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Trauma Informed Care - Episode 4 · Mind & Medicine - A Behavioral Health Podcast by Sentara

• 0:00
  SPEAKER_00: You're listening to Vital Signs, a podcast for Sentera providers.
• 0:04
  SPEAKER_00: Welcome to episode four of the Trauma Informed Care Series.
• 0:08
  SPEAKER_00: In today's episode, we're joined by Tommy Batum, Director of Clinical Practice Management, and Austin Alderman, licensed professional counselor.
• 0:18
  SPEAKER_00: Before we turn things over to the team, here are a few important CME announcements.
• 0:23
  SPEAKER_00: This episode is accredited for AMA Pre-Category 1 credits.
• 0:28
  SPEAKER_00: For full accreditation, designation, and disclosure information, please refer to the show notes.
• 0:33
  SPEAKER_00: And now here are Tommy and Thomas.
• 0:37
  SPEAKER_01: Hello and welcome to Vital Signs, a podcast for Sentera providers.
• 0:42
  SPEAKER_01: I'm your host, Tommy Bateman, and we're back for part four of the trauma-informed care series with Austin Otterman, licensed professional counselor with Sentera Health Plans.
• 0:52
  SPEAKER_01: And in this fourth part, uh we are building up on everything we talked about.
• 0:56
  SPEAKER_01: We started with a definition.
• 0:58
  SPEAKER_01: We talked about the core principles, we talked about implementation, and now we want to see how do we know how it's working?
• 1:05
  SPEAKER_01: Measuring impact and how do we sustain this trauma-informed care culture.
• 1:10
  SPEAKER_01: So, Austin, once we have trauma-informed care in place, it's implemented, it is, you know, policies have been changing.
• 1:17
  SPEAKER_01: How do we know it's working?
• 1:19
  SPEAKER_01: Yeah, uh, so that's great.
• 1:21
  SPEAKER_02: So I think trauma-informed care, we know is both that mindset changes and the set of practices.
• 1:27
  SPEAKER_02: And I think because of that, we have to measure it not only just from like a quantitative side, but there's also has to be like qualitative indicators.
• 1:35
  SPEAKER_02: Because a lot of the things with trauma-informed care, the things we're seeking to improve is safety, trust, engagement, and just the client or patient's well-being.
• 1:45
  SPEAKER_02: So that's going to show up in probably more tangible ways of maybe how the patients or clients are interacting with our services, how they feel when they're coming into the clinics and leaving, and how we're responding to those challenges when they come up from our clients when it doesn't quite fit into our policies and procedures.
• 2:06
  SPEAKER_01: So give me an example of that.
• 2:08
  SPEAKER_02: Yeah, so um some of the things I think when it doesn't show up necessarily is the the staff stories, right?
• 2:17
  SPEAKER_02: Like you you have the staff the the patient stories where the patient maybe files a grievance because they felt like something wasn't fair to them due to, I know last uh part we discussed no showing or showing late to their appointments, right?
• 2:33
  SPEAKER_02: And even though we may have been clear in our policies of, hey, you get X amount of no shows before um we end the relationship, you know, it it and they file that grievance, right?
• 2:46
  SPEAKER_02: So that might be things that would be a challenge, but we need to also then take that grievance and go back and relook at did we follow it, our trauma lens for this?
• 2:56
  SPEAKER_02: Was there an area, did we miss something?
• 2:58
  SPEAKER_02: Was there an area that maybe we could have intervened to change the outcome?
• 3:02
  SPEAKER_02: Um, and again, that we got to be honest with ourselves.
• 3:05
  SPEAKER_02: And it's okay if we miss the mark, right?
• 3:07
  SPEAKER_02: Like this is a huge change that we're undergoing and we're not always gonna get it right.
• 3:12
  SPEAKER_02: Um, but if we did get it right, you know, we just reconfirm, like, yes, this policy that we're following is is trauma informed.
• 3:19
  SPEAKER_02: We did what we could as the provider to get there.
• 3:22
  SPEAKER_02: So let's keep let's keep going with the people that we have, and then looking from the areas where things are well, right?
• 3:29
  SPEAKER_02: Like when the um someone who's chronically missing appointments or something, and all of a sudden they're coming, right?
• 3:35
  SPEAKER_02: They're showing up to the appointment.
• 3:37
  SPEAKER_02: Something's changed, right?
• 3:38
  SPEAKER_02: Asking them, what was the change, right?
• 3:41
  SPEAKER_02: Like what made the difference?
• 3:42
  SPEAKER_02: And maybe it had nothing to do with us.
• 3:44
  SPEAKER_02: Maybe it was like, oh, I have a different shift now at work, so now I can make my appointments.
• 3:49
  SPEAKER_02: Um, but maybe it's them saying, Well, every time I leave here, I feel better.
• 3:53
  SPEAKER_02: So I want to keep coming, right?
• 3:55
  SPEAKER_02: It's it's asking them for their stories and making sure we take their feedback to see, are we hitting the safety?
• 4:03
  SPEAKER_02: Are we are they building trust with us?
• 4:05
  SPEAKER_02: Are they engaging more with us?
• 4:07
  SPEAKER_02: And then are we seeing better health outcomes based off of those things?
• 4:11
  SPEAKER_01: All right.
• 4:11
  SPEAKER_01: So yeah, we're yeah, you said, yeah, we're getting those patients' stories or the success stories and adding to the numbers that we're seeing.
• 4:19
  SPEAKER_01: I mean, heck, if we're seeing engagement rates that are, you know, 10% 10% increased, I mean, yeah, after a while we could say, okay, it's definitely due to our change in culture here.
• 4:30
  SPEAKER_01: It's not just because all these little incidents.
• 4:32
  SPEAKER_01: Oh, I changed my, I changed my shift.
• 4:34
  SPEAKER_01: I uh I actually got a car now or something like that.
• 4:37
  SPEAKER_01: It's because of the trauma-informed ethic that we have now within within the organization.
• 4:43
  SPEAKER_01: Uh, I I think another interesting thing is what what staff, the staff's relationship to their organization seems to change too, right?
• 4:52
  SPEAKER_01: Uh they see you seem to hang on to staff a little bit longer.
• 4:55
  SPEAKER_02: Yeah, yeah.
• 4:56
  SPEAKER_02: So I I think it's it's great that you brought that up because I think at some point I would be a terrible presenter if I didn't talk about vicarious trauma, right?
• 5:04
  SPEAKER_02: That as providers, um, interacting with people who have experienced trauma, um, we we bring our own trauma to the table, possibly, right?
• 5:14
  SPEAKER_02: Trauma that we haven't worked on, or maybe we have worked on it and we felt like we're in a good place, but then we get that one patient or client that has maybe some sort of similarity in their experience to where it triggers something in us, right?
• 5:27
  SPEAKER_02: So if we as an organization are operating from a trauma-informed care and our leadership is offer operating from a trauma-informed care, then staff retention and satisfaction is gonna go up, right?
• 5:39
  SPEAKER_02: Trauma-informed organizations not only invest in the patient well-being, but also their staff, that they're not closed-minded, that staff are also gonna have their own stuff that they need to address.
• 5:51
  SPEAKER_02: Um, and I think you will see an increase in retention, a decrease in burnout.
• 5:56
  SPEAKER_02: And that alone is gonna suggest that we have built a healthier environment.
• 6:00
  SPEAKER_01: What is um what is a a supervision between frontline staff um and a supervisor look like, you know, when in a trauma and care environment?
• 6:10
  SPEAKER_02: Yeah, absolutely.
• 6:11
  SPEAKER_02: Yeah, I think for a lot of the supervisions is you know, really taking an interest in them as the staff, as a person before you dive into the productivity, the um performance, right?
• 6:24
  SPEAKER_02: Like checking, checking in with them, checking inventory of how are you doing?
• 6:28
  SPEAKER_02: Like what is happening in your world?
• 6:30
  SPEAKER_02: Is there things I can do as your supervisor to to help?
• 6:34
  SPEAKER_02: Or, you know, building on the strengths, what's going well, right?
• 6:37
  SPEAKER_02: It's how we approach those supervisions as well, what language we're using to bring out those strength-based things for them.
• 6:45
  SPEAKER_02: Um, and then also from the staff, if if they're struggling with a particular case or patient, it's breaking that down.
• 6:51
  SPEAKER_02: Like, why, what is happening in that relationship where this client is so difficult, right?
• 6:55
  SPEAKER_02: Like, can we help them reset their mindset on this patient or client?
• 7:00
  SPEAKER_02: Um, help them refocus their trauma lens.
• 7:03
  SPEAKER_02: Or if there is some vicarious trauma happening, I feel like as a leader, it's my job to also protect that staff.
• 7:10
  SPEAKER_02: So I need to maybe reassign that client or patient.
• 7:13
  SPEAKER_02: I need to make sure that the staff's taken care of because they're also gonna be the ones taking care of the other patients and clients.
• 7:19
  SPEAKER_02: And I need them to be on their A game or they're not gonna do a very good job doing what I'm asking them to do.
• 7:25
  SPEAKER_02: And it's just a vicious cycle that we'll go through until they eventually have staff burnout, and then I'm gonna have to train a whole new staff and we're back to square one, right?
• 7:34
  SPEAKER_01: Yeah, and and that kind of goes back to that first principle we talked about with safety, right?
• 7:39
  SPEAKER_01: The you know, of course we want to, you know, help the patient have safety, but if the staff doesn't know where safe is, or if safe doesn't exist for that staff member, I can imagine, not imagine, I remember.
• 7:51
  SPEAKER_01: And I think Austin, you can as well, where we didn't feel quite too protected by our company, you know, and and that we were put in situations where no human being would naturally even be in, you know, and it's we're being you know professionally and physically unsafe.
• 8:08
  SPEAKER_01: Um, and our our supervision may not have backed us up.
• 8:12
  SPEAKER_01: Um absolutely.
• 8:14
  SPEAKER_01: Did we want to stay there?
• 8:14
  SPEAKER_01: Like, did I did not want to stay there?
• 8:17
  SPEAKER_02: Yeah, absolutely.
• 8:18
  SPEAKER_02: And and it comes down to, you know, also at that same point of like when I've done done this with schools, right?
• 8:24
  SPEAKER_02: If the teacher is struggling with her own trauma or his own trauma and isn't coming to class with a mindset ready to teach, right?
• 8:34
  SPEAKER_02: Like you're kind of asking for a disaster, right?
• 8:37
  SPEAKER_02: When you have that maybe difficult child in your classroom and you're not in a good place, it's usually a recipe for disaster, you know.
• 8:43
  SPEAKER_02: From our school-based days, it some teachers need a lot of support.
• 8:48
  SPEAKER_02: And if they can't get that support somewhere, then they're not going to be able to support the children that need it most.
• 8:54
  SPEAKER_02: And so then you have a bigger problem because that teacher's constantly maybe sending that chill, that child out of the room, or you know, they their relationship is pretty volatile because they're both triggering one another.
• 9:06
  SPEAKER_02: It's like someone as leader has to step in and say, what's happening here?
• 9:10
  SPEAKER_02: How can I help you as the teacher?
• 9:13
  SPEAKER_02: How can I help you as um the doctor?
• 9:16
  SPEAKER_02: And like, how can we reset this relationship?
• 9:18
  SPEAKER_02: Or do we need to change that relationship?
• 9:20
  SPEAKER_02: Right?
• 9:21
  SPEAKER_02: If we can't reset it, what how can we do so that both staff feel supported and the patient feels supported?
• 9:27
  SPEAKER_01: I love it.
• 9:28
  SPEAKER_01: And that's and and that kind of goes back to that, you know, we were talking about transparency and expectations, where um, you know, this is what we're gonna do for the patient, but you know, hey, staff member, this is what the patient's gonna be doing for us too.
• 9:41
  SPEAKER_01: And if those aren't met, this is where your safety is, and this is where you know we take action at the same time, because you know, trauma-informed care is not an excuse to allow staff to be abused and know or or ill-used, so that it cut cuts both ways, you know.
• 10:00
  SPEAKER_01: Uh, so very good.
• 10:02
  SPEAKER_01: Yep.
• 10:03
  SPEAKER_01: So lastly, but you know, just to kind of wrap everything up, you know, when an organization puts this in place, you know, how can they make sure that trauma-informed care becomes a lasting part of who they are as an organization?
• 10:21
  SPEAKER_02: Yeah, I think um looking at how how they're gonna make sure that they have left a footprint of being a trauma-informed care, you know, I think it's it's making sure we sustain that culture, right?
• 10:33
  SPEAKER_02: It goes back to that leadership modeling that leaders have to embody these values.
• 10:38
  SPEAKER_02: Um, and that when leaders model it, people are gonna follow because they're gonna see the work, they're gonna feel safe, they're gonna feel trusted, they're gonna be want to do the same.
• 10:48
  SPEAKER_02: Um, making sure that our policies are revisited and aligned, that our workflows should reflect the trauma-informed care principles.
• 10:57
  SPEAKER_02: And then again, this goes back into embedding it into our daily operations, not just a one-time check the box moving on.
• 11:05
  SPEAKER_02: Um, making sure that we have the continuous training and onboarding uh of trauma-informed care, not only for new staff to receive the training, but even our most seasoned staff.
• 11:16
  SPEAKER_02: There needs to be refreshers and consistency and even looking at creating uh work groups to model this.
• 11:25
  SPEAKER_02: Um one of the biggest ones that I'm a big component of is community partnerships.
• 11:30
  SPEAKER_02: Um so the idea of trauma-informed care, when I started in into this, it was creating trauma-informed communities.
• 11:38
  SPEAKER_02: So doing these trainings from not just at the CSB level, not just at the school, but doing it at with judges and lawyers and law enforcement and social service offices, like making sure that schools, hospitals, community partners across all systems have this mindset and lens, because it's only going to strengthen that continuity of care and strengthen the community as a whole.
• 12:05
  SPEAKER_02: If everyone in the community that interacts with individuals have a trauma lens, I still don't see anything bad that could that could happen from someone approaching it that way.
• 12:16
  SPEAKER_02: Um, and I think as an organization, making sure you celebrate and recognize the successes, whether small ones, right?
• 12:24
  SPEAKER_02: Reinforce that the organizational commitment is is working.
• 12:28
  SPEAKER_02: Because I think it takes that work up front to realign policies and make sure policies are trauma-informed care.
• 12:36
  SPEAKER_02: But then when when you start seeing those successes trickle in, you got to recognize them.
• 12:40
  SPEAKER_02: And that's gonna energize your teams to want to keep doing it.
• 12:44
  SPEAKER_01: Right.
• 12:44
  SPEAKER_01: I love that.
• 12:45
  SPEAKER_01: And and the impression I get in my mind too is that to be a trauma-informed care practice, it takes leadership, but it takes a specific kind of leadership, a strong leader.
• 12:59
  SPEAKER_01: You talked about how things are strengthened when you know communities adopt these practices.
• 13:04
  SPEAKER_01: But I have to imagine, though, that it does take a strong leader to not only implement the policies but and and and and start that culture.
• 13:13
  SPEAKER_01: But when it when a you know push comes to shove, literally sometimes, it takes a strong leader to say this is our boundary and we're not crossing it.
• 13:21
  SPEAKER_01: Um or these are the expectations and and having those hard conversations with people.
• 13:29
  SPEAKER_01: Uh, these are these are skills that take strength to do.
• 13:32
  SPEAKER_01: And uh no doormat can necessarily impl be a leader in a trauma-informed care environment.
• 13:38
  SPEAKER_01: This is a a this comes from a position of strength, not passivity.
• 13:43
  SPEAKER_02: Yeah, absolutely.
• 13:44
  SPEAKER_02: And I think depending on the communities you're in, right?
• 13:47
  SPEAKER_02: There's a lot of communities where things have been done the same way for a long time, right?
• 13:52
  SPEAKER_02: And coming in with this idea of changing and asking other entities to change with you, you're gonna get some pushback, right?
• 13:59
  SPEAKER_02: And so it's you being the first one to maybe take that step forward to say, okay, you guys might not be on board yet, but I'm gonna do this.
• 14:06
  SPEAKER_02: And then when we start seeing the benefits, I'm gonna come back and revisit this of how here are the benefits since we've done this.
• 14:15
  SPEAKER_02: Do you want me to help you guys now too?
• 14:16
  SPEAKER_02: Like we we did the hard work of being the first to do it.
• 14:19
  SPEAKER_02: Can I help you jump on board for the benefit of the people that we're working with?
• 14:24
  SPEAKER_02: It's the same, it's a lot of the same individuals, right?
• 14:27
  SPEAKER_02: And if we're all working from that same point, it again, all the the areas that seem like barriers to our patients and clients can be areas of support.
• 14:36
  SPEAKER_01: So Austin, is there any final words you have for our audience before we sign off?
• 14:42
  SPEAKER_02: I I think just going back to what we've said before of trying not to look at trauma-informed care as more to your plate, uh, and and making sure that you as the provider or or counselor, you're you're taking care of yourself, that you're aware of what uh vicarious trauma looks like, and that you are willing to seek help if you start seeing those symptoms come up and not using that EAP that's available to you if it's available to you, or um not take offense if maybe your leadership identifies something's going on before you see it.
• 15:19
  SPEAKER_02: I think a lot of times I like to tell people like people around you see changes in you before you ever recognize it's happened, right?
• 15:26
  SPEAKER_02: So if some someone brings something to your attention, my hope is that you don't always throw up your guard and be like, what is that, you know, that person doesn't know what they're talking about versus like, is is there any validity to what they're saying?
• 15:37
  SPEAKER_02: Have I been more uh easily upset?
• 15:41
  SPEAKER_02: Have I been getting angry more easily than normal?
• 15:44
  SPEAKER_02: And maybe if the answer is yes to those, you take a step back and see it what we do to take care of ourselves and make sure that we're in a good mindset so we can be in a good mindset to take care of those around us.
• 15:55
  SPEAKER_01: Wonderful.
• 15:56
  SPEAKER_01: Austin, thank you so much for this uh four-part series.
• 16:00
  SPEAKER_02: You're welcome.
• 16:01
  SPEAKER_02: Thank you for having me.
• 16:02
  SPEAKER_01: All right, folks, this is Vital Signs, a podcast for Sentera providers.
• 16:06
  SPEAKER_01: I'm your host, Tommy Bateman, signing off.
• 16:08
  SPEAKER_01: Thank you.
• 16:10
  SPEAKER_00: Thank you for joining us.
• 16:11
  SPEAKER_00: You've been listening to Sentera Vital Science, a podcast created for Sentera providers.
• 16:16
  SPEAKER_00: As a reminder, please check today's show notes for details on how to claim your continuing education credits.
• 16:23
  SPEAKER_00: That's it for now.
• 16:24
  SPEAKER_00: But we'll be back soon with another episode of Vital Signs, the podcast that delivers evidence based education for physicians and healthcare providers on the go.