Building a Trauma-Informed UI Health

Increasing life expectancy Reducing obesity Reducing preventable hospitalizations Reducing discrimination Improving overall health Reducing economic hardship Increasing opportunities for children to live healthy lives Institutionalizing a Health in All Policies approach BECOMING A TRAUMA-INFORMED CITY AMY Becoming a trauma-informed city is priority for CDPH and for the City of Chicago. UI Health is working collaboratively with CDPH and other hospitals in Chicago to support the development of trauma-informed hospitals.

Trauma-Informed Hospitals Workgroup 16 Participating hospitals including: UI Health Northwestern University of Chicago Rush Presence Advocate Mercy AMY

Defining trauma “Individual trauma results from an event, series of events, or set of circumstances that is experiences by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” AUDREY Source: Substance Abuse and Mental Health Administration; Health Management Associates Trauma Informed Care Webinar

Neurodevelopment and Attachment Around the same time period as the collection of the ACE Study data, there was an explosion of sophisticated neuroscience research from 1990-1999 , the Decade of the Brain . We’re going to do a crash course in normal neurodevelopment and attachment to better understand how experience can cause disease, disability and death. For the sake of simplicity, our brain is composed of three parts, the brainstem or survival brain, the midbrain or emotional brain, and the cortex or thinking brain. Our brain develops in response to our experiences and our environment from the bottom up from the survival brain to the cortex, starting prenatally and continuing until about age 24. This responsiveness of the brain is called neuroplasticity. Also important to note is that there are critical and sensitive periods for development. For example, if we remain in a dark room during the critical period for development of vision, we will be blind. Attachment is the special emotional relationship that involves an exchange of comfort, care, and pleasure. Early attachment styles are established in childhood through the infant/caregiver relationship. Attunement is the perception and understanding of the wants and needs of others. Stress and trauma can disrupt attachment, derail the optimal growth and development of the brain and autonomic nervous system, its signaling to all of the other body systems, and our overall physiology . Secure attachments and attunement protect and heal from later stress, distress and trauma. Sources: Bruce Perry, MD PhD; Daniel Siegel, MD

Brain Regulates Body through Autonomic Nervous System Thoughts or reactions to memories (am I safe? am I loved?) are transmitted from brain to body in less than a second

Hospitals as a Traumatized Community Both staff and patients carry the burden and stress of their own individual ACEs and traumas. In addition, healthcare workers carry the ADDITIONAL secondary traumatic stress of exposure to their patients’ ACEs and traumas and the stress of their workplace, which often is high demand and inadequately resourced. AUDREY Source: Illinois ACE Response Collaborative Group, The Center for Childhood Resilience – Lurie Children’s Hospital;

What does trauma mean for UI Health staff? Impact of chronic worker stress Increased chronic pain, fatigue, diabetes, heart disease Increased healthcare costs and worker’s comp costs (on job injuries) Increased worker turnover Takes ~10 months for organizations to recover if leadership leaves Costs $3.5K to replace an $8/hr employee (recruitment, training) Increased tardiness and absenteeism Caused by burnout, low moral and engagement Costs organizations $84 billion annually ($2.6-$3.5K/employee/ year) Decreased presenteesim, not functioning to full capacity 60% of workers reported decreased productivity due to workplace stress Leads to increased likelihood of mistakes, poor quality, increased time for tasks Costs organizations $168 billion annually in lost productivity AUDREY Source: Anda, Robert F et al. “Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance.” The Permanente Journal 8.1 (2004): 30–38; Health Management Associates Trauma Informed Care Webinar

What does trauma really mean for ui health staff? RANI and AUDREY to share stories of how trauma has impacted team members in the last year.

SAMHSA’s Concept of a Trauma-Informed Approach

What can UI Health do? We can START WITH OUR STAFF by following SAMSHA or other guidelines for Trauma-Informed Institutions to support staff through trauma-informed: Developing leaders and champions Policies Hiring Practices Staff Training and Support Content of Care Physical Environment CREATE A CULTURE OF SAFETY and CONNECTION that SUPPORTS SELF-REGULATION AUDREY Source: Illinois ACE Response Collaborative Group, The Center for Childhood Resilience – Lurie Children’s Hospital

The continuum of change Trauma-Aware Staff understand the term “trauma” and how it can change the way they view and interact with others. Workplace safety is a priority and the workplace considers both physical and mental health. Trauma-Sensitive The organization values a trauma-informed lens and identifies trauma and resilience in policies. Trauma training is institutionalized for all staff. Staff feel supported and understood in the workplace. Trauma-Responsive Staff applies knowledge of trauma and resilience in work. Staff utilizes language that supports safety, choice, collaboration, trustworthiness, and empowerment. Trauma-Informed The entire staff is skilled in using trauma-informed practices. Individuals outside the organization understand that trauma and resilience are at the center of our mission. AUDREY Implementing change takes time. Becoming a trauma-informed hospital is a multi-year process that starts with a shift in staff knowledge, perspectives, attitudes, and skills. Source: This framework was adapted by the Philadelphia ACE Task Force from the Missouri Model: A Development Framework for Trauma Informed

Why this, why now? Harness momentum Leverage existing resources Chicago-wide effort Staff stories Leverage existing resources Staff expertise TeamSTEPPS Align with KRAs Increase employee engagement Increase physician engagement ANNA

What’s Already HapPENING In OUR INSTITUTION

What exisiting Programs Can We Align With

Which EXISITNG ORGANIZATIONAL MEASURES WILL BENEFIT FROM THIS WORK

EXISTING employee resources Can we do more to support staff and address burnout? ANNA

Potential next steps Define how does becoming trauma-informed support the goals of our organization? Assemble a core team and specific recommendations/next steps