Developmental Disabilities Mental Health and Addiction Services. John R. Kasich, Governor Tracy J. Plouck, Director John L.

Transcription

1 Developmental Disabilities Mental Health and Addiction Services John R. Kasich, Governor Tracy J. Plouck, Director John L. Martin, Director 1

2 What is Trauma? Individual trauma results from an event, series of events, or a set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual s functioning and physical, social, emotional, or spiritual wellbeing (SAMHSA) 2

3 Prevalence of Trauma Exposure to trauma is widespread Trauma can occur at any age Trauma can affect individuals from all walks of life 3

4 What is Trauma? The individual s experience of these events or circumstances helps to determine whether it is a traumatic event. The long-lasting adverse effects on an individual are the result of the individual s experience of the event or circumstance. 4

5 Prevalence of Trauma Exposure to trauma is especially common among individuals with mental illness, substance use disorders and developmental disabilities 5

6 Trauma Affects Over one out of three females with mental health disorder; and About one out of five males with mental health disorder in Ohio Source: Client Self-Reported Experiences of Trauma, SFY13, Ohio Behavioral Health Module

7 Trauma Affects Ohioans with Developmental Disabilities 2 out of every 10 individuals with Developmental Disabilities experience trauma each year in Ohio Ohio Department of Developmental Disabilities 2013 MUI Data

8 Individuals with Developmental Disabilities and Trauma Increased risk for abuse as compared to the general population (Gil, 1970; Mahoney & Camilo, 1998; Ryan, 1994) Over four times as likely to be victims of crime as the nondisabled population (Sobsey, 1996) Two - ten times more likely to be sexually abused than those without disabilities (Westat Ind., 1993) Often experience rejection and loneliness (Pitonyak) 8

9 Trauma Affects Ohioans with Developmental Disabilities According to the World Health Organization: Children with disabilities are 4 times more likely to be exposed to trauma than children without disabilities Adults with disabilities are 1 ½ times more likely to be exposed to trauma than adults without disabilities Jones, et. al., 2013 (Children) Hughes, et. al., (Adults)

10 Interaction between DD and Trauma Bi-directional effects Abuse and neglect have profound influences on brain development. The more prolonged the abuse or neglect, the more likely it is that permanent brain damage will occur. Not only are people with developmental disabilities more likely to be exposed to trauma, but exposure to trauma makes developmental delays more likely. -Joan Gillece, Ph.D. 10

11 DD, MI and trauma Cognitive and processing delays that interfere with understanding of what is happening in abusive situations Feelings of isolation and withdrawal due to their differences, which may make them more vulnerable to manipulation because of their increased responsiveness to attention and affection. -Joan Gillece, Ph.D. 11

12 Cost of Trauma Trauma is a major driver of medical illness, including cardiac disease and cancer Addressing trauma can positively impact the physical, behavioral, social and economic health of Ohio and Ohioans 12

13 What is Trauma Informed? A program, organization or system that is traumainformed: Realizes the widespread prevalence and impact of trauma Understands potential paths for healing Recognizes the signs and symptoms of trauma and how trauma affects all people in the organization, including: Patients Staff Others involved with the system Responds by fully integrating knowledge about trauma into practices, policies, procedures, and environment Not the same as treatment for PTSD 13

14 Outcomes with TIC Improved quality of care and impact of care Improved safety for patients and staff Decreased utilization of seclusion and restraint Fewer no-shows Improved patient engagement Improved patient satisfaction Improved staff satisfaction Decreased burnout and staff turnover 14

15 Ohio s Trauma Informed-Care (TIC) Initiative Many mental health, addiction treatment and DD serving providers have already provided training and consultation in trauma informed practice Many clinicians are trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization training (EMDR); Dialectical Behavioral Therapy (DBT) and other treatment modalities 15

16 Ohio s Trauma-Informed Care (TIC) Initiative There continues to be a need for training for staff/facilities and community system partners The ability of all communities and providers to organize trauma trainings internally is often beyond their finances, time and capabilities, yet the need of persons served has not changed The initiative will seek to provide additional resources for agencies and programs in Ohio who may need this support 16

17 Ohio s Trauma-Informed Care (TIC) Initiative Since Summer of 2013, an interagency workgroup comprised of leaders from Ohio MHAS and Ohio Department of Developmental Disabilities (DODD) has been meeting to formulate plans to expand TIC across the state A portion of the Strong Families, Safe Communities funds from the Governor s Office have been earmarked for this purpose The National Center for Trauma-Informed Care (NCTIC)/SAMHSA and Ohio Center for Innovative Practices (CIP) have also consulted formally 17

18 Ohio s Trauma-Informed Care (TIC) Initiative Vision: To advance Trauma-Informed Care in Ohio Mission: To expand opportunities for Ohioans to receive trauma-informed interventions by enhancing efforts for practitioners, facilities, and agencies to become competent in trauma- informed practices 18

19 Ohio s TIC Initiative Trauma-Informed Care The TIC model assesses a service delivery system and makes modifications based on the basic understanding of how trauma affects the life of an individual (those served and those providing the service) TIC means that every part of an organization or program understands the impact of trauma on the individuals they serve and promotes cultural and organization change in responding to the consumers/clients served This is not a service; rather it is an approach to interpersonal interactions that takes into account the potential scars of a person s past experience The TIC Initiative is not about endorsing particular trauma-informed practices, treatment models, screening or assessment instruments or processes and takes an across-the lifespan approach 19

20 Trauma-Informed Care (TIC) Promotes Cultural Change What s wrong with you? What has happened to you? 20

21 TIC Planning Framework Advisory Committee OhioMHAS and DODD Leadership TIC Project Coordinator Interdepartmental Team (OhioMHAS and DODD) Technical Support Organization(s) Internal Departmental Implementation (Hospitals/community support network, developmental centers, therapeutic communities) Statewide Trauma Informed (TIC) Propagation Plan For MH, DD and AoD TIC Training/Summit for Clinical and Administrative Leaders Regional TIC Collaboratives Community Agencies CO Partners, Specialty Groups (Children, older adults, DD) Collaboration with other departments and agencies Ongoing communications/training for Regions, Boards, Agencies and Providers

22 Interdepartmental Leadership Team Dr. Mark Hurst, OhioMHAS, Co-Chair Kathy Coate-Ortiz, OhioMHAS Jody Lynch, OhioMHAS Angie Bergefurd, OhioMHAS Trudy Sharp, OhioMHAS Dr. Lisa Gordish, Twin Valley RPH Dr. Kraig Knudsen, OhioMHAS Latonya White, OhioMHAS Pam Berry, DODD, Co-Chair Sarah Lawson, DODD Patrick Kanary, CIP, Case Western Reserve University Joyce Starr, OhioMHAS Dr. Tammy Collins, OhioMHAS Jackie Doodley, OhioMHAS Dr. Afet Kilinc, OhioMHAS Rob Robbins, DODD Kim Kehl, OhioMHAS, Project Coordinator 22

24 Framework for Ohio s TIC Initiative Progress so far: June 2013: Initial training of ODMH/MHAS Central Office and Regional Psychiatric Hospital (RPH) leadership in TIC On site training of clinical and support staff at all RPHs, with participation of DODD Developmental Centers, as available Regular consultation with NCTIC on next steps Plans for subsequent visits and consultation from NCTIC Launch of TIC research study in collaboration with OSU College of Social Work 24

25 Framework for Ohio s TIC Initiative Progress: Statewide November 2013: TIC Project Coordinator started (Kim Kehl) Advisory Group formed (Co-chairs: Dr. Julie Gentile and Dr. Patrick Palmieri) Endorsed Fundamentals of TIC approach Serve as ambassadors of TIC Submitted application to NCTIC for technical support in December 2013 Train-the-trainers model System infrastructure and infiltration Updated TIC Website: 25

26 TIC Advisory Committee: Survivors of Trauma DODD Ohio Hospital Association Medicaid PCSAO OACBHA Ohio Council OACCA ODH Hamilton County Board of DD Wright State University :MI/DD CCOE Depart of Aging Human Trafficking Commission CIP ODJFS ODYS Ohio Women s Network Board of Regents Center for the Treatment and Study of Traumatic Stress Ohio Provider Resources Association (DD) 26

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29 Framework for Ohio s TIC Initiative TIC Summit June 26, 2014 Thematic fundamental training for clinical and administrative leaders AM session: Didactic by leaders from NCTIC PM session: Regional breakouts to advance TIC locally Identify strengths, weaknesses, needs, champions Identify initial plan to proceed, with support from departments for communication, facilitation, etc. Sustainability Regional Collaboratives Progressively transmit TIC and increase expertise within regions Topical workgroups (prevention, DD, child, older adult, etc.) Department(s) continue to support, facilitate, communicate 29

30 Athens Region Lawrence Meigs Gallia Washington Monroe Scioto Adams Brown Hamilton Butler Warren Clinton Highland Jackson Ross Vinton Athens Preble Greene Fayette Madison Clark Miami Darke Champaign Franklin Pickaway Fairfield Hocking Mercer Auglaize Shelby Logan Union Hardin Allen Van Wert Paulding Putnam Hancock Wyandot Marion Delaware Morrow Seneca Sandusky Ottawa Lucas Fulton Williams Henry Wood Defiance Erie Huron Lorain Wayne Medina Cuyahoga Summit Knox Holmes Licking Coshocton Muskingum Tuscarawas Guernsey Perry Morgan Noble Belmont Harrison Carroll Columbiana Stark Portage Mahoning Trumbull Ashtabula Geauga Lake Crawford Twin Valley Region Lawrence Gallia Scioto Adams Hamilton Pike Jackson Vinton Athens Madison Miami Darke Fairfield Hocking Mercer Auglaize Shelby Union Hardin Allen Putnam Hancock Wyandot Marion Delaware Seneca Sandusky Ottawa Lucas Wood Erie Huron Holmes Guernsey Perry Morgan Noble Belmont Harrison Clermont Jefferson Richland Crawford Ashland Montgomery Lower Northeast Central Southeast Upper Northeast Southwest Northwest TIC Regional Collaboratives

31 Framework for Ohio s TIC Initiative Sustainability: Based on the passion of those involved in the initiative Encourage use and repurposing of existing resources Technical support: NCTIC and deliverables of CCOEs Encourage regions and state to develop internal expertise and learning communities to transmit, maintain and advance our ability to respond to those with trauma needs 31

32 TIC: Why is this important? 32

33 TIC: Why is this important? What Happened to You? 33

34 Ohio Department of Developmental Disabilities National Center for Trauma-Informed Care OhioMHAS Office of Research Public Children s Services Association of Ohio Ohio Human Trafficking Commission Ohio Department of Health Ohio Domestic Violence Network SAMHSA Ohio MHAS Trauma Website: 34

35 Dr. Mark Hurst, M.D., FAPA Medical Director, OhioMHAS 30 East Broad Street, 36 th Floor, Columbus, OH (614) Pamela Berry Senior Policy Advisor, Ohio Department of Developmental Disabilities 30 East Broad Street, 12 th Floor, Columbus, OH (614) Kim Kehl TIC Project Coordinator, Office of the Medical Director OhioMHAS 30 East Broad Street, 36 th Floor, Columbus., OH (614)

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