Trauma informed Pediatrics an update on Healthy Tomorrows Project Meredith Kieschnick MD Wednesday, June 28, 2017

Background Healthy Tomorrows is a HRSA grant administered through the American Academy of Pediatrics and Maternal Child Health. We have matching local funding from the county and from First Five. The grant began March 1, 2015 and will continue through March 1 2020.

Roseland Pediatrics Federally Funded, 96% of children are insured through medicaid. Most live in the Southwest corridor of Sonoma Country, 70% speak Spanish, 18000 + visits annually. Large foster care community Ages 0-19 years

Six Primary Goals of This Effort 1.To ensure that all staff at Roseland Pediatrics understand the toxic effects of trauma/violence and the principles of trauma informed care. Year one saw this goal accomplished through multiple all staff trainings. Staff committed to Trauma informed care. Year 2 was an updated version of training for all staff, given that we had many new members. Commitment remains high to trauma informed care.

Goal 2 To introduce evidence based trauma/violence screening at Roseland Pediatrics to a population of disadvantaged, low income children, ages 0-19 years, and to better identify youth and families affected by trauma/violence. Screening is fully integrated into well child and new patient exams. We continue to screen parents and adults, and have encountered acceptance from our families for this effort.

Our goal of screening 80% of these visits has not been met Our goal of screening 80% of these visits has not been met. Currently 54-56%. Data review and chart audits show that we continue to miss eligible families. We have reviewed the workflow with all providers and MA buddies, and have seen some improvement over time. We need to make sure all very part time providers who are covering shifts are doing this as well. We will continue to work towards this goal with chart audits and feedback to individual MA/Provider teams.

Year prior to grant

Sept 1,2015 –Sept 1,2016

Sept 1,2016 – June 23,2017

Cumulative

Goal 3 To augment counseling services at Roseland Pediatrics for children and families who have experienced trauma and improve the emotional well-being of children We have doubled our number of therapists, and integrated their work with our regular visits. We have identified and used outside counseling resources for parents and children who still need support beyond our abilities

Rate of Referrals Our rate of referral prescreening to mental health was 24%. Post implementation of screening it ranges from 25-28% with time to next appt markedly improved. Resources referrals prescreening was 6% Post screening has been 9-10%.

Goal 4 To make Appropriate Treatment options available to all children and families who have experienced trauma/violence. Resource Specialist Offering more specific Parent classes Have normalized being able to ask for help or support, and also normalized the offering of help by our staff. Counseling referrals fine tuned, and short time to first appointment.

Trauma screening Positives/Children

Trauma Screening Positives parents

Trauma Screening Positives /Youth

Goal 5 To support healthy family behaviors and build community understanding of the negative impact trauma has on children, and to help sustain the program beyond the grant funding Conversations one on one about Resiliency in families in the exam room. Triple P and other classes. Strong support for our foster care families

Presentations outside of Roseland

More Presentations Vista Family Health – 8 lectures given on becoming trauma informed, 2016 Center for Youth Wellness, national conference on trauma, pediatric panel presentation, and poster presentation, 2016 Southwest Community Health Center, 2016 on becoming trauma informed as a practice

More presentations

Publications Integrating Mental and Physical Health Services Using a Social-Emotional Trauma Len, Dayton, L, and Bernard-Pearl, D. In publication Pediatric Adolescent Health Journal

Sustainability Integrated Mental Health services sustainable by Licensed providers(LCSW”s) Resource Specialist in next years budget, which included cuts across all sites Uncertain future of Medicaid for families and support for community Health Centers. Trauma/Resiliency screening well integrated now, so very stable.

Goal 6 Reduce the prevalence of community, family, and domestic violence. Continue with our trauma informed Care!!

Compassion Satisfaction Scale: Roseland All Staff Pleasure & satisfaction derived from working in helping, care giving systems May be related to: Providing care To the system Work with colleagues Beliefs about self Altruism

Burnout Scale: Roseland All Staff Inefficacy & feeling overwhelmed Work-related hopelessness & feelings of inefficacy

Secondary Traumatic Stress Scale: Roseland All Staff Work – related secondary exposure to extremely or traumatically stressful events

How do patients react to this project?

Goal 6 Reduce the prevalence of community, family, and domestic violence. Continue with our trauma informed Care!!

Thank you to all our Funders Questions, Feedback