Trauma Informed Care: Proposal for statewide implementation

1. Trauma Informed Care:Proposal for statewide implementation John R. Kasich, Governor Tracy J. Plouck, Director John L. Martin, DODD Director

2. Ohio’s Trauma Informed (TIC) Care 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.

3. What we know . . . • Exposure to trauma is widespread and is a major contributor to illness and high healthcare costs • The majority of individuals with mental illness and substance use disorders have experienced trauma • Trauma experiences are almost universal among individuals in foster care systems • 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

4. What we know . . . • Many mental health and addiction treatment agencies, inpatient facilities, county boards of developmental disabilities, child-serving agencies and other community partners, 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 • Ohio has embarked on the development of a universal • trauma screening tool for youth in the juvenile justice • system

5. Ohio’s Trauma Informed (TIC) Care Initiative • Summer of 2013, interagency workgroup 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” project funded by the Governor’s Office and additional block grant dollars have been earmarked for this purpose • Outside consultants from National Center for Trauma Informed Care (NTIC) and Case Western Reserve University’s Center for Innovative Practices have also consulted formally • Additional conversations and advice from Ohio Hospital Association, Ohio Association of County Behavioral Health Authorities, Ohio Council, Public Childrens Services Association of Ohio, Ohio Association of Child Caring Agenciesand many others

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

7. Ohio’s Interdepartmental TeamState department leadership and identified experts that assist with coordinating, facilitating and communicating about TIC; responsible for the Internal Departmental Implementation of TIC and the Statewide TIC Propagation and Sustainability Plan • Dr. Mark Hurst, OhioMHAS • Kathy Coate-Ortiz, OhioMHAS • Jody Lynch, OhioMHas • Angie Bergefurd, OhioMHAS • Trudy Sharp, OhioMHAS • Dr. Lisa Gordish, Twin Valley RPH • Dr. Kraig Knudsen, OhioMHAS • Pam Berry, DODD • Sarah Lawson, DODD • Patrick Kanary, CIP, Case Western Reserve University • Joyce Bednarek Starr, OhioMHAS • Tammy Collins, OhioMHAS • Jackie Doodley, OhioMHAS • Afet Klinic, OhioMHAS • Latonya White, OhioMHAS • Rob Robbins, DODD

8. Ohio’s Trauma Informed (TIC) Care Initiative: Goals • Recognize trauma as a public health concern by increasing awareness of trauma’s impact on the emotional and physical well-being of Ohioans. • Utilize a public health model to support environmental strategies for prevention, identification, intervention and support. • Provide appropriate training, skill development, and support for persons who have contact with individuals who have experienced trauma. • Promote regional learning communities, networks and training events, to assist in developing inpatient and outpatient systems of care that are knowledgeable and informed about trauma practices, through local and national consultation. • Interface with other Health and Human Services Cabinet Agencies regarding TIC in Ohio.

9. Ohio’s Trauma Informed (TIC) Care Initiative: Goals • Promote TIC principles that are: • Based on public health model • Culturally and intellectually sensitive • Developmentally appropriate • Support of cross-system collaboration regarding TIC and based upon sound data a fiscal strategies. • Enhance community based capacity to deliver trauma-informed evidence-based practices. • Support communities in developing comprehensive workforce investment strategies. • Support TIC policies that are driven by outcomes.

10. Priorities . . . • Statewide needs assessment • Identify needs of TIC of the behavioral health system. • Identify organization readiness of systems and workers on the principles of trauma-informed care and trauma-informed practices. • TIC Summit • Thematic statewide training for clinical and administrative leaders; regional breakouts • Develop regional groups to advance TIC within regions to encompass all 88 counties.

11. Priorities . . . • Regional TIC workgroups/Trauma activities • Identify strengths, champions and areas of excellence as resources in TIC implementation. • Identify gaps, weaknesses and barriers for implementation of TIC. • Develop a repository of expertise, knowledge and shared resources which will assist in dissemination of information and support the implementation of TIC throughout the state, assuring that TIC opportunities are available everywhere. • Train individuals to serve as local/regional/state faculty to assist in the dissemination of TIC. • Develop TIC implementation strategies specific to specialty groups such as: DD, children, older adults and AoD. • Facilitate cultural change within organizations by addressing gaps and barriers and taking effective steps based on the science of implementation.

12. Priorities . . . • Regional TIC workgroups/Trauma activities (continued) • Identify/develop a self-assessment measure/instrument to evaluate TI practice including: a] continuing education, training and staff competence, b] policies and procedures; c] response tactics/mechanisms, d] availability of resources for staff, employees and consumers; and, e] management and commitment to implementation. • Complete NCTIC training in OhioMHAS Regional Psychiatric Hospitals and outpatient facilities (CSN). • Complete NCTIC in Developmental Centers. • Complete TIC training for appropriate DODD and OhioMHAS Central Office staff.

13. Priorities . . . • Communications plan • Develop and implement a statewide public information, education and awareness campaign on trauma and its association to health and behavioral health. • Develop a web-based clearinghouse to streamline the availability of resource materials, training and technical assistance on trauma and trauma-informed practices.

14. Next Steps . . . • Systems wide survey/assessment - • Identify needs of the system • Identify current resources and resources needed • Technical Assistance request to National Center for Trauma Informed Care (NCTIC) - Update: Submitted January 2, 2014 • Advisory Committee – Update: January 30, 2014 • Planning for TI Summit—Spring 2014 thematic broad-based training for clinical and administrative leaders • Regional breakouts to advance TIC within regions • Establish and support regional workgroups • Sustainability • Communications Plan

15. Contact information . . . Kim Kehl Trauma Informed Care Project Coordinator Office of the Medical Director Ohio Dept. of Mental Health & Addiction Services 30 East Broad Street, Floor 36 Columbus, Ohio 43215 (614) 644-8442 kim.kehl@mha.ohio.gov Visit the OhioMHAS website at: http://mha.ohio.gov/Default.aspx?tabid=104