Community Care Publications

Community Care Publication Abstracts

2023 2022 | 2021 | 2020

Implementing a trauma-informed system of care: An analysis of learning collaborative outcomes

Trauma exposure can negatively impact health. Trauma-informed care implementation within health care systems may improve the identification and treatment of trauma-related illness on a population health level. The current study investigated outcomes of a multiagency implementation of trauma-informed care for Medicaid-enrolled adults and children in 23 rural Pennsylvania (United States) counties. Changes in trauma symptom screening, the number of staff trained in trauma-informed care, and clinician confidence in using trauma-informed care were assessed in participating treatment agencies (N = 22) over the course of a 15-month trauma-informed care learning collaborative (TLC). Data included monthly agency-reported screening, training, and confidence outcomes, which were analyzed using repeated-measures analyses of variance. Trauma symptom screening rates improved from 41.1% (SD = 43.0%) to 93.3% (SD = 12.0), p < .001; ηp2 = .30. The average number of cumulative staff members trained in trauma-informed care per agency increased from 24.43 (SD = 42.22) to 140.00 (SD = 150.87), p < .001, Kendall’s W = .09. The percentage of agencies that reported high confidence in delivering trauma-informed care increased from 15.8% (SD = 15.5%) to 80.5% (SD = 17.7%), p < .001; ηp2 = .45. Pairwise comparisons revealed both screening rates and confidence ratings reached significant improvement in Month 11 of the TLC, suggesting that these processes may be related. A total of 2,935 staff members were trained during the TLC. The immediate impact of system-level implementation of trauma-informed care was evident for agency processes and staff confidence, with support provided by multiple stakeholders.

Lessons learned implementing a trauma-informed system of care in rural communities

Background: The negative impact of trauma on health is devastating. Providers, especially those in rural areas, require support to implement trauma-informed care (TIC) on a systems level.

Objectives: This paper describes a partnership of county behavioral health administrators, service providers, and a behavioral health managed care organization and steps taken over a 5-year initiative to enhance capacity and quality of community services to meet the needs of individuals in a rural setting to receive TIC.

Methods: The initiative included trainings in evidence-based and best practices in TIC, improved trauma screening, development of TIC centers, and development of community-based networks for ongoing support. Lessons learned were summarized through discussions between partnership members.

Lessons Learned: Shared ownership, opportunity to build networks, and continuous assessment of organizational strengths resulted in successful implementation and sustained practice. Challenges included turnover among staff and organizations.

Conclusions: Building a TIC network across a rural healthcare system can be successful with long-term support and investment from multiple stakeholders.

Implementing trauma‑informed care through a Learning Collaborative: A theory‑driven analysis of sustainability

This study investigated the sustainability of a multi-agency 15-month Learning Collaborative (LC) for implementing trauma-informed care in 23 rural Pennsylvania counties. Provider agencies (N = 22) were assessed three years following completion of the LC. Sustained trauma-informed practices were assessed through criteria indicating organizational achievement as a trauma-informed care center. A theoretical model of clinical training was applied to determine the extent to which training and skill-related factors were associated with sustained trauma-informed care. Three years after the LC, trauma symptom screening rates and staff training improvements were sustained, while staff confidence in delivering trauma-informed care worsened across time. Sustained trauma-informed care was associated with implementation milestone completion and third-party ratings of quality improvement skills during the LC. Building capacity for organizational change through training and skill development during active phases of implementation is important for sustained trauma informed care in behavioral health service.

Organizational change strategies to support high-quality behavioral health care for LGBTQ individuals

There is growing recognition of the need to provide high quality behavioral health care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) individuals. Research suggests that the LGBTQ community experiences high levels of psychological distress, psychological trauma, and other mental health symptoms as a result of minority stress. Despite these findings, the LGBTQ community continues to face barriers when seeking affirming behavioral health treatment. Using an established framework, this commentary highlights one behavioral health managed care organization’s (BHMCO) work towards organizational change in the hopes of creating an affirming and inclusive environment for individuals influenced by the BHMCO (e.g., staff, members, behavioral health providers). In this commentary, we: (1) discuss the importance and role of insurers in promoting strategies to increase and deliver high quality care for LBGTQ individuals, (2) outline the steps our organization took to implement changes, (3) highlight the lessons learned throughout this process, and (4) provide recommendations for future efforts.

Human services and behavioral health integration: A model for whole person Medicaid managed care

A comprehensive, whole-person approach to individuals’ health care can be achieved by aligning, integrating, and coordinating health services with other human services. HealthChoices, Pennsylvania’s managed Medicaid program, delegates responsibility for Medicaid-funded behavioral health service management to individual counties or multicounty collaboratives. County administrators’ programmatic and fiscal oversight of Medicaid-funded services allows them to create synergies between behavioral health and other human service delivery systems and to set priorities on the basis of local needs. This model supports access to community-based care, integration of general medical and behavioral health services, and programs that address social determinants of health.