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The future: Patient-centered and trauma informed
Patient-focused philosophies have been shown to not only produce better patient outcomes, but experts say they can also help improve retention rates, lower costs and make successful providers more attractive partners for payers.
Both patient-centered and trauma-informed care strategies focus on the needs of the individual. By seeing behavioral healthcare through the eyes of the patient, providers are able to create an environment that fosters collaboration and promotes a feeling of safety and security—something that some in the behavioral healthcare field believe is lacking in the industry today.
And the need is great. As many as 70 percent of U.S. adults have experienced trauma, according to experts, so tailored care for this special population is becoming a necessity for treatment programs.
Deni Carise, PhD, chief clinical officer of Recovery Centers of America (RCA), says she believes the reason more people with behavioral health needs don’t seek help is because they don’t anticipate much benefit from the services that are currently available.
“They don’t want what we have to offer, and a part of that is because we don’t pay attention to the patient as an individual,” Carise says.
Patient-centered addiction treatment
Addiction treatment is one segment that has a clear opportunity to build on its legacy of individualized programming. Many substance abuse and addiction recovery services began initially as one person with addiction helping another through the 12 Steps.
Moving the industry away from what Carise calls a “tough love” approach, to a more consumer-driven approach, to full patient-centered care is a long process, but one she feels is well worth the effort.
“People come into treatment, but they have ideas about what they want to get out of it,” she says. “They have ideas about how they could be helped, and we owe it to them, of course, to introduce ways we think we could help as well. We can’t just put them into this cookie-cutter program where everybody gets the same thing.”
Instead, patient-centered care takes into account the patient’s goals for treatment and creates an environment that is respectful and responsive to the individual patient’s needs and desires. Some might be looking for harm reduction, for example, while others might be looking for full abstinence.
“It’s a little tough when the goal of the patient may be to drink socially when they’ve never been able to do that,” she says. “But if you meet the patient where they are at and offer them suggestions—as opposed to demands—and explore with them what would work, you are going to get a lot more responsiveness from the patient. It’s better than what you get if you bang them over the head with, “You can never drink again.’”
It’s a significant shift in philosophy for many facilities and clinicians, who may have no experience in trying to meet patients where they are at.
RCA is opening eight new addiction treatment centers in the Northeast that are specifically designed to be patient-centered. Carise says she has the luxury as a new organization to hire staff who fully embrace the idea of patient-centered care. Starting with a blank slate is the easiest way to get employee buy-in, but, she says, existing facilities can move in a deliberate way toward more patient-centered approaches as well.
“It takes an enormous amount of training,” she says. “You have to get staff buy-in at every level.”
One of the most important things to watch as facilities move toward a more patient-centered approach to care is the language being used by staff and therapists. Instead of saying, for example, “He’s just in denial,” Carise recommends asking more pointed questions, such as “Why don’t you think this is a problem for you?”
For facilities to succeed in making the shift, providers need to model the new patient-centered approaches, train staff and make resources available to employees.
Carise says choice is another important element to patient-centered care. For instance, offering daily schedules with built-in flexibility that allows the patients to decide whether they want to spend a given hour in a women’s group, LGBT group, yoga or a home budgeting class, for example, allows patients an opportunity to exercise their personal preferences.
“There are some services that every patient will get, but everybody doesn’t need the exact same thing,” Carise says.
She also recommends involving patients in the development of their own treatment plans, listening to patient’s ideas about their own treatment and transitioning patients between levels of care by explaining what’s coming next and why it’s being done.
Getting to know the individual patient, including their hopes, their fears and their goals, is another essential element to patient-centered care. Carise says getting to know the patients on an more individual level can improve patient engagement, which will increase the likelihood that they will make behavioral changes.
Trauma-Informed Care
Whether it’s a recent tragedy reported on the television news or more hidden abuses such as rape or physical abuse, it’s clear that trauma has become a prevalent part of today’s society. Increasingly, programs are responding to the need in their communities.
“It’s estimated that 70 percent of adults in the United States have experienced some type of traumatic event in their life,” says Jim Clarkson, the chief executive officer of Via Positiva, a behavioral health consulting firm. “When it comes to behavioral health, unfortunately, it’s almost a universal phenomenon.”
What’s even more troubling is that MRIs of the brain have shown that if memory of a past trauma—even from decades earlier—is triggered, the brain and body still respond as if the trauma is happening in the present moment. Trauma can be an ongoing treatment proposition.
Due to the high prevalence of trauma in today’s society, Clarkson says it’s important that behavioral healthcare providers are trauma-informed and create environments that are safe and welcoming to potential clients.
“If the provider is not trauma-informed, understanding the prevalence and the symptoms of trauma and how to create environments for welcome, positive, therapeutic outcomes, it makes it that much more difficult to engage,” he says.
While working with a managed behavioral healthcare organization, Clarkson found that those providers who were not-trauma informed were also the same who had less engagement, less retention and more critical incidents.
He says too often programs are built around operational efficiency rather than creating an environment where people feel safe and understood. For instance, patients that initially have a difficult time navigating the facility exterior won’t feel welcome. An office with a window between clients and the receptionist might communicate barriers to entering the program. And in some cases, on-site security guards could put a patient ill at ease.
“These things are all common triggers that essentially make the environment less safe, less trustworthy, less collaborative,” Clarkson says. “Many of our behavioral health organizations—unknowingly in a lot of cases—are creating environments that are absolutely not trauma informed.Then they have a harder time with engagement and retention of patients and family members.”
To become more trauma informed, he recommends facilities use the 16 strategies identified in SAMHSA’s “A Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services.” Clarkson recommends working through the SAMHSA strategies and developing a plan for each.
Organizations could examine their programs through the patient’s eyes with a role playing exercise: Two of the organization’s top leadership would go through the entire process of services from making the first call, to driving into the parking lot to sitting in the waiting room. Clarkson says they would be able to evaluate how staff interact with patients and whether it’s a welcoming environment.
While one person might play the role of a typical client for the facility, Clarkson says, the second should portray a family member so leadership can gain a perspective from both angles.
Out in the community beyond the treatment center campus, Clarkson says providers can also participate in trauma-informed efforts by creating partnerships with payers to help them understand the nuances of the tailored care needs. Consider inviting payers on-site for training or volunteer to serve on payer committees, such as clinical advisory committees or family and consumer committees.
“Many times, the most frequent utilizers of insurance services are people with substance use disorders or mental health disorders. The providers actually offer access to a population that traditionally has been harder to manage because of a more acute model of care,” Clarkson says.
Jill Sederstrom is a Kansas-based freelance writer.
