national council for behavioral health · 2014-2015 national trauma-informed care learning...

Contact: [email protected]

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ww w. TheNat i ona l Counc i l . o rg

National Council for Behavioral Health

2014-2015 National Trauma-Informed Care Learning Community

Kickoff Webinar

March 25, 2014


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Agenda for Adopting and Sustaining Change to Become Trauma-Informed

• Welcome and Introductions

• Trauma and Trauma-Informed Care

• The Learning Community (LC)

> Definitions

> Past Learning Community Accomplishments

> Voices From the Field

• Best Practices in Organizational Change

> Building Your Team

> Assessing Your Organization Using the Organizational Self-Assessment (OSA)

• Preparing Next Steps

> Tentative Schedule

> Face to Face Meeting

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National Council Learning Community Faculty

Cheryl S. Sharp, MSW, MWT, is the Senior Advisor for

Trauma-Informed Care for the National Council for

Behavioral Health. She has served as project coordinator

and faculty lead for the National Council’s 2011, 2012 and

2013 Adoption of Trauma-Informed Practices Learning as

well as BMHS 2013 and 2014 Learning Communities. She

holds the unique perspective of a person with lived

experience both as a family member and as an ex-consumer

of services as well as a provider of services. She is a

Master WRAP Trainer and serves as an international

trainer/consultant for the Copeland Center for Wellness &

Recovery, a Mental Health First Aid Trainer®, and a trainer

of Intentional Peer Support (Shery Mead). Cheryl has

worked with over 800 organizations to support their work in

trauma-informed practices.

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Linda Ligenza is a licensed clinical social worker in the field of

Mental Health for more than 30 years. She has held a variety of

positions within a large public mental health facility in New York

State including director of a large mental health center in an inner

city community, statewide coordinator of family support services,

and coordinator of NYC mental health response for families

affected by 9/11 for the NYC Field Office of the NYS OMH. She

transitioned to federal service where she became a Special

Expert in Disaster Mental Health for SAMHSA in the Traumatic

Stress Services Branch of the Center for Mental Health Services.

In September, 2010, she left federal service to become an

independent consultant, national trainer, and part-time

psychotherapist. Ms. Ligenza is currently Director of Clinical

Services for the National Council for Behavioral Health and

specializes in Trauma-Informed Care Initiatives and the

Integration of Behavioral Health and Primary Care Services.

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National Council Learning Community Faculty


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Tony Salerno, PhD is a Licensed psychologist with more than 30 years of public mental health experience in inpatient and outpatient settings. He has expertise in organizing and facilitating learning communities to help behavioral health organizations apply Continuous Quality Improvement methods to enhance the quality of services. At the National Council, he guides the use of learning communities to promote integrated care systems, trauma- informed care, and social work curriculum development. Dr. Salerno also serves as a Senior Research Scientist, New York University McSilver Institute for Poverty, Policy and Research.

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Anthony Salerno, PhD, Senior Integrated Health Consultant, National Council for Behavioral Health


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How many of your team members are on this webinar?

A. All/Most

B. Some

C. Only Me

D. We have not yet established our team

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Checking In With You: Polling Question 1


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Is your consumer leader(s) on this webinar?

A. Yes

B. No

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Polling Question 2


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Trauma and Trauma-Informed Care

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Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically and/or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, and/or spiritual well-being

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SAMHSA’s Concept of Trauma (draft)


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• The majority of adults and children in psychiatric treatment settings have trauma histories

• A sizable percentage of people with substance use disorders have traumatic stress symptoms that interfere with achieving or maintaining sobriety

• A sizable percentage of adults and children in the prison or juvenile justice system have trauma histories

(Hodas, 2004, Cusack et al., Mueser et al., 1998, Lipschitz et al., 1999, NASMHPD, 1998)

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What the Prevalence Data Tells Us


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• Center for Disease Control and Kaiser Permanente

(an HMO) Collaboration

• Over a ten year study involving 17,000 people

• Looked at effects of adverse childhood experiences

(trauma)over the lifespan

• Largest study ever done

on this subject

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Prevalence: The Adverse Childhood Experiences (ACE) Study


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Growing up in household with:

> Alcohol or drug user > Member being imprisoned > Mentally ill, chronically depressed, or institutionalized

member > Mother being treated violently > Both biological parents absent > Emotional or physical abuse > Recurrent and severe physical abuse > Recurrent and severe emotional abuse > Sexual abuse

(Fellitti et al, 1998)

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Adverse Childhood Experiences (ACE) Study: Adverse Events


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Adverse Childhood Events (ACEs) leads to: • Neurobiological (brain) changes • Adoption of health risk behaviors as coping

mechanisms Eating disorders, smoking, substance abuse, self harm,

sexual promiscuity

• Severe medical conditions: heart disease, pulmonary disease, liver disease, STDs, GYN cancer

• Early Death

(Felitti et al., 1998)

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Adverse Childhood Experiences (ACE) Study: Research Findings


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We need to presume that the clients we serve have a history of traumatic stress and exercise “universal precautions” by creating systems of care that are trauma-informed.

(Hodas, 2005)

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Therefore…


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Staff may:

• Have their own traumatic histories, including historical trauma

• Seek to avoid re-experiencing their own emotions

• Respond personally to others’ emotional states

• Perceive behavior as personal threat or provocation rather than as re-enactment

• Perceive client’s simultaneous need for and fear of closeness as a trigger of their own loss, rejection, and anger

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Recognize Staff Exposure to Trauma


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A Trauma-Informed Approach:

1) Realizes the prevalence of trauma

2) Recognizes how trauma affects all individuals involved with the program, organization, or system, including its own workforce

3) Resists re-traumatization

4) Responds by putting this knowledge into practice

(SAMHSA, 2012)

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Definition of Trauma-Informed Approach


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• Safe, calm, and secure environment with supportive care

• System wide understanding of trauma prevalence, impact and trauma-informed care

• Cultural Competence

• Consumer voice, choice and advocacy

• Recovery, consumer-driven and trauma specific services

• Healing, hopeful, honest and trusting relationships

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Principles of Trauma-Informed Approach


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The Learning Community

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• Builds on the collective knowledge and real world experiences of members

• Social networking and shared learning encounters are activating

• Efficient and effective method to support widespread practice improvement

• Ensures that the common and unique concerns, challenges and needs of grantees are addressed

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Learning Community


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• Participants are organized into cohorts to maximize shared experiences and problem solving

• Each cohort has a Learning Community Faculty Member as a liaison and facilitator

• Each organization identifies a core implementation team who interfaces with their fellow core implementation teams

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How a Learning Community is Organized


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A. Single program within an organization Child/youth focus

Adult focus

Both

B. Multiple similar programs (2 or more concurrently) Child/youth

Adult focus

Both

C. Multiple different programs (2 or more concurrently) Child/youth

Adult

Both

D. Organization wide (many or all programs concurrently) Child/youth focus

Adult focus

Both

Send your cohort choice to Jordan Winn

at [email protected] by

April 25th.

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Options: Choosing Your Cohort

mailto:[email protected]


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Facilitated by Learning Community Faculty:

● Kickoff Meeting

● Three Individual Team Consultation Calls

● At Least Six Customized Webinars

● Two Learning Community Group Calls

● Access to webinars focused on specific trauma-informed care domains

● Access to vast array of tools and resources related to each domain

● Consultation/Special Interest calls

● List serve communication

•

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Learning Community Activities, Resources and Supports


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Trauma-Informed Care 2013-2014 Learning Community

Accomplishments

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Number of Domains that were Improved by % of Organizations


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Voices from the Field

Novant Health Presbyterian Medical Center

Vikki Johnson, RN, BC, Nurse Project Coordinator

Penny M. Felker, RN, BSN, MSW, Clinical Educator Behavioral Health

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• Novant Health Presbyterian Medical Center

• Behavioral Health Department- Inpatient

• 72 beds

• 3 adult units, 1 child/adolescent unit

• Average length of stay: 6 days

• 170 full time staff: Multidisciplinary

Who Are We?

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• Began in May 2011

• First Learning Community

• Core Implementation Team:

Social Worker

Clinical Nurse Educator

Nurse Project Coordinator

• Our Top Three standards upon self-assessment

Institute TIC Practices

Develop Your Workforce

Community Outreach

Trauma-Informed Care Learning Community

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• Trauma-Informed Care language in policies and scope

of care

• Trauma-Informed Care education during orientation

• Trauma-Informed Care and Recovery Model education

for staff

• Annual Trauma-Informed Care CBL

• Quarterly TIC component refreshers

• Trauma assessments on all BH admissions

• Triggers and Soothers assessment/plan for all BH

admissions

• TIC added to all agendas in our department and

corporate service line meeting

Initial Implementation 2011

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• Partnered with Peer-led community organization for

time-limited training on Recovery Model and PSS

role

• Peer Support Specialist volunteers added to the

team

• Introduction of TIC and PSS role to other Novant

Hospitals with BH departments

• TIC training for Executive Leaders and Presidents

• BH Symposium- provided full day conference on TIC

for school counselors in community

• Program enhancement with new groups

Continuing The Journey 2012-2013

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• 2011- No Director or Nurse Manager at the start of

implementation

• Without Nurse Managers for one year

• 2011-Priority was focused on restructuring operations

• 2012- Worked on project pursuing paid positions for PSS

for a year then project was cancelled by upper

administration

• 2012- change in leadership, new Nurse Managers

• 2012- turnover in staff

• No financial support

• Physician buy-in

• Executive leadership buy-in

Obstacles and Challenges

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• Core Implementation Team continues

• TIC highlighted in Magnet

• Other BH departments in our hospital system using

components of TIC education

• Paid PSS position at sister hospital (grant funded)

• Approval in budget for Cheryl Sharp to train all BH

staff on Trauma in May 2014

• Approval to have 2 instructors trained in Mental

Health First Aid

• Grant writing for paid PSS and additional MHFA

instructors

Where We Are Now in 2014

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• Expanding core implementation team

• MHFA instruction in community and other

departments within our hospital

• Hardwiring TIC with new “round the clock” supervisors

• Data collection

• Trauma training in May

• Goal to reduce restraints

• TIC language in marketing

• Sustaining PSS volunteers

Next Steps

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• Believe that TIC is the right thing…the BEST practice

• Have the right people on your Core Implementation Team

(deeply committed to TIC principles, part of their value

system, invested)

• Any aspect you have control over, you can shape practice

• Shout it from the mountain top…talk about it everywhere,

and all the time

• Keep it in the forefront of people’s minds (mixed media)

• Take it to the next levels

• Identify your partners and resources and use them

• It’s a journey of ups and downs

• Never give up…Be Persistent !!!

Lessons Learned

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“Nothing in this world can take the place of

persistence. Talent will not: nothing is more

common than unsuccessful men with talent.

Genius will not; unrewarded genius is

almost a proverb. Education will not: the

world is full of educated derelicts.

Persistence and determination alone are

omnipotent.”

Calvin Coolidge

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Best Practices in

Organizational Change

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The Heart of Change

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John Kotter’s Eight Stages of Change


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• Key decision makers

• Committed leadership with responsibility and authority to guide the change process

• Those affected by the change (add additional consumers/peers/family members)

• Those expected to carry out the change in day to day activities

• Those with experience or knowledge related to accomplishing the aims of the TIC initiative

• Those who can provide needed resources

• Involves those whose values, interests, beliefs and orientation aligns with the improvement effort (Trauma Champions)

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Build The Right Core Implementation Team


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How confident are you about involving a consumer as an active and full member of the Core Implementation Team?

A. Very confident/already accomplished

B. Confident

C. Somewhat confident

D. Not confident (major concern)

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Core Implementation Team Members Polling Question 3:


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• Utilize the supports and resources of the Learning Community

• Share experiences, successes, resources and challenges with fellow Core Implementation Team members via

• list serve, small group calls, special interest calls and webinars

• Complete tools designed to assess, track and evaluate progress

• Meet regularly to guide the aims of the trauma-informed care initiative

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Role of the Learning Community Core Implementation Team Members (CIT) – That’s You!


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We have an existing committee specific to TIC

A. Yes

B. No

We have a committee that has as one of it’s priorities, TIC efforts

A. Yes

B. No

We will need to establish a CIT to address TIC

A. Yes

B. No

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Existing TIC Committee Polling Questions 4, 5 & 6:


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The Trauma-Informed Care Organizational Self-Assessment (OSA)

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How Does Your Organization Measure Up?


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SHOW OSA

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A multi-purpose tool

• Educates and builds the organization’s awareness of the key domains of trauma-informed care

• Helps the core implementation team to develop a shared vision

• Assists the organization to understand its current state: relative strengths and areas to improve

• Establishes an overall trauma-informed care baseline (starting point of the organization) that may be used to measure overall progress.

• Guides decision making related to the overall implementation plan

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Trauma-Informed Care Organizational Self-Assessment (OSA)


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• 6 core trauma focused domains

• 1 performance improvement and evaluation domain (refers to the organization’s infrastructure for data collection and evaluation of outcomes)

• Each domain consist of a set of performance indicators or standards

• Each standard is rated on a 5 point scale

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The Organizational Self-Assessment Trauma-Informed Care


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• Domain 1: Early Screening & Comprehensive Assessment of Trauma

• Domain 2: Consumer Driven Care & Services

• Domain 3: Trauma-Informed, Educated & Responsive Workforce

• Domain 4: Provision of Trauma-Informed, Evidence-Based and Emerging Best Practices

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Domains of the Organizational Self-Assessment


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• Domain 5: Safe & Secure Environment

• Domain 6: Community Outreach & Partnership Building

• Domain 7: Ongoing Performance Improvement & Evaluation

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Organizational Self-Assessment


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Instructions: Indicate, as best you can, the degree to which the following standards describe your organization on a five point scale, ranging from 0 to 4:

0 = we don’t meet this standard at all

1 = we minimally meet this standard

2 = we partially meet this standard

3 = we mostly meet this standard

4 = we are exemplary in meeting this standard

*A score of 4 means you have expertise in this area that may be of help to other organizations interested in improving their performance around this standard.

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Organizational Self-Assessment Rating


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SHOW SCORING GUIDE

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DOMAIN 1

Standard A: __2__ Standard B _2__

Standard C __1__ Standard D _2__

ADD all 4 scores (TOTAL SCORE) = __7__

Divide TOTAL SCORE by 4 =

1.75

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Example of Scoring the OSA: Domain 1 Screening and Assessment


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• Each member of the CIT completes the OSA individually

• Each members score is transferred to an excel template that we provide (if needed)

• All scores are entered

• The combined scores are plotted on a graph

• The graph is emailed to Kelly Conover at [email protected]

• Each team brings a copy to the Kickoff meeting in D.C.

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How the Core Implementation Team (CIT) uses the OSA in the Learning Community



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SHOW EXCEL SCORING

TEMPLATE

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ORGANIZATIONAL SELF-ASSESSMENT: ADOPTION OF TRAUMA-INFORMED CARE PRACTICE (April 2012)ss

Domains Survey 1 Survey 2 Survey 3 Survey 4 Survey 5 Survey 6

1A

1B

1C

1D

2A

2B

2C

2D

3A

3B

3C

3D

3E

3F

3G

3H

4A

4B

4C

4D

4E

4F

5A

5B

5C

5D

5E

5F

6A

6B

6C

7A

7B

7C


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Place your DOT on the graph corresponding to the score for Domain 1 and repeatfor each of the domains


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Example of an OSA with graph for all domains. It’s about moving your DOT


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Next Steps

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• March

Orientation Webinar – 25th

Finalize your Core Team (5 plus members)

• April

Consultation call with faculty to answer your

questions regarding OSA, cohorts and/or

kickoff

Choose your cohort – submit to Jordan by

April 25th

• May – Conference and Kickoff

4th – Pre-conference University

5-7th – Trauma Track

7th – 8th – Kickoff Meeting – RSVP to

Jordan by April 18th

• June

Webinar 2

Individual Team Calls

• July

Webinar 3

• August

Webinar 4

• September

Webinar 5

PMT Due

Cohort Call

• October

Webinar 6

November

Individual Team Calls

You will receive a full schedule of

activities including webinars at the

kickoff meeting.

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Tentative Schedule of 2014-2015 Learning Community Activities


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• Finalize Your Core Implementation Team Members

• Attend Group Consulting Call with Faculty Leads prior to Kickoff Meeting

• Select the focus of your initial implementation efforts (e.g. adults, child, system-wide cohort)

• Attend the Pre-Conference University – May 4th from 9:00 – 5:00

• Attend the Meet and Greet – May 4th from 5:30 – 7:00

• Attend the National Council Annual Conference – May 5 – 7th

• Attend the Kickoff Meeting – May 7th – 1:00 – 5:00 and

May 8th - 9:00 – 3:30

• Assess Your Organization Using the OSA

• Commit to a Performance Improvement Process

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Next Steps: Planning for the Face to Face Kickoff Meeting


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AM

•Trauma and Trauma-Informed Care

•Consumer Voice, Choice and Advocacy

•Learning Community as a Vehicle for Change

•The Heart of Change – Building Sustainability

PM

•Organizational Self Assessment

•Performance Monitoring Tool

•Implementation Planning

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Agenda for the Trauma-Informed Care Face to Face Kickoff Meeting


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Describe your previous efforts to become a more Trauma-Informed Organization:

A. We have already been seriously working on becoming a more trauma-informed organization

B. We have already started working in this area to a limited degree

C. This Learning Community is our first real effort

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Checking in With You Polling Question 7


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In what way is this Trauma-Informed Care Learning Community aligned with your expectations?

A. Exceeds our expectations

B. Meets our expectations

C. Less than what we expected

D. We had no idea what to expect

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Checking in With You Polling Question 8


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Please use the chat box to indicate your major concern/barrier that

would need to be addressed in order to accomplish the aims of this

initiative

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Let’s Chat: Barriers or Concerns


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• Access to List Serve - Contact Jordan Winn to provide her with a list of names and contact information for all those who should receive list serve information

[email protected]

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Important TIC Resources – Get Ready



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National Council: Breaking

the Silence

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http://www.thenationalcouncil.org/consulting-best-practices/magazine/




202.684.7457

Cheryl Sharp

[email protected]

202/684-7457, ext. #254

Linda Ligenza

[email protected]

Tony Salerno

[email protected]

Jordan Winn, Administrative Support

[email protected]

202/684-7457, ext. #242

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National Council TIC Learning Community Faculty





national council for behavioral health · 2014-2015 national trauma-informed care learning...

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