Trauma Informed Care Integration in HIV Primary and Behavioral Care: Two Different Models

1. Trauma Informed Care Integration in HIV Primary and Behavioral Care: Two Different Models

2. Learning Objectives At the conclusion of this activity, the participant will be able to: Explore three core actions of the funder to facilitate implementation and success of capacity building projects Describe the impact of trauma exposure among PWLH on health outcomes along the HIV continuum. Describe trauma informed care training and technical assistance strategies and processes for successful integration into current service delivery and workforce development at your agency.

3. Integrating Trauma Informed Care into Culture and Service Delivery in NJ: An Innovative Model • Loretta Dutton, NJ DOH DHSTS • Tony Jimenez, CAI • Mary Dino, CAI • Beth Hurley, CAI

4. Disclosures Presenter(s) have no financial interest to disclose. This continuing education activity is managed and accredited by AffinityCE/Professional Education Services Group in cooperation with HRSA and LRG. PESG, HRSA, LRG and all accrediting organization do not support or endorse any product or service mentioned in this activity. PESG, HRSA, and LRG staff as well as planners and reviewers have no relevant financial or nonfinancial interest to disclose. Commercial Support was not received for this activity.

5. Obtaining CME/CE Credit If you would like to receive continuing education credit for this activity, please visit: http://ryanwhite.cds.pesgce.com

6. New Jersey Trauma Informed Care Project

7. Loretta Dutton, MPA, CSWDirector, HIV Care and TreatmentNew Jersey Department of HealthDivision of HIV, STD and TB Services Impetus for change; yield and expectations Core actions taken to ensure success What has been achieved

9. Trauma and Viral Load “Substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality”. https://www.ncbi.nlm.nih.gov/pubmed/18519880 Role of depression, stress, and trauma in HIV disease progression. Leserman J1 Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill

10. Prevalence

12. But Wait… “Trauma? Isn’t that a mental health issue?”

13. But Wait… “Don’t touch it! You’ll make it worse!”

14. “If not us, then who? If not now, then when?”

15. But Wait… “There is limited time and limited resources.”

16. But Wait… “How is this going to help my agency? How is this going to help my patients and clients?”

17. As part of technical assistance, CAI works with key staff to establish performance and patient-level measures to track and monitor outcomes to help an organization to sustain a fully integrated trauma informed care environment. We also work with leadership to explore mechanisms for financing trauma related services

19. NJ Trauma Informed Care Project Model Integration of TIC in to Organizational Culture, Systems, Policies and Practices Leadership led Awareness of and Education about trauma for all staff and for clients and patients Every staff Member has an important Role in TIC

20. Trauma Informed Service Approach The Four R’s: Realizeswidespread impact of trauma and understands potential paths for recovery Recognizes signs and symptoms of trauma in clients, staff, and others involved with the system Responds by fully integrating knowledge about trauma into policies, procedures, and practices Resist re-traumatization SAMHSA, Trauma Informed Care Initiative

21. Commitment to Services that Support Consumers and Staff Create physical, emotional, and psychological safety Maximize opportunities for educating, empowerment, choice and control Foster collaboration and connections Manage emotions and promoting self-reflection Liebman, L., retrieved online, 2016

22. Key Steps In Project Roll-out Engagement of leadership Education session in trauma for all staff at each site Providing individualized technical assistance Skills based training for staff delivering targeted services Implementation Sustainability

23. Trauma InformedCareServices Framework

24. ISTSS, 2012; Herman, J., 1992; Ford, J., Courtois, C, et al, 2005, Saxe, G., Ellis, B.H., 2006, 2017

25. Trauma Informed Care Services New: Psychoeducation Session(s)

26. Staff and Leadership Educational Sessions

27. Total Staff Educated on Trauma by Role (n=509) Stakeholders

29. Feedback from Staff “Make sure my team implements screeners…this is a moral imperative” “Looking forward to applying the skills and what I learned not only to my job, but my everyday life interactions.” “Continue to educate myself about the impact of trauma on so many of the patients I work with - even if they have not shared their traumatic experiences.”

30. Feedback from Leadership “We created an algorithm for front-desk staff – AID: Acknowledge, Introduce Self, and Describe what will happen next” “Increased awareness of our need to understand patient’s story” “Gave us a common language” “This work aligns and build on work we are already doing now” “We rearranged the chairs in our waiting room to give staff and patients more space and things are much more calm now”

31. Summary Statement CAI’s model of Trauma Informed Care is based on implementation science and the strategic use of the transformative power of educating clients and staff about trauma and its impact on people’s lives. Our model of TIC implementation: • Aims to ensure that health care organizations have the capacity to integrate the principles of trauma informed care into their culture, environment, policies and procedures and delivery of care and support services. • Ensures early involvement of organization’s leaders act as champions of the project

32. Provides ongoing technical assistance and training to ensure service integration • Ensures implementation of services to screen for trauma, and referral of patients to appropriate services. • Supports organizations in building its awareness of the secondary trauma that may arise for any staff working with individuals who suffer trauma.

33. Questions? For more information, contact: CAI Project Co-Directors Mary Dino: mdino@caiglobal.org Beth Hurley: bhurley@caiglobal.org NJDOH Loretta Dutton: Loretta.Dutton@doh.nj.gov Nahid Suleiman: Nahid.Suleiman@doh.nj.gov