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An estimated 60 percent of adults in the United States have experienced an adverse life event at least once in their lives, which contributes to persisting physical health, mental health and addiction problems. A trauma-informed approach equips providers with methods, tools and resources enabling them to effectively partner with patients and staff to achieve individual and community health and wellness.
Earlier this year, to help primary care address the impacts of trauma, the National Council for Mental Wellbeing, with the support of Kaiser Permanente, launched a three-year initiative, Trauma-Informed Primary Care: Fostering Resilience and Recovery.
“Trauma work is not new to the National Council. With effects across the lifespan, we’ve spent the last decade implementing trauma-informed approaches within behavioral health organizations. Now it’s time to transition that work to primary care,” said Linda Rosenberg, president and CEO of the National Council. “This project offers strategies primary care providers can implement to improve the overall health of individuals with histories of trauma.”
Over the next 14 months, seven primary care organizations will work with National Council experts to pilot resources, tools and processes, developed by a multidisciplinary team of health care stakeholders, designed to guide the planning, implementation and evaluation of a trauma-informed approach in primary care.
The selected participants are:
- Malama I Ke Ola – Wailuku, Hawaii
- Colorado Coalition for the Homeless – Denver, Colo.
- Richmond Behavioral Health Authority – Richmond, Va.
- Zufall Health Center – Dover, N.J.
- Peninsula Community Health Services – Bremerton, Wash.
- Oregon Health & Science University, Family Medicine at Richmond Clinic – Portland, Ore.
- Willamette Family, Inc. – Eugene, Ore.
The Practice Transformation Team
In July 2017, the National Council convened a multidisciplinary group of 11 health care stakeholders, who serve as the Practice Transformation Team for this initiative. Over the next few months, the team will develop a model for primary care providers and their behavioral health partners to effectively support patients impacted by trauma.
The process for implementing trauma-informed approaches in primary care, developed by the Practice Transformation Team, will focus on recommendations for standardized screening and assessment tools, evidence-based clinical interventions, implementation processes, relevant and replicable outcome measures and potential critical policy changes. Primary care organizations who adopt these efforts will contribute to the advancement of primary care and behavioral health integration and achievement of the Triple Aim: improving care, health and costs.
The 11 Practice Transformation Team participants include:
Director
Kennedy-Satcher Center for Mental Health Equity
Chair: Glenda Wrenn, MD
Glenda Wrenn, MD, is currently Director of the Kennedy-Satcher Center for Mental Health Equity of the Satcher Health Leadership Institute. Dr. Wrenn has worked to develop integrated primary and behavioral health care demonstration sites in safety net systems of care and educational curriculum for the integrated, interprofessional Veteran’s Administration, Women’s Center of Excellence for Specialty Care in Atlanta. She currently oversees the Smart and Secure Children Quality Parenting Program and Integrated Care Leadership Program and their related research initiatives. Her other research interests include strengthening resilience in vulnerable populations, addressing the disparity in help seeking for post-traumatic stress disorder among African Americans, and culturally sensitive collaborative care models. She is also an Associate Professor for the Department of Psychiatry and Behavioral Sciences at the Morehouse School of Medicine.
Former Director of Research and Evaluation
Community Connections
Roger Fallot, Ph.D
Roger Fallot, Ph. D, is a licensed clinical psychologist. He has 22 years of experience as Director of Research and Evaluation at Community Connections, a not-for-profit provider of a full range of supportive services in the metropolitan Washington, DC area. He is the primary developer of the “Creating Cultures of Trauma-Informed Care” approach to agency transformation. His professional areas of specialization include the development and evaluation of services for trauma survivors and the role of spirituality in recovery and he consults widely on the development of trauma-informed cultures of care. Dr. Fallot was Principal Investigator on the District of Columbia Trauma Collaboration Study, a SAMHSA-funded research project examining the effectiveness of integrated services for women trauma survivors with mental health and substance abuse problems (1998-2004). He is a principal collaborator in the development of a men’s version (M-TREM) of the Trauma Recovery and Empowerment Model (TREM), a manualized group intervention for working with survivors of physical and sexual abuse. Dr. Fallot is also interested in the relationships among spirituality, recovery, and well-being.
Former Medical Director
Center for Youth Wellness
Susan Briner, MD
Susan Briner, MD, has chosen to work with underserved populations. Dr. Briner has long believed that helping mothers breastfeed successfully ensuring all children are protected from vaccine-preventable disease, and helping parents nurture the emotional wellbeing of their children are the “bread-and-butter” of pediatrics. In response to profound changes in health care during the past thirty years, she has become focused on improving systems and processes which may interfere with the delivery of high-quality patient-centered care and has taken on medical leadership roles with that goal in mind. In her roles as Medical Director for Center for Youth Wellness (CYW) and Bayview Child Health Center (BCHC), Dr. Briner will apply her recent experience as Medical Director for a community health center in Dallas, where she supervises pediatricians, behavioral and mental health professionals, internists, obstetricians, and Family Practice physicians in an integrated primary care medical home. Helping others succeed including the children, youth, and families served by CYW and BCHC, and the dedicated staff of both organizations is Dr. Briner’s highest aspiration. She joins the CYW/BCHC team with eager anticipation of the work ahead, as CYW strives to improve the health of children and adolescents exposed to Adverse Childhood Experiences.
Adult Mental Health Director
Native American Rehabilitation Association of the Northwest, Inc.
Pamela Jacobs, Ph.D
Pamela Jacobs, Ph. D, is a licensed psychologist and has worked with NARA Northwest since 2012. She is currently an Adult Mental Health Director. She received her degree in 1993 and has worked both in public mental health with older adults and children, and in private practice. Her current interests include integrating the psychological treatment with medical care and addiction services, as well as helping all staff incorporate the understanding of how traumatic experiences affect development and coping. She hopes to be part of the broadening understanding of cultural practices as it applies to better mental health for Native Americans and for all clients at NARA.
Social Services Director
Bread for the City
Tracy Knight, LICSW
Tracy Knight, LICSW, joined the Social Services program in 2000 as a social worker and became the director in 2002. In that capacity, Ms. Knight supervises and coordinates staff, volunteers, and student counselors and case workers; coordinates client intakes, applications for public assistance, and case management; establishes and maintains relationships with community partner agencies; and conducts counseling and case management with individual clients. Ms. Knight serves on the board of the DC Behavioral Health Association Board and received her M.S.W. with a concentration in Clinical Practice from the University of Pennsylvania.
Associate Director for Strategic Initiatives
Center for Mental Health Innovations, School of Public Health, City University of New York
Virna Little, Psy. D, LCSW-r, MBA, CCM, SAP
Virna Little, Psy. D, LCSW-r, MBA, CCM, SAP, is a nationally and internationally known specialist in the integration of health and behavioral health services, the development of viable behavioral health services in community settings and strategies to implement effective depression identification and treatment programs in health settings. Dr. Little has worked as part of the evidenced based depression care model, Project IMPACT, as part of the international consulting team since 2004. Dr. Little has worked with many primary care associations around the country including Ohio, New York, New Jersey and Alaska and internationally in Singapore. Dr. Little has been instrumental in promoting the use of electronic health technology in behavioral health settings, particularly in the utilization of physician portals to involve community organizations in patient care and coordination. Dr. Little has extensive experience providing behavioral health services in healthcare settings for safety net populations as well as developing and operating community programs. Dr. Little has actively worked to promote the use of evidence based practices in community health and behavioral health settings and is versed in the current evidenced based behavioral health tools and practices in community settings.
Professor of Medicine and Director of the Women’s HIV Program
The University of California, San Francisco
Edward Machtinger, MD
Edward Machtinger, MD, primary academic interest is the relationship between HIV and violence against women. The current focus of Dr. Machtinger’s research, advocacy and clinical innovation has been towards developing, implemented and evaluating a scalable model of trauma-informed primary care. Dr. Machtinger has convened, with Positive Women’s Network-USA, a national strategy group to develop the trauma-informed primary care model to guide national implementation and evaluation efforts. In partnership with the Robert Wood Johnson Foundation, he now leads a national demonstration site of trauma informed primary care at UCSF. His team is conducting the first implementation study of this powerful model, with the goal of publishing an evidence-based scalable blueprint any clinic can use to implement trauma-informed primary care. Dr. Machtinger is a respected thought leader and advocate nationally for education and policy pertaining to trauma informed care and women’s health. He presently serves on the NIH prioritization committee for women and girls with HIV across all institutes and led the effort to include addressing trauma as a priority for 2016.
Medical Director, Northern California Family Violence Prevention
Kaiser Permanente
Brigid McCaw, MD, MPH, MS, FACP
Brigid McCaw, MD, MPH, MS, FACP, is the Medical Director of the Family Violence Prevention Program for Kaiser Permanente, Northern California Region. She oversees the implementation of a comprehensive, coordinated approach for improving screening, identification, and services for family violence. She guides the national Kaiser Permanente efforts in this area, impacting 10 million members. Dr. McCaw’s leadership, research, and publications focus on developing a health systems response to family violence, adverse childhood experiences (ACE’s), and trauma informed care. She received her MD from the University of California, San Francisco, and her MS and MPH from the University of California, Berkeley. She is a Fellow of the American College of Physicians, Past President of the National Health Collaborative on Violence and Abuse, and a member of the Forum on Global Violence Prevention, National Academies of Science, Engineering, and Medicine.
Assistant Clinical Professor
University of New England
Arabella Perez, LCSW
Arabella Perez, LCSW, was a system of care director from 2005-2015, leading three Substance Abuse Mental Health Services Administration (SAMHSA) grants. During these years, she managed to find time to start a non-profit, THRIVE, a technical assistance center for trauma-informed care. She is a certified cultural competency trainer and has presented extensively, both locally and nationally, on Trauma Systems Change, Cultural and Linguistic Competency issues, and Youth-Adult Partnerships. She is a founding member of several community collaboratives and has provided ethnic self-help organizations with logic modeling and nonprofit development support. She provides technical assistance and consultation to states and communities on the development of trauma informed systems and provides system of care consultation through federal site monitoring and one on one peer mentoring for the American Institutes for Research (AIR) Technical Assistance Partnership in Washington D.C. and the University of Maryland’s Technical Assistance Network.
Founding Partner/CEO
Change Matrix, LLC
Suganya Sockalingam, Ph.D
Suganya Sockalingam, Ph. D, has extensive experience addressing issues related to cultural and linguistic competence, health inequities and disparities, cross-cultural communication, conflict management and leadership solutions. She has worked with several state health agencies and has consulted with a variety of public health and mental health organizations to address systems change at the national, state, and local level. She has co-developed several curricula to guide systems transformation. Suganya assists agencies develop their leadership capacity to address workforce diversity and inclusivity, and to institutionalize the provision of culturally and linguistically competent services.
Founder
The House of Sharon
Sharon Wise, MHS
Sharon Wise, MHS, was diagnosed with a mental illness at a young age and hospitalized for the first time at the age of nine. Following over thirty institutions and hospitalizations, many of them by force, including being secluded and restrained, she has learned to use the trauma she suffered as learning and teaching tools. She is now an advocate for others who’ve had similar experiences. Sharon goes around the country teaching and training peers, government officials and the community about trauma-informed care, sharing her experience, strength and hope. She also is an independent filmmaker and documentarian. Sharon is a Certified Wellness Recovery Action Plan Facilitator located in Washington, D.C. with over fifteen years in the mental health consumer movement and operated the first 100% consumer-run organization in the Washington DC metropolitan area. She was successful in winning one of the first major contracts from the D.C. Department of Mental Health in consumer-run history. Sharon is an artist-in residence for the St. Elizabeth’s Hospital and performs at major conferences that support mental health recovery for consumers all over the world. She recently completed an Alternatives to Seclusion and Restraint documentary entitled, “Leaving the Door Open” and a cable show “The Great Hip-Hop Debate.”
2015-16 Trauma-informed Primary Care Learning Community
Prior to launching the Trauma-Informed Primary Care: Fostering Resilience and Recovery initiative, the National Council implemented the Trauma-informed Primary Care Initiative, from June 2015 to March 2016. This initiative included a learning community of 14 primary care organizations.
Read more about the initiative in the Oct. 25, 2017 issue of Mental Health Weekly.
In the span of just a few months, a number of trauma-related incidents have occurred in this country — wildfires, hurricanes and mass shootings among them. Additionally, an estimated 60 percent of adults in the United States have experienced an adverse life event at least once in their lives, according to research pointed out by the National Council for Mental Wellbeing.
