WORKSHOP 1A: TRAUMA-INFORMED CARE: AN INNOVATIVE CHC / PUBLIC HEALTH PARTNERSHIP

1. Trauma-Informed Care:
An Innovative Partnership
CACHC Conference 2015
Linda Dawson Kiri Shafto

2. Overview
• Upstream Thinking
• Klinic (Then & Now)
• PHAC and the Canadian Public Health
ServiceService
• Klinic project - how it came about
• What is Trauma?
• What does it mean to be Trauma-
informed?
Discussion throughout!
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3. Upstream Thinking @ Klinic

4. The Project…
1. Develop and implement a strategy to help
Klinic become a trauma-informed
organization
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5. The Project…
2. Develop and implement a decision
support tool for new projects/programs
that addresses the social determinants of
health and the root causes of diseasehealth and the root causes of disease
using a community development lens
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6. The Project…
3. Create a framework using
principals of trauma-informed care
and social determinants of health to
inform programming, policies andinform programming, policies and
practices
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7. The Project…
4. Share learnings
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8. Klinic (Then & Now)

9. The Story of Klinic
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https://www.youtube.com/watch?v=rHU6MCgXTSc

10. Klinic – 1970s
• Takin’ it to the streets
• Student docs start seeing people on the
street and in the park – sex, drugs and
rock n’ rollrock n’ roll
• Move into the crypt (church basement)
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Klinic
Crisis
Response
Acute Medical
Care

11. Klinic – 2015
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12. Klinic Service Delivery
• Medical services – Community*
• Counseling services – City
• Crisis lines & education – Province
• Manitoba Trauma Information and• Manitoba Trauma Information and
Education Centre - North America
• Calm in the storm app – World
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13. Klinic Innovation
• Calm in the Storm - http://calminthestormapp.com/
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14. Discussion Points
• Show of hands – have you seen/used the
Calm in the Storm app?
• How does your CHC remain current?
• How does your CHC assess and address• How does your CHC assess and address
need?
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15. The Public Health Agency of
Canada and the Public Health
OfficerOfficer

16. History
• Created in 2004
• Focal point for managing
public health emergencies
• Post SARS (Naylor report)• Post SARS (Naylor report)
• Response to concerns about
capacity of Canada’s public
health system
“The record of the last several decades is depressingly clear… Governments
have steadily committed virtually all new health spending to areas other than
public health.” – The Naylor Report
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17. What is the Canadian Public
Health Service?
• Created as part of the 2006 Avian and Pandemic
Influenza Preparedness Treasury Board
Submission, intended to:
–Build a federal public health workforce across Canada
–Provide public health capacity to respond during a–Provide public health capacity to respond during a
public health emergency
• Focus on surveillance (infectious/chronic), EPR and
health promotion
• Work on specific projects in jurisdictions across
Canada, for short-term (1-4year) placements
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18. CPHS Accomplishments
15 –Active federal Public Health Officers
(PHOs) across Canada
6 – Currently placed with northern and/or
First Nations organizations (40%)First Nations organizations (40%)
63 –Different projects across Canada since
2006 (F/P/T/local and NGOs)
49 –Co-op students
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19. Who are the PHOs?
• Qualified public health employees, trained in
epidemiology, policy analysis and public health
nursing
• PHOs offer a variety of expertise:
– Infectious disease
– Chronic disease– Chronic disease
– Vaccine preventable disease
– Injury prevention
– Health promotion
– Public health policy
– Environmental health
• Not involved with delivery of front-line patient care
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20. Show of Hands
• Have you heard of the Canadian Public
Health Service or Public Health Officers?
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21. Partnership

22. Klinic
Engaged and
healthy
communities
Shared Visions?
PHAC
Healthy Canadians
and communities
in a healthier worldcommunities in a healthier world
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23. Klinic and the Public Health
Officer
• PHAC annual call for placements
• Klinic proposal
“…community health centres face the challenge of transferring knowledge
of trauma and the social determinants of health into policy and practice”
• Klinic proposal
– Develop a strategy/framework to become
a trauma-informed organization
– Integrate knowledge of trauma and SDH
into policy, procedures, practices, and
settings
– Share learnings
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24. Benefits of the partnership
• PHAC strengthens its public health capacity
by building:
– workforce
– Infrastructure
– knowledge & networks– knowledge & networks
• Klinic
– Time
– Naivety and Curiosity (new eyes)
– Deadline
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25. Discussion Points
• Are partnerships (other than simply
financial) with governmental agencies part
of your CHC?
• Do these partnerships enhance the work?• Do these partnerships enhance the work?
• How does your CHC partner with external
agencies?
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26. What is Trauma?

27. What is Trauma?
“…out of control, frightening experience that
has disconnected us from all sense of
resourcefulness or safety or coping orresourcefulness or safety or coping or
love”.
- Tara Brach
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28. What is Trauma?
• Common elements:
– The event was unexpected
– The person was unprepared
– There was nothing the person could have– There was nothing the person could have
been done to stop it
• Psychological impacts for all
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29. Types of trauma
1. Single incident trauma
2. Developmental trauma
3. Complex trauma
4. Intergenerational trauma4. Intergenerational trauma
5. Historical trauma
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30. The Effect of Stress
“…the effects of early stress or
adverse experiences directly
shape both the psychology and
the neurobiology of addiction inthe neurobiology of addiction in
the brain.”
Gabor Mate
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31. Adverse Childhood
Experiences Study
• Kaiser Permanente and Centers for
Disease Control
• Over 17,000 participants (1995-1997)
– Mostly middle-class, employed, educated,– Mostly middle-class, employed, educated,
insured
• Ten yes or no questions
• Discovered that childhood trauma (ACEs)
connected to long-term health and social
outcomes
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32. Toxic stress
• Result of high levels of stress over time,
without support
• Weakens the architecture of the developing
brain
• Increases the likelihood of developmental• Increases the likelihood of developmental
delays and later health problems
• Supportive, responsive relationships with
caring adults can prevent or reverse the
damage
• Evidence that mindful awareness practices
are protective
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33. “Difficult” patients
• Difficulty remembering appointments
• Reluctant to make changes
• Abuse(d) medication
• Become overwhelmed by what others would
consider a minor setback
• Become overwhelmed by what others would
consider a minor setback
• Continue to engage in high risk behaviours
even when they recognize the negative
effects.
• Exhibit frequent mood changes ranging from
anger to resignation in the space of minutes
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34. “Strategic” patients
• Strategies that “almost work”
– Disordered eating, risk taking, promiscuity,
etc.
• Difficult to counter despite evidence to the• Difficult to counter despite evidence to the
contrary
– Smoking to relax
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35. Discussion Points
• Wordplay – Trauma
• Do different professions within your
organization look at this word differently?
• Have you had any conversations about• Have you had any conversations about
this?
• Do you define physical and psychological
trauma differently?
• Do we need to apply a different lens?
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36. What does it mean to be
Trauma-Informed?Trauma-Informed?

37. So why trauma-informed?
• Shift “What’s wrong with you” to “What
happened to you”
• Practical ways to engaging a patient with
high ACE score:high ACE score:
1. Build patient-centred approach
2. Identify strategies to help calm the patient’s
sympathetic nervous system
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38. What is Trauma-Informed
• Trauma-Informed Staff
– individual practice
• Trauma-Informed Space
– environment– environment
• Trauma-Informed Organizations
– policies and procedures
– plus individual and environmental
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39. Case study
• Patients dropping out of weight loss
program as they approached target
weights
• Interviews identified high amounts of• Interviews identified high amounts of
childhood abuse and neglect
• Complex and multidetermined disease
• Not simply mismatch between caloric
intake and energy expenditure
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40. What do people want?
• Talking about ACEs brought sense of
consolation
• Pleased that HCP looked beyond
presenting health issues
• Want to be seen holistically (strengths and
challenges)
• Will asking the hard questions re-
traumatize patients?
• “How do these experiences impact your
life now?”
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41. Hide logo
Trauma-informed –
Caregivers

42. Communication tips
• Be curious about people
• Become vulnerable with patients and
their families
• Listen compassionately
• Learn the therapeutic value of touch• Learn the therapeutic value of touch
• Make meaningful connections as an
act of self-care
• Appreciate silence
• Tolerate uncertainty
• Develop mindful presence
• See the patient as a person
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43. Self-care and protective factors
• Burnout
• Emotional fatigue
• Mindfulness
• Self-compassion• Self-compassion
• Social supports
• Exercise
• Trauma exposure response
• Eating and sleeping well
• Communities of practice
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44. https://itunes.apple.com/us/app/calm-in-storm-stress-management/id966020512?mt=8
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45. Self-Care / Client-Care
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46. More Stress…
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47. More Stress…
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48. More Calm…
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49. More Calm…
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50. Calm for everyone…
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51. Hide logo
Trauma-Informed – Space

52. Physical space?
• Calming and welcoming
– Waiting and treatment rooms have space
for people to move
– Confidential space available for intake– Confidential space available for intake
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53. Safety inside the building
• The space inside
the building is safe
– Common areas are
well lit
– Bathrooms offer
privacy
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54. Safety outside the building
• The space around
the building is safe
– Parking lot and
sidewalks well lit
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55. Hide logo
Trauma-informed –
Organizations

56. What is a Trauma-Informed
Organization?
• Commitment to providing services in a
manner that is welcoming and appropriate
to the special needs of those affected by
traumatrauma
• Integrating an understanding of the impact
of trauma and violence into the
organization’s policies, procedures, and
interactions.
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57. Trauma Process Plan
• Evaluate current literature / tools
• Create checklists / tools
• Evaluate current TIP (checklist evaluation)
• Share checklists / tools / presentation with• Share checklists / tools / presentation with
external agencies
• 6 month post evaluation
• Create infographic of progress
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58. Checklist
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59. Checklist Specifics
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60. Discussion Points
• Has your workplace considered trauma-
informed principles when:
– Using space?
– Implementing programs?– Implementing programs?
– Developing policy and procedure
• Is this another buzzword?
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61. Next Steps

62. Part 3 - Goals
• Create a framework using principals of
trauma-informed care and social
determinants of health to inform
programming, policies and practicesprogramming, policies and practices
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63. Where do Trauma and the Social
Determinants of Health Meet?
• Phase 1 – 50% of work
– safety (emotional & physical), housing,
biological needs (food) & relationships
• Phase 2 – 25% of work• Phase 2 – 25% of work
– Remembering and mourning – includes grief,
recognizing impact of trauma &
acknowledging the loss
• Phase 3 – 25% of work
– Resolution and reconnection
– Trauma is in the past
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64. Discussion Points
• How to begin the work? – Trauma
informed has to start somewhere
• How to sustain work? – Trauma informed
can’t be staticcan’t be static
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65. Information Sharing

66. Part 4 - Goals
• Share learnings
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67. Discussion Points
• What, if anything, would you want us to
share?
• How would you like us to share it?
• What do you see as the value add for you• What do you see as the value add for you
and for your workplace?
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68. Summary

69. Project Summary
• What is Klinic left with when Kiri leaves?
– People understand the tool and the process
behind the tools
– People know what a Logic model is– People know what a Logic model is
– Klinic Quality lead is left with a structured
evaluation plan
– Somehow share information broadly
– Hope to integrate Trauma Informed with
SDOH into one tool
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70. Linda Dawson
Director of Health Services
Klinic Community Health Centre
(204) 784-4063
ldawson@klinic.mb.ca
Kiri Shafto
Public Health Officer
Klinic Community Health Centre
Public Health Agency of Canada
204-784-4207
kshafto@klinic.mb.ca
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