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How trauma-informed care helps Medicaid members

Traumatic events can have long-lasting effects on overall health. But trauma can also make people less likely to trust the health care system. That’s why Aetna is partnering with the National Council for Behavioral Health to help people who have experienced trauma get the treatment and support they need.


Elizabeth Guroff is the director of trauma informed services at the National Council for Behavioral Health. She says there’s an urgent need for training around trauma in the health care system. The family therapist has been acutely aware of the issue since early in her career, when she worked at a residential mental health facility for children and adolescents.


“When the children didn’t do what we thought was in their best interests, we’d get frustrated,” she says. “This would start a downward spiral: The patient would also get frustrated and act out more. We ended up having to use more extreme tactics to control patient behavior that we considered destructive or dangerous.”


Children were quickly labeled as defiant, disrespectful or manipulative when they acted out or refused treatment. This labeling then affected how the staff treated those kids. 


Many kids there had a history of abuse or neglect. Guroff recognized that some things she and her colleagues were doing to help their patients, like using restraints to keep them from hurting themselves or others, were actually retraumatizing them.


“I started to think, How would I respond to this situation if I had experienced trauma? I realized some of my own behaviors would mirror what we were calling ‘manipulative’ or ‘disrespectful,’” Guroff says. “When you take a step back, recognize how past trauma can influence someone’s current behavior, and then acknowledge that the patient is doing the best they can, it makes you a better clinician.”


Guroff draws heavily on that experience in her current role with the NCBH. Recognizing the effects of past trauma, avoiding simplistic labels and accepting that a patient is doing their best are all important parts of trauma-informed care (TIC), a treatment framework designed to promote a culture of safety, empowerment and healing. TIC is gaining wider recognition as the American medical establishment begins to understand the prevalence of trauma and its impact on health outcomes.



Why trauma-informed care matters to Medicaid members


The Medicaid population is more likely to have a history of trauma than other Americans. That’s because members tend to come from environments where trauma is common, like foster care, poverty and incarceration.


To combat the effects of trauma, Aetna is implementing a trauma-informed approach across its operations. The company is educating providers about the benefits of TIC and incentivizing them to receive training on the subject. Aetna is also training its own employees at every level to understand the foundations of a trauma-informed approach.


The goal is to make sure Medicaid members feel safe and respected when they receive care.



The benefits of trauma-informed care


Research shows that people who have experienced trauma are more likely to experience serious health effects years, even decades, after the traumatizing event. For example, serious childhood trauma more than doubles your likelihood of suffering from heart disease as an adult and makes you 40% more likely to experience a stroke later in life.


While a number of factors contribute to this increased risk, one is that patients who have experienced trauma are less likely to visit a physician, take their medication as prescribed or follow the advice of their health care providers. They’re also less likely to exercise.


Like the children Guroff worked with, the failure of traumatized patients to act in their own best interest can frustrate physicians and result in labeling. Patients who don’t follow their physician’s advice can be classified as “non-compliant” and sometimes ignored when they reach out for care.


Guroff remembers an adult patient with a history of trauma who sought care from two health care organizations, one whose staff had gone through trauma-informed training and the other who had not. The patient had occasional mental health emergencies and often sought care late at night or on weekends. The organization with no special training took hours or even days to respond. The trauma-informed organization responded promptly, because its providers felt their approach would make the patient more likely to take their advice and engage in behaviors beneficial to her health.


Data backs up that claim. Eight of ten agencies whose staff underwent trauma-informed training reported their patients maintained high treatment adherence. One clinic reported that 75% of patients flagged as at-risk for diabetes were no longer high-risk because they were able to stick to their recommended diet and medication — an incredible feat considering that adherence to oral antidiabetic medications can be as low as 36%.


“When patients aren’t continually retraumatized by their care and in reactive mode, they can focus on the things clinicians want them to focus on,” says Guroff. “And those things are what they need to get better.”


What trauma-informed care is — and what it isn’t


Trauma-informed doesn’t work miracles: Patients don’t suddenly begin behaving better after health care providers attend training. “It’s a lens, a perspective, a culture,” Guroff says. “In trauma-informed care we respond to everyone in a universal way that doesn’t retraumatize people.”


In practice that means everyone from doctors and nurses to social workers and care coordinators need to be involved in TIC and work together in implementing a trauma-informed approach. For example, a patient who suffers from chronic health problems following a physical assault may be triggered every time they are asked to give their health history, by forcing them to relive elements of their attack. This could lead the patient to skip doctors’ visits.


However, in a trauma-informed organization, a social worker could obtain the relevant details about the violent incident in a way that doesn’t trigger the patient and then share it with a care coordinator. The care coordinator then provides the information to the patient’s physicians. These physicians no longer have to ask the patient for details directly, and the patient can attend appointments without fear of clinicians unwittingly retraumatizing them.


Trauma-informed care is an ethos


The amount of coordination needed for TIC means that it works most effectively on a systemic level. That’s one reason why Aetna is focused on becoming a trauma-informed organization rather than just training a few key employees.


By making TIC an organization-wide goal, Aetna is in a position to improve the health of its members while also encouraging health care providers to take up a trauma-informed approach. This is particularly important, because being trauma-informed can fundamentally transform the way health care providers deliver services to the Medicaid population. TIC holds the potential to make every part of the insurance provider-clinician-patient relationship more efficient and effective. As Guroff puts it, “A trauma-informed approach means we are creating a healing environment so we can all be our best selves.

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