The Stephen and Sandra Sheller 11th Street Family Health Services Center, 850 N. 11th Street, offers nurse-led care to North Philadelphia residents. (Halkin/Mason Photography)
Physical and behavioral health problems associated with trauma can linger long after someone experiences abuse, neglect, discrimination or violence, a growing body of evidence shows. With that knowledge in mind, a movement called “trauma-informed” care is making headway at schools, hospitals, social service organizations and health clinics across the country, including the Stephen and Sandra Sheller 11th Street Family Health Services Center of Drexel University.
The approach, based on the notion that the impact of trauma is widespread, shifts the conversation from “What is wrong with you?” to “What has happened to you?” Still, the best ways to put that idea into action are not well known. At 11th Street, health care providers are working to improve that.
The nurse-led center, 850 N. 11th Street, is one of six organizations chosen to participate in a two-year, national initiative to implement and evaluate “trauma-informed” health care approaches. To do this, the center will develop an integrated health care model that focuses on treating a patient’s mind, body and spirit — not just the disease. The holistic, “mind-body” method aims to provide better trauma-informed care to the center’s patients, primarily low-income residents of North Philadelphia public housing units.
The effort is part of a multi-site project, called “Advancing Trauma-Informed Care,” led by the Center for Health Care Strategies (CHCS) and made possible through support from the Robert Wood Johnson Foundation. Its goals are to improve patient outcomes and decrease costs in the health care and social service systems.
“Health care providers and policymakers are increasingly aware of the harmful consequences of trauma, yet strategies for best serving patients with a trauma history are not clear,” said Allison Hamblin, vice president of strategic planning at CHCS.
At 11th Street, health care workers already operate under the assumption that virtually all of their patients have experienced some kind of trauma. The center takes measures to actively avoid re-traumatizing patients and to ensure its staff members do not fall victim to vicarious mental and emotional pain.
“We call it using universal precautions for trauma — from the way the waiting rooms are set up to how patient names are being called,” said 11th Street Director Patricia Gerrity, PhD, RN, professor and associate dean for community programs in the College of Nursing and Health Professions. “We are trying to cultivate a compassionate, caring community for patients who are traumatized, while at the same time caring for our staff.”
Gerrity said the CHCS initiative allows the 11th Street health center to expand and enhance its patient care by providing resources necessary to promote mindfulness and create an “organizational approach” to trauma. The center already has a number of mind-body therapy and behavioral health practices, including dance and creative arts therapies, yoga and nutrition services. However, mind-body care is not yet standard across all of the 11th Street services, Gerrity said.
In order to bolster the use of more mind-body therapies, staff members will participate in monthly workshops that utilize the center’s diverse collection of existing services. Clinicians will learn how to incorporate neuroscience, neurodevelopment, somatic approaches, mindfulness and resilience enhancements into their practice. With technical assistance from CHCS, the center will also determine the best way to screen patients of varying ages for issues like substance abuse, domestic abuse and food insecurity during visits with their primary care doctors.
The proposed outcomes of the initiative are:
- Increasing staff participation in programs offered at the center based on mindfulness, stress reduction, yoga and therapeutic use of the breath.
- Implementing mindfulness practices in the clinical setting to promote trust, shared decision making and effective treatment decisions.
- Implementing a system of age-appropriate screening for trauma across the lifespan
- Increasing internal referrals to the center’s mind-body therapies through staff development
- Conducting patient satisfaction surveys to evaluate patient responses and track referrals.
Completing all implementation steps to obtain full Sanctuary certification to become a member of the Sanctuary Institute, which symbolizes an organization’s commitment to providing a higher level of trauma-sensitive care.
The 11th Street health center was competitively selected by CHCS to participate in the initiative, along with five additional sites across the country, each representing a range of delivery systems and populations. The pilot sites will each receive funding support and participate in a two-year learning collaborative where they will vet new approaches, exchange best practices and advance practical strategies for implementing trauma-informed care. A publicly available online toolbox will share emerging best practices and case studies from the sites.
“This is more than just a grant, it’s a collaborative,” said Gerrity. “Each site participating in the initiative is approaching the problem in a different way, so we’re learning from and sharing with some of the top health leaders in the country. It’s really going to move us forward.”