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

2. 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

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

4. 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.

5. 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.

6. 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.

7. Year prior to grant

8. Sept 1,2015 –Sept 1,2016

9. Sept 1,2016 – June 23,2017

10. Cumulative

11. 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

12. 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%.

13. 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.

14. Trauma screening Positives/Children

15. Trauma Screening Positives parents

16. Trauma Screening Positives /Youth

17. 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

18. Presentations outside of Roseland

19. 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, on becoming trauma informed as a practice

21. More presentations

22. 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

23. 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.

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

25. 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

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

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

31. How do patients react to this project?

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

33. Thank you to all our Funders
Questions, Feedback