Integrating Primary and Behavioral Health Services for Trafficking Survivors

Integrating Primary and Behavioral Health Services for Trafficking Survivors


>>WELL, GOOD MORNING, EVERYONE AGAIN. THANK YOU SO MUCH FOR BEING HERE TODAY. IT IS REALLY MY PRIVILEGE TO MODERATE THIS
FIRST PANEL OF OUR SIX OF OUR PANELS TODAY. THIS IS THE INTEGRATING PRIMARY AND BEHAVIORAL
HEALTH SERVICES FOR TRAFFICKING SURVIVORS, FIRST PANEL. AGAIN, I’M SABRINA MATOFF STEPP, I’M THE DIRECTOR
OF THE OFFICE OF WOMEN’S HEALTH AT THE HEALTH RESOURCES AND SERVICES ADMINISTRATION. THE HRSA OFFICE OF WOMEN’S HEALTH LEADS HEALTH
RELATED ACTIVITY ACROSS OUR AGENCY. WE SUPPORT PROGRAMS THAT SUPPORT UNDERSERVED
WOMEN AND GIRLS WHO ARE GEOGRAPHICALLY ISOLATED, MEDICALLY VULNERABLE OR ECONOMICALLY VULNERABLE. ONE OF THE THINGS THAT’S REALLY IMPORTANT
TO KNOW ABOUT OUR OFFICE, WE INTEGRATE, WE COLLABORATE, AND WE INTEGRATE, WE COLLABORATE
AND WE INNOVATE. I THINK WE REALLY HAVE A GREAT PLACE AS PART
OF BEING HERE TODAY. SO, AGAIN, I REALLY AM PRIVILEGED TO BE HERE
TO WELCOME WHAT I THINK IS JUST AN INCREDIBLE GROUP OF EXPERTS, JOINING ME TODAY. I REALLY SEE THEM AS KIND OF OUR CNN HEROES. I FEEL LIKE I’M UP HERE LIKE ANDERSON COOPER
AND THEY ARE OUR HEROES. SO, THINK OF YOURSELVES LIKE THAT. HERE WITH US TODAY IS DR. KIMBERLY CHANG, SITE DIRECTOR AND PHYSICIAN
AT ASIAN HEALTH SERVICES IN OAKLAND. SHE WILL BE HELPING US UNDERSTAND MORE ABOUT
INTEGRATION TO PRIMARY AND BEHAVIORAL HEALTH AND HOW TO MAKE THIS HAPPEN. WE ALSO ARE JOINED BY DR. ANNIE LEWIS O’CONNOR, DIRECTOR OF COORDINATED
APPROACH TO RESILIENCE AND EMPOWERMENT AND BRIGHAM AND WOMEN’S HOSPITAL IN BOSTON AND
WILL HELP US EXPLORE AND UNDERSTAND TRAUMA AND ITS IMPACT ON PERSPECTIVE OF A CLIENT
OR PATIENT. WE ALSO HAVE MISS HOLLY AUSTIN GIBBS, SHE’S
ONE OF OUR VERY IMPORTANT TRAFFICKING SURVIVORS AND SHE’S ALSO THE PROGRAM DIRECTOR OF HUMAN
TRAFFICKING RESPONSE AT DIGNITY HEALTH IN SACRAMENTO, CALIFORNIA. AND WILL TALK ABOUT PRINCIPLES OF TRAUMA INFORMED
APPROACHES AND WHAT THIS LOOKS LIKE IN ACTION. FINALLY WE’RE ALSO JOINED BY DR. RENEE ORNELAS, A PEDIATRIC SPECIALIST, AND
SHE’S AT THE FAMILY ADVOCACY CENTER AT THE TSHOOTSOO MEDICAL CENTER IN FORT DEFIANCE,
ARIZONA. DR. ORNELAS WILL EXPLORE HOW TO DO INTEGRATED
CARE WORK IN A CULTURALLY COMPETENT WAY IN RURAL COMMUNITIES. TAKE A LOOK AT THEIR BIOS. THEY WILL EACH TALK FOR TEN MINUTES AND WE’LL
HAVE TIME FOR GREAT QUESTIONS AND ANSWERS. ON THIS SLIDE YOU SEE OUR LEARNING OBJECTIVES
FOR THIS FIRST SESSION. I WON’T READ THEM WORD FOR WORD. YOU CAN SEE THEM ON THE SLIDE BUT WE’RE GOING
TO DELVE INTO A NUMBER OF REALLY IMPORTANT PRINCIPLES AND ISSUES FOR THIS FIRST PANEL. AGAIN, TALKING ABOUT INTEGRATED AND TRAUMA
INFORMED CARE, EXISTING MODELS AND FRAMEWORK, ORGANIZATIONAL CONDITIONS NECESSARY FOR SUCCESS,
AND EXPLORING HEALTHENED CULTURALLY SPECIFIC, ALL VERY IMPORTANT. I HAVE A FEW MINUTES NOW REALLY TO SET SOME
FRAMING FOR THIS PANEL. WE’RE GOING TO TALK ABOUT THE IMPORTANCE OF
INTEGRATION OF PRIMARILY AND BEHAVIORAL HEALTH SERVICES IN RESPONDING TO THE HEALTH NEEDS
OF SURVIVORS OF HUMAN TRAFFICKING, WE’RE ALSO GOING TO TOUCH ON CARE COORDINATION AND LOOK
AT CULTURAL COMPETENCY. YOU HEARD THE PREVIOUS SPEAKER SPEAK TO THIS. WE’LL GIVE YOU CONCRETE PRACTICAL INNOVATIVE
APPROACHES. YOU’RE HERE TO TAKE ACTION AS WE’VE HEARD
FROM OUR ASSISTANT SECRETARY JOHNSON. SO, MOVING ON, THIS SYMPOSIUM COMMITTEE ASKED
ME TO SET SOME GROUNDING BACKGROUND AND PRINCIPLES, AND SO WHAT I’D LIKE TO SHARE WITH YOU TO
START HERE IS NO MATTER THE APPROACH REALLY FOR ANY PRACTITIONER WORKING IN THIS SPACE
WORKING WITH HUMAN TRAFFICKING SURVIVORS, THIS WORK COMES BACK TO THE SURVIVOR, THE
SURVIVOR AT THE CENTER OF ALL THAT WE DO. SO, WHAT DOES THAT REALLY LOOK LIKE? DO SURVIVORS REALLY FEEL HEARD BY THEIR PROVIDERS
AND SUPPORTED BY HEALTHCARE SERVICE TEAM? DO PROVIDERS THEMSELVES FEEL THEY CAN SUPPORT
THE SURVIVORS’ CULL CONSTELLATION OF CONCERNS THEY BRING? CAN THEY ENGAGE AND WORK WITH OTHER NETWORKS
OF REFERRAL? AND CAN WE CONNECT SURVIVORS TO ALL KINDS
OF SOCIAL DETERMINANTS OF HEALTH NEEDS SUCH AS HOUSING, FOOD, CHILD CARE, TRANSPORTATION,
EMPLOYMENT, LEGAL, OTHER NEEDS? SO WE’RE GOING TO LOOK AT ALL OF THAT IN TODAY’S
SESSION. SO A LITTLE ABOUT MY AGENCY, WHY IS HEALTH
RESOURCES AND SERVICES ADMINISTRATION HERE, WE’RE PART OF THE DEPARTMENT OF HEALTH AND
HUMAN SERVICES, HHS. OUR ADMINISTRATOR WELCOMES YOU ALL TO THIS
VERY IMPORTANT MEETING. AND REALLY HRSA IS THE AGENCY THAT REALLY
FOCUSES ON UNDERSERVED POPULATIONS. TENS OF MILLIONS OF AMERICANS RECEIVE THEIR
HEALTH CARE THROUGH AFFORDABLE HEALTH CARE AND OTHER SERVICE PROGRAMS. HRSA HAS OVER 90 PROGRAMS THAT SERVE THE UNDERSERVED. WE HAVE OVER 3000 GRANTEES ACROSS THE AGENCY. OUR PROGRAMS REALLY SERVE RURAL POPULATIONS,
ADOLESCENTS, PREGNANT WOMEN, LGBTQ, PEOPLE WITH HIV AND AIDS AND INDIVIDUALS LIVING WITH
SUBSTANCE USE DISORDERS. WE KNOW HOW IMPORTANT PRIMARY CARE IS AS AN
INITIAL POINT OF INTERVENTION FOR SURVIVORS. AND WITHIN ALL OF OUR SYSTEMS OF CARE AT HRSA
WE REALLY UNDERSTAND AND TRY TO MERGE AND INTEGRATE INTO PRIMARY CARE, LEVERAGE TEAM
BASE APPROACH AND PATIENT CENTERED MEDICAL HOMES. PART OF BEHAVIORAL HEALTH INTEGRATION IS PATHWAYS
FOR THE CONTINUUM OF TREATMENT SERVICES UNIQUE TO THEIR OWN NEEDS. SO, LET’S START WITH A COMMON DEFINITION WHEN
WE’RE TALKING ABOUT INTEGRATION. INTEGRATION IS MORE THAN PROVIDING MENTAL
HEALTH AND SUBSTANCE USE SERVICES. IT’S REALLY ABOUT BUILDING AND SUSTAINING
INTEGRATED CARE ACROSS ALL FACETS OF AN ORGANIZATION, THAT REFLECTS THE VALUES OF THAT ORGANIZATION,
COLLABORATIVE CARE AND UNDERSTANDING SO THAT WE’RE REALLY MAKING A DIFFERENCE ON CLINICAL
OUTCOMES. THIS DEFINITION COMES FROM THE SAMHSA HRSA
CENTER FOR INTEGRATIVE SERVICES OR SOLUTIONS. IT’S IMPORTANT THAT WE UNDERSTAND THAT SIMILAR
TO OTHER CLINICAL OUTCOMES LIKE HYPERTENSION OR DIABETES, THESE KINDS OF BEHAVIORAL HEALTH
CONDITIONS CAN REALLY BE SILENT KILLERS, THAT PATIENTS THAT MAY PRESENT WITH ALL KINDS OF
PROBLEMS BUT NOT NECESSARILY A CLINICAL PROBLEM ARE REALLY TRYING TO TELL US THAT THERE IS
OTHER ISSUES GOING ON AND THAT THESE ARE REALLY IMPORTANT MEDIATING FACTORS WE NEED TO PAY
ATTENTION TO BECAUSE WITHOUT PAYING ATTENTION TO THOSE MEDIATING FACTORS, WE MAY NOT REALLY
MAKE ANY DIFFERENCE ON THE HEALTH OUTCOMES THEMSELVES. AND THAT’S REALLY AN IMPORTANT POINT FOR US
TO THINK ABOUT THAT THERE ARE HEALTH OUTCOMES DIRECTLY BUT THERE ARE ALL THESE MEDIATING
FACTORS. AND I THINK IN SOME CASES HUMAN TRAFFICKING
IS ONE OF THOSE MEDIATING FACTORS. SO OUR PANEL MEMBERS HERE TODAY ARE GOING
TO TALK ABOUT THIS. THEY ARE GOING TO TALK ABOUT TRAUMA INFORMED
CARE APPROACHES TO REALLY IMPROVING HEALTH OUTCOMES. AS YOU ALL KNOW, TRAUMA INFORMED CARE REALIZES
THE WIDESPREAD IMPACT OF TRAUMA AND UNDERSTANDS POTENTIAL PATHS FOR RECOVERY, RECOGNIZES SIGNS
AND SYMPTOMS OF TRAUMA IN CLIENTS, FAMILY, STAFF AND OTHERS INVOLVED WITH THE SYSTEM. TRAUMA INFORMED CARE FULLY INTEGRATES KNOWLEDGE
INTO POLICY, PROCEDURES AND PRACTICES. AND WE REALLY SEEK TO AVOID RETRAUMATIZATION. THAT’S REALLY WHAT WE’RE TRYING TO DO, REALLY
AT A SYSTEM LEVEL. I THINK THAT’S ANOTHER ASPECT OF WHY WE’RE
HERE TODAY TO THINK ABOUT SYSTEMS, INDIVIDUALS, COMMUNITIES, BUSINESSES, THE WHOLE SOCIAL
ECOLOGICAL MODEL. WE KNOW TRAUMA EXISTS ON A CONTINUUM. THERE ARE COMPLEX NEEDS WHEN IT COMES TO HELPING
SURVIVORS WORK THEIR WAY THROUGH THE SYSTEM SO BY EMPLOYING THESE TRAUMA INFORMED APPROACHES
AND INTEGRATION YOUR ORGANIZATION, OUR ORGANIZATIONS WORKING TOGETHER CAN BE BETTER POSITIONED
TO HELP SURVIVORS WITH HEALING, WITH RESILIENCY, AND A NEW TERM THAT I LEARNED IN THE LAST
COUPLE OF WEEKS, SOMETHING CALLED POST TRAUMATIC GROWTH. THAT’S A NOVEL CONCEPT, SOMETHING THAT WE’RE
GOING TO STRIVE FOR TOGETHER. SO YOU’LL HEAR, AGAIN, FROM OUR PANEL ABOUT
ALL HANDS ON DECK APPROACHES, I’D LIKE TO SHARE A COUPLE THINGS WE’VE DONE AT HRSA THAT
IS REALLY TAKEN THIS KIND OF IDEA OF ALL HAND ON DECK, AT THE HEALTH RESOURCES AND SERVICES
ADMINISTRATION WE HAVE DEVELOPED A HRSA STRATEGY TO ADDRESS INTIMATE PARTNER VIOLENCE. AS WE KNOW, THERE’S OFTENTIMES INTEGRATION
AND OVERLAP WITH IPV AND HUMAN TRAFFICKING. AND JANE IS IN THE AUDIENCE WITH ME FROM THE
TEAM, OUR LEAD FOR STRATEGIC INITIATIVES AND A BIG THANKS TO JANE FOR HER HELP WITH ALL
OF THIS WORK. BECAUSE WE KNOW THAT TRAUMA, AGAIN, IS PART
OF A LOT OF THE PROGRAMS THAT WE WORK ON, WE LAUNCHED THIS INITIATIVE IN 2017, AND WE’RE
WORKING ACROSS ALL OF HRSA’S PROGRAMS, ALL THE BUREAUS AND OFFICES TO ADDRESS VIOLENCE
PREVENTION, OVER THE NEXT THREE YEARS. ONE OTHER INITIATIVE THAT WE’RE WORKING ON
IN AT HRSA IS PROJECT CATALYST, WE’RE DOING THIS WITH OUR COLLEAGUES AT THE ADMINISTRATION
OF CHILDREN AND FAMILIES WITH THEIR GRANTEES, FUTURES WITHOUT VIOLENCE, AND HRSA’S BUREAU
OF PRIMARY HEALTH CARE, A STATE LEVEL INITIATIVE FOCUSING ON IMPLEMENTING PRACTICE AND POLICIES,
HEALTH CENTER, PROVIDERS AND SOCIAL SERVICE ORGANIZATIONS TO ADDRESS IPV AND HUMAN TRAFFICKING,
SO PLEASE REACH OUT TO ME OR JANE OR TO OUR COLLEAGUES AT ACF OR FUTURES WITHOUT VIOLENCE
IF YOU’D LIKE TO LEARN MORE ABOUT THOSE PROJECTS. SO THAT IS JUST THE BEGINNING OF WHAT I THINK
WE’RE GOING TO BE LOOKING AT TODAY. I CERTAINLY KNOW THAT I NEED TO LEARN AS MUCH
AS ANYONE HERE ABOUT THESE ISSUES MORE SO WE CAN DO THE GREAT WORK THAT WE NEED TO DO
AT HRSA. I’M GOING TO TURN THE MICROPHONE OVER NOW
TO SOMEONE WHO REALLY IS A PIONEER WHEN IT COMES TO TRAUMA INFORMED CARE, CULTURALLY
COMPETENT CARE, DR. KIMBERLY CHANG FROM THE ASIAN HEALTH SERVICES
CLINIC IN OAKLAND, CALIFORNIA, AND SHE’S GOING TO GET US STARTED ON THIS VERY RICH DISCUSSION. SO THANK YOU. [APPLAUSE]>>DON’T START THE TIMER YET. NO, JUST KIDDING. GOOD MORNING, EVERYONE. YOU CAN DO BETTER THAN THAT. POSTPRANDIAL THANKSGIVING MUST HAVE LASTED
FOR A LONG TIME. GOOD MORNING. THANK YOU FIRST OFF TO ASSISTANT SECRETARY
JOHNSON FROM ADMINISTRATION FOR CHILDREN AND FAMILIES, AND PARTICULARLY TO DIRECTOR CHON
FOR ALL YOUR LEADERSHIP IN ORGANIZING THIS TODAY. ALSO, TO THE FEDERAL STAFF WHO HELPED TO ORGANIZE
AND PUT THIS TOGETHER, THANK YOU SO MUCH. THIS IS VERY ESSENTIAL AND WE APPRECIATE IT
FROM THE GROUND LEVEL. THANK YOU, DR. MATOFF STEPP, FOR THE INTRODUCTION. AND LAYING THE GROUND WORK. MY PRESENTATION IS IN THREE PARTS. FIRST I’M GOING TO START BY SHARING WHAT THE
INTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES FOR TRAFFICKING SURVIVORS
REALLY MEANS AND WHAT IT REALLY LOOKS LIKE. SECOND I’LL GIVE A BRIEF HISTORY OF INTEGRATION
AND WHERE OUR CURRENT EFFORTS ARE IN THE HEALTH CARE DELIVERY SYSTEM. FINALLY I’LL SHARE WHAT MY HEALTH CENTER,
ASIAN HEALTH SERVICES IS DOING AROUND INTEGRATION AND A LITTLE ABOUT FEDERALLY QUALIFIED HEALTH
CENTERS FQHCS, AND THEIR IMPACT FOR REACH. I’M SETTING UP WHAT WE CAN SEE AS INFRASTRUCTURE
BUILDING FOR THE INTEGRATION OF SERVICES AND PRIMARY CARE AND BEHAVIORAL HEALTH FOR TRAFFICKING
SURVIVORS IN THE FUTURE. SO, REALLY WHAT IS INTEGRATION AND WHAT DOES
IT TAKE TO GET THERE? TODAY I’M REPRESENTING THE VOICE OF COLLEAGUES
NATIONALLY SHARING QUOTES FROM AN EXPERT BASE CONVENING OF NATIONAL ASSOCIATION OF COMMUNITY
HEALTH CENTERS THIS YEAR. INTEGRATED SYSTEMS APPROACH TAKES A FUNDAMENTAL
REDESIGN TO JUSTICE, LEGAL, MEDICAL, HEALTH, FOOD, HOUSING AND TRANSPORTATION. IT’S A WHOLE REDO WHERE SERVICES ARE COORDINATED
WITHIN AN INTEGRATED SYSTEM INCLUDING CONTINUUM OF CARE, AVAILABLE 24/7. IT’S WHERE PATIENTS ENTER THE SYSTEM, BASED
ON WHAT THEY NEED AT THAT POINT IN TIME, WITHIN THEIR LIFE CONTEXT. YOU GOT IT, RIGHT? THAT’S INTEGRATION. REALLY WHAT IS IT? HERE IT IS. INTEGRATION IS REALLY A PROXY WORD FOR QUALITY
AND VALUE. INTEGRATION MEANS ADDING A SCOPE OF PRACTICE
TO A HEALTH SYSTEM, WHETHER IT’S PRIMARY CARE SIDE OR BEHAVIORAL HEALTH SIDE. THAT MEANS ADDING NEW WORK FLOWS, NEW PERSONNEL,
NEW SERVICES AND NEW SKILL SETS. WITH THE GOAL BEING BETTER QUALITY OF HEALTH
CARE, AND BETTER VALUE OF HEALTH CARE, FOR THE PATIENTS AND THE PAYERS. SO NOTICE HOW I SAY HEALTH CARE AND NOT MEDICAL
CARE. IT’S AN INTEGRATED SYSTEMS APPROACH WITH OTHER
SECTORS AND OUTSIDE PARTNERS ADDED TO CARE WE’RE PROVIDING. IT’S NOT JUST ABOUT A WARM HANDOFF OR HAVING
A PSYCHIATRIST OR COUNSELOR IN THE SAME BUILDING AS A PRIMARY CARE DOCTOR. SO INTEGRATION IS CARE RESULTING FROM PRACTICE
TEAM OF PRIMARY CARE AND BEHAVIORAL HEALTH CLINICIANS WORKING TOGETHER WITH PATIENTS
AND FAMILIES USING SYSTEMATIC AND COST EFFECTIVE APPROACH TO PROVIDING PATIENT CENTERED CARE
FOR A DEFINED POPULATION, THAT MAY ADDRESS MENTAL HEALTH, SUBSTANCE ABUSE CONDITIONS,
HEALTH BEHAVIORS, INCLUDING CONTRIBUTION TO MEDICAL ILLNESSES, CHRONIC MEDICAL ILLNESS,
LIFE STRESSORS AND CRISES, STRESS RELATED PHYSICAL SYMPTOMS AND INEFFECTIVE PATTERNS
OF HEALTH CARE UTILIZATION. AS WELL AS ADDRESSING PATIENTS’ CONCRETE NEEDS
AND SERVICES THAT THEY NEED. SO THIS IS A ROAD MAP OF WHAT WE THINK INTEGRATION
SHOULD LOOK LIKE IN THE FUTURE, FOR HEALTH CARE. HISTORICALLY, WE THOUGHT ABOUT HEALTH CARE
IN A VERY LINEAR FASHION. FOR EXAMPLE, WE’LL SEE A PATIENT, IN THE OFFICE,
IN PRIMARY CARE. WE’LL SCREEN OR ASSESS THE PATIENT FOR EXPLOITATION
OR HUMAN TRAFFICKING OR VIOLENCE OR HIV OR HEART DISEASE OR WHATEVER ISSUE WE’RE ATTENDING
TO THAT DAY. WE’LL TREAT OR REFER THE PATIENT FOR ADDITIONAL
SERVICES OR SPECIALTY SERVICES. IT’S HISTORICALLY BEEN A VERY LINEAR PROCESS. HOWEVER IN THE REAL WORLD, PATIENTS DON’T
ALWAYS PRESENT THAT WAY, LINEARLY. IT’S NOT LINEAR CARE. IT’S CYCLICAL. AND PATIENTS ENTER AND LEAVE THE SYSTEM AT
DIFFERENT POINTS. IN AN INTEGRATED SYSTEM ACCESS TO CARE NEEDS
TO BE 24/7, THERE NEEDS TO BE TRIAGE SYSTEMS, PHONE SYSTEMS, POINT PERSON OR PEOPLE TO HELP
MANAGE ANXIETY, OR OTHER EMOTIONAL CRISES, OR CONCRETE NEEDS OF THE PATIENT HOUSING,
FOOD INSECURITY AND SUCH. FOR TRUE INTEGRATION WE HAVE TO THINK ABOUT
HOW WE MAY NEED TO REDO OUR SERVICES TO KEEP PEOPLE IN CARE. IT’S NOT JUST NINE TO FIVE OFFICE CARE OR
CARE WITHIN THE FOUR WALLS OF OUR CLINIC. SO PEOPLE WITH BEHAVIORAL HEALTH ISSUES COME
TO THE SYSTEMS OF CARE IN DIFFERENT PLACES. AND THERE SHOULD BE NO WRONG DOOR. THEY MATCH THROUGH A FOOD BANK, SHELTER, SCHOOLS,
BEHAVIORAL HEALTH OR MEDICAL CARE, FOR EXAMPLE. SO FUNDAMENTALLY WE NEED TO UNDERSTAND IT’S
NOT LINEAR. AND MORE IMPORTANTLY, IT’S ALSO NOT FAILURE. IT’S NOT FAILURE WHEN PATIENTS ARE IN THE
CYCLICAL STAGE. FOR EXAMPLE, IN REGARDS TO TRAFFICKING, I’VE
HAD PATIENTS AT ASIAN HEALTH SERVICES WHO DO COME IN LINEAR PRESENTATION, COME TO CLINIC,
WE’LL ASK ABOUT EXPLOIT OR VIOLENCE, SOMETIMES WE HAVE DISCLOSURE, SOMETIMES WE DON’T.
THE POINT IS TO GET THE CARE THEY NEED. WE’VE HAD PATIENTS WHO HAVE BEEN IN AND OUT
OF EXPLOITATION AND TRAFFICKING SITUATIONS, BUT THEN GO BACK INTO IT. DO WE COUNT THAT AS A FAILURE? NO. WE COUNT THAT AS PART OF THEIR CARE AND CONTINUUM
OF CARE. WE’VE HAD PATIENTS WHO HAVE COME THROUGH ENGAGEMENT
WITH OTHER SECTORS, SO LAW ENFORCEMENT, OR OTHER SOCIAL SERVICES. FOR EXAMPLE, WE HAD A PATIENT WHO WAS SEX
TRAFFICKED IN ANOTHER COUNTY, BUT SHE RESIDED IN OUR COUNTY. SO HER LEGAL CASE IS BEING DEALT WITH AND
SOCIAL SERVICES IN THE COUNTY SHE WAS SEX TRAFFICKED IN BUT SHE NEEDED TO ACCESS WHERE
SHE LIVED IN OUR COUNTY. WE DID SOME CARE COORDINATION AND GOT HER
HEALTH CARE SERVICES WITH US IN THE SPECIALTY MENTAL HEALTH SERVICES AT ASIAN HEALTH SERVICES
BECAUSE SHE WAS EXHIBITING SOME PARANOIA AND PSYCHOSIS. THERE ARE PATIENTS THAT CYCLE IN AND OUT OF
BEING TRAFFICKED, THE CYCLING AND CYCLICAL NATURE, THE CONTINUUM, DOESN’T REPRESENT FAILURE. WE NEED TO INTEGRATE SYSTEMS OF CARE, THERE’S
BEEN A LEGACY OF SEPARATE AND PARALLEL SYSTEMS. INTEGRATED BEHAVIORAL HEALTH LEADS TO BETTER
MATCH OF CLINICAL SERVICES TO THE REALITIES THAT PATIENTS AND CLINICIANS FACE DAILY. SO, YOU KNOW, IT’S NOT WE’RE NOT JUST A PHYSICAL
BODY OR A MIND OR EMOTIONAL CREATURE. WE’RE INTEGRATED, JUST AS WE’RE HOLISTIC CREATURES
AS HUMAN BEINGS, SO SHOULD OUR CARE BE. IF WE’RE I’M GOING TO LEAVE THIS POINT HERE. WE SHOULD HAVE ANOTHER BOX ADDED TO THIS. WE SHOULD TALK ABOUT INTEGRATION OF ORAL HEALTH
CARE. SOMEONE SAID YES, THANK YOU. WE SHOULD TALK ABOUT ORAL HEALTH CARE. I LIKE IT WHEN YOU RESPOND BACK. ORAL HEALTH CARE IS BEING INTEGRATED INTO
PRIMARY CARE, ESPECIALLY IN FQHCs RIGHT NOW. WE NOW FROM MY COLLEAGUE’S RESEARCH STUDY,
IN THE STUDY OF SURVIVORS 26.5% OF TRAFFICKED SURVIVORS HADN’T SEEN A DENTIST. HERE IS AN EXAMPLE THAT ASIAN HEALTH SERVICES,
OUR DENTAL CLINICIAN ARE INCORPORATING DEPRESSION SCREENING WITH ON SITE SOCIAL WORKERS TO ADDRESS
ANY POSITIVE SCREENS. THAT’S JUST ABOUT DEPRESSION BUT THAT COULD
BE AN ENTREE INTO POSSIBLE HISTORY OF BEING TRAFFICKED OR CURRENT TRAFFICKING SITUATIONS. SO THAT’S ANOTHER ROUTE FOR INTEGRATION. SO WHY SHOULD WE INTEGRATE CARE? THIS IS THE SEMINAL STUDY FROM INSTITUTE OF
MEDICINE IN 2006, REPORT IMPROVING THE QUALITY OF HEALTH CARE FOR MENTAL AND SUBSTANCE USE
CONDITIONS. I’M ALMOST OUT OF TIME. THIS IS FOUNDATION IN ESTABLISHING PRINCIPLES. WE NEED TO INTEGRATE. PRIMARY CARE IS DE FACTO MENTAL HEALTH SYSTEM
FOR PEOPLE RECEIVING BEHAVIORAL HEALTH CARE, THE MAJORITY IN THE PRIMARY CARE SETTING. THESE ARE THREE TYPES OF THREE TYPES OF INTEGRATION,
CONSULTATIVE MODEL WHERE YOU RECEIVE CARE IN TWO DIFFERENT SETTINGS. WE SEVERE TO PSYCHIATRY OR COUNSELING AND
THEY RECEIVE IT IN A SEPARATE SETTING. CO LOCATED. OR NEXT TO EACH OTHER IN THE SAME BUILDING. AND COLLABORATIVE WHERE WE’RE TRYING TO GO,
WHERE WE’RE WORKING TOGETHER AS A TEAM. THESE ARE THE CURRENT EXAMPLES. WE HAVE THEM ALL AT ASIAN HEALTH SERVICES. AND WE’RE MOVING TOWARDS THAT ROAD MAP THAT
I SHOWED YOU EARLIER. COMPONENTS FOR INTEGRATION ARE VERY IMPORTANT. WE NEED PARTNERSHIPS, NOT JUST PARTNERSHIPS,
ME AS A PRIMARY CARE DOCTOR WORKING WITH A COUNSELOR OR SOCIAL WORKER. WE NEED PARTNERSHIPS AT LEADERSHIP LEVEL. YOU HEARD FROM DR. MATOFF STEPP ABOUT THE PROJECT CATALYST AND
FUTURE ABOUT VIOLENCE PROGRAM, AT LEADERSHIP LEVEL, STATE DEPARTMENTS OF HEALTH, STATE
DOMESTIC VIOLENCE COALITIONS AND PRIMARY CARE ASSOCIATIONS OF COMMUNITY HEALTH CENTERS ON
A LEADERSHIP LEVEL. REFERRAL SYSTEMS, CAPACITY BUILDING OF WORKFORCE,
CASE MANAGEMENT, VERY IMPORTANT. CASE MANAGEMENT FOR EXTERNAL SERVICES AND
NEEDS. CARE COORDINATION WITHIN OUR SYSTEM. AND THINKING ABOUT THE COMORBIDITIES THAT
PATIENTS HAVE. YOU HEARD FROM DIRECTOR CHON’S REMARKS EARLIER
THAT PATIENTS CAME IN WITH A LOT OF PHYSICAL ILLNESS AND DISEASE. WE NEED TO ADDRESS THAT AS WELL. WE NEED TO DO UNIVERSAL ASSESSMENTS AND SCREENINGS
FOR A WHOLE HOST OF ISSUES AND MAKE OUR CARE PATIENT CENTRIC, CULTURALLY AND LINGUISTICALLY
RESPONSIBLE. A LOT OF THIS IS NOT REIMBURSABLE BUT THIS
IS WHAT WE NEED. IN THE INTEGRATED SYSTEMS APPROACH WE HAVE
TO HAVE THESE PARTNERS AND SYSTEMS OF CARE. WE CAN’T PUT IT ON THE BACKS OF OUR PATIENTS
TO FIGURE THIS OUT. WE NEED TO BE DOING IT FOR THEM. FINALLY, NATIONAL IMPACT OF FQHCs, THIS IS
YEAR OVER YEAR CARE OF BEHAVIORAL HEALTH SERVICES WITHIN THE FEDERALLY QUALITIED HEALTH CENTERS
FROM 2016 TO 2017. INCREASE OF BEHAVIORAL HEALTH SERVICES BY
16% TO 9.9 MILLION VISITS, 2 MILLION PATIENTS UNIQUE INDIVIDUAL PATIENTS RECEIVED CARE FOR
BEHAVIORAL HEALTH, OUT OF A TOTAL PATIENT POPULATION OF 27 MILLION NATIONWIDE. FINALLY, YOU’LL HEAR ON ANOTHER PANEL I THINK
LATER TODAY ABOUT SUBSTANCE MAYBE TOMORROW, SUBSTANCE USE DISORDERS. SAME THING, A GROWTH IN THE CARE FOR SUBSTANCE
USE DISORDERS AND FEDERALLY QUALIFIED HEALTH CENTERS YEAR OVER YEAR, EXPANDING AND GROWING
AS WE GO FORWARD. SO A LOT OF REACH, A LOT OF OPPORTUNITY IN
THE FQHCs, THE INFRASTRUCTURE IS THERE, AND WE NEED TO FIND WAYS TO SCALE THIS AND INCORPORATE
THIS TO REACH MORE PATIENTS WHO ARE BEING TRAFFICKED. THANK YOU SO MUCH. [APPLAUSE]>>GOOD MORNING. I HOPE EVERYBODY HAS WARMED UP BY NOW. I WANTED TO STAND HERE BECAUSE I COULDN’T
SEE THE PROMPT FROM OVER THERE BUT I CAN’T SEE IT FROM HERE EITHER. [LAUGHTER]
OKAY. GOOD MORNING, EVERYBODY. I’M SO EXCITED THAT I HAVE SOME FINANCIAL
DISCLOSURES AND I’M NOT GOING TO READ THEM ALL OFF BUT I REALLY WANT TO RECOGNIZE THE
SENIOR LEADERSHIP AT BRIGHAM AND WOMEN’S HOSPITAL FOR REALLY GIVING ME THE OPPORTUNITY SIX YEARS
AGO TO CREATE A CLINIC THAT WOULD IN FACT BE INNOVATIVE AND CREATIVE IN THINKING ABOUT
HOW WE TAKE CARE OF ALL PEOPLE WHO ARE IMPACTED BY INTENTIONAL VIOLENCE. SO I’M PROUD TO SAY THAT THE CARE CLINIC WHICH
IS OVERSEEN BY PATIENT ADVISORS DOES SEE PATIENTS WITH DOMESTIC AND SEXUAL VIOLENCE, HUMAN TRAFFICKING
AND OTHER FORMS OF COMMUNITY VIOLENCE. SO, I ALSO WANT TO SHARE THAT I DO WORK AT
BRIGHAM AND WOMEN’S HOSPITAL IN BOSTON, 750 BED HOSPITAL. WE HAVE 150 OUTPATIENT PRACTICES, OVER 1400
PHYSICIANS, 3500 NURSES, 650 SOCIAL WORKERS. WE ARE BIG.
AND I HAVE BEEN TASKED ALONG WITH OTHER COLLEAGUES OF MINE TO THINK ABOUT HOW WE BECOME A TRAUMA
INFORMED CARE INSTITUTION. I WANT TO ACKNOWLEDGE DR. CAROL WARSHAW FOR MENTORSHIP OF ME TO LEARN
ABOUT TRAUMA INFORMED AND BE A LEADER IN THAT REALM. I’M GOING TO GROUND US ALL HERE BY SAYING
WHAT I ALWAYS SAY WHEN I GIVE THIS TALK, WE ASK PATIENTS TO EMBRACE SYSTEMS, PARTICULARLY
HEALTHCARE SYSTEM WHEN WE KNOW INHERENTLY WE HAVE PROBLEMS. IS THAT FAIR ENOUGH? I SHOULD SEE MORE HEADS NODDING. RIGHT? SO I’VE SOMETIMES TAKEN MYSELF AND WALKED
MYSELF THROUGH THE SYSTEM TO SEE WHAT IT WOULD FEEL LIKE. WE CALL THEM TRACERS, RIGHT, IN THE HEALTH
CARE SYSTEM. I WOULD ENCOURAGE MANY OF US TO THINK ABOUT
DOING TRACERS BECAUSE IT REALLY OPENS OUR EYES TO THE JOURNEY THAT AT LEAST IN MY LINE
OF WORK AS A HEALTHCARE PROVIDER THAT MY PATIENTS EXPERIENCE. SO, WHAT IS TRAUMA? AND I CAN SAY THAT WHEN WE FIRST STARTED OUR
TRAUMA INFORMED STEERING COMMITTEE SIX YEARS AGO THIS SLIDE LOOKED DIFFERENT. WE’VE EVOLVED IN OUR THINKING, PARTNERED WITH
MANY OF YOU HERE, WE HAVE WORKED WITH SAMHSA AND OTHER FOLKS THAT THINK ALIKE. AND IN THAT REALM, WE HAVE DEFINED TRAUMA
AS FAR AS WHAT YOU SEE IN FRONT OF YOU. I THINK IN THE HEALTHCARE SYSTEM WHAT I’VE
LEARNED IS MY COLLEAGUES REALLY KIND OF GET WHAT INDIVIDUAL AND INTERPERSONAL TRAUMA IS,
BUT WHAT’S LACKING IS UNDERSTANDING OF CULTURAL, HISTORICAL OPPRESSIONS. I’M PROUD TO SAY FIRST TIME IN MY CAREER,
I’M THREE DECADES IN, WE’RE TALKING ABOUT THINGS IN HEALTH CARE SUCH AS RACISM, STRUCTURAL
OPPRESSION, UNCONSCIOUS BIAS, AND PROUD TO BE AN INSTITUTION PUTTING POLICIES IN PLACE
AND HOLDING PEOPLE ACCOUNTABLE. WE DEFINED RACISM AS TRAUMATIC. WE THINK RACISM IS TRAUMA. AND
[APPLAUSE] THANK YOU.
AND WE DEFINE IT AS A PREJUDICE OR DISCRIMINATION OR ANTAGONISM AGAINST SOMEONE OF A DIFFERENT
RACE BASED ON THE BELIEF OUR OWN RACE IS SUPERIOR. IT TOOK US A WHILE TO LOOK AT ALL THE DIFFERENT
DEFINITIONS OF RACISM AND FELT THAT ONE RESONATED WITH US. THE OTHER THING THAT I THINK IS THAT WE’VE
LEARNED ON OUR JOURNEY IS THE INTERSECTION OF ALL OF THIS. AND SO I REALLY I KNOW WE’RE HERE TO CREATE
A RESEARCH AGENDA AND DISCUSSION, I SAY LET’S DO IT ALL AND NOT SILO THE SERVICES. I THINK OF THE SAME NURSES, WHETHER A GREAT
INFRASTRUCTURE AND GREAT WORK NURSES HAVE DONE BUT IT WOULD BE GREAT IF THEY DID ALL
KINDS OF TRAUMA. A GREAT INFRASTRUCTURE WITH KNOWLEDGE. WE’RE SEEING INTERSECTION OF ALL THESE DIFFERENT
TYPES OF VIOLENCE. I WANT TO TAKE YOU ON THE JOURNEY WITH THE
SIX GUIDING PRINCIPLES. I ASSUME EVERYBODY IS FAMILIAR WITH THIS,
CORRECT? WHAT I WANT TO DO WITH YOU IS LOOK AT THESE
SIX GUIDING PRINCIPLES AND I WANT TO CONSIDER IT THROUGH THE EYES OF A VICTIM OR A SURVIVOR. SO I’M GOING TO ASK YOU TO GO ON A JOURNEY
WITH ME. WHEN A PATIENT COMES TO US, LET’S SAY IT’S
A PATIENT WHO HAS BEEN TRAFFICKED, ALSO HAS A HIGH ACE SCORE, WHO MIGHT BE SUBJECTED TO
RACISM AND MICRO AGGRESSION AND THAT PATIENT IS COMING TO BE SEEN BY US, BROUGHT BY LAW
ENFORCEMENT. THE PATIENT MIGHT BE THINKING WHAT ARE THEY
GOING ASK ME? DO I HAVE TO TELL THEM EVERYTHING? WILL I REACT TO THE QUESTIONS AND WILL THEY
THINK I’M CRAZY IF I GET TRIGGERED? I STILL HAVE BODY MEMORIES. WILL THEY DO SOMETHING THAT HURTS? I HAVE A TERRIBLE TIME DEALING WITH PAIN. MY PAIN TOLERANCE IS AWFUL. WILL THEY HELP ME TO CONNECT WITH OTHERS? WILL THEY UNDERSTAND WHAT I BRING WITH ME
FROM MY CULTURE, MY HISTORICAL BACKGROUND? MY RACE? MY ETHNICITY? GOSH, I HOPE THEY DON’T ASK WHY DID YOU STAY,
WHY DO YOU KEEP GOING BACK AND DOING THIS. BOY, I’VE BEEN ASKED THAT BEFORE. I WONDER WHAT THEY ARE WRITING IN THE MEDICAL
RECORD. WILL IT BE THERE FOREVER OR I CAN TAKE IT
OUT? WHO IS GOING TO SEE TO THAT FOR ME? I HOPE I FEEL SAFE. I HOPE THAT I CAN SHARE. I HOPE THAT I’LL FEEL SUPPORTED. I HOPE I CAN FIND MY VOICE. I HOPE I CAN BE ACKNOWLEDGED FOR WHO I AM
AND WHERE I AM, REGARDLESS OF WHO MY RACE, MY CULTURE, MY GENDER, OR MY ETHNICITY. WHEN I FIRST STARTED LEARNING ABOUT THE SIX
GUIDING PRINCIPLES I WAS REALLY THINKING WITH THE TRIPLE AIM OF MY ORGANIZATION, PROVIDERS
AND THEIR PATIENT RELATIONSHIPS, AND PEER TO PEER. NOW I’M THINKING ABOUT IT THROUGH HOW DOES
THIS LOOK FOR THOSE THAT WE SERVE? AND I THINK THOSE PRINCIPLES STILL APPLY. SO ONE OF THE THINGS THAT I’VE BEEN TASKED
WITH AT THE HOSPITAL IS, ANNIE, WHAT IS THIS TRAUMA INFORMED CARE STUFF ABOUT, WHAT’S IT
GOING TO COST US, IS THERE A RETURN ON INVESTMENT IF WE USE IT? HOW DO YOU MEASURE IT? IS THERE MEASURABLE THINGS WE SHOULD BE LOOKING
AT? I’VE BEEN THINKING ABOUT THAT FOR THE LAST
FEW YEARS. I’M GOING TO SHOW YOU A LITTLE BIT OF PILOT
DATA THAT WE CAN SCALE IT UP WITH SOME BETTER FUNDING. I HAVE NOTICED IN MY CLINIC ENGAGEMENT WITH
PATIENTS THAT I’VE NOT SEEN BEFORE. I REALLY THINK IT’S BECAUSE OF THE USING THE
T.I.C. APPROACH. I KNOW IF I CAN GO BACK TO MY HOSPITAL AND
I CAN SHOW THEM I CAN DO THESE THINGS THAT I CAN DECREASE EMERGENCY DEPARTMENT UTILIZATION,
THAT I CAN DECREASE NO SHOW RATES BECAUSE NOW PEOPLE ARE READY TO ENGAGE. THAT THE LENGTH OF STAY FOR OUR PATIENTS THAT
ARE IN OUR UNDERRESOURCED OR LOW RESOURCED COMMUNITIES IS AT LEAST TWO DAYS LONGER. IF I CAN DECREASE THAT, IF I CAN LOOK AT HEALTH
OUTCOMES, SOME OF THE ONES THAT WE’RE LOOKING AT, IF WE CAN THINK ABOUT SOME INNOVATIVE
AND CREATIVE WAYS TO DO THIS WORK. LET ME SHARE A COUPLE THINGS WE LEARNED. WE’VE ALREADY HEARD THIS TODAY THAT DISCLOSURE
IS NOT THE GOAL, RIGHT? I HAVE TO SAY THAT THERE’S NOT A DAY THAT
GOES BY AT WORK THAT I DON’T GET A CALL FROM A PRACTITIONERS THAT SAYS I KNOW SHE’S BEING
TRAFFICKED BUT SHE WON’T TELL ME. ONE STUDY IS LOOKING AT TIERED SCREENING. I’VE BEEN PRACTICING AT THE BEDSIDE FOR A
LONG TIME AND I’VE BEEN TAUGHT TO GET THE DETAILS, UNDERSTAND THE FULL BREADTH OF WHAT
IT IS WE’RE TRYING TO UNDERSTAND, AND WHAT I’VE COME TO LEARN IS I DON’T NEED THAT ANYMORE. I NEED SOME BASIC INFORMATION. I NEED TO CAST A WIDE NET. TELL ME, HAS ANYTHING OCCURRED IN YOUR LIFE
THAT YOU FEEL HAS IMPACTED YOU? IF IT HAS, HOW HAS IT IMPACTED YOU? I START VERY GENERAL NOW. I STEPPED AWAY FROM SORT OF ARE YOU BEING
HIT, KICKED OR PUNCHED, IS SOMETHING PUSHING OR SHOVING YOU, STEPPED AWAY FROM THAT COMPLETELY
BECAUSE I THINK IN A TIERED SCREENING SYSTEM WE SHOULD ALL FIGURE OUT WHAT ARE YOU GOING
TO DO WITH THAT INFORMATION AND HOW MUCH OF THAT INFORMATION DO YOU ACTUALLY NEED? AND WHAT I’M FINDING IS LESS IS MORE. THAT’S WHAT IS ON MY DOOR TO MY OFFICE NOW. LESS IS MORE. SO I CHALLENGE US TO THINK ABOUT THIS. I KNOW WE’RE GOING TO DO A PILOT STUDY ON
THIS AT MY WORK. I THINK THE BROAD SCREENING GETS INFORMATION,
NICE WARM HANDOVER TO YOUR NEXT PERSON, LET THEM DO THE SAFETY AND RISK ASSESSMENT, OUR
ADVOCATES, SOCIAL WORKERS ARE GOOD AT THAT. SAVE THE DETAILS FOR GOING INTO THERAPY AND
WHOEVER IS GOING TO WORK WITH YOU ON THAT. BUT I DO THINK IN HEALTH CARE WE’RE ASKING
WAY TOO MANY QUESTIONS. THE OTHER THING WE’RE FOCUSING ON IN OUR TRAUMA
ASSESSMENT INQUIRY IS LOOKING AT STRENGTH. WHEN YOU COME TO MY CLINIC ONE OF THE FIRST
QUESTIONS WE ASK, TELL ME SOMETHING YOU’RE PROUD OF. TELL ME WHAT FEELS GOOD IN YOUR LIFE. AND MOST PEOPLE SAY, WELL, YOU GET THOSE PATIENTS
THAT CAN’T FIND ANYTHING, THAT’S NOT WHAT I’M EXPERIENCING. I’M FINDING THAT WITH A LITTLE GINGERLY LOVE,
KINDNESS AND EMPATHY THEY ARE WILLING TO SHARE LOTS OF THINGS AND WE’RE WORK FROM THOSE STRENGTHS. I WANT TO SHARE DATA. WE’VE BEEN DOING A LOT OF TRAINING. THIS SLIDE RECOMMENDS 768 PROVIDERS IN OUR
SYSTEM. PRE POST DESIGN EFFORTS, TRAINING ON TRAUMA
INFORMED CARE, THAT SLIDE I SHOWED YOU, WHAT IS TRAUMA. WE TALK ABOUT ALL THAT. TRAFFICKING AND RACISM AND UNCONSCIOUS BIAS. A COUPLE QUICK FINDINGS ON THIS. YOU CAN SEE THAT HOW KNOWLEDGEABLE ARE YOU
ABOUT TRAUMA INFORMED CARE WENT UP. WE FELT 30% IN THE ROOM RAISED THEIR HAND
AND SAID YEAH, I’M GOOD, I GET TRAUMA INFORMED CARE BUT YOU CAN SEE THE NUMBERS WENT UP AFTER. ONE INTERESTING THING BECAUSE OF LACK OF TIME
I’M HAPPY TO TALK WITH ANY OF YOU THROUGHOUT THE NEXT DAY AND A HALF, IS WHEN ASKED THE
QUESTION, THE VERY LAST QUESTION, TO THE RIGHT, HOW IMPORTANT DO YOU FEEL IT IS TO BE AWARE
OF WAYS THAT YOUR OWN LIFE EXPERIENCES NEGATIVELY IMPACT YOUR ABILITY TO DELIVER CARE, SO THIS
IS WHERE WE GET HEALTH CARE, PEOPLE’S OWN HISTORIES OF TRAUMA, AND VERY INTERESTINGLY
THOSE NUMBERS WERE QUITE LOW IN THE BEGINNING. THEY JUMPED UP SIGNIFICANTLY, YOU CAN SEE.
AND THEN LAST, WHAT MY INSTITUTION CARES ABOUT AND THOSE OF US IN A HEALTHCARE INSTITUTION
KNOW MONEY AND EFFICIENCY ARE AT THE TOP OF OUR AGENDA THESE DAYS. I WANTED TO TAKE A LOOK AT TEN CASES, THE
INTERVENTION HERE WAS MY CLINIC. THE TEN CASES, TEN CASES THAT CAME INTO BEING
REFERRED TO THE CLINIC BY PRESENTING TO THE EMERGENCY DEPARTMENT WITH SOME SORT OF INTERPERSONAL
TYPE OF VIOLENCE. AS YOU CAN SEE FROM THE BLUE IS MEDICAL MODEL
OF CARE. AND THEN THE GRAY IS THE TRAUMA INFORMED. IN THESE TEN CASES, THIS IS WHERE WE’LL SCALE
UP WITH OUR ACL MEDICAID POPULATION, EMERGENCY ROOM VISITS CAME DOWN SIGNIFICANTLY, THAT
OUR ENGAGEMENT WITH PRIMARY CARE WENT SKY HIGH BECAUSE WE USED TRAUMA INFORMED CARE
PRIMARY CARE PROVIDERS. AND SERVICES THAT CAN OFTEN HELP OUR PATIENTS
WITH PAIN SUCH AS P.T. AND O.T. AND THINGS OF THAT SORT ALSO WENT UP. PEOPLE ENGAGED AND OUR LENGTH OF STAY DID
COME DOWN. WE’LL BE SCALING THIS UP IN OUR ACL MEDICAID
PROJECT AND I’M EXCITED TO SEE WE MIGHT HAVE SOME RETURN ON THE DATA. SO, LASTLY, I THINK I HAVE 30 SECONDS HERE,
IN HEALTH CARE WE HAVE ACCESS TO A LOT OF DATA. I’VE BEEN LOOKING AT PRESS GANEY’S, HCAHPS
AND DATA, WHAT ARE TRAUMA SENSITIVE OR TRAUMA CENTRIC. WE HAVE DATA AND SHOULD WORK OFF DATA TO SEE
WHERE IT’S APPLICABLE. I HAVE BEEN BLESSED TO HAVE ENORMOUS INSTITUTIONAL
SUPPORT, AND I SAY I STAND BEFORE YOU, I STAND ON THE SHOULDERS OF AN AMAZING TEAM BACK AT
THE HOSPITAL THAT’S INTERDISCIPLINARY, LENSES ARE BROUGHT TO THE TOPIC. CHALLENGES WILL BE SHIFTING THE PARADIGM BUT
I’M SEEING A SHIFT HAPPEN. WE NEED THAT LONG TERM FUNDING TO SORT OF
MAKE SURE WE GET OUR METRICS RIGHT AND THEY CONTRIBUTE. AND THEN ONCE AGAIN SUSTAINABILITY. HOW ARE WE GOING TO MAKE THIS LAST ONCE WE
KNOW WE’VE GOT A GOOD PRACTICE, WE TEND TO REGRESS TO THE MEAN AND I’M REALLY PROACTIVELY
INTERESTED IN THINKING ABOUT SUSTAINABILITY AND TALKING TO MANY OF YOU THAT HAVE GOOD
PRACTICES. SO THANK YOU. [APPLAUSE]>>I’M HOLLY GIBBS, I’M THE DIRECTOR OF THE
DIGNITY HEALTH HUMAN TRAFFICKING RESPONSE PROGRAM. I’M EXCITED TO SHARE WITH YOU ABOUT ALL THAT
WE’VE DONE AT DIGNITY HEALTH. DIGNITY HEALTH IS ONE OF THE LARGEST HEALTHCARE
SYSTEMS IN THE NATION. AND WE LAUNCHED A PROGRAM IN 2014 CALLED HUMAN
TRAFFICKING RESPONSE PROGRAM WHERE WE INTENDED TO EDUCATE STAFF ABOUT HUMAN TRAFFICKING,
TRAUMA INFORMED CARE, IMPLEMENT POLICIES AND PROCEDURES TO IDENTIFY POTENTIAL VICTIMS AND
PROVIDE LONG TERM CARE AND SERVICES. I’M GOING TO JUMP AHEAD A COUPLE SLIDES TO
THE PEARR TOOL. WHEN I FIRST STARTED AT DIGNITY HEALTH, MY
GOAL WAS TO CREATE A POLICY OR PROCEDURE TO ADVISE STAFF ON HOW TO RESPOND IF A POTENTIAL
VICTIM COMES INTO THE HEALTHCARE FACILITY, OKAY? AND WHEN WE STARTED THIS PROCESS, WE WERE
THINKING THAT PATIENTS WOULD BE IN A PLACE WHERE THEY ARE ACTIVELY BEING VICTIMIZED,
AND READY TO ACCEPT HELP, BUT MAY NOT BE ABLE TO ASK FOR HELP FOR SOME REASON. MAYBE THERE’S A CONTROLLING COMPANION WITH
THEM. AND SO OUR FIRST VICTIM RESPONSE PROCEDURE
SORT OF LOOKED LIKE, OKAY, IF YOU IDENTIFY THE RED FLAGS AT TRIAGE, THEN THESE ARE ALL
THE STEPS THAT YOU’RE GOING TO TAKE AND YOU’RE GOING TO GET THEM IN A ROOM, ASK THEM SOME
QUESTIONS BY THEMSELVES, IN A ROOM BY THEMSELVES, ASK QUESTIONS AND CONNECT THEM WITH RESOURCES. WHAT WE LEARNED OVER THREE YEARS, WE’VE HAD
MANY, MANY CASES OF PATIENTS PRESENTING WITH SIGNS OF LABOR OR SEX TRAFFICKING, IN THE
FIRST YEAR ALONE WE HAD OVER 31 CASES. PATIENTS ARE PRESENTING ON A SPECTRUM, RIGHT? WE HAVE PATIENTS PRESENTING WHO ARE AT RISK
OF LABOR OR SEX TRAFFICKING VICTIMIZATION, PATIENTS WHO ARE PRESENTING IN A WAY WE SUSPECT
THEY MAY BE ACTIVELY BEING GROOMED BY A LABOR OR SEX TRAFFICKER, AND THEN WE HAD PATIENTS
PRESENTING WHO WE SUSPECTED TO BE VICTIMS BUT EITHER WERE OPEN TO QUESTIONS OR NOT OPEN
TO QUESTIONS. EITHER WERE READY FOR ASSISTANCE OR WEREN’T
READY FOR ASSISTANCE. AND THEN WE WERE SEEING SURVIVORS WHO WERE
DAYS, WEEKS, MONTHS, EVEN YEARS PAST THE EXPERIENCE. SO WITH THIS HUGE SPECTRUM, THIS SIMPLIFIED
ALGORITHM ON IDENTIFYING RED FLAGS AND TRIAGE, FOLLOWING THIS PROCESS, IT DIDN’T MAKE SENSE. SO, WE WERE LOOKING FOR A TRAUMA INFORMED
APPROACH TO OFFERING VICTIM ASSISTANCE TO A PATIENT. THIS IS WHAT WE CAME UP WITH. THE PEARR TOOL. WE PARTNERED WITH HEAL TRAFFICKING AND PACIFIC
SURVIVOR CENTER TO COME UP WITH THESE STEPS. SO THE PEARR TOOL IS BASED ON A UNIVERSAL
EDUCATION APPROACH WHICH IS ALIGNED WITH BOTH A PATIENT CENTERED APPROACH AND TRAUMA INFORMED
APPROACH. UNIVERSAL EDUCATION APPROACH MEANS YOU’RE
EDUCATING THE PATIENT ABOUT VARIOUS FORMS OF ABUSE, NEGLECT AND VIOLENCE IN THIS SITUATION,
HUMAN TRAFFICKING. AND THEN OFFERING ASSISTANCE. IF THAT’S WHAT SEEMS TO BE APPROPRIATE. STEPS ARE PROVIDE PRIVACY, EDUCATE THE PERSON
ABOUT HUMAN TRAFFICKING OR ANY FORM OF VIOLENCE, IF APPROPRIATE MOVE INTO ASKING ABOUT SAFETY
CONCERNS, ESPECIALLY IN A HOSPITAL SETTING AND THE PERSON IS PRESENTING WITH RED FLAGS. ASK ABOUT SAFETY CONCERNS AND OFFER TO CONNECT
THEM WITH COMMUNITY AGENCIES. THE LAST STEP IS TO RESPECT AND RESPOND, REGARDLESS
OF HOW THE PATIENT ANSWERS, EVEN IF THEY DISCLOSE THAT THEY ARE EXPERIENCING VICTIMIZATION,
IF THEY DON’T WANT ASSISTANCE YOU RESPECT THEIR DECISION. AND THEN RESPOND ACCORDLY, INCLUDING REPORTING
SAFETY CONCERNS AND SUSPICIONS OF ABUSE, NEGLECT AND VIOLENCE, TO APPROPRIATE INTERNAL STAFF,
AND TO AGENCIES AS REQUIRED OR PERMITTED BY LAW. THE PEARR TOOL ISN’T MEANT TO REPLACE MANDATED
REPORTING, IT’S MEANT TO COINCIDE. WHEN IT COMES TO MANDATED REPORTING A LOT
OF TIMES THE PATIENT IS LEFT OUT OF THE EQUATION. WE NEED A PRIVATE CONVERSATION WITH THE PATIENT
BECAUSE CHANCES ARE THE PATIENT DOESN’T EVEN KNOW WHAT HUMAN TRAFFICKING IS, RIGHT? SO YOU MAY HAVE JUST EDUCATED THEM ON WHAT’S
HAPPENING TO THEM MAY BE THIS THING CALLED HUMAN TRAFFICKING. THAT MAY BE THE FIRST STEP FOR THEM. THEY ARE GOING TO SIT AND PROCESS THAT AND
MAYBE SEEK ASSISTANCE FROM YOU OR FROM SOMEONE ELSE AFTER THE VISIT. SO IN ORDER TO IMPLEMENT THIS PROCEDURE AT
DIGNITY HEALTH, WE WANTED TO EDUCATE STAFF ABOUT TRAUMA. THIS IS A PART OF OUR PROCESS, OUR ENDEAVOR
TO BE A TRAUMA INFORMED ORGANIZATION. SO I’M WORKING WITH SEVERAL STAKEHOLDERS TO
DEVELOP A SORT OF CRASH COURSE MODULE ON TRAUMA INFORMED CARE. I JUST WANT TO INTRODUCE THE TOPIC TO HEALTHCARE
STAFF, INCLUDING EFFECTS OF TRAUMA, DIFFERENT TYPES OF TRAUMA, AND HOW IT CAN AFFECT THEIR
COMMUNITIES AND THEMSELVES, THE HEALTHCARE PROFESSIONALS PROVIDING THE CARE AND SERVICES. AND SO WE INCLUDE THIS SLIDE FROM THIS CENTER
FOR HEALTH CARE STRATEGIES AT THE END OF EDUCATIONAL MODULE DESCRIBING WHAT TRAUMA IS, AND ALL
THE WAYS THAT IT CAN HAVE LONG TERM AND WIDESPREAD IMPACT. THIS SORT OF DESCRIBES A PATIENT CENTERED
APPROACH, PATIENT EMPOWERMENT, CHOICE, COLLABORATION, SAFETY AND TRUSTWORTHINESS. I THINK A LOT OF HEALTHCARE ORGANIZATIONS
ARE CORE VALUES, INCLUDING DIGNITY HEALTH’S CORE VALUES ARE WRITTEN IN A WAY WHERE THE
PATIENT IS AT THE CENTER. WE ARE ALL TRYING TO PROVIDE A PATIENT CENTERED
APPROACH. BUT IF YOU’RE EDUCATED ON TRAUMA, I THINK
THAT CAN ONLY BETTER YOUR ABILITY TO PROVIDE A PATIENT CENTERED APPROACH. THEN YOU CAN UNDERSTAND WHY YOUR PATIENT MAY
NOT WANT TO ACCEPT SERVICES OR WHY YOUR PATIENT MAY BE REACTING TO YOU IN A NEGATIVE WAY. IT MAY BE BASED ON PRIOR TRAUMA. SO IN THIS MODULE, WE’RE ASKING HOW CAN YOU
CHANGE YOUR PATIENT CARE INTERACTIONS TO REFLECT THESE CORE PRINCIPLES OF A TRAUMA INFORMED
AND PATIENT CENTERED APPROACH. WE’RE ASKING THIS AT DIGNITY HEALTH FROM THE
TOP DOWN AND BOTTOM UP. WE’RE TRYING TO MAKE CHANGES ON AN ORGANIZATIONAL
LEVEL, WHERE WE’RE CURRENTLY DESIGNING A SYSTEM POLICY TO ADVISE STAFF ON HOW TO RESPOND TO
A PATIENT WHO WE SUSPECT TO BE A VICTIM OF ANY KIND OF VIOLENCE, INCLUDING HUMAN TRAFFICKING,
THAT POLICY WILL INCLUDE THE PEARR TOOL. LET ME SHARE SOME EXAMPLES HOW LEADERS IN
OUR SYSTEM HAVE TAKEN A STAND AND IMPLEMENTED TRAUMA INFORMED APPROACHES. SO IN ARIZONA, WE HAVE A HOSPITAL CALLED ST. JOSEPH’S HOSPITAL AND MEDICAL CENTER. THEY PARTNERED WITH THE PHOENIX CHILDREN’S
HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO RESIDENTS RECEIVING CARE AT THE PHOENIX DREAM
CENTER. THIS INCLUDES SURVIVORS OF HUMAN TRAFFICKING. SO ST. JOSEPH’S WAS PROVIDING OR IS PROVIDING THE
OB/GYN SERVICES TO WOMEN AND GIRLS ON CAMPUS, MEANING AT PHOENIX DREAM CENTER. SO TWO TAKEAWAYS FROM THIS, COMMUNITY PARTNERSHIP
AND MEETING THE PATIENTS WHERE THEY ARE AT. SO FOR SOME, COMING INTO A HOSPITAL SETTING
ON ARE LEAVING THE DOORS OF THE CLINIC MAY BE SCARY. SO OUR PROVIDERS ARE GOING TO THE PHOENIX
DREAM CENTER AND PROVIDING SERVICES TO THE GIRLS. THE BARROW NEUROLOGICAL INSTITUTE ALSO IN
PHOENIX BEGAN WITH THE TRAUMATIC BRAIN INJURY PROGRAM. WORKERS WERE TRAINED TO USE A TOOL CALLED
HELPS. WE KNOW THE STRONG CONNECTION BETWEEN DOMESTIC
VIOLENCE AND SEX TRAFFICKING, AND SO WE’RE ALSO SEEING SURVIVORS OF HUMAN TRAFFICKING
THROUGH THIS PROGRAM. RESIDENTS ARE OFFERED A VISIT TO THE BARROW
INSTITUTE IF THEY SCREEN POSITIVE FOR THIS TOOL. EACH PATIENT SEES A NEUROLOGIST AND THE CLINIC
SOCIAL WORKER. ALL PATIENT CARE IS FREE OF CHARGE REGARDLESS
OF INSURANCE STATUS. THEY ARE OFFERED, THEY BEING THE PATIENTS,
ARE OFFERED STATE OF THE ART TBI CARE THAT ALL PATIENTS RECEIVE INCLUDING MRI IMAGING,
MEDICATION, OUTPATIENT THERAPY, PSYCHIATRIC SERVICES AND SO ON. THE LEAD OF THIS PROGRAM, DR. JAVIER CARDENAS IS HERE TODAY. I ENCOURAGE YOU TO CONNECT WITH HIM IF YOU’D
LIKE TO LEARN MORE. THE THIRD PROGRAM IS MERCY FAMILY HEALTH CENTERS
HUMAN TRAFFICKING MEDICAL SAFE HAVEN IN SACRAMENTO. THE MERCY FAMILY HEALTH SERVICE IS A FAMILY
MEDICINE RESIDENCY TRAINING FACILITY. IT’S BASED ON THE CAMPUS OF OUR METHODIST
HOSPITAL IN SACRAMENTO. SO MERCY FAMILY HEALTH CENTER OFFERS COMPREHENSIVE
SERVICES FOR PATIENTS OF ALL AGES INCLUDING PRIMARY AND URGENT CARE, X RAYS, LAB, ACCESS
TO HOSPITAL SPECIALISTS. DEVELOPING THE SAFE HAVEN AND SO THE SERVICES
ARE BEING PROVIDED THROUGH THIS PROGRAM, SURVIVORS OF BOTH LABOR AND SEX TRAFFICKING CAN RECEIVE
THE SAME QUALITY CARE THAT ALL PATIENTS ARE RECEIVING AT THE MERCY FAMILY HEALTH CENTER. THE PHYSICIANS AND STAFF WHO ARE WORKING WITH
PATIENTS THROUGH THIS PROGRAM WERE ALL EDUCATED ON HUMAN TRAFFICKING AND TRAUMA INFORMED CARE
AND HERE ARE SOME EXAMPLES OF SOME CHANGES THAT WERE MADE FOR THESE PATIENTS. SO THERE’S A DIRECT PHONE LINE TO THE CLINICAL
COORDINATOR, AND A PATIENT ADVOCATE, WHO IS TRAINED BY THE LOCAL DOMESTIC VIOLENCE SHELTER
WHO PROVIDES SERVICES TO SURVIVORS OF HUMAN TRAFFICKING. WE OFFER EXTENDED PATIENT CARE VISITS TO PATIENTS
THROUGH THE HT MEDICAL SAFE HAVEN, FROM AN HOUR TO 90 MINUTES. THERE’S NO JUDGMENT FOR MISSED APPOINTMENTS. THIS WILL HAPPEN WHEN WE’RE SEEING SURVIVORS,
ESPECIALLY THOSE WHO ARE STAYING IN A SHELTER. AND THE LAST ONE I WANT TO MENTION IS OUR
STAFF COMMUNICATE WITH PATIENTS BY TEXT MESSAGE SO WE’RE MEETING THE PATIENTS WHERE THEY ARE
AT. IF THEIR PREFERRED FORM OF COMMUNICATION IS
TEXT THAT’S WHAT WE SET UP WITH THEM. SO I’M GOING TO READ A QUOTE FROM A SURVIVOR
WHO IS A PATIENT AT THE MEDICAL SAFE HAVEN, JENNA MACKAY. JENNA IS A SURVIVOR AND ADVOCATE AND SHE’S
THE FOUNDER OF AN ORGANIZATION CALLED THE JENNA MACKAY FOUNDATION. I NEVER SAW A DOCTOR WHILE I WAS TRAFFICKED,
WHICH WAS A DECADE AGO. I SAW PLENTY AFTER. IT TOOK SIX YEARS FOR SOMEONE TO RECOGNIZE
THE SIGNS. AND FINALLY TREAT ME. UNTIL I SAW DR. CHAMBERS, I HAD NEVER GOTTEN THE CARE I NEEDED. HE CREATED A SAFE PLACE TO SHARE MY STORY
AND DISCOMFORT AND TREATED ME WITH COMPASSION. I FELT RESPECTED BY A DOCTOR, AND FINALLY
FEEL THAT I WILL HAVE A SAFE PLACE TO RECEIVE CARE THAT I NEVER RECEIVED BEFORE. HIS PROFESSIONALISM AND KINDNESS TRULY IS
WHAT DIGNITY HEALTH TALKS ABOUT. I CAN WALK INTO THAT OFFICE, TAKE A DEEP BREATH,
AND TRUST IN THE CARE THAT I WILL RECEIVE. SO DR. RON CHAMBERS IS THE DIRECTOR OF THE MEASURESY
FAMILY HEALTH CENTER, RON IS ALSO HERE TODAY. RON RECOGNIZED THAT BY ESTABLISHING SUCH A
PROGRAM RESIDENT PHYSICIANS WITH NOT ONLY LEARN ABOUT HUMAN TRAFFICKING AND TRAUMA INFORMED
CARE IN A HANDS ON MANNER BUT UPON GRADUATION WOULD TAKE THE KNOWLEDGE WITH THEM TO OTHER
PRACTICES, WE’RE CREATING A PHYSICIAN WORKFORCE ACROSS THE COUNTRY WHO ARE READY TO SERVE
VICTIMS OF VIOLENCE AND ANYONE WHO IS IN A POSITION OF VULNERABILITY, INCLUDING SURVIVORS
OF HUMAN TRAFFICKING. THANK YOU. [APPLAUSE]>>HELLO. I’M RENEE ORNELAS, AND I’M SHOULD I HAVE WAITED
FOR SOMEBODY TO INTRODUCE ME? OKAY. ALL RIGHT. SORRY ABOUT THAT. I’M A CHILD ABUSE PEDIATRICIAN BY TRAINING
AND BY BOARD CERTIFICATION. AND I GUESS I DO THIS. WHERE I WORK NOW IS THE TS HOOTSOO MEDICAL
CENTER. I WORKED IN ALBUQUERQUE FOR 28 YEARS AND STARTED
A PROGRAM THERE THAT PROVIDED MEDICAL SERVICES FOR CHILDREN WITH CONCERNS OF SEXUAL ABUSE,
TEENAGERS, AFTER SEXUAL ASSAULT, AND THEN A GROUP OF ADULTS THAT WERE DEVELOPMENTALLY
DISABLED OR DISABLED IN SOME WAY THAT THIS KIND OF APPROACH MADE SENSE. I WAS RECRUITED TO COME TO NAVAJO NATION AND
START A PROGRAM FOR THEM. THAT’S WHERE I’VE BEEN FOR THE LAST THREE
YEARS. AND I’M GOING TO TALK TO YOU ABOUT CULTURAL
COMPETENCY, WHICH I REALLY HAVEN’T PUT IN THAT KIND OF A FRAMEWORK, BUT I HOPE I HAVE
SOME THINGS I CAN OFFER YOU. THIS IS THE DEFINITION OF CULTURAL COMPETENCY. DEVELOPED BY THE HEALTH AND HUMAN SERVICES
DEPARTMENT, OFFICE OF MINORITY HEALTH. AND IT’S A VERY NECESSARILY BROAD DEFINITION. AND IT ENCOMPASSES MANY ASPECTS OF A PERSON’S
BACKGROUND AND ENVIRONMENT, EXPERIENCES, EVERYTHING THAT GOES TO FORM THAT PARTICULAR PERSON’S
CULTURE, AND INCLUDES THINGS SUCH AS AGE, ORIENTATION, SEXUAL ORIENTATION, RURAL VERSUS
URBAN, ALL THOSE THINGS THAT GO INTO CREATING WHO EACH OF US ARE. ALL OF OUR EXPERIENCES ALTOGETHER. I WANT TO START BY SHOWING YOU A PICTURE OF
WHERE I LIVE AND WORK. I DON’T HAVE A POINTER. IF YOU LOOK AT THE THIS IS FORT DEFIANCE,
ARIZONA. THE NAVAJO NATION HAS 330,000 PEOPLE IN IT. LAST CENSUS BUREAU. AND MY THE ADVOCATE JUST TEXT AND TOLD ME
ACCORDING TO THE CHAPTER HOUSE THERE’S 6000 PEOPLE IN THE FORT DEFIANCE AREA. IF YOU LOOK AT THIS, WHAT I WANTED TO SHOW
WAS THAT IT’S A VERY RURAL UNPOPULATED AREA OF THE COUNTRY. AND YOU SEE THE RED ROOFS, WHERE WE LIVE. IT’S THE HOUSING. IF YOU LOOK IN THE MIDDLE YOU’LL SEE THESE
BUILDINGS THAT ARE WHITE, THAT’S THE HOSPITAL. AND THEN ALL AROUND YOU’LL NOTICE ARE BEAUTIFUL
HILLS, RED ROCKS, BLUE SKY. I TOOK THIS PICTURE FROM THE TOP OF THE HILL
BEHIND THE HOUSING WHERE I WALK MY DOGS. AS YOU CAN SEE, IT’S A VERY RURAL SETTING. AND ACCESS TO MEDICAL SERVICES IS DIFFICULT. AND IT’S DIFFICULT BECAUSE OF MANY DIFFERENT
KINDS OF FACTORS WHICH I LEARNED ONCE I MOVED THERE, I’M FORTUNATE TO LIVE IN THE HOUSING
I DO. I CAN WALK ACROSS THE STREET TO WORK, I HAVE
A CAR. AND EVEN THINGS THAT YOU MIGHT TAKE FOR GRANTED
LIKE MEDICAL TRANSPORT IS VERY COMPLICATED THERE, IN THAT YOU CAN ONLY GET HELP, THE
MEDICAL TRANSPORT, WHICH ACCESS PAYS FOR, WHICH IS A FORM OF MEDICAID, IF YOU ARE GOING
TO AN APPOINTMENT AT A MEDICALLY AFFILIATED PLACE, A HOSPITAL, AND IF AND THIS REQUIRES
A REFERRAL FROM YOUR PRIMARY CARE PHYSICIAN TO A CASE WORKER, WHO THEN SETS IT UP WITH
A DRIVER AND YOUR PATIENT. AND ALL OF THIS MIGHT SEEM NOT SO DIFFICULT
BUT WHEN YOU HAVE LIMITATIONS OF COMMUNICATIONS SUCH AS CELL PHONE SERVICE, WHERE YOU CAN’T
EVEN GET SERVICE UNLESS YOU DRIVE FIVE MILES TO THE ROAD, IT BECOMES VERY DIFFICULT. AND JUST SIMPLE OBSTACLE OF NOT BEING ABLE
TO LEAVE A MESSAGE, NOT BEING ABLE TO PICK UP A MESSAGE, THINGS LIKE THAT, CAN REALLY
INTERFERE WITH THE HEALTH CARE. SO, IT’S BUT IT’S A BEAUTIFUL PLACE. AND I LOVE LIVING THERE AND I LOVE WORKING
THERE. AND I’M LEARNING HOW TO DO A BETTER JOB BY
PAYING ATTENTION. SO MY ADVICE IN TERMS OF PAYING ATTENTION
IS THAT BEFORE YOU GO TO WORK IN AN AREA, SUCH AS THIS, WHICH FOR ME WAS THE NAVAJO
NATION I THOUGHT I UNDERSTOOD THE WORK I DO, CHILD SEXUAL ABUSE PRIMARILY, AND I STARTED
SEEING ADULTS ONCE I GOT OUT THERE, SEXUAL ASSAULT. SO, I THOUGHT I UNDERSTOOD THE AREA BECAUSE
I HAD BEEN IN ALBUQUERQUE FOR 28 YEARS, TWO AND A HALF HOURS AWAY, HAD SEEN PEOPLE FROM
THE PUEBLOS AND APACHE RESERVATION AND NAVAJO, BUT IT’S A TOTALLY DIFFERENT EXPERIENCE ONCE
YOU GO AND LIVE THERE. AND IT’S IMPORTANT TO BE OPEN. AND LEARN ABOUT THE CULTURE, LANGUAGE, TRADITIONS
AND CUSTOMS. THIS CAN HAPPEN IN A VARIETY OF WAYS. I HAVE THE WHAT IS IT IN THE NAVAJO LANGUAGE? IT JUST WENT OUT OF MY HEAD. BUT IT’S LIKE, YOU KNOW, THE PROGRAM THAT
YOU PLUG IN AND CAN LEARN FRENCH AND SPANISH AND ALL OF THAT. SOMEBODY SHOUTS OUT THE NAME I’LL WHAT IS
IT? YEAH, ROSETTA STONE. I HAVE ROSETTA STONE ON NAVAJO LANGUAGE. AND I HAVE TO SAY IT’S STILL IN THE BOX AND
I HAVEN’T LOOKED AT IT SINCE MY FIRST FEW WEEKS BEING THERE. AND I’M TRYING. SO YOU DO, YOU HAVE TO LEARN AS MUCH AS YOU
CAN ABOUT THESE DIFFERENT ESPECIALLY TRADITIONS AND CUSTOMS, MAKE YOUR SPACE CULTURALLY WELCOMING
AND FAMILIAR. YOU HAVE TO BE HUMBLE AND HONEST ABOUT YOUR
STATUS AS A NEWBY TO THE AREA. IF YOU DON’T DO THESE THREE THINGS PEOPLE
WILL NOT USE YOUR SERVICES AND YOU WON’T HAVE ANY CREDIBILITY. SO, YOU HAVE TO GO GENTLY AND OPENLY INTO
AREAS THAT YOU’VE PROBABLY NEVER NAVIGATED BEFORE. THE THING THAT I HAVE ON MY SIDE IS A CHILD
ABUSE PEDIATRICIAN, I WAS PROVIDING A SERVICE THAT HADN’T EXISTED ON THE NAVAJO NATION BEFORE
AND THERE WAS A HUGE NEED. AND I GOT TO DO THE THING I’M REALLY GOOD
AT, THAT I LOVE, TAKING CARE OF KIDS AND ADULTS, NOW ADULTS, WHO HAVE BEEN EITHER SEXUALLY
ABUSED OR SEXUALLY ASSAULTED. I LEARNED ABOUT IHS 638, FORTUNATE TO WORK
FOR A 638, WHICH IS A HOSPITAL WHICH HAS FORMED A BOARD, IN MY CASE THE FORT DEFIANCE INDIAN
HOSPITAL BOARD BECAUSE NATIVE COMMUNITIES HAVE A RIGHT TO SELF GOVERNANCE, TRIBES, NATIONS,
AND THE MONEY THEY FORM A BOARD AND THE MONEY INSTEAD OF GOING TO IHS FACILITY GOES TO THIS
BOARD. THEY DECIDE WHAT KINDS OF SERVICES ARE GOING
TO BE AT THAT HOSPITAL WHICH IS WHY I’M THERE. IT’S A HUGE NEED. BUT AS FAR AS I KNOW, IT’S THE ONLY PROGRAM
OF ITS KIND ON THE NATION, AND MAYBE EVEN NATIONALLY. IF SOMEBODY KNOWS OF SOMETHING ELSE, PLEASE
LET ME KNOW. I WAS USE TO 24 HOUR HOTLINES, KNOWING WHO
DID THIS WORK, FINDING IT OUT, MAKING CONNECTIONS, GETTING CARDS FROM PEOPLE. THE KIND OF SERVICES OUR PATIENTS NEED ARE
SPREAD OUT AMONG MANY DIFFERENT ORGANIZATIONS. SOME OF THEM ARE FEDERAL. SOME OF THEM ARE STATE. SOME OF THEM ARE TRIBAL. THINGS LIKE STRENGTHENING FAMILIES, THAT’S
WHERE THE ADVOCATES WHEN WE HAVE DOMESTIC VIOLENCE, CO OCCURRING PROBLEM, THAT’S WHO
WE CALL, ALTHEA IS THE PERSON WHO COMES, AND TALKS TO OUR PATIENTS ABOUT RESTRAINING ORDERS,
HELPS THEM GET TO A SHELTER. WE USE SERVICES IN CHINLEY, I’LL SAY THE WORD
ADABE, I CAN’T BEGIN TO SAY THE CORRECT NAME, BUT THEY CAME, THEY HAD MONEY FOR A WHILE,
AND THEY SENT US SOMEBODY WHO WOULD COME AND WORK WITH OUR PATIENTS WITH ISSUES OF DOMESTIC
VIOLENCE, AND THEY TRAVELED AN HOUR AND A HALF ONCE A WEEK ONE WAY TO COME AND DO THOSE
SERVICES BUT THEY WERE GREAT. THEIR MONEY RAN OUT SO WE LOST THAT SERVICE. IN OTHER WORDS WHEN YOU GO INTO THESE COMMUNITIES,
THERE ARE SERVICES THERE. THEY ARE NOT YOU JUST HAVE TO ASK, INTRODUCE
YOURSELF, GO TO MEETINGS, PASS OUT BROCHURES AND YOUR CARD, CONNECT WITH OTHER PEOPLE IN
THE AREA DOING THIS KIND OF WORK. YOU’LL FIND TRIBAL AND LOCAL ORGANIZATIONS
WHO PROVIDE SERVICES, AND A VERY IMPORTANT THING WHERE I WORKED ON NAVAJO NATION, PARTNERING
WITH TRADITIONAL HEALERS WHICH ARE A PART OF THE HOSPITAL STAFF, WE’RE BLESSED TO HAVE
THAT. AND I WILL SHOW YOU, THIS IS A PICTURE OF
SOME OF THE THINGS THAT ARE AVAILABLE AT TS HOOTSOO MEDICAL CENTER. SO IN LINE WITH THE TRADITIONAL HEALING ASPECT
OF PROVIDING SERVICES, I MAKE A REFERRAL JUST LIKE YOU WOULD FOR DENTAL OR P.T. OR ANY OF THOSE THINGS, MAKE A REFERRAL FOR
A TRADITIONAL HEALER. THE SERVICES, IF THEY ARE A VICTIM OF CRIME
AND MADE A POLICE REPORT, CRIME VICTIMS COMMISSION HAS A FORM YOU CAN FILL OUT AND THEY WILL
PAY FOR THOSE SERVICES FOR TRADITIONAL HEALING BECAUSE LIKE ANYTHING ELSE, THERE’S GOING
TO BE SOME KIND OF FEE. AND THEY WILL BE IN COMMUNICATION WITH THE
FAMILY. WHAT YOU SEE, OH, THERE’S SOME THINGS. YEAH, I JUST WANT TO POINT OUT, DO YOU SEE
THIS? WHAT YOU SEE ON THE RIGHT HAND SIDE OF THIS
SLIDE IS A SCULPTURE AS YOU WALK INTO THE HOSPITAL IT’S ON THE RIGHT HAND SIDE. IT’S A NAVAJO DOCTOR TALKING TO A BOY, AND
YOU CAN SEE HIS PARENTS IN THE BACKGROUND. THERE’S THIS BEAUTIFUL MURAL IN THE BACK THAT
THIS SITS AGAINST. THAT’S WHAT THE AREA LOOKS LIKE. SO THINGS LIKE THAT ARE REALLY IMPORTANT IN
TERMS OF CREATING AN ATMOSPHERE THAT’S WELCOME AND WELCOMING TO THE PATIENTS. THIS IS THEIR PLACE. WE ARE THERE TO PROVIDE SERVICES, TO HELP,
BUT THIS IS THEIR LIFE AND THEIR COUNTRY. THE HOGON YOU SEE ON THE RIGHT SIDE OF THIS
SLIDE IS WHERE THE TRADITIONAL SERVICES OCCUR. THIS IS ON YOU CAN SEE IN THE BACKGROUND THERE’S
A WALL. THAT’S PART OF THE THE HOGON IS ON THE HOSPITAL
PROPERTY, ON THE VERY NORTH END OF THE HOSPITAL PROPERTY. THERE’S ANOTHER HOGON WITHIN THE HOSPITAL
WALLS IN THE ADOLESCENT CARE UNIT WHICH IS A PROGRAM, 10 WEEK PROGRAM FOR ADOLESCENTS
13 17 YEARS OF AGE, TWO SWEAT LODGES ALSO FOR THE PATIENTS, ONE FOR THE MALES, ONE FOR
THE FEMALES. IT’S A PROGRAM THAT HAS SCHOOL, BUT THE MOST
IMPORTANT ASPECT IS SCHOOLING IN LANGUAGE, TRADITION, THEIR CLANS, THEIR CULTURE, AND
IT’S MEANT TO BRING A CHILD A TEENAGER WHO MIGHT BE STRUGGLING BACK TO THEIR CENTER. SO ONE OF THE PRINCIPLES I’VE LEARNED IN THE
NAVAJO CULTURE IS THAT OF BALANCE, THAT HEALTH COMES FROM BEING BALANCED. AND THIS IS ONE EFFORT TO HELP THOSE TEENAGERS
BECOME MORE AWARE OF WHO THEY ARE, WHERE THEY COME FROM, AND ACHIEVE HEALTH THROUGH BALANCE. ON THE LEFT HAND SIDE THAT’S OUR EXAM ROOM. YOU’LL SEE THERE ARE FOUR SECRET MOUNTAINS,
ACTUALLY SEVEN, BUT FOUR MAIN ONES. AND THIS IS THE NORTH WALL. YEAH, THE NORTH WALL. AND THAT’S THE PELVIC TABLE, THE CULPOSCOPE
TO DO OUR EXAMINATIONS, THE MURAL REPRESENTS NORTH, SOUTH, EAST AND WEST. I HAVE CLOUDS IN A CORNER, A RAINBOW OVER
THE DOOR, THE ROOM NEXT DOOR IS WHAT WE CALL THE FAMILY OFFICE, FAMILY ROOM, AND THAT’S
ALSO WHERE THE ADVOCATE SITS, AND THAT’S THE MURALS OF RED ROCKS AND PLATEAUS, AND ANIMALS,
BIRDS, AND WELL, THE EAGLES AND HORSES, AND THEN THE ADMINISTRATION ROOM IS RED ROCKS,
ALL RED ROCKS THAT ARE FROM THE AREA. BUT THE EFFORT IS MADE TO CREATE THIS ENVIRONMENT
THAT FEELS WELCOMING TO THE INDIVIDUALS WHO COME TO US FOR SERVICES. WHEN I FIRST GOT THERE I ASKED ONE OF THE
TRADITIONAL WHAT I COULD DO TO HELP CREATE THIS SORT OF ENVIRONMENT AND MY BOSS, DR. TUT, SUGGESTED THE MURALS. YOU TRADITIONAL HEALER TOLD ME YOU SHOULD
WEAR TURQUOISE ANYWHERE TO HELP THE KIDS RECOGNIZE YOU AND FEEL COMFORTABLE WITH YOU. SO IF YOU END UP DOING THIS KIND OF WORK,
IN A SETTING THAT’S NOT FAMILIAR TO YOU, I’M FROM LOS ANGELES, BORN AND RAISED IN EAST
L.A., WENT TO ALBUQUERQUE, I HAVE STILL A LOT TO LEARN. THE MOST IMPORTANT THING IS TO I THINK CONNECT
WITH THE COMMUNITY AROUND YOU AND THE OTHER PROFESSIONALS ASK FOR HELP AND DIRECTION,
AND ONE OF THE MOST COMMON QUESTIONS I GOT WHEN I FIRST MOVED OUT THERE WAS HOW LONG
ARE YOU GOING TO BE HERE FOR. I TOLD THEM, THE LAST PLACE I WORKED, I WORKED
FOR 28 YEARS, I DON’T KNOW. I MEAN, AT FIRST I THOUGHT, OH MY GOD, DID
I JUST I DID, I SIGNED A CONTRACT FOR A YEAR. BUT WHAT IT IS IS THAT YOU MAY BE DEALING
I WAS DEALING WITH A GROUP OF PEOPLE, A COMMUNITY WHERE PEOPLE COME AND GO, PROVIDERS COME AND
GO. AND IT’S IMPOSSIBLE TO FORM A BOND, IF THEY
GET TO KNOW YOU, YOUR FAMILY, ALL THE PROBLEMS YOU HAVE, AND THEN THE NEXT TIME YOU GO TO
A VISIT YOU’RE GONE, YOU’RE SUPPOSED TO OPEN AGAIN TO THE NEXT PERSON COMING IN? SO, WE HAVE TO LOOK AT THINGS FROM THE PERSPECTIVE
OF THE COMMUNITY THAT WE SERVE. AND NOW I’M NOT ASKED THAT QUESTION ANYMORE. I DON’T KNOW WHAT THAT MEANS, BUT IT’S A COMPLETELY
FAIR QUESTION TO ASK. AND IT’S SOMETHING THAT WE HAVE TO THINK ABOUT
AS WE GO INTO THESE COMMUNITIES, WHAT IS YOUR COMMITMENT TO THAT COMMUNITY? CAN YOU PUT THAT ACROSS? BE HONEST ABOUT WHAT YOUR INVESTMENT IS AND
WHY YOU’RE THERE AND WHERE YOU COME FROM. ALL OF THOSE THINGS GO TO INCREASE YOUR CREDIBILITY. SO THANK YOU. [APPLAUSE]>>OKAY. WELL, WE ARE RUNNING A LITTLE BEHIND. BUT I THINK WE DO WANT TO TAKE SOME TIME FOR
QUESTIONS. WE DID GET SOME QUESTIONS FOR EACH OF OUR
PANEL MEMBERS TO ASK, THERE MAY BE SOME QUESTIONS IN THE AUDIENCE AS WELL. SO WE’LL BE SUCCINCT, RIGHT? WE’LL BE CONCISE MAYBE IN OUR RESPONSES. SO I’M GOING TO POSE A COUPLE OF THE QUESTIONS
THAT WE HAVE ALREADY COLLECTED SO FAR, FOR EACH OF THE PANEL MEMBERS. LET’S GET STARTED. THE FIRST QUESTION IS FOR HOLLY. AND THAT QUESTION IS WHAT DOES IT MEAN TO
BE SURVIVOR INFORMED? AND HOW IS THAT IMPORTANT TO TRAUMA INFORMED
PRACTICE?>>SO LET’S TEST THIS OUT. IT’S GOOD, IT’S WORKING. I’M GOING TO READ A DEFINITION THAT WAS DEVELOPED
IN 2017 BY THE HUMAN TRAFFICKING LEADERSHIP ACADEMY. THIS WAS ORGANIZED BY NITAC IN NORTHERN CALIFORNIA. OKAY. SO TO BE SURVIVOR INFORMED IS A PROGRAM, POLICIES,
INTERVENTION OR PRODUCT THAT IS DESIGNED, IMPLEMENTED AND EVALUATED WITH INTENTIONAL
LEADERSHIP AND INPUT FROM VICTIMS AND SURVIVORS TO ENSURE THAT THE PROGRAM OR PRODUCT ACCURATELY
REPRESENTS THE NEEDS, INTERESTS, AND PERCEPTIONS OF THE TARGET VICTIM POPULATION. BEING SURVIVOR INFORMED IS KEY TO A TRAUMA
INFORMED APPROACH BECAUSE NO ONE KNOWS OUR TRAUMA BETTER THAN SURVIVORS. SO FOR THOSE WHO DON’T KNOW ME, I’M A SURVIVOR
OF HUMAN TRAFFICKING. I WAS TRAFFICKED FOR COMMERCIAL SEX WHEN I
WAS 14 YEARS OLD BY A MAN I MET AT MY LOCAL SHOPPING MALL. SO YOU’LL SEE I DON’T HAVE, YOU KNOW, “DOCTOR”
NEXT TO MY TITLE, I DON’T HAVE M.D. NEXT TO MY TITLE BUT I BRING A DIFFERENT KIND OF EXPERTISE
TO THE TABLE. AS A SURVIVOR, AS A VICTIM, AT 14, I HAD TO
GO THROUGH AN EMERGENCY DEPARTMENT. I HAD TO BE ASSESSED BY AN OB/GYN PHYSICIAN,
ASSESSED BY AN EMERGENCY PSYCHIATRIST. THIS WAS ALL AFTER BEING INTERROGATED BY SIX
DIFFERENT MALE DETECTIVES WHO WERE ALL TREATING ME IN A VERY NON VICTIM CENTERED, NON TRAUMA
INFORMED MANNER. I BRING THESE EXPERIENCES TO THE TABLE, AND
WE’RE ALWAYS ACTIVELY REACHING OUT TO OTHER SURVIVORS OF SEX AND LABOR TRAFFICKING TO
INFORM WHAT WE ARE DOING AT DIGNITY HEALTH. MOST RECENTLY, WE WENT TO DESIGN VICTIM OUTREACH
POSTERS, SO WE PROVIDED FUNDING TO THE NATIONAL SURVIVOR NETWORK TO HELP US CREATE POSTERS
WHERE THE LANGUAGE AND THE IMAGERY IS SURVIVOR INFORMED. IF I MAY, I WANT TO ENCOURAGE ANYONE HERE
WORKING IN A HEALTH CARE SYSTEM TO GET TO KNOW THE SURVIVORS WHO ARE HERE TODAY. THERE’S MANY SURVIVORS IN THE AUDIENCE. FOR THOSE OF YOU THAT IDENTIFY AS A SURVIVOR
PUBLICLY, AND YOU WOULD LIKE TO SHARE THAT YOU’RE HERE AND AVAILABLE AS A CONSULTANT,
IF YOU WOULDN’T MIND STANDING. THANK YOU. [APPLAUSE]>>THANK YOU, HOLLY, FOR SHARING. THAT WAS INCREDIBLY MOVING. OKAY. OUR NEXT QUESTION IS FOR DR. CHANG. WHAT WOULD IT TAKE TO SCALE THE INTEGRATION
OF PRIMARY CARE AND BEHAVIORAL HEALTH SERVICE FORCEFULLY INTO THE HRSA FEDERALLY QUALIFIED
HEALTH CENTER PROGRAM?>>THANKS. HELLO. THANKS FOR THAT QUESTION. I ACTUALLY PLANTED THAT ONE. SO, YOU KNOW, I THINK YOU HEARD FROM THE PRESENTATION
INFRASTRUCTURE IS THERE. WE HAVE THE PIECES. WE HAVE CAPACITY BUILDING. WE HAVE THE SOAR TRAINING. WE HAVE WAYS THAT PEOPLE ARE LEARNING ABOUT
HUMAN TRAFFICKING AND ISSUES, WE HAVE DIFFERENT SCREENING TOOLS AND ASSESSMENTS, WE HAVE THE
PERSONNEL, RIGHT? WE HAVE SPECIALTY MENTAL HEALTH, WE HAVE SOCIAL
WORKERS, WE HAVE CASE MANAGERS AND CARE COORDINATION IN HEALTH CENTERS ACROSS THE COUNTRY. THIS IS ALL DONE IN PIECEMEAL FASHION, EVERY
HEALTH CENTER IS TRYING TO FIGURE OUT HOW TO MAKE THIS DONE, PROBABLY DR. CHAMBERS AT DIGNITY AND YOUR CLINIC, HOW ARE
WE GOING TO MAKE THE LEADERSHIP WORK ON THE ORGANIZATIONAL LEVEL AND COUNTY LEVEL AND
STATEWIDE LEVEL. SO OF COURSE THIS COMES DOWN TO A COORDINATED
FUNDING STREAM, WAYS TO MEASURE SUCCESS AND STANDARD MEASURES FOR SUCCESS, DIFFERENT DEMONSTRATION
PROJECT MONIES TO TRY TO SEE HOW WOULD THIS WORK IN DIFFERENT COMMUNITIES. YOU’VE SEEN ONE HEALTH CENTER, YOU’VE SEEN
ONE HEALTH CENTER, RIGHT? EVERYONE IS DIFFERENT. EVERY COMMUNITY, EVERY UNDERSERVED POPULATION
IS DIFFERENT. THAT’S ONE PIECE OF IT. ON MY SECOND TO THE LAST SLIDE, THE FOURTH
TO THE LAST SLIDE, SORRY, I TALKED ABOUT REMOVING POLICY BARRIERS AND REIMBURSEMENT, SAME DAY
BILLING MIGHT HELP A LITTLE BIT. RIGHT NOW IF YOU SEE A PRIMARY CARE DOCTOR,
I DO A WARM HANDOFF TO A SOCIAL WORKER OR TO ANOTHER BEHAVIORAL HEALTH WORKER, YOU CAN
ONLY BILL OUT FOR ONE VISIT. SO IS THAT PATIENT CENTERED WHEN I SAY COME
BACK TOMORROW AND YOU CAN SEE THE COUNSELOR? IT’S NOT, RIGHT? SO POLICY BARRIERS AROUND SHARING OF INFORMATION
BETWEEN MENTAL HEALTH AND PRIMARY CARE AND HIPAA BARRIERS ARE SOME POLICY BARRIERS. AND WORKFORCE TRAINING, WE HAVE TO DO CAPACITY
BUILDING AMONGST DIFFERENT SECTORS FOR THIS ISSUE AS WELL AS TRAUMA, AS WELL AS BEHAVIORAL
HEALTH CARE.>>GREAT. THANK YOU. OKAY. CONTINUING, THIS QUESTION IS FOR DR. ORNELAS. WHAT ARE THE ISSUES THAT ARISE WHEN SCHOOL
AGE CHILDREN OR ADOLESCENTS ARE IDENTIFIED AND ATTEMPTED TO INTEGRATE THEM IN FAMILY
AND SCHOOL ENVIRONMENTS?>>SO, THAT’S A QUESTION I ALSO PLANTED. YOU HAVE MYSELF AS A CHILD ABUSE PEDIATRICIAN,
DR. JORDAN GREENBAUM, AND ANOTHER WOMAN I JUST
MET, THE THREE OF US ARE CHILD ABUSE PEDIATRICIANS. I WOULD SAY ANY ONE OF US IF YOU WANT TO KNOW
MORE YOU COULD SPEAK TO US ABOUT YOUR SPECIFIC QUESTION. BUT THE PROBLEM IS THAT IN MY EXPERIENCE OUR
RESPONSE HASN’T BEEN GOOD. IT HAS NOT BEEN OF THE QUALITY THAT YOU MIGHT
SEE FOR AN ADULT, USUALLY YOU SEE IN PEDIATRICS WE TRAIL BEHIND WHAT HAPPENS FOR ADULTS. IF THOSE OF YOU WHO WORKED WITH CHILDREN,
WHO ARE NEGLECTED, AND THEN TRY TO PLACE THEM IN FOSTER HOMES, AND THESE ARE KIDS WHO WILL
WHO DON’T KNOW ABOUT SITTING DOWN TO EAT DINNER, DON’T KNOW ABOUT GOING TO SLEEP AT 8:00 AT
NIGHT. THEY DON’T KNOW WHAT IT’S LIKE TO SIT IN A
CLASSROOM AND LEARN THEIR MULTIPLICATION TABLES. A LOT OF THESE ARE THE SAME KINDS OF ISSUES. SO SOMEBODY WHO YOU HAVE A 14 YEAR OLD WHO
HAS BEEN TAKING CARE OF HER LITTLE BROTHERS AND SISTERS, COUSINS AND THE OTHER SIBLINGS
OF THE OTHER PEOPLE IN THE HOUSEHOLD, AND NOW YOU EXPECT HER TO ACT LIKE A NINTH GRADER,
FRESHMAN IN HIGH SCHOOL, THEY ARE GOING TO THINK ALL THAT IS REALLY DUMB. AND, YOU KNOW, THEY ARE USED TO HANGING OUT
WITH KIDS WHO ARE A LOT OLDER, HAVING A LOT MORE INDEPENDENCE. IT BECOMES DIFFICULT TO TRY TO TAKE THESE,
THAT WE WOULD IDENTIFY AS TEENAGERS OR CHILDREN, AND PUT THEM IN THESE ENVIRONMENTS THAT ARE
MEANT FOR KIDS WHO HAVE HAD A MORE NORMAL UPBRINGING. SO, I THINK WHATEVER IT IS THAT WE DECIDE
TO DO, AND THERE ARE PROGRAMS OUT THERE, THERE’S MANY ISSUES THAT COME UP BECAUSE THEY CAN’T
BECAUSE THERE’S DIFFERENT ISSUES BECAUSE THEY ARE MINORS, AND THEY HAVE RIGHTS, EVEN AS
MINORS, ADDRESSING A VERY COMPLICATED SET OF CONCERNS FOR SOMEBODY WHO DOESN’T HAVE
THE MATURITY NECESSARILY TO UNDERSTAND WHAT THE IMPLICATIONS ARE OF ALL OF THEIR BEHAVIORS,
AND THE LIFE THEY MAY SEEK TO GET BACK INTO. SO, IT’S NOT AN EASY THING. AND I THINK WE HAVE TO GO CAREFULLY INTO IT,
AND CONSIDER EACH INDIVIDUAL TEENAGER AND WHAT IT IS THEY WANT OUT OF THE PROGRAMS THAT
WE’RE PUTTING TOGETHER FOR THEM.>>GREAT. OKAY. I’M GOING TO ASK A QUESTION OF DR. LEWIS O’CONNOR, A QUESTION ON A NOTE CARD
AND ANOTHER QUESTION THAT GO TOGETHER. ONE OF THE QUESTIONS
WHAT ARE WAYS WE CAN PUSH OURSELVES FURTHER? YOU IDENTIFIED SOME GAPS, SOME WAYS WOMEN’S
AND BRIGHAM HOSPITAL IN BOSTON BUT HOW DO WE EXPLORE THAT AREA AND PUSH OURSELVES A
LITTLE BIT FURTHER, THAT ALIGNS WITH THE QUESTION THAT CAME IN ON A NOTE CARD WHICH IS REALLY
LOOKING AT QUANTIFYING EFFICACY AND PATIENT OUTCOMES. SO IF YOU CAN SORT OF INTEGRATE THOSE TWO
QUESTIONS INTO HOW YOU SEE THAT, THAT WOULD BE HELPFUL.>>OKAY. THE FIRST QUESTION I THINK IS REALLY EASY
TO ANSWER IN SOME WAYS THAT WE HAVE TO HOLD OURSELVES ACCOUNTABLE, AND BE COMMITTED TO
LIFELONG LEARNING, AND WHEN WE DO OUR TRAUMA INFORMED CARE TRAINING WE GIVE OUT A CARD,
WE ASK EVERYBODY TO CARRY IT WITH THEM AND WRITE THREE THINGS DOWN THAT YOU’RE GOING
TO CHANGE. SO EVERYBODY WILL COMPLAIN ABOUT SORT OF THE
DELIVERY OF CARE TO ANY OF THE POPULATIONS WE’RE TALKING ABOUT TODAY BUT NOBODY WANTS
TO DO ANYTHING DIFFERENT. SO I THINK THAT’S ONE. THEN THE OTHER THING IS THOSE OF US THAT ARE
ON OUR JOURNEY LEARNING AND EMBRACING THE CONCEPTS OF T.I.C. IS TO REALLY MODEL THAT. YOU KNOW, SO WHEN SOMEONE PRESENTS TO ME A
PATIENT AND SAYS THIS MORBIDLY OBESE PATIENT IN ROOM 3, A ROLE MODEL BACK, MARY JONES,
BMI IS 40, WHO HAPPENS TO BE IN ROOM 3, IS TO REALLY THINK ABOUT OUR LANGUAGE AND MODEL
THAT BACK. IT’S A SHORT OFF THE TOP OF MY HEAD ANSWER. CAN YOU SAY THE SECOND QUESTION?>>YEAH, THE QUESTION HAD TO DO WITH QUANTIFYING
EFFICACY IN PATIENT OUTCOMES. THE TOUGH QUESTION.>>YEAH, SO I MEAN I’M REALLY THINKING A LOT
ABOUT THE METRICS AND ANYBODY INTERESTED IN THE RESEARCH AND THE METRICS PLEASE LET’S
DIALOGUE WHILE WE’RE HERE. I THINK IT HAS TO BE WHAT’S MEANINGFUL TO
PATIENTS. I USED TO THINK THAT THE A1c IS REALLY IT,
THE BLOOD PRESSURE IS REALLY IS, THE FACT THEY MADE IT TO INFECTIOUS DISEASE. I DON’T KNOW THAT’S IT. WHAT IS MEANINGFUL TO THE PATIENT? I WAS RESPECTED. I WAS TREATED KINDLY. I JUST HAD A DUAL DIAGNOSIS PATIENT THAT IS
NOW SITTING IN A DUAL DIAGNOSIS PROGRAM THAT WAITED IN OUR E.R. FOR THREE DAYS BEFORE SHE
COULD GET THAT BED. AND WHEN I CONNECTED WITH HER YESTERDAY WHAT
SHE SAID TO ME IS I JUST WANT TO THANK PEOPLE THAT TREATED ME SO KIND. IT WAS DIFFERENT THIS TIME. AND THE WAY YOU WOULD EXPLAIN TO THE PEOPLE
HERE, I FELT LIKE WHEN I GOT HERE THEY REALLY UNDERSTOOD ME. I DIDN’T HAVE TO SAY IT ALL AGAIN. ISN’T THAT SWEET? THAT’S A MEASUREMENT. HOW DO WE CAPTURE THAT? LIKE YOU SAID, INCLUDE PATIENT ADVISORS, THAT
THEY HAVE DONE SO MUCH FOR ME IN MY THINKING AND MY PERSONAL GROWTH, HOW I THINK ABOUT
WHAT MY CLINIC SHOULD LOOK LIKE BECAUSE THEY HAVE BEEN THERE FROM THE GET GO. UH UH. I’M LIKE, OKAY. IN THE NAME OF THE CLINIC, THEY CAME UP WITH
THIS, THEY LIKED CARE. THERE’S A MILLION CARE CLINICS. BUT OURS IS DIFFERENT, COORDINATED APPROACH
TO RESILIENCE AND EMPOWERMENT.>>THE QUESTION FOR HOLLY, PEOPLE WOULD LIKE TO KNOW
HOW TO GET A COPY OF THE PEARR TOOL.>>DOWNLOAD IT FOR FREE FROM THE WEBSITE,
DIGNITYHEALTH.ORG/HUMAN TRAFFICKING RESPONSE. THERE’S AN EXTENDED DESCRIPTION, THE ACTUAL
TOOL IS AVAILABLE FOR DOWNLOAD THERE. YOU CAN LEARN ABOUT OUR OTHER PROGRAMS THROUGH
OUR WEBSITE AS WELL.>>ARE THERE QUESTIONS FROM THE AUDIENCE ANYONE
WANTS TO COME TO THE MIC. WE’LL TAKE ONE OR TWO QUESTIONS FROM THE AUDIENCE
AND BE TONE TO BREAK.>>BILLING FOR NAVAJO IF IT’S NOT A REPORT,
DOES 638 COME INTO PLAY, HOW DO YOU PAY FOR THE SERVICES?>>LET’S SEE. THEY ARE PART OF MENTAL HEALTH SERVICES. THE ONLY WAY I’VE EVER SEEN THAT IT GETS PAID
FOR IS THROUGH WHAT THEY CALL ACCESS, WHICH IS MEDICAID PROGRAM. BUT, WHAT A LOT OF THE THING ABOUT THE TRADITIONAL
HEALERS THAT WE HAVE AT THE HOSPITAL, THE INDIVIDUAL FAMILIES OFTENTIMES HAVE THEIR
OWN HEALERS THAT THEY WANT TO GO TO. THAT’S WHAT THE CVRC MONEY IS HELPFUL WITH. IF THEY WANT TO USE THE HEALERS THAT WE HAVE
AT OUR HOSPITAL, THAT’S PART OF THE MEDICAL SERVICES THAT THEY ARE ENTITLED TO.
AND SO IT’S EITHER ONE OR THE OTHER USUALLY.>>I JUST WANT TO SAY, HERE’S AN ASSUMPTION
I MADE WHEN I FIRST MOVED OUT THERE. THERE’S MORMONS, CATHOLICS, BORN AGAIN CHRISTIAN,
EVANGELICAL, THERE’S A LOT OF MISSIONARY WORK THAT WAS DONE IN THE VARIOUS NATIONS ACROSS
THE INDIGENOUS NATIONS, ACROSS THE COUNTRY. AND THE EFFECTS ARE THERE. AND SO TO ASSUME THAT SOMEBODY IDENTIFIES
WITH TRADITIONAL SERVICES IS THAT. IT’S AN ASSUMPTION, SOMETHING THAT YOU HAVE
TO ASK AS YOU’RE PROVIDING SERVICES, IS THIS SOMETHING THAT WOULD BE HELPFUL TO YOU BECAUSE
WE HAVE THIS, WE HAVE THIS. SO, THAT’S PROBABLY THE FIRST STEP.>>GREAT. NEXT QUESTION.>>YES, HI, I’M CHANDIA. I WOULD LIKE TO TALK ABOUT VICTIMS AND SURVIVORS
HERE. ALL THE PRESENTATIONS, I DIDN’T HEAR SPECIFIC
TALK ABOUT PEOPLE THAT CAME FROM OUTSIDE THE UNITED STATES, AND GOT TREATMENT, THE BEST
TREATMENT THAT THEY HAVE. AND THEY ARE NOW I FOUND OUT THAT THE VICTIMS
DIDN’T GET THE BEST TREATMENT THAT THEY NEED BECAUSE OF LANGUAGE, CULTURAL, YOU MENTIONED
ABOUT HOW THEY WANT TO BE TREATED AS PEOPLE THAT DON’T KNOW ABOUT THE SYSTEM HERE. SO I WORK WITH SOME MEDICAL PRACTITIONERS
IN NEW YORK, AND WE FIND OUT SO I HELP THEM TO DEVELOP HOW TO WORK WITH MULTI FOREIGNERS
HERE, PEOPLE FROM AFRICA, PEOPLE FROM ASIA, PEOPLE FROM, YOU KNOW, THEY HAVE A DIFFERENT
THING HOW MEDICAL PRACTITIONERS CAN APPROACH THEM. IT’S DIFFICULT. DID YOU DEVELOP THAT PIPELINE AND IF YOU CAN
SHARE WITH US IT WOULD BE GOOD SO I CAN LEARN MORE ABOUT FROM YOUR PROFESSIONAL PERSPECTIVE
SINCE I HAVE MINE, AND I WORK WITH 85% SURVIVORS FROM 27 COUNTRIES.>>DR. CHANG WOULD LIKE TO START.>>YEAH, THANKS FOR THAT QUESTION. I’M GOING TO TALK MORE BROADLY ABOUT PATIENT
CARE OVERALL FOR DIFFERENT FOR PATIENTS WHO ARE FROM DIFFERENT COUNTRIES OR SPEAK DIFFERENT
LANGUAGES AND CULTURE. WE’RE MANDATED BY LAW TO HAVE A BOARD OF DIRECTORS
THAT IS 51% PATIENTS OR USERS OF THE SYSTEM. SO AT ASIAN HEALTH SERVICES WE HAVE BOARD
MEMBERS WHO IN THE PAST HAVE SPOKEN KOREAN, TAGALOG, CHINESE OR VIETNAMESE, WE BRING INTERPRETERS
FOR THEM WHEN THEY DO THEIR GOVERNANCE BOARD MEETINGS, SO THAT’S ONE LEVEL OF SORT OF MAKING
SURE THAT THE PATIENT’S VOICE IS HEARD. THE SECOND THING WE’VE DONE OPERATIONALLY
IS DO A LOT OF AT OUR MEETINGS, ALL STAFF MEETINGS, WE DO A LOT OF HISTORY, TEACHING
ABOUT THE DIFFERENT WAYS IMMIGRATION AND CULTURAL COMPETENCIES OF THOSE DIFFERENT ASIAN POPULATIONS,
FOR EXAMPLE, FOR THE CAMBODIAN PATIENTS WE HAD PEOPLE COME IN AND TALK ABOUT THE GENOCIDE
AND THE CONFLICT, WHERE PEOPLE WERE COMING FROM AND WHAT DOES THAT MEAN HERE IN THE UNITED
STATES WHEN THEY EMIGRATE OR RECEIVE REFUGEE STATUS. WE’RE DOING A LOT OF PROGRAMMING THAT’S NOT
NECESSARILY MEDICALLY RELATED BUT IT IS ABOUT THE CONTEXT IN WHICH OUR PATIENTS COME TO
HEALTH CARE TO ACCESS HEALTH CARE. SO WE ADDRESS INTERGENERATIONAL TRAUMAS AND
THINGS LIKE THAT. YOU KNOW, WHEN I THINK ABOUT HUMAN TRAFFICKING,
IT’S MORE BROADLY IN THE CONTEXT OF PRIMARY CARE AND PATIENT CARE. SO THINKING ABOUT THE SOCIAL, HISTORICAL CULTURAL
ASPECTS OF PATIENTS IS IMPORTANT AND FAMILY CONTEXT AND WE ALSO HAVE INTERPRETERS.>>I WANT TO ADD ONE THING. IF YOU REALLY LOOK AT GUIDING PRINCIPLES OF
T.I.C., THE AND APPLY THOSE AT ORGANIZATIONAL LEVEL AS WELL, CULTURAL, HISTORICAL, GENDER
ACKNOWLEDGMENT, VOICE, CHOICE, EMPOWERMENT, SAFETY, WHAT DOES THAT LOOK LIKE? I FIND THAT THOSE PRINCIPLES ARE GROUNDING
IN THE WORK AS WE THINK ABOUT IT.>>I THINK THIS WILL BE OUR LAST QUESTION
FROM THE AUDIENCE.>>SO AS A SURVIVOR ONE OF THE THINGS I THINK
ABOUT, A COUPLE PEOPLE MENTIONED CODING, INCLUDING INFORMATION ACROSS HEALTHCARE PROVIDERS SO
THEY ARE ON THE SAME PAGE, I THINK THAT’S REALLY IMPORTANT, MY CONCERN IS FOR SURVIVORS
AND HAVING THAT WRITTEN PERMANENTLY ON THEIR HEALTH RECORD AND JUST THE UNDERSTANDING THAT,
YOU KNOW, THE POLITICAL ENVIRONMENT IS ALWAYS CHANGING, WE DON’T KNOW HOW INSURANCE COMPANIES
ARE GOING TO RESPOND. OFTENTIMES THERE CAN BE NEGATIVE CONSEQUENCES
TO THAT. SO WHAT ARE THE CONSIDERATIONS THAT WE HAVE
OR THAT ARE BEING TALKED ABOUT OR NEED TO BE TALKED ABOUT IN ORDER TO INCLUDE THAT AND
MAKE SURE THAT WE’RE BEING AWARE OF HOW THOSE THINGS CAN ACTUALLY HAVE NEGATIVE IMPACTS
WHILE STILL TRYING TO MOVE FORWARD POSITIVELY?>>YEAH, DR. LEWIS O’CONNOR?>>THE ELECTRONIC HEALTH RECORD GOT WAY IN
FRONT OF US, WE’RE BACKING INTO THE CONUNDRUM HOW DO WE DOCUMENT, HOW MUCH, WHO SEES IT. I STILL BRING IT BACK TO GIVING YOU A CHOICE. HOW MUCH OF THIS DO YOU WANT IN YOUR MEDICAL
RECORD? IF IT’S REALLY SENSITIVE WHAT YOU’RE WRITING
AND IF YOU THINK IT’S GOING TO BE A TENDER TOPIC FOR SOMEBODY, YOU’VE GOT TO WORK WITH
YOUR EHR TO SEGMENT IT, TO PROTECT IT, TO BREAK THE GLASS FOUR TIMES BEFORE YOU OPEN
IT. BUT AGAIN I THINK THE PATIENTS NEED TO BE
INCLUDED IN US MAKING POLICIES AND PROCEDURES.>>GREAT. OKAY. WELL, WE HAVE REALLY BEEN REWARDED WITH A
WONDERFUL PANEL THIS MORNING. JUST A COUPLE CONCEPTS I PULLED OUT AND WE’LL
BRING THIS FIRST PANEL TO A CLOSE. I THINK WE’VE HEARD A LOT ABOUT CYCLICAL VERSUS
LINEAR IN SYSTEMS. WE’VE HEARD SO MUCH ABOUT THE IMPORTANCE OF
PATIENT AND SURVIVOR ENGAGEMENT. THEY ARE THE EXPERTS. HEALTH PRACTITIONERS MAY HAVE FANCY DEGREES
BUT WE AREN’T THE EXPERTS IN THIS SPACE. I LEARNED SOMETHING NEW ABOUT REFERRAL TO
SPIRITUAL HEALING REALLY THINKING ABOUT CULTURAL COMPETENCE, INTEGRATING INTO THAT SYSTEMS
OF CARE. WE HEARD ABOUT MEASUREMENT. WE’RE NEVER GOING TO HAVE ALL THE MEASUREMENT
AND DATA ISSUES RESOLVED BUT WE STILL NEED TO KEEP WORKING ON THEM AND GET THOSE INTO
SYSTEMS WHERE WE’RE MEASURING WHAT WE NEED TO MEASURE FOR THE RIGHT REASONS TO IMPROVE
OUTCOMES. AND THEN I THINK ONE OF THE LAST THINGS I
HEARD THAT I LIKED, ONE OF OUR PANEL MEMBERS SAID HEALTH COMES FROM BEING IN A BALANCED
WORLD, A BALANCED ENVIRONMENT, AND SO IT’S ABOUT HELPING OURSELVES, HELPING PATIENTS,
HELPING OUR COLLEAGUES, HELPING EACH OTHER. NONE OF THIS WORK WE CAN DO BY OURSELVES. IT’S A COMMUNITY EFFORT, WE WANT TO SEE A
DAY WHEN THERE IS NO TRAFFICKING. SO IT DOES TAKE EVERYONE TO GET THERE. AND I JUST WOULD LIKE TO CLOSE ALSO WITH SORT
OF A PERSONAL COMMENT. AS I WAS SITTING, WAITING FOR THE SYMPOSIUM
TO START SOMEONE ASKED HOW LONG I’VE BEEN IN THE FEDERAL GOVERNMENT, AT HRSA FOR 24
YEARS, NOT MY ENTIRE FEDERAL CAREER, I’VE BEEN IN THE FEDERAL GOVERNMENT 28 YEARS, AND
SO THERE’S REALLY VERY FEW TIMES WHEN YOU’RE A FEDERAL WORKER WHEN YOU HAVE AN OPPORTUNITY
TO REALLY HAVE ONE OF THESE TIMES, YOU’RE HUMBLED AND INSPIRED BY PEOPLE. AND THE CAUSE WE’RE ALL STRUGGLING AND FIGHTING
FOR TODAY. AND SO THIS I WILL SAY IS ONE OF THOSE TIMES,
ONE OF THOSE TIMES WHEN I’M REALLY INSPIRED AND HUMBLED AND SO I JUST WANT TO THANK OUR
PANEL. THANK YOU ALL FOR THE COURAGE YOU BRING, THE
STORIES, THE STORIES WE HEARD, THE STORIES YOU ALL HOLD UP, BECAUSE IT IS ABOUT THE STORY,
IT’S ABOUT THE PURPOSE. AND AS WE HEARD FROM HOLLY, WE’VE HEARD FROM
SOME OF OUR OTHER SURVIVORS, EVERYONE NEEDS TO BE HEARD, RIGHT? WHEN WE LISTEN, WE LEARN. AND WHEN WE LEARN, WE CAN REALLY GROW. AND THEN AS WE GROW, WE CAN MAKE CHANGE HAPPEN. SO I WOULD LIKE TO SAY THANK YOU AGAIN TO
OUR AMAZING PANEL. THANK YOU TO OUR SYMPOSIUM DEVELOPERS HERE,
AND WE’RE GOING TO TAKE A BREAK AND I’LL TURN IT BACK OVER TO OUR EMCEE. THANK YOU. [APPLAUSE]

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