1. Working Toward a Comprehensive Trauma Informed System of Care
Oregon’s work to advance trauma informed care and recognition of impacts of adverse childhood experiences
National Association of Medicaid Directors (NAMD)
2017 Fall Conference
November 7, 2017

2. Overview – Trauma Informed Care
What is it?
Why should state Medicaid programs pay attention to it?
What is Oregon doing about it?
What have we learned?
What’s next?

3. What is Trauma Informed Care?
“A program, organization, or system that is trauma-informed:
realizes the widespread impact of trauma and understands potential paths for recovery;
recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system, and;
responds by fully integrating knowledge about trauma into policies, procedures, and practices,
and seeks to actively resist re-traumatization”
SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach, 2014

4. Why now? Why is it important?
Significant advances over the last two decades in developmental neuroscience, interpersonal neurobiology, brain imaging
Adverse Childhood Experiences study (Kaiser and CDC)
Link with mental, behavioral, and physical outcomes
Compelling evidence for a population health perspective
Trauma affects how people approach services
Service system has often been activating or re-traumatizing

5. Prevalence of ACEs Among Children risk behavior in adulthood
Source: Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);

6. Flourishing and ACEs (US Children Age 6-17)
Source:

7. 4+ ACEs and Health Outcomes for Adults in Oregon
Physical Health
1.98 times as likely to have fair or poor general health
1.91 times as likely to have asthma
2.10 times as likely to have kidney disease
High Risk Behaviors
2.03 times as likely to be a heavy drinker
1.70 times as likely to engage in binge drinking
3.39 times as likely to be a smoker
Mental Health and Disability
3.37 times as likely to have depression
4.56 times as likely to have frequent mental distress
4.48 times as likely to have difficulty concentrating, remembering, and making decisions
Source: Behavioral Risk Factor Surveillance System

8. $32,648 in childhood health care costs $10,530 in adult medical costs
Estimated Average Lifetime Costs Per Victim of Nonfatal Child Maltreatment
$32,648 in childhood health care costs
$10,530 in adult medical costs
$144,360 in productivity losses
$7,728 in child welfare costs
$6,747 in criminal justice costs
$7,999 in special education costs
Source: Fang, X., Brown, D.S., Florence, C.S,. And Mercy, J.A. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse and Neglect, 36,

9. Oregon Health Authority Trauma Informed Services Policy
WHO – All behavioral health programs licensed by OHA and any other entities receiving behavioral health funding, directly or indirectly, through Medicaid or state general funds
PURPOSE – Ensure that all state and community providers and those who oversee public mental health and addictions services are knowledgeable and:
Informed about the effects of psychological trauma;
Able to assess for the presence of trauma and related challenges;
Able to offer or refer to services that facilitate recovery

10. Trauma Informed Services Policy
Shared Responsibility
Providers
Engage in a clearly outlined process to become trauma informed
Examine existing practices, environment, and treatment approaches
Provide trauma informed care and ensure availability of trauma specific services
Deliver services in a person-centered collaborative process
OHA
Provide educational resources, toolkits, and other technical assistance to agencies, customers, community partners, and providers
Share guidelines for behavioral health providers to screen, assess, and treat acute, chronic, and complex trauma

11. Trauma Informed Oregon www.traumainformedoregon.org
Launched in 2014 under sponsorship by the Oregon Health Authority and in partnership with:
Portland State University
Oregon Health and Science University
Oregon Pediatric Society
Stakeholders all over Oregon
MISSION
A statewide collaborative aimed at preventing and ameliorating the impact of adverse experiences in children, adults, and families. Trauma Informed Oregon works in partnership with providers, individuals with lived experience, and families to promote and sustain trauma informed policies and practices across physical, mental, and behavioral health systems and to disseminate promising strategies to support wellness and resilience.

13. Trauma Informed Oregon
Activity and Successes
Nearly 10,000 people have been trained on Trauma Informed Care – Including early learning, education, healthcare, judicial, legislature, and housing
Developed trauma informed care online and classroom course for Portland State University
Oregon Pediatric Society training provided to practicing pediatrician and other primary care physicians
Oregon Health and Science University providing trauma informed care and adverse childhood experiences related content in residency program
Published article about implementing trauma informed care1
Developing research agenda for trauma informed care
1. Yatchmenoff, D.K., Sundborg, S.A., & Davis, M.A. (2017). Implementing Trauma Informed Care in Organizations: Observations and Recommendations on the Process. Advances in Social Work

14. Selected Trauma Informed Activities Across Oregon
Coordinated Care Organizations
Coordinating with County Mental Health Program on home visiting curriculum on healthy development, group parenting sessions, respite services, and tobacco cessation
Conducting community-wide Resilience Trumps ACEs training
Increasing screening and education of high risk behaviors during well child visits
Providing ACEs training to parents and foster parents to develop understanding between childhood trauma and chronic conditions
Coordinating with Early Learning HUB to identify behavioral and developmental delays earlier in life
Community Health Centers
Social determinants of health assessment (PRAPARE)
Oregon Legislature
House Concurrent Resolution (HCR-33; 2017)

15. Expected Outcomes Improved Workforce Wellness
Sense of confidence, satisfaction with work
Reduced burnout, stress, absenteeism, turnover
Improved organizational environment
Cross-System/Integrated Care
Shared language – shared resources
Increased Engagement
Follow-through on appointments/classes (reduced no-shows)
Adherence to plans or treatment protocols
Follow-through on referrals
Reduced ED utilization
Improved satisfaction with care or services
Reduced suspensions or other punishments

16. Thank You! David Simnitt Interim State Medicaid Director Oregon Health Authority