the article, I thought about the issue of trauma and health, how much we know, and how little is actually happening. The quandary for the health and human service field is, how best to address the effects of trauma and how to prevent trauma.
The original Adverse Childhood Experiences Study (ACE) study, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, was conducted at Kaiser Permanente from 1995 to 1997, and published in 1998. The basic findings were quite clear—there is a strong relationship between exposure to abuse during childhood, and elevated risk for several leading causes of death for adults.
Since then, there has been an impressive body of research addressing the health effects of trauma and the related issue of epigenetics. The list is long and includes addiction (see Children Who Witness Violence Are Three Times More Likely To Inject Drugs As Adults), Lupus (see Women Who Experience Trauma Are At Higher Risk Of Developing Lupus), depression, anxiety, diabetes, heart disease, and cancer (see Physical Health Problems After Single Trauma Exposure: When Stress Takes Root in the Body, Trauma, PTSD, and Physical Health, and Understanding the Impact of Trauma).
Preventing trauma—childhood trauma, sexual violence, gun violence, etc.—is a complex problem (too long and too complex to address here) that current U.S. public policy is not doing a good job of addressing. This leaves the health and human service field to focus on strategies for how best to address the victims of trauma. So, how do you build a trauma-informed culture within your organization?
First, recognizing and screening for trauma needs to be present for every consumer—not just those with documented histories of trauma. Second, build your consumer experience (from intake to service deliver to care management) on a foundation of safety and stability to assume that the consumer experience is comfortable and not re-traumatizing. Finally, take a whole person approach to care that addresses a consumer’s physical, behavioral, and social support needs, and is based on a goal of integrating consumers into the community (see Trauma Informed Care In Integrated Settings: It’s All About Relationships and Making Trauma-Informed Care An Operational Reality).
For a more on this, I reached out to OPEN MINDS Senior Associate, George Braunstein, who notes:
It is very difficult to address trauma-informed needs of those seeking services in any health care environment, given the structure of payments systems and acute care/symptom management focus of many organizations. However regardless of the challenges faced by an organization, the issue leadership must address is what type of culture do they want to have and does that culture place the consumer’s needs as a top priority. If that decision is affirmative, then an organization needs to look at all aspects of their system, including administrative and clinical admissions, service delivery, and service environment.
An effective service-oriented culture cannot just train staff and hope for the “best.” The purpose of an effective service culture is to reflect the value of addressing the consumer’s needs. Trauma-informed training, awareness, and treatment is only one of several evidence-based practices that become part of the culture. Changing a culture also means incorporating new evidence-based approaches that focus on the consumer. In my experience, establishing a service-oriented culture leads to improved performance in many different ares – including improvements in quality measures; improved employee satisfaction due to a clearer understanding of their role in the mission; and an improved bottom-line, even in a risk-based reimbursement environment. The key is that the service is focused on addressing the true needs of consumers, not just managing their symptoms.
I think we’ll see increasing attention on trauma, because the health care costs related to trauma-related disorders aren’t small. A multitude of studies have explored the lifetime costs and long-term effects of trauma. The Center for Disease Control (CDC) estimates that the lifetime cost of care for every child victim of maltreatment was about $210,012 – in comparison, the CDC estimates that the lifetime costs of care for a person who has had a stroke was $159,846 and the lifetime cost of care for a person with type 2 diabetes is estimated at $181,000-$253,000 (see Cost of Child Abuse and Neglect Rival Other Major Public Health Problems). Studies have also shown the incredible cost increases that accompany consumers who suffer with post-traumatic stress disorder (PTSD) – women with PTSD have and estimated 104% increase in medical costs (see Health Care Costs Associated With Posttraumatic Stress Disorder Symptoms In Women) and Vietnam veterans with a PTSD diagnosis have medical costs 60% higher than average (see Medical-Care Costs Associated With Posttraumatic Stress Disorder In Vietnam Veterans).
Having a strategy to address the effects of trauma is an element in a plan for succeeding in a value-based environment. For more on the issue of trauma, check out these resources in the OPEN MINDS Industry Library:
- Traumatic Consequences
- The Adverse Childhood Experiences (ACE) Study
- Relationship Of Childhood Abuse And Household Dysfunction To Many Of The Leading Causes Of Death In Adults. The Adverse Childhood Experiences (ACE) Study
- What’s An ACE Score?
- Making The Link – Trauma & High-Needs Consumers
And for even more, join moderator Denny Morrison, Ph.D., chief clinical advisor at Netsmart, along with experts from across the health care community, on December 14, at 2 p.m. EST, for the web briefing, Panel Discussion: The Path To Whole-Person Care.