nnhvip conf 2014 bmo c presentation v6
TRANSCRIPT
Linnea Ashley
National Training and Advocacy Manager, Youth ALIVE! Nicky MacCallum
Clinical Director, Youth ALIVE! Anne Marks
Executive Director, Youth ALIVE! Vincent Chong, MD
Surgery Resident, Highland Hospital/UCSF-East Bay John Rich, MD
Director, Center for Nonviolence and Social Justice Ted Corbin, MD
Medical Director, Healing Hurt People
Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A
Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A
Some people have symptoms from trauma
Those symptoms are often undiagnosed
Symptoms make people vulnerable to violent trauma
Young men of color are disproportionately exposed to violence and trauma
Understand BMoC experiences with systems ◦ How and where do they seek care?
◦ What helped them heal from trauma?
Learn appropriate language to use/avoid
Create a trauma symptoms tool
Provide short but effective interventions
Goal: a practical application of Trauma-Informed Care
Even if you don’t have PTSD, trauma symptoms disrupt your life.
Create “aspirin” for the
daily aches and pains of trauma
Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A
Assembled/convened the research team and Advisory Board
Prepared a literature review
Conducted 4 focus groups with GSW survivors
69 structured survey and intervention pilot interviews with local young men of color
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
Youth ALIVE!
Alameda Health System / Highland Hospital
Center for Nonviolence and Social Justice
Consultants & volunteers
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
Advisors represented: Study population Public hospital system Private hospital system Children’s hospital Public health department Courts Probation School district Service provider Policy advocate Subject matter experts
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
Purpose: To summarize research related to the health challenges facing BMoC, where they seek care, and how they can better be served, specifically as it relates to their trauma symptoms.
Topics:
Portals of Care
PTSD
Screening Tools and Interventions
SBIRT
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
4 Focus Groups with:
18-25 year olds
Current/former clients (GSW survivors)
African-American and/or Latino
Topics:
Where they seek care
Who they trust to provide care
What support they would want after trauma
How they experience and talk about trauma symptoms
What interventions work for them
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
69 interviews with: 18-30 year olds African-American and/or Latino Snowball sample Survey: 2 versions each of screening
questions for 6 trauma symptoms Where and with whom they would
answer screening questions Pilot: How they experience and talk
about trauma symptoms What interventions work for them
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
6 screening questions:
Focus
Re-experiencing
Dissociation
Hyperarousal
Physical manifestations
Sleep issues
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
7 brief interventions:
Common symptoms of trauma Psychoeducation handout on Every day ways trauma is impactful
Belly breathing Calming/Grounding exercise
Domino Grounding exercise
Progressive relaxation Relaxation/Grounding exercise
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
Continued..
Hand massage Relaxation/Grounding exercise
B.E.T.T.E.R. Sleep Psychoeducation handout on healthy sleep hygiene practices
Safety or “S.O.S.” plan Booklet of self-care activities utilized to develop an individualized plan for symptom management.
Advisory
Board
Literature
review
Focus
Groups
Structured
Interviews
5
9
5
8
9
5
7
5
3
4 4
2 2
0
2
4
6
8
10
18 19 20 21 22 23 24 25 26 27 28 29 30
Age
Participant Age
African-
American,
48
Latino, 15
Mixed, 5
Racial Breakdown
Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A
Larger Themes ◦ Provider-patient
misalignment of expectations
◦ Different provider characteristics i.e. “Children’s treats
you…” i.e. “Highland treats
you…” ◦ Nontraditional
providers i.e. Cannabis Clubs
◦ Issues of trust
◦ Manifestations of Trauma and Stress What patients need
to seek for help Coping mechanisms How young people
talk about stress
Re-experiencing ◦ Replay
◦ Surviving
◦ Scars
◦ Déjà vu
Avoidance ◦ Staying under
(the radar) ◦ Laying low
Hyperarousal ◦ Mental pain ◦ Insomnia ◦ Being on Ps
and Qs
“And I don’t gang-bang or anything like or have any enemies. That’s why I still living…I still live in the location where I got shot and it’s a trauma just passing by like every time. It’s crazy. I don’t even want to talk about it.”
“Sometime you do need a prescription and just by how you acting, how you look, the doctor would be like, ‘No, you need it because you wanna get high.’ I’m gonna get high if I need it. You haven't been knowin’ what I went through.”
“Let me holler at you, let me see your paperwork. How you feelin’? Good. Alright, bam. Throw it back out. Do whatever you gotta do.
Come back. “Oh, you still here” “Yeah, you haven't seen me.” “Ok. Let me see you.’ Bam, bam, bam. “Okay you cool. Come back in two- three weeks.”
Say what the fuck? (cont.)
They just write stuff on the paper. This what was wrong with you last time. This what’s wrong with you this time. This is getting better.
Okay. Bam. Two week check-up, see how you’re doing’. Come back and that’s it.
Ain’t nobody gonna come back because you didn’t do nothin’ while I was there.”
M4: We can talk to him, everyone, like in the slang or in our accents like how we is -- M3: Straightforward -- M4: And then he can still talk to us cool. Not like everybody else. Not like these guys came from somebody else. After listenin' to him, getting advice or stuff. I'm gonna help you out.
They never call you back or nothin'. You call at four shit and forget about you. All that. He don't. He just be, "Alright, I'm gonna try to do this.” And if not then he'll just give you a call back. "Oh, I can't do it today. Just give me two, three more days or somethin’ and I'll get back at ya'.”
Male3: 'Cause he cool. You ain't gotta be nobody different, man. You just be yourself. No matter if you bad, good, sick, green, purple, ugly, man. If you know how to talk, he understandin'. He gonna talk to you. If not, he's just gonna be like,"I can't help you."
Or he gonna tell you why he can't help you because this person is being a cat or this, this, this. He ain’t speakin' down to you he just said, "Well we can't do it because of this reason." If you can be the bigger person like okay, that's it, then when the next time maybe it be better for you.
Moderator: When you went back, what would you expect or would you want out of the doctors or the nurses who were helping you? M5: Shit, just to check me. Check me. Check my injury. Check it right M4: Do it faster, huh.
M5: Not faster, but take care of it. M4: Not to check it faster but take care of business faster. M5: Yeah.
Sometimes you do need a prescription and just by how you actin', how you look, the doctor would be like, "No, you need it because you wanna get high." I'm gonna get high if I need it. You haven’t been knowin what I went through. You seen it or I gotta get to know you. What do you gotta get to know me for? You already seen my record that’s all you need to know about me.
Shit, just tell them man, we was born to live. One day we gotta die. So today's your day, shit, you gotta die. There's nothin' you can do about it. If it's your day, it's your day. M1: For real.
M3: For real. If it is, it's gonna come how it's gonna come -- M4: That's how your destiny is M3: 'cause you kickin' it with us you gonna make your bed and lay in it in the same time. So if this what you doin' wrong, this is what's gonna come wrong.
P1: Because I’ll be up all night. Yeah.
P2: If you sleep during the day.
P1: If I take a nap during the day, I’ll be up. I ain’t going to sleep ‘til late.
P2: What’s strange is babies sleep all day and night, but as you grow older, you sleep, like you said, during the day. Nighttime is when you’re not gonna sleep.
P1: The effects. Effects. P2: It’s probably like when it just flashes in and out like every now and then. P1: Yeah. When you just have flashbacks and stuff… P2: Dreams.
Nightmares… ooh, I’ve been having nightmares… I have a lot of nightmares too. That ain’t no joke. Nightmares… they be causing you cold sweats.
Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A
No Symptoms,
3% 1 symptom, 6%
2 symptoms,
20%
3 symptoms,
17% 4 symptoms,
25%
5 symptoms, 9%
6 symptoms,
20%
Number of moderate to severe trauma symptoms
in study population
97% had at least one moderate trauma symptom
never
3%
rarely
26%
someti
mes
54%
often
17%
1. focus
never
12%
rarely
39%
someti
mes
27%
often
22%
3. dissociation
never
7%
rarely
32%
someti
mes
34%
often
27%
2. re-experiencing
never
10% rarely
10%
someti
mes
30%
often
50%
4. hyperarousal
never
23%
rarely
41%
someti
mes
27%
often
9%
5. physical
never
15%
rarely
17%
someti
mes
29%
often
39%
6. sleep
Trauma Screening Results
never
3%
rarely
26%
someti
mes
54%
often
17%
1. focus
never
12%
rarely
39%
someti
mes
27%
often
22%
3. dissociation
never
7%
rarely
32%
someti
mes
34%
often
27%
2. re-experiencing
never
10% rarely
10%
someti
mes
30%
often
50%
4. hyperarousal
never
23%
rarely
41%
someti
mes
27%
often
9%
5. physical
never
15%
rarely
17%
someti
mes
29%
often
39%
6. sleep
Trauma Screening Results
0 0 0 0 0
4 4
2
6 6
4
11
5 5
7
3
2 1
3 3 3
0 0 0 0 0 0
4
2
5
4
5
4
6
5
8 8
5
0 2
5
4
1 1 0
2
4
6
8
10
12
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Trauma Symptom Screening Scores
Version A # of responses Version B # of responses
Yes, no
matter
what
55%
Yes, if
they're
trying
to help
36%
No
9%
mentor
Yes, no
matter
what
29% Yes, if
they're
trying
to help
49%
No
22%
social worker
Yes, no
matter
what
33%
Yes, if
they're
trying
to help
56%
No
11%
psychiatrist
Yes, no
matter
what
40%
Yes, if
they're
trying
to help
41%
No
19%
counselor
Yes, no
matter
what
47%
Yes, if
they're
trying
to help
47%
No
6%
therapist Would you answer these questions if this person asked you?
Answer
1-on-1,
57%
Answer
alone,
14%
Don't
Know,
1%
Either,
23%
Not at
all, 3%
Would you prefer if someone asked you these questions, or to read and answer by yourself?
30%
37%
29%
60%
62%
57%
64%
54%
45%
46%
31%
30%
38%
32%
Domino
Hand Massage
Tensing
Breathing
Common
Symptoms
Sleep
Safety Plan
Was This Intervention Helpful?
a lot some-what
=96%
=95%
=92%
=91%
=75%
=84%
=82%
SOS Plan
Progressive Relaxation
a lot
64%
some
-
what
32%
not
at all
4%
SOS Plan
a lot
56%
some
-
what
38%
not
at all
6%
Sleep
a lot
60%
some
-
what
31%
not
at all
9%
Breathing
a lot
62%
some
-
what
31%
not at
all
7%
Common Symptoms
a lot
37%
some
-
what
45%
not
at all
18%
Hand Massage
a lot
30%
some
-what
54%
not at
all
16%
Domino
a lot
29%
some-
what
46%
not at
all
25%
Prog. Relaxation Was this relaxing/ useful/ helpful?
Yes
77%
No
16%
Maybe
7%
Domino
Yes
90%
No
6%
Maybe
4%
Hand Massage
Yes
78%
No
16%
Maybe
6%
Prog Relaxation
Yes
90%
No
4%
Maybe
6%
Breathing
Yes
99%
No
1%
SOS Plan
Would you feel comfortable doing this exercise again?
Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A
Universally applied:
Six-question screening questionnaire (2-3 minutes)
Brief psycho-education and a handout on common trauma symptoms (3-4 minutes)
Potentially applied, based on screening score:
Structured discussion of sleep hygiene tips and patient selection of next steps (3-5 minutes)
Short breathing/relaxation or hand massage/grounding exercise (2-4 minutes each)
Patient creation of a personalized stress reduction (S.O.S.) plan (10-18 minutes)
Referral to mental health assessment for PTSD
Each of the START interventions can be done discreetly at home
START kit materials provided free to patient
We are working with partners to create a START smartphone app
Purpose of our trauma research project
Research design
Focus group results
Piloting & Survey results
What START looks like
Next steps
Q&A
Disseminate completed research
Prepare START Kits – training and implementation materials ◦ Conduct trainings for others to use START ◦ Create smartphone app
Pilot START at multiple locations ◦ Health clinics ◦ Schools ◦ Juvenile justice ◦ HVIPs
If you are interested in participating in the expanded pilot please contact: