Deep-Rooted Issues Require Deep Provider Investment
How Does the Colorado Coalition for the Homeless Do It?
Extreme trauma is commonplace at the Colorado Coalition for the Homeless, a Denver-based nonprofit provider organization that provides integrated primary-behavioral health, housing and other care and services to Coloradans.
“People are homeless for reasons far deeper than what you can possibly see when you see someone standing on the street corner,” according to Jennifer Perlman, coordinator of trauma-informed care at Colorado Coalition. And what lies beneath is more often than not, a history of traumatic experiences.
Trauma coexists with the companions of homelessness — addiction, mental illness and early-onset chronic and acute illness. The damage trauma inflicts breeds distrust, making it difficult for people to form the relationships they need to heal.
“It was apparent to us that people presented at the medical clinic before they would present in other places and that [Colorado Coalition] had an opportunity to intervene at a deeper, more systemic, lasting and impactful level if we could infuse trauma-first care within our medical integrated care clinic,” said Perlman.
When the organization became aware of the Trauma-Informed Primary Care Initiative — the National Council and Kaiser Permanente’s initiative to create a health care culture that recognizes and supports individuals dealing with the long-term impact of trauma — Colorado Coalition was already moving toward integrating trauma-informed care. The program provided the support they needed to take the next steps to establish trauma-informed care as core value of everything they do.
Perlman recognized that competing demands within the organization required formalizing trauma-informed care in the organizational culture. So, she set up an advisory committee comprised of staff representing the whole organization — from psychiatry to case management to human resources. Everyone from the front desk to the corner office now gets a full day of training in trauma-informed care and the agency wrote it into the strategic plan.
“When you have a strategic plan, you have goals. Because you’re always looking at that document, you get things done that are on your plan — it’s a whole organizational push,” said Perlman. “So, it seemed to me that if this was going to carry any weight, it needed to be modeled after what we value in our organization in terms of ‘what gets measured, gets done.’”
There is, she admits, an upfront cost in time and resources to train staff and to build relationships with coworkers and clients. But the backend cost will be much lower as clients feel heard and understood creating a sense of trust and safety with providers. This will lead to reduced no-show rates, resulting in more revenue and more opportunity to provide ongoing care rather than starting from the beginning each appointment. Improved health outcomes will motivate both clients and providers, ultimately reducing clinician burnout due to frustration over lack of results. Clients also benefit from an ongoing relationship with a trusted provider with a greater sense of control of their circumstances and become invested in caring for themselves.
Dealing with clients who have experienced the severe ongoing trauma of extreme poverty and societal stigma is a lifetime of work, she says. But there are small victories.
For three years, one of Perlman’s clients struggled with high blood pressure – probably trauma-induced – and a paralyzing fear of going to doctors and taking medication. Perlman listened and honored her fears, acknowledging that it was a scary situation and that her reaction was understandable. After talking about the medication for almost six months, she was still too frightened to take the medication. At this point, Perlman shared her own experience of taking medication for high blood pressure that may have been caused by things that happened in her own life with no ill effects. Together, they agreed that the client would begin taking a very small dose and increase it as she became more comfortable, all under the supervision of her primary care provider. “Self-disclosure can be a powerful thing, when it’s done in the interest of the client,” Perlman explained.
She also anticipates a decrease in staff turnover, which will also reduce costs, as well as provide greater care continuity. When the staff has greater understanding of the effects that dealing with human trauma and suffering on a daily basis has on them, they will be able to effectively address it in their own lives, and the agency will be in a better place to support their ongoing work in this challenging environment. Ultimately, it will create a resilient workforce that is more likely to stay and be responsive to their clients, co-workers and themselves. Reduced staff turnover will mean more productivity and a better working environment. She noted that she is already seeing levels of frustration decrease among those who consistently apply the lessons of trauma-informed care.
For 30 years, Colorado Coalition has worked to remove the barriers that restrict access to adequate housing and health care. Through an agency-wide commitment to trauma-informed care, they are addressing the root problems leading to homelessness and chronic health conditions by creating an environment where physical and mental healing can begin.
The National Council, in partnership with and sponsored by Kaiser Permanente, selected 14 organizations, including Colorado Coalition, to participate in the Trauma-Informed Primary Care Initiative as part of an ongoing effort to create a health care culture that recognizes and supports individuals dealing with the long-term impact of trauma. At the program’s halfway point, we reached out to some of the participants and are now sharing their stories.