{"id":2035,"date":"2018-01-29T08:56:02","date_gmt":"2018-01-29T16:56:02","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=2035"},"modified":"2018-01-18T16:25:11","modified_gmt":"2018-01-19T00:25:11","slug":"putting-trauma-informed-care-into-practice-part-1","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=2035","title":{"rendered":"Putting Trauma Informed Care into Practice &#8211; Part 1"},"content":{"rendered":"<p><strong>By Karen Stephen, Ph.D., PHC Mental Health Clinical Director<\/strong><\/p>\n<p><strong>Part I:\u00a0 Implementing Trauma-Informed Care in Pediatric and Adult Primary Care Settings\u00a0 (Nadine Burke-Harris MD Center for Youth Wellness and Edward Machtinger MD, Women\u2019s HIV Program UCSF)<\/strong><\/p>\n<p><strong>Link to audio of entire webinar session: <\/strong><a href=\"https:\/\/www.youtube.com\/watch?v=VbqwJ1h1Qy8&amp;feature=youtu.be\">https:\/\/www.youtube.com\/watch?v=VbqwJ1h1Qy8&amp;feature=youtu.be<\/a><\/p>\n<p><strong>Definition of trauma:<\/strong> Event or series of events, or set of circumstances that are experienced by the individual as physically or emotionally harmful or life threatening that can have lasting effects on the individual\u2019s mental, physical, social, emotional, or spiritual well-being.<\/p>\n<p><strong>Types of Adverse Childhood Experiences (ACEs)<\/strong><\/p>\n<ul>\n<li><strong>Abuse<\/strong>: Physical, emotional, and sexual<\/li>\n<li><strong>Neglect<\/strong>: Physical, emotional<\/li>\n<li><strong>Household<\/strong> <strong>Dysfunction<\/strong>: Mental illness, mother treated violently, divorce, incarcerated relative, substance abuse<\/li>\n<\/ul>\n<p><strong>Increasing number of ACEs experienced increases impact on all aspects of physical and mental health, behavioral outcomes (e.g., smoking, addiction, alcoholism), and life potential (school and work success). <\/strong><\/p>\n<p><a href=\"https:\/\/www.samhsa.gov\/capt\/practicing-effective-prevention\/prevention-behavioral-health\/adverse-childhood-experiences\">SAMSA data on ACE outcomes<\/a>. \u00a0<a href=\"https:\/\/www.cdc.gov\/violenceprevention\/acestudy\/\">The landmark Kaiser study on ACEs.<\/a><\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"34\"><\/td>\n<td width=\"230\"><strong>Leading Causes<\/strong> <strong>of Death in US, 2013<\/strong><\/td>\n<td width=\"157\"><strong>Odds with 4 or more ACEs<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">1<\/td>\n<td width=\"230\"><strong>Heart<\/strong> <strong>Disease<\/strong><\/td>\n<td width=\"157\"><strong>2.1<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">2<\/td>\n<td width=\"230\"><strong>Cancer<\/strong><\/td>\n<td width=\"157\"><strong>2.3<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">3<\/td>\n<td width=\"230\"><strong>Chronic Lower Respiratory Diseases<\/strong><\/td>\n<td width=\"157\"><strong>3.0<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">4<\/td>\n<td width=\"230\">Accidents<\/td>\n<td width=\"157\"><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">5<\/td>\n<td width=\"230\"><strong>Stroke<\/strong><\/td>\n<td width=\"157\"><strong>2.4<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">6<\/td>\n<td width=\"230\"><strong>Alzheimer\u2019s<\/strong><\/td>\n<td width=\"157\"><strong>11.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">7<\/td>\n<td width=\"230\"><strong>Diabetes<\/strong><\/td>\n<td width=\"157\"><strong>1.5<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">8<\/td>\n<td width=\"230\">Influenza and Pneumonia<\/td>\n<td width=\"157\"><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">9<\/td>\n<td width=\"230\">Kidney Disease<\/td>\n<td width=\"157\"><\/td>\n<\/tr>\n<tr>\n<td width=\"34\">\u00a0\u00a0 10<\/td>\n<td width=\"230\"><strong>Suicide<\/strong><\/td>\n<td width=\"157\"><strong>30.1<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>The biology of adversity:<\/strong><\/p>\n<ul>\n<li><strong>Neurologic<\/strong>:\n<ul>\n<li>Dysregulation of HPA and SAM Axes<\/li>\n<li>Activation of the amygdala<\/li>\n<li>Inhibition of the prefrontal cortex<\/li>\n<li>Hippocampal neurotoxicity<\/li>\n<li>VTA and reward center dysregulation<\/li>\n<\/ul>\n<\/li>\n<li><strong>Immunologic:<\/strong>\n<ul>\n<li>Increased inflammatory mediators and markers of inflammation such as interleukins, TNG alpha, IFN-y<\/li>\n<li>Inhibition of anti-inflammatory pathways<\/li>\n<li>Impaired cell-mediated acquired immunity<\/li>\n<\/ul>\n<\/li>\n<li><strong>Endocine:<\/strong>\n<ul>\n<li>Long term endocrine changes in ACTH, cortisol, adrenaline and other hormones<\/li>\n<li>Inhibition of thyroid function<\/li>\n<li>Alterations in Growth Hormone and pubertal hormones<\/li>\n<\/ul>\n<\/li>\n<li><strong>Cardiovascular:<\/strong>\n<ul>\n<li>Increased plasma endothelin 1, total peripheral resistance, DBP and pulse wave velocity<\/li>\n<\/ul>\n<\/li>\n<li><strong>Epigenetic<\/strong>:\n<ul>\n<li>Altered epigenetic regulation leads to differential gene expression<\/li>\n<li>Changes in way DNA is read and expressed lead to changes in the way brain and organ systems respond to stress<\/li>\n<li>Telomere erosion leads to premature cell death and altered cell replication<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>What is trauma-informed care in a nutshell?<\/strong><\/p>\n<ul>\n<li>Take the person\u2019s experience into account<\/li>\n<li>Don\u2019t ask \u201cWhat\u2019s wrong with you? Ask, \u201cWhat happened to you?\u201d<\/li>\n<li>Needs to be addressed at clinical and organizational level.<\/li>\n<\/ul>\n<p><strong>Core principles of trauma-informed care:<\/strong><\/p>\n<ul>\n<li>Empower patients\u2014use their strengths to develop treatment plans<\/li>\n<li>Provide options, let patients choose<\/li>\n<li>Maximize collaboration\u2014patients, family members, staff<\/li>\n<li>Ensure physical and emotional safety<\/li>\n<li>Create trust through clear expectations regarding who, what, and how\u2019s of treatment<\/li>\n<\/ul>\n<p><strong>Tools to screen for ACEs:<\/strong><\/p>\n<p><a href=\"https:\/\/www.ncjfcj.org\/sites\/default\/files\/Finding%20Your%20ACE%20Score.pdf\">Adults<\/a><\/p>\n<p><a href=\"http:\/\/www.palmbeachpediatricsociety.org\/assets\/docs\/2016\/cyw%20ace-q%20teen%20sr.pdf\">Teens<\/a><\/p>\n<p><a href=\"https:\/\/www.humankind.org\/wp-content\/uploads\/2016\/10\/Keynote-Handout-3.pdf\">Children<\/a><\/p>\n<p>ACE score 0-3 without symptoms = Provide Anticipatory guidance<\/p>\n<p>ACE score 1-3 with symptoms or 4 or more ACEs = Counsel and refer<\/p>\n<p><strong>Basics to Institute Trauma-Informed Primary Care:<\/strong><\/p>\n<p><strong>Foundation<\/strong>: Train ALL staff, use clinic champions, support providers, ongoing evaluation<\/p>\n<p><strong>Screen<\/strong>:\u00a0 Inquire about current and lifelong abuse, PTSD, depression, substance use<\/p>\n<p><strong>Create Environment<\/strong>:\u00a0 Calm, safe, empowering for patients AND staff<\/p>\n<p><strong>Respond<\/strong>:\u00a0 Use onsite and community based programs that promote safety and healing<\/p>\n<p><strong>What can you do tomorrow!<\/strong><\/p>\n<p><strong>Realize<\/strong> that a lot of who we are and what we do is because of what happened to us.<\/p>\n<p><strong>Embrace<\/strong> trauma-informed values.<\/p>\n<p><strong>Distribute<\/strong> literature about impact of trauma on health<\/p>\n<p><strong>Get training<\/strong> for staff<\/p>\n<p><strong>Assemble<\/strong> a team to support the process<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Karen Stephen, Ph.D., PHC Mental Health Clinical Director Part I:\u00a0 Implementing Trauma-Informed Care in Pediatric and Adult Primary Care Settings\u00a0 (Nadine Burke-Harris MD Center for Youth Wellness and Edward Machtinger MD, Women\u2019s HIV Program UCSF) Link to audio of &hellip; <a href=\"https:\/\/phcprimarycare.org\/?p=2035\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2035","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Putting Trauma Informed Care into Practice - Part 1 - PHC Primary Care Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/phcprimarycare.org\/?p=2035\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Putting Trauma Informed Care into Practice - Part 1 - PHC Primary Care Blog\" \/>\n<meta property=\"og:description\" content=\"By Karen Stephen, Ph.D., PHC Mental Health Clinical Director Part I:\u00a0 Implementing Trauma-Informed Care in Pediatric and Adult Primary Care Settings\u00a0 (Nadine Burke-Harris MD Center for Youth Wellness and Edward Machtinger MD, Women\u2019s HIV Program UCSF) Link to audio of &hellip; 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