Health & Human Trafficking Symposium | November 2018 | Part 2: Health Services for Survivors

>> WELL, Good morning, EVERYONE AGAIN. THANK YOU SO MUCH FOR BEING HERE TODAY. IT IS REALLY MY PRIVILEGE TO MODERATE THISFIRST PANEL OF OUR SIX OF OUR PANELS TODAY. THIS IS THE INTEGRATING PRIMARY AND BEHAVIORALHEALTH Service FOR TRAFFICKING SURVIVORS, FIRST PANEL. AGAIN, I’M SABRINA MATOFF STEPP, I’M THE DIRECTOROF THE OFFICE OF WOMEN’S HEALTH AT THE HEALTH Assets AND Works ADMINISTRATION. THE HRSA OFFICE OF WOMEN’S HEALTH LEADS HEALTHRELATED ACTIVITY ACROSS OUR AGENCY. WE SUPPORT PROGRAMS THAT SUPPORT UNDERSERVEDWOMEN AND GIRLS WHO ARE GEOGRAPHICALLY ISOLATED, MEDICALLY VULNERABLE OR ECONOMICALLY VULNERABLE. ONE OF THE THINGS THAT’S REALLY IMPORTANTTO KNOW ABOUT OUR OFFICE, WE INTEGRATE, WE COLLABORATE, AND WE INTEGRATE, WE COLLABORATEAND WE INNOVATE. I Fantasize WE Genuinely HAVE A GREAT PLACE AS PARTOF BEING HERE TODAY. SO, AGAIN, I Truly AM PRIVILEGED TO BE HERETO WELCOME WHAT I THINK IS JUST AN INCREDIBLE GROUP OF EXPERTS, JOINING ME TODAY. I Actually SEE THEM AS KIND OF OUR CNN HEROES.I FEEL LIKE I’M UP HERE LIKE ANDERSON COOPERAND THEY ARE OUR HEROES. SO, THINK OF YOURSELVES LIKE THAT. HERE WITH US TODAY IS DR. KIMBERLY CHANG, SITE DIRECTOR AND PHYSICIANAT ASIAN HEALTH Business IN OAKLAND. SHE WILL BE HELPING US UNDERSTAND MORE ABOUTINTEGRATION TO PRIMARY AND BEHAVIORAL HEALTH AND HOW TO MAKE THIS HAPPEN. WE Likewise ARE Participated BY DR. ANNIE LEWIS O’CONNOR, DIRECTOR OF COORDINATEDAPPROACH TO RESILIENCE AND EMPOWERMENT AND BRIGHAM AND WOMEN’S HOSPITAL IN BOSTON ANDWILL HELP US EXPLORE AND UNDERSTAND TRAUMA AND ITS IMPACT ON PERSPECTIVE OF A CLIENTOR PATIENT. WE ALSO HAVE MISS HOLLY AUSTIN GIBBS, SHE’SONE OF OUR VERY IMPORTANT TRAFFICKING SURVIVORS AND SHE’S ALSO THE PROGRAM DIRECTOR OF HUMANTRAFFICKING RESPONSE AT DIGNITY HEALTH IN SACRAMENTO, CALIFORNIA.AND WILL TALK ABOUT PRINCIPLES OF TRAUMA INFORMEDAPPROACHES AND WHAT THIS LOOKS LIKE IN ACTION. Ultimately WE’RE ALSO JOINED BY DR. RENEE ORNELAS, A PEDIATRIC SPECIALIST, ANDSHE’S AT THE FAMILY ADVOCACY CENTER AT THE TSHOOTSOO MEDICAL CENTER IN FORT DEFIANCE, ARIZONA. DR. ORNELAS WILL EXPLORE HOW TO DO INTEGRATEDCARE WORK IN A CULTURALLY COMPETENT WAY IN RURAL COMMUNITIES. TAKE A LOOK AT THEIR BIOS. THEY WILL EACH TALK FOR TEN MINUTES AND WE’LLHAVE TIME FOR GREAT QUESTIONS AND ANSWERS. ON THIS SLIDE YOU SEE OUR LEARNING OBJECTIVESFOR THIS FIRST SESSION. I WON’T READ THEM WORD FOR WORD. YOU CAN Discover THEM ON THE SLIDE BUT WE’RE GOINGTO DELVE INTO A NUMBER OF Truly important PRINCIPLES AND Controversy FOR THIS FIRST PANEL.AGAIN, TALKING ABOUT INTEGRATED AND TRAUMAINFORMED 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 SOMEFRAMING FOR THIS PANEL. WE’RE GOING TO TALK ABOUT THE IMPORTANCE OFINTEGRATION OF PRIMARILY AND BEHAVIORAL HEALTH SERVICES IN RESPONDING TO THE HEALTH NEEDSOF SURVIVORS OF HUMAN TRAFFICKING, WE’RE ALSO GOING TO TOUCH ON CARE COORDINATION AND LOOKAT CULTURAL COMPETENCY.YOU HEARD THE PREVIOUS SPEAKER SPEAK TO THIS. WE’LL GIVE YOU CONCRETE PRACTICAL INNOVATIVEAPPROACHES. YOU’RE HERE TO TAKE ACTION AS WE’VE HEARDFROM OUR ASSISTANT SECRETARY JOHNSON. SO, Is moving forward, THIS Symposium Committee ASKEDME TO SET SOME GROUNDING BACKGROUND AND PRINCIPLES, AND SO WHAT I’D LIKE TO SHARE WITH YOU TOSTART HERE IS NO MATTER THE APPROACH REALLY FOR ANY PRACTITIONER WORKING IN THIS SPACEWORKING WITH HUMAN TRAFFICKING SURVIVORS, THIS Labor COMES BACK TO THE SURVIVOR, THESURVIVOR AT THE CENTER OF ALL THAT WE DO. SO, WHAT DOES THAT REALLY LOOK LIKE? DO SURVIVORS REALLY FEEL HEARD BY THEIR PROVIDERSAND SUPPORTED BY HEALTHCARE SERVICE TEAM? DO PROVIDERS THEMSELVES FEEL THEY CAN SUPPORTTHE SURVIVORS’ CULL CONSTELLATION OF CONCERNS THEY BRING? CAN THEY ENGAGE AND WORK WITH OTHER NETWORKSOF REFERRAL? AND CAN WE CONNECT SURVIVORS TO ALL KINDSOF SOCIAL DETERMINANTS OF HEALTH NEEDS SUCH AS HOUSING, FOOD, Child care homes, TRANSPORTATION, EMPLOYMENT, LEGAL, OTHER NEEDS? SO WE’RE GOING TO LOOK AT ALL OF THAT IN TODAY’SSESSION.SO A LITTLE ABOUT MY AGENCY, WHY IS HEALTHRESOURCES AND Business ADMINISTRATION HERE, WE’RE Area OF THE DEPARTMENT OF HEALTH ANDHUMAN SERVICES, HHS. OUR ADMINISTRATOR WELCOMES YOU ALL TO THISVERY IMPORTANT MEETING. AND REALLY HRSA IS THE AGENCY THAT REALLYFOCUSES ON UNDERSERVED POPULATIONS. TENS OF MILLIONS OF AMERICANS RECEIVE THEIRHEALTH 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 WITHSUBSTANCE USE DISORDERS. WE KNOW HOW IMPORTANT PRIMARY CARE IS AS ANINITIAL POINT OF INTERVENTION FOR SURVIVORS. AND WITHIN ALL OF OUR SYSTEMS OF CARE AT HRSAWE REALLY UNDERSTAND AND TRY TO MERGE AND INTEGRATE INTO PRIMARY CARE, LEVERAGE TEAMBASE APPROACH AND PATIENT CENTERED MEDICAL HOMES. Segment OF BEHAVIORAL HEALTH INTEGRATION IS PATHWAYSFOR THE CONTINUUM OF TREATMENT Service UNIQUE TO THEIR OWN NEEDS.SO, LET’S START WITH A COMMON DEFINITION WHENWE’RE TALKING ABOUT INTEGRATION. INTEGRATION IS MORE THAN PROVIDING MENTALHEALTH AND SUBSTANCE USE Service. IT’S REALLY ABOUT BUILDING AND SUSTAININGINTEGRATED CARE ACROSS ALL FACETS OF AN ORGANIZATION, THAT Shows THE VALUES OF THAT ORGANIZATION, COLLABORATIVE CARE AND UNDERSTANDING SO THAT WE’RE REALLY MAKING A DIFFERENCE ON CLINICALOUTCOMES. THIS DEFINITION COMES FROM THE SAMHSA HRSACENTER FOR INTEGRATIVE Assistance OR SOLUTIONS. IT’S IMPORTANT THAT WE UNDERSTAND THAT SIMILARTO OTHER CLINICAL OUTCOMES LIKE HYPERTENSION OR DIABETES, THESE Categories OF BEHAVIORAL HEALTHCONDITIONS CAN REALLY BE SILENT KILLERS, THAT PATIENTS THAT MAY PRESENT WITH ALL KINDS OFPROBLEMS BUT NOT NECESSARILY A CLINICAL PROBLEM ARE REALLY TRYING TO TELL US THAT THERE ISOTHER ISSUES GOING ON AND THAT THESE ARE Truly important MEDIATING FACTORS WE NEED TO PAYATTENTION TO BECAUSE WITHOUT PAYING ATTENTION TO THOSE MEDIATING FACTORS, WE MAY NOT REALLYMAKE ANY DIFFERENCE ON THE HEALTH OUTCOMES THEMSELVES.AND THAT’S REALLY AN IMPORTANT POINT FOR USTO THINK ABOUT THAT THERE ARE HEALTH OUTCOMES DIRECTLY BUT THERE ARE ALL THESE MEDIATINGFACTORS. AND I Review IN SOME CASES HUMAN TRAFFICKINGIS ONE OF THOSE MEDIATING FACTORS. SO OUR PANEL MEMBERS HERE TODAY ARE GOINGTO TALK ABOUT THIS. THEY ARE Departing TO TALK ABOUT TRAUMA INFORMEDCARE APPROACHES TO REALLY IMPROVING HEALTH OUTCOMES. AS YOU ALL KNOW, TRAUMA INFORMED CARE REALIZESTHE WIDESPREAD IMPACT OF TRAUMA AND UNDERSTANDS POTENTIAL PATHS FOR RECOVERY, RECOGNIZES SIGNSAND SYMPTOMS OF TRAUMA IN CLIENTS, FAMILY, STAFF AND OTHERS INVOLVED WITH THE SYSTEM. TRAUMA INFORMED CARE FULLY INTEGRATES KNOWLEDGEINTO POLICY, PROCEDURES AND PRACTICES. AND WE Certainly SEEK TO AVOID RETRAUMATIZATION. THAT’S Truly WHAT WE’RE TRYING TO DO, REALLYAT A SYSTEM LEVEL.I THINK THAT’S ANOTHER ASPECT OF WHY WE’REHERE TODAY TO THINK ABOUT SYSTEMS, INDIVIDUALS, COMMUNITIES, BUSINESSES, THE WHOLE SOCIALECOLOGICAL MODEL. WE KNOW TRAUMA EXISTS ON A CONTINUUM. THERE ARE COMPLEX NEEDS WHEN IT COMES TO HELPINGSURVIVORS WORK THEIR WAY THROUGH THE SYSTEM SO BY EMPLOYING THESE TRAUMA INFORMED APPROACHESAND INTEGRATION YOUR ORGANIZATION, OUR ORGANIZATIONS WORKING TOGETHER CAN BE BETTER POSITIONEDTO HELP SURVIVORS WITH HEALING, WITH RESILIENCY, AND A NEW TERM THAT I LEARNED IN THE LASTCOUPLE OF WEEKS, SOMETHING CALLED POST TRAUMATIC GROWTH. THAT’S A NOVEL CONCEPT, SOMETHING THAT WE’REGOING TO STRIVE FOR TOGETHER. SO YOU’LL HEAR, AGAIN, FROM OUR PANEL ABOUTALL HANDS ON DECK APPROACHES, I’D LIKE TO SHARE A COUPLE THINGS WE’VE DONE AT HRSA THATIS REALLY TAKEN THIS KIND OF IDEA OF ALL HAND ON DECK, AT THE HEALTH Assets AND SERVICESADMINISTRATION “Were having” DEVELOPED A HRSA STRATEGY TO ADDRESS INTIMATE PARTNER VIOLENCE.AS WE KNOW, THERE’S OFTENTIMES INTEGRATIONAND OVERLAP WITH IPV AND HUMAN TRAFFICKING. AND JANE IS IN THE AUDIENCE WITH ME FROM THETEAM, OUR LEAD FOR STRATEGIC INITIATIVES AND A BIG THANKS TO JANE FOR HER HELP WITH ALLOF THIS WORK. BECAUSE WE KNOW THAT TRAUMA, AGAIN, IS PARTOF A LOT OF THE PROGRAMS THAT WE WORK ON, WE LAUNCHED THIS INITIATIVE IN 2017, AND WE’REWORKING ACROSS ALL OF HRSA’S PROGRAMS, ALL THE BUREAUS AND OFFICES TO ADDRESS VIOLENCEPREVENTION, OVER THE NEXT THREE YEARS.ONE OTHER INITIATIVE THAT WE’RE WORKING ONIN AT HRSA IS PROJECT CATALYST, WE’RE DOING THIS WITH OUR COLLEAGUES AT THE ADMINISTRATIONOF CHILDREN AND FAMILIES WITH THEIR GRANTEES, FUTURES WITHOUT VIOLENCE, AND HRSA’S BUREAUOF 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 VIOLENCEIF YOU’D LIKE TO LEARN MORE ABOUT THOSE PROJECTS. SO THAT IS JUST THE BEGINNING OF WHAT I THINKWE’RE GOING TO BE LOOKING AT TODAY. I CERTAINLY KNOW THAT I NEED TO LEARN AS MUCHAS ANYONE HERE ABOUT THESE ISSUES MORE SO WE CAN DO THE GREAT WORK THAT WE NEED TO DOAT HRSA. I’M GOING TO TURN THE MICROPHONE OVER NOWTO SOMEONE WHO REALLY IS A PIONEER WHEN IT COMES TO TRAUMA INFORMED CARE, CULTURALLYCOMPETENT CARE, DR. KIMBERLY CHANG FROM THE ASIAN HEALTH SERVICESCLINIC 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 LASTEDFOR A LONG TIME. Good morning. THANK YOU FIRST OFF TO ASSISTANT SECRETARYJOHNSON FROM ADMINISTRATION FOR CHILDREN AND FAMILIES, AND PARTICULARLY TO DIRECTOR CHONFOR ALL YOUR LEADERSHIP IN ORGANIZING THIS TODAY. Likewise, TO THE FEDERAL STAFF WHO HELPED TO ORGANIZEAND PUT THIS TOGETHER, THANK YOU SO MUCH. THIS IS VERY ESSENTIAL AND WE APPRECIATE ITFROM 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 THEINTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH Business FOR TRAFFICKING SURVIVORSREALLY Makes AND WHAT IT REALLY LOOKS LIKE. SECOND I’LL GIVE A BRIEF HISTORY OF INTEGRATIONAND WHERE OUR CURRENT EFFORTS ARE IN THE HEALTH CARE DELIVERY SYSTEM. Eventually I’LL Share WHAT MY HEALTH CENTER, ASIAN HEALTH Assistance IS DOING AROUND INTEGRATION AND A LITTLE ABOUT FEDERALLY QUALIFIED HEALTHCENTERS FQHCS, AND THEIR IMPACT FOR REACH. I’M SETTING UP WHAT WE CAN SEE AS INFRASTRUCTUREBUILDING FOR THE INTEGRATION OF SERVICES AND PRIMARY CARE AND BEHAVIORAL HEALTH FOR TRAFFICKINGSURVIVORS IN THE FUTURE. SO, REALLY WHAT IS INTEGRATION AND WHAT DOESIT TAKE TO GET THERE? TODAY I’M REPRESENTING THE VOICE OF COLLEAGUESNATIONALLY SHARING QUOTES FROM AN EXPERT BASE CONVENING OF NATIONAL ASSOCIATION OF COMMUNITYHEALTH CENTERS THIS YEAR. INTEGRATED SYSTEMS APPROACH TAKES A FUNDAMENTALREDESIGN TO JUSTICE, LEGAL, MEDICAL, HEALTH, FOOD, HOUSING AND TRANSPORTATION.IT’S A WHOLE REDO WHERE Assistance ARE COORDINATEDWITHIN AN INTEGRATED SYSTEM INCLUDING CONTINUUM OF CARE, AVAILABLE 24/7. IT’S WHERE PATIENTS ENTER THE SYSTEM, BASEDON 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. Incorporation IS REALLY A PROXY WORD FOR QUALITYAND VALUE. INTEGRATION MEANS ADDING A SCOPE OF PRACTICETO A HEALTH SYSTEM, WHETHER IT’S PRIMARY CARE SIDE OR BEHAVIORAL HEALTH SIDE. THAT Wants ADDING NEW WORK FLOWS, NEW PERSONNEL, NEW SERVICES AND NEW SKILL Begin. WITH THE GOAL BEING BETTER QUALITY OF HEALTHCARE, AND BETTER VALUE OF HEALTH CARE, FOR THE PATIENTS AND THE PAYERS. SO NOTICE HOW I SAY HEALTH CARE AND NOT MEDICALCARE. IT’S AN INTEGRATED SYSTEMS APPROACH WITH OTHERSECTORS AND OUTSIDE PARTNERS ADDED TO CARE WE’RE PROVIDING. IT’S NOT Time ABOUT A Heated HANDOFF OR HAVINGA PSYCHIATRIST OR COUNSELOR IN THE SAME BUILDING AS A PRIMARY CARE DOCTOR.SO INTEGRATION IS CARE RESULTING FROM PRACTICETEAM OF PRIMARY CARE AND BEHAVIORAL HEALTH CLINICIANS WORKING TOGETHER WITH PATIENTSAND FAMILIES USING SYSTEMATIC AND COST EFFECTIVE APPROACH TO PROVIDING PATIENT CENTERED CAREFOR 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 PATTERNSOF HEALTH CARE UTILIZATION. AS WELL AS ADDRESSING PATIENTS’ CONCRETE NEEDSAND Service THAT THEY NEED. SO THIS IS A ROAD MAP OF WHAT WE THINK INTEGRATIONSHOULD LOOK LIKE IN THE FUTURE, FOR HEALTH CARE. HISTORICALLY, WE THOUGHT ABOUT HEALTH CAREIN 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 EXPLOITATIONOR HUMAN TRAFFICKING OR VIOLENCE OR HIV OR HEART DISEASE OR WHATEVER ISSUE WE’RE ATTENDINGTO THAT DAY. WE’LL TREAT OR REFER THE PATIENT FOR ADDITIONALSERVICES OR SPECIALTY Services. IT’S HISTORICALLY BEEN A VERY LINEAR PROCESS. HOWEVER IN THE REAL WORLD, PATIENTS DON’TALWAYS PRESENT THAT WAY, LINEARLY.IT’S NOT LINEAR CARE. IT’S CYCLICAL. AND PATIENTS ENTER AND LEAVE THE SYSTEM ATDIFFERENT POINTS. IN AN INTEGRATED SYSTEM ACCESS TO CARE NEEDSTO BE 24/7, THERE NEEDS TO BE TRIAGE SYSTEMS, Telephone system, POINT PERSON OR PEOPLE TO HELPMANAGE ANXIETY, OR OTHER EMOTIONAL CRISES, OR CONCRETE NEEDS OF THE PATIENT HOUSING, FOOD INSECURITY AND SUCH. FOR TRUE INTEGRATION WE HAVE TO THINK ABOUTHOW WE MAY NEED TO REDO OUR Assistance TO KEEP PEOPLE IN CARE. IT’S NOT JUST NINE TO FIVE OFFICE CARE ORCARE WITHIN THE FOUR WALLS OF OUR CLINIC.SO PEOPLE WITH BEHAVIORAL HEALTH Matters COMETO THE SYSTEMS OF CARE IN DIFFERENT PLACES. AND THERE SHOULD BE NO WRONG DOOR. THEY Parallel THROUGH A FOOD BANK, SHELTER, SCHOOLS, BEHAVIORAL HEALTH OR MEDICAL CARE, For example. SO FUNDAMENTALLY WE NEED TO UNDERSTAND IT’SNOT LINEAR. AND MORE IMPORTANTLY, IT’S Likewise NOT FAILURE. IT’S NOT FAILURE WHEN PATIENTS ARE IN THECYCLICAL STAGE. FOR EXAMPLE, IN REGARDS TO TRAFFICKING, I’VEHAD PATIENTS AT ASIAN HEALTH Business 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 OUTOF 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 CONTINUUMOF CARE. WE’VE HAD PATIENTS WHO HAVE COME THROUGH ENGAGEMENTWITH OTHER SECTORS, SO LAW ENFORCEMENT, OR OTHER SOCIAL Service. FOR EXAMPLE, WE HAD A PATIENT WHO WAS SEXTRAFFICKED IN ANOTHER COUNTY, BUT SHE RESIDED IN OUR COUNTY. SO HER LEGAL CASE IS BEING DEALT WITH ANDSOCIAL Assistance IN THE COUNTY SHE WAS SEX TRAFFICKED IN BUT SHE NEEDED TO ACCESS WHERESHE LIVED IN OUR COUNTY. WE DID SOME CARE COORDINATION AND GOT HERHEALTH CARE Service WITH US IN THE SPECIALTY MENTAL HEALTH Work AT ASIAN HEALTH SERVICESBECAUSE SHE WAS EXHIBITING SOME PARANOIA AND PSYCHOSIS. THERE ARE PATIENTS THAT CYCLE IN AND OUT OFBEING TRAFFICKED, THE CYCLING AND CYCLICAL NATURE, THE CONTINUUM, DOESN’T REPRESENT FAILURE. WE NEED TO INTEGRATE SYSTEMS OF CARE, THERE’SBEEN A LEGACY OF SEPARATE AND PARALLEL SYSTEMS. INTEGRATED BEHAVIORAL HEALTH LEADS TO BETTERMATCH OF CLINICAL Business TO THE REALITIES THAT PATIENTS AND CLINICIANS FACE DAILY.SO, YOU KNOW, IT’S NOT WE’RE NOT JUST A PHYSICALBODY OR A MIND OR EMOTIONAL CREATURE. WE’RE INTEGRATED, JUST AS WE’RE HOLISTIC CREATURESAS 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 HEALTHCARE. 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 INTOPRIMARY 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 Assistance, OUR DENTAL CLINICIAN ARE INCORPORATING DEPRESSION SCREENING WITH ON SITE SOCIAL WORKERS TO ADDRESSANY POSITIVE SCREENS. THAT’S JUST ABOUT DEPRESSION BUT THAT COULDBE 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 OFMEDICINE IN 2006, REPORT IMPROVING THE QUALITY OF HEALTH CARE FOR MENTAL AND SUBSTANCE USECONDITIONS.I’M ALMOST OUT OF TIME. THIS IS FOUNDATION IN ESTABLISHING PRINCIPLES. WE NEED TO INTEGRATE. PRIMARY CARE IS DE FACTO MENTAL HEALTH SYSTEMFOR 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 ANDTHEY 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. “Were having” THEM ALL AT ASIAN HEALTH Business. AND WE’RE MOVING TOWARDS THAT ROAD MAP THATI SHOWED YOU EARLIER. Constituents 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 ANDFUTURE ABOUT VIOLENCE PROGRAM, AT LEADERSHIP LEVEL, STATE DEPARTMENTS OF HEALTH, STATEDOMESTIC VIOLENCE COALITIONS AND PRIMARY CARE ASSOCIATIONS OF COMMUNITY HEALTH CENTERS ONA LEADERSHIP LEVEL. REFERRAL SYSTEMS, CAPACITY BUILDING OF WORKFORCE, CASE MANAGEMENT, VERY IMPORTANT.CASE MANAGEMENT FOR EXTERNAL SERVICES ANDNEEDS. CARE COORDINATION WITHIN OUR SYSTEM. AND THINKING ABOUT THE COMORBIDITIES THATPATIENTS HAVE. YOU HEARD FROM DIRECTOR CHON’S REMARKS EARLIERTHAT 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 SCREENINGSFOR A WHOLE HOST OF ISSUES AND MAKE OUR CARE PATIENT CENTRIC, CULTURALLY AND LINGUISTICALLYRESPONSIBLE. A Slew OF THIS IS NOT REIMBURSABLE BUT THISIS WHAT WE NEED. IN THE INTEGRATED SYSTEMS APPROACH WE HAVETO HAVE THESE PARTNERS AND SYSTEMS OF CARE. WE CAN’T PUT IT ON THE BACKS OF OUR PATIENTSTO FIGURE THIS OUT. WE NEED TO BE DOING IT FOR THEM. FINALLY, NATIONAL IMPACT OF FQHCs, THIS ISYEAR OVER YEAR CARE OF BEHAVIORAL HEALTH SERVICES WITHIN THE FEDERALLY QUALITIED HEALTH CENTERSFROM 2016 TO 2017. INCREASE OF BEHAVIORAL HEALTH SERVICES BY16% TO 9.9 MILLION VISITS, 2 MILLION PATIENTS UNIQUE INDIVIDUAL PATIENTS RECEIVED CARE FORBEHAVIORAL HEALTH, OUT OF A TOTAL PATIENT POPULATION OF 27 MILLION NATIONWIDE. FINALLY, YOU’LL HEAR ON ANOTHER PANEL I THINKLATER TODAY ABOUT SUBSTANCE MAYBE TOMORROW, SUBSTANCE USE DISORDERS.SAME THING, A Increment IN THE CARE FOR SUBSTANCEUSE DISORDERS AND FEDERALLY QUALIFIED HEALTH CENTERS YEAR OVER YEAR, EXPANDING AND GROWINGAS WE GO FORWARD. SO A LOT OF REACH, A Lot OF OPPORTUNITY INTHE FQHCs, THE INFRASTRUCTURE IS THERE, AND WE NEED TO FIND WAYS TO SCALE THIS AND INCORPORATETHIS TO REACH MORE PATIENTS WHO ARE BEING TRAFFICKED. THANK YOU SO MUCH.[ APPLAUSE] >> Good morning. I HOPE EVERYBODY HAS WARMED UP BY NOW. I Required TO STAND HERE BECAUSE I COULDN’TSEE THE PROMPT FROM OVER THERE BUT I CAN’T SEE IT FROM HERE EITHER.[ LAUGHTER] OKAY. GOOD MORNING, EVERYBODY. I’M SO Aroused THAT I HAVE SOME FINANCIALDISCLOSURES AND I’M NOT GOING TO READ THEM ALL OFF BUT I REALLY WANT TO RECOGNIZE THESENIOR LEADERSHIP AT BRIGHAM AND WOMEN’S HOSPITAL FOR REALLY GIVING ME THE OPPORTUNITY SIX YEARSAGO TO CREATE A CLINIC THAT WOULD IN FACT BE INNOVATIVE AND CREATIVE IN THINKING ABOUTHOW WE TAKE CARE OF ALL PEOPLE WHO ARE IMPACTED BY INTENTIONAL VIOLENCE.SO I’M PROUD TO SAY THAT THE CARE CLINIC WHICHIS OVERSEEN BY PATIENT ADVISORS DOES SEE PATIENTS WITH DOMESTIC AND SEXUAL VIOLENCE, HUMAN TRAFFICKINGAND OTHER FORMS OF COMMUNITY VIOLENCE. SO, I Also Require TO SHARE THAT I DO WORK ATBRIGHAM AND WOMEN’S HOSPITAL IN BOSTON, 750 BED HOSPITAL. “Were having” 150 OUTPATIENT PRACTICES, OVER 1400 Specialists, 3500 Harbours, 650 SOCIAL WORKERS. WE ARE BIG.AND I HAVE BEEN TASKED ALONG WITH OTHER COLLEAGUES OF MINE TO THINK ABOUT HOW WE BECOME A TRAUMAINFORMED CARE INSTITUTION. I WANT TO ACKNOWLEDGE DR. CAROL WARSHAW FOR MENTORSHIP OF ME TO LEARNABOUT TRAUMA INFORMED AND BE A LEADER IN THAT REALM. I’M GOING TO GROUND US ALL HERE BY SAYINGWHAT I ALWAYS SAY WHEN I GIVE THIS TALK, WE ASK PATIENTS TO EMBRACE SYSTEMS, PARTICULARLYHEALTHCARE SYSTEM WHEN WE KNOW INHERENTLY WE HAVE PROBLEMS.IS THAT FAIR ENOUGH? I SHOULD Attend MORE Tops NODDING. Privilege? SO I’VE SOMETIMES TAKEN MYSELF AND WALKEDMYSELF THROUGH THE SYSTEM TO SEE WHAT IT WOULD FEEL LIKE. WE CALL THEM TRACERS, RIGHT, IN THE HEALTHCARE SYSTEM. I WOULD Spur MANY OF US TO THINK ABOUTDOING TRACERS BECAUSE IT REALLY OPENS OUR EYES TO THE JOURNEY THAT AT LEAST IN MY LINEOF WORK AS A HEALTHCARE PROVIDER THAT MY PATIENTS EXPERIENCE.SO, WHAT IS TRAUMA? AND I CAN SAY THAT WHEN WE FIRST STARTED OURTRAUMA INFORMED STEERING COMMITTEE SIX YEARS AGO THIS SLIDE LOOKED DIFFERENT. WE’VE EVOLVED IN OUR THINKING, PARTNERED WITHMANY OF YOU HERE, WE HAVE WORKED WITH SAMHSA AND OTHER FOLKS THAT THINK ALIKE. AND IN THAT REALM, WE HAVE DEFINED TRAUMAAS FAR AS WHAT YOU SEE IN FRONT OF YOU. I Anticipate IN THE HEALTHCARE SYSTEM WHAT I’VELEARNED 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, STRUCTURALOPPRESSION, UNCONSCIOUS BIAS, AND PROUD TO BE AN INSTITUTION PUTTING POLICIES IN PLACEAND HOLDING PEOPLE ACCOUNTABLE.WE DEFINED RACISM AS TRAUMATIC. WE Make RACISM IS TRAUMA. AND[ APPLAUSE] THANK YOU.AND WE DEFINE IT AS A PREJUDICE OR DISCRIMINATION OR ANTAGONISM AGAINST SOMEONE OF A DIFFERENTRACE BASED ON THE BELIEF OUR OWN RACE IS SUPERIOR. IT TOOK US A WHILE TO LOOK AT ALL THE DIFFERENTDEFINITIONS OF RACISM AND FELT THAT ONE RESONATED WITH US. THE OTHER THING THAT I Recollect IS THAT WE’VELEARNED ON OUR JOURNEY IS THE INTERSECTION OF ALL OF THIS.AND SO I REALLY I KNOW WE’RE HERE TO CREATEA RESEARCH AGENDA AND DISCUSSION, I SAY LET’S DO IT ALL AND NOT SILO THE SERVICES. I Believe OF THE SAME NURSES, WHETHER A GREATINFRASTRUCTURE AND GREAT WORK NURSES HAVE DONE BUT IT WOULD BE GREAT IF THEY DID ALLKINDS OF TRAUMA. A GREAT INFRASTRUCTURE WITH KNOWLEDGE. WE’RE Visualize INTERSECTION OF ALL THESE DIFFERENTTYPES OF VIOLENCE. I Miss TO TAKE YOU ON THE JOURNEY WITH THESIX GUIDING PRINCIPLES. I ASSUME EVERYBODY IS FAMILIAR WITH THIS, CORRECT? WHAT I WANT TO DO WITH YOU IS LOOK AT THESESIX 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 JOURNEYWITH ME. WHEN A PATIENT COMES TO US, LET’S SAY IT’SA PATIENT WHO HAS BEEN TRAFFICKED, ALSO HAS A HIGH ACE SCORE, WHO MIGHT BE SUBJECTED TORACISM AND MICRO AGGRESSION AND THAT PATIENT IS COMING TO BE SEEN BY US, BROUGHT BY LAWENFORCEMENT.THE PATIENT MIGHT BE THINKING WHAT ARE THEYGOING ASK ME? DO I HAVE TO TELL THEM EVERYTHING? WILL I REACT TO THE QUESTIONS AND WILL THEYTHINK 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 MEFROM 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 MEDICALRECORD. WILL IT BE THERE FOREVER OR I CAN TAKE ITOUT? WHO IS GOING TO SEE TO THAT FOR ME? I HOPE I FEEL SAFE. I HOPE THAT I CAN SHARE. I To be expected that I’LL FEEL SUPPORTED. I HOPE I CAN FIND MY VOICE. I HOPE I CAN BE Affirmed FOR WHO I AMAND WHERE I AM, REGARDLESS OF WHO MY RACE, MY CULTURE, MY GENDER, OR MY ETHNICITY. WHEN I FIRST STARTED LEARNING ABOUT THE SIXGUIDING PRINCIPLES I WAS REALLY THINKING WITH THE TRIPLE AIM OF MY ORGANIZATION, PROVIDERSAND THEIR PATIENT RELATIONSHIPS, AND PEER TO PEER.NOW I’M THINKING ABOUT IT THROUGH HOW DOESTHIS LOOK FOR THOSE THAT WE SERVE? AND I Study THOSE PRINCIPLES STILL APPLY. SO ONE OF THE THINGS THAT I’VE BEEN TASKEDWITH AT THE HOSPITAL IS, ANNIE, WHAT IS THIS TRAUMA INFORMED CARE STUFF ABOUT, WHAT’S ITGOING 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 LOOKINGAT? I’VE BEEN THINKING ABOUT THAT FOR THE LASTFEW YEARS. I’M GOING TO SHOW YOU A LITTLE BIT OF PILOTDATA THAT WE CAN SCALE IT UP WITH SOME BETTER FUNDING. I HAVE NOTICED IN MY CLINIC ENGAGEMENT WITHPATIENTS THAT I’VE NOT SEEN BEFORE. I Certainly Thoughts IT’S BECAUSE OF THE USING THET.I.C. Approach. I KNOW IF I CAN GO BACK TO MY HOSPITAL ANDI 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 THATARE IN OUR UNDERRESOURCED OR LOW RESOURCED COMMUNITIES IS AT LEAST TWO DAYS LONGER. IF I CAN Abridge THAT, IF I CAN Search AT HEALTHOUTCOMES, SOME OF THE ONES THAT WE’RE LOOKING AT, IF WE CAN THINK ABOUT SOME INNOVATIVEAND CREATIVE WAYS TO DO THIS WORK. LET ME SHARE A COUPLE THINGS WE LEARNED. WE’VE ALREADY HEARD THIS TODAY THAT DISCLOSUREIS NOT THE GOAL, RIGHT? I HAVE TO SAY THAT THERE’S NOT A DAY THATGOES BY AT WORK THAT I DON’T GET A CALL FROM A PRACTITIONERS THAT SAYS I KNOW SHE’S BEINGTRAFFICKED BUT SHE WON’T TELL ME.ONE STUDY IS LOOKING AT TIERED SCREENING. I’VE BEEN PRACTICING AT THE BEDSIDE FOR ALONG TIME AND I’VE BEEN TAUGHT TO GET THE DETAILS, UNDERSTAND THE FULL BREADTH OF WHATIT 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. “ve been told”, HAS ANYTHING OCCURRED IN YOUR LIFETHAT 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 BEINGHIT, KICKED OR PUNCHED, IS SOMETHING PUSHING OR SHOVING YOU, STEPPED AWAY FROM THAT COMPLETELYBECAUSE I THINK IN A TIERED SCREENING SYSTEM WE SHOULD ALL FIGURE OUT WHAT ARE YOU GOINGTO 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 now A PILOT STUDY ONTHIS AT MY WORK. I Visualize THE BROAD SCREENING GETS INFORMATION, NICE WARM HANDOVER TO YOUR NEXT PERSON, LET THEM DO THE SAFETY AND RISK ASSESSMENT, OURADVOCATES, SOCIAL WORKERS ARE GOOD AT THAT. SAVE THE DETAILS FOR GOING INTO THERAPY ANDWHOEVER IS GOING TO WORK WITH YOU ON THAT. BUT I DO THINK IN HEALTH CARE WE’RE ASKINGWAY TOO MANY QUESTIONS. THE OTHER THING WE’RE FOCUSING ON IN OUR TRAUMAASSESSMENT INQUIRY IS LOOKING AT STRENGTH. WHEN YOU COME TO MY CLINIC ONE OF THE FIRSTQUESTIONS WE Ask, “ve been told” SOMETHING YOU’RE PROUD OF. TELL ME WHAT FEELS GOOD IN YOUR LIFE. AND MOST “Theyre saying”, WELL, YOU GET THOSE PATIENTSTHAT CAN’T FIND ANYTHING, THAT’S NOT WHAT I’M Knowing. I’M See 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 OURSYSTEM. PRE POST DESIGN EFFORTS, TRAINING ON TRAUMAINFORMED CARE, THAT SLIDE I Registered YOU, WHAT IS TRAUMA. WE TALK ABOUT ALL THAT. TRAFFICKING AND RACISM AND UNCONSCIOUS BIAS. A COUPLE QUICK FINDINGS ON THIS. YOU CAN Accompany THAT HOW KNOWLEDGEABLE ARE YOUABOUT TRAUMA INFORMED CARE WENT UP. WE FELT 30% IN THE ROOM RAISED THEIR HANDAND 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 TIMEI’M HAPPY TO TALK WITH ANY OF YOU THROUGHOUT THE NEXT DAY AND A HALF, IS WHEN ASKED THEQUESTION, THE VERY LAST QUESTION, To the realization of the rights, HOW IMPORTANT DO YOU FEEL IT IS TO BE AWAREOF WAYS THAT YOUR OWN LIFE EXPERIENCES NEGATIVELY IMPACT YOUR ABILITY TO DELIVER CARE, SO THISIS WHERE WE GET HEALTH CARE, PEOPLE’S OWN HISTORIES OF TRAUMA, AND VERY INTERESTINGLYTHOSE 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 INSTITUTIONKNOW MONEY AND EFFICIENCY ARE AT THE TOP OF OUR AGENDA THESE DAYS. I Demanded TO TAKE A LOOK AT TEN CASES, THEINTERVENTION HERE WAS MY CLINIC. THE TEN CASES, TEN CASES THAT CAME INTO BEINGREFERRED TO THE CLINIC BY PRESENTING TO THE EMERGENCY DEPARTMENT WITH SOME SORT OF INTERPERSONALTYPE OF VIOLENCE. AS YOU CAN SEE FROM THE BLUE IS MEDICAL MODELOF CARE. AND THEN THE GRAY IS THE TRAUMA INFORMED. IN THESE TEN CASES, THIS IS WHERE WE’LL SCALEUP WITH OUR ACL MEDICAID POPULATION, EMERGENCY ROOM VISITS CAME DOWN SIGNIFICANTLY, THATOUR ENGAGEMENT WITH PRIMARY CARE WENT SKY HIGH BECAUSE WE USED TRAUMA INFORMED CAREPRIMARY CARE PROVIDERS.AND Business THAT CAN OFTEN HELP OUR PATIENTSWITH PAIN SUCH AS P.T. AND O.T. AND THINGS OF THAT SORT ALSO WENT UP. PEOPLE ENGAGED AND OUR LENGTH OF STAY DIDCOME DOWN. WE’LL BE SCALING THIS UP IN OUR ACL MEDICAIDPROJECT AND I’M EXCITED TO SEE WE MIGHT HAVE SOME RETURN ON THE DATA. SO, LASTLY, I Reflect I HAVE 30 SECONDS HERE, IN HEALTH CARE WE HAVE ACCESS TO A LOT OF DATA. I’VE BEEN LOOKING AT PRESS GANEY’S, HCAHPSAND DATA, WHAT ARE TRAUMA SENSITIVE OR TRAUMA CENTRIC. “Were having” DATA AND SHOULD WORK OFF DATA TO SEEWHERE IT’S APPLICABLE. I HAVE BEEN Ordained TO HAVE ENORMOUS INSTITUTIONALSUPPORT, AND I SAY I STAND BEFORE YOU, I STAND ON THE SHOULDERS OF AN AMAZING TEAM BACK ATTHE HOSPITAL THAT’S INTERDISCIPLINARY, LENSES ARE BROUGHT TO THE TOPIC. CHALLENGES WILL BE SHIFTING THE PARADIGM BUTI’M SEEING A SHIFT HAPPEN. WE NEED THAT LONG TERM FUNDING TO SORT OFMAKE SURE WE GET OUR METRICS RIGHT AND THEY CONTRIBUTE.AND THEN ONCE AGAIN SUSTAINABILITY. HOW ARE WE GOING TO MAKE THIS LAST ONCE WEKNOW WE’VE GOT A GOOD PRACTICE, WE TEND TO REGRESS TO THE MEAN AND I’M REALLY PROACTIVELYINTERESTED IN THINKING ABOUT SUSTAINABILITY AND TALKING TO MANY OF YOU THAT HAVE GOODPRACTICES. SO THANK YOU.[ APPLAUSE] >> I’M HOLLY GIBBS, I’M THE DIRECTOR OF THEDIGNITY HEALTH HUMAN TRAFFICKING RESPONSE PROGRAM. I’M EXCITED TO SHARE WITH YOU ABOUT ALL THATWE’VE DONE AT DIGNITY HEALTH. DIGNITY HEALTH IS ONE OF THE LARGEST HEALTHCARESYSTEMS IN THE NATION. AND WE LAUNCHED A Platform IN 2014 CALLED HUMANTRAFFICKING RESPONSE PROGRAM WHERE WE INTENDED TO EDUCATE STAFF ABOUT HUMAN TRAFFICKING, TRAUMA INFORMED CARE, IMPLEMENT POLICIES AND PROCEDURES TO IDENTIFY POTENTIAL VICTIMS ANDPROVIDE LONG TERM CARE AND Assistance. I’M GOING TO JUMP AHEAD A COUPLE SLIDES TOTHE PEARR TOOL. WHEN I FIRST STARTED AT DIGNITY HEALTH, MYGOAL WAS TO CREATE A POLICY OR PROCEDURE TO ADVISE STAFF ON HOW TO RESPOND IF A POTENTIALVICTIM COMES INTO THE HEALTHCARE FACILITY, OKAY? AND WHEN WE STARTED THIS PROCESS, WE WERETHINKING 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 WITHTHEM. AND SO OUR FIRST VICTIM RESPONSE PROCEDURESORT OF LOOKED LIKE, OKAY, IF YOU IDENTIFY THE RED FLAGS AT TRIAGE, THEN THESE ARE ALLTHE STEPS THAT YOU’RE GOING TO TAKE AND YOU’RE GOING TO GET THEM IN A ROOM, ASK THEM SOMEQUESTIONS BY THEMSELVES, IN A ROOM BY THEMSELVES, ASK QUESTIONS AND CONNECT THEM WITH Source. WHAT WE LEARNED OVER THREE YEARS, WE’VE HADMANY, MANY CASES OF PATIENTS PRESENTING WITH SIGNS OF LABOR OR SEX TRAFFICKING, IN THEFIRST YEAR ALONE WE HAD OVER 31 Instances. Patients ARE Introducing ON A SPECTRUM, RIGHT? “Were having” PATIENTS PRESENTING WHO ARE AT RISKOF LABOR OR SEX TRAFFICKING VICTIMIZATION, PATIENTS WHO ARE PRESENTING IN A WAY WE SUSPECTTHEY MAY BE ACTIVELY BEING GROOMED BY A LABOR OR SEX TRAFFICKER, AND THEN WE HAD PATIENTSPRESENTING WHO WE SUSPECTED TO BE VICTIMS BUT EITHER WERE OPEN TO QUESTIONS OR NOT OPENTO QUESTIONS.EITHER WERE READY FOR ASSISTANCE OR WEREN’TREADY FOR ASSISTANCE. AND THEN WE WERE SEEING SURVIVORS WHO WEREDAYS, WEEKS, MONTHS, EVEN YEARS PAST THE EXPERIENCE. SO WITH THIS HUGE SPECTRUM, THIS SIMPLIFIEDALGORITHM ON IDENTIFYING RED FLAGS AND TRIAGE, FOLLOWING THIS PROCESS, IT DIDN’T MAKE SENSE. SO, WE WERE LOOKING FOR A TRAUMA INFORMEDAPPROACH TO OFFERING VICTIM ASSISTANCE TO A PATIENT. THIS IS WHAT WE CAME UP WITH. THE PEARR TOOL. WE PARTNERED WITH HEAL TRAFFICKING AND PACIFICSURVIVOR CENTER TO COME UP WITH THESE STEPS.SO THE PEARR TOOL IS BASED ON A UNIVERSALEDUCATION APPROACH WHICH IS ALIGNED WITH BOTH A PATIENT CENTERED APPROACH AND TRAUMA INFORMEDAPPROACH. UNIVERSAL EDUCATION APPROACH MEANS YOU’REEDUCATING THE PATIENT ABOUT VARIOUS FORMS OF ABUSE, NEGLECT AND VIOLENCE IN THIS SITUATION, Trafficking in human beings. AND THEN OFFERING ASSISTANCE. IF THAT’S WHAT SEEMS TO BE APPROPRIATE. STEPS ARE PROVIDE PRIVACY, EDUCATE THE PERSONABOUT Trafficking in human beings OR ANY FORM OF VIOLENCE, IF APPROPRIATE MOVE INTO ASKING ABOUT SAFETYCONCERNS, ESPECIALLY IN A HOSPITAL SETTING AND THE PERSON IS PRESENTING WITH RED FLAGS. ASK ABOUT SAFETY CONCERNS AND OFFER TO CONNECTTHEM WITH COMMUNITY AGENCIES. THE LAST STEP IS TO RESPECT AND RESPOND, REGARDLESSOF 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 REPORTINGSAFETY 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 MANDATEDREPORTING, IT’S MEANT TO COINCIDE. WHEN IT COMES TO MANDATED REPORTING A LOTOF TIMES THE PATIENT IS LEFT OUT OF THE EQUATION. WE NEED A PRIVATE CONVERSATION WITH THE PATIENTBECAUSE CHANCES ARE THE PATIENT DOESN’T EVEN KNOW WHAT Trafficking in human beings IS, RIGHT? SO YOU MAY HAVE JUST EDUCATED THEM ON WHAT’SHAPPENING TO THEM MAY BE THIS THING CALLED Trafficking in human beings. THAT MAY BE THE FIRST STEP FOR THEM. THEY ARE Extending TO SIT AND PROCESS THAT ANDMAYBE SEEK ASSISTANCE FROM YOU OR FROM SOMEONE ELSE AFTER THE VISIT. SO IN ORDER TO IMPLEMENT THIS PROCEDURE ATDIGNITY HEALTH, WE WANTED TO EDUCATE STAFF ABOUT TRAUMA. THIS IS A Role OF OUR PROCESS, OUR ENDEAVORTO BE A TRAUMA INFORMED ORGANIZATION. SO I’M WORKING WITH SEVERAL STAKEHOLDERS TODEVELOP A SORT OF CRASH COURSE MODULE ON TRAUMA INFORMED CARE.I JUST WANT TO INTRODUCE THE TOPIC TO HEALTHCARESTAFF, INCLUDING EFFECTS OF TRAUMA, DIFFERENT TYPES OF TRAUMA, AND HOW IT CAN AFFECT THEIRCOMMUNITIES AND THEMSELVES, THE HEALTHCARE PROFESSIONALS PROVIDING THE CARE AND Work. AND SO WE INCLUDE THIS SLIDE FROM THIS CENTERFOR HEALTH CARE STRATEGIES AT THE END OF EDUCATIONAL MODULE DESCRIBING WHAT TRAUMA IS, AND ALLTHE WAYS THAT IT CAN HAVE LONG TERM AND WIDESPREAD IMPACT.THIS SORT OF DESCRIBES A PATIENT CENTEREDAPPROACH, PATIENT EMPOWERMENT, CHOICE, COLLABORATION, SAFETY AND TRUSTWORTHINESS. I Belief A Mas OF HEALTHCARE ORGANIZATIONSARE CORE VALUES, INCLUDING DIGNITY HEALTH’S CORE VALUES ARE WRITTEN IN A WAY WHERE THEPATIENT IS AT THE CENTER. WE ARE ALL TRYING TO PROVIDE A PATIENT CENTEREDAPPROACH. BUT IF YOU’RE EDUCATED ON TRAUMA, I THINKTHAT CAN ONLY BETTER YOUR ABILITY TO PROVIDE A PATIENT CENTERED APPROACH. THEN YOU CAN UNDERSTAND WHY YOUR PATIENT MAYNOT WANT TO ACCEPT Service 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 YOUCHANGE YOUR PATIENT CARE INTERACTIONS TO REFLECT THESE CORE PRINCIPLES OF A TRAUMA INFORMEDAND PATIENT CENTERED APPROACH. WE’RE ASKING THIS AT DIGNITY HEALTH FROM THETOP DOWN AND BOTTOM UP. WE’RE TRYING TO MAKE CHANGES ON AN ORGANIZATIONALLEVEL, WHERE WE’RE CURRENTLY DESIGNING A SYSTEM POLICY TO ADVISE STAFF ON HOW TO RESPOND TOA PATIENT WHO WE SUSPECT TO BE A VICTIM OF ANY KIND OF VIOLENCE, INCLUDING Trafficking in human beings, THAT POLICY WILL INCLUDE THE PEARR TOOL.LET ME SHARE SOME EXAMPLES HOW LEADERS INOUR 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’SHOSPITAL TO PROVIDE HEALTHCARE Business TO RESIDENTS RECEIVING CARE AT THE PHOENIX DREAMCENTER. THIS INCLUDES SURVIVORS OF HUMAN TRAFFICKING. SO ST. JOSEPH’S WAS PROVIDING OR IS PROVIDING THEOB/ GYN Work TO WOMEN AND GIRLS ON CAMPUS, MEANING AT PHOENIX DREAM CENTER. SO TWO TAKEAWAYS FROM THIS, COMMUNITY PARTNERSHIPAND MEETING THE PATIENTS WHERE THEY ARE AT. SO FOR SOME, COMING INTO A HOSPITAL SETTINGON ARE LEAVING THE DOORS OF THE CLINIC MAY BE SCARY. SO OUR PROVIDERS ARE GOING TO THE PHOENIXDREAM CENTER AND PROVIDING Work TO THE GIRLS. THE BARROW NEUROLOGICAL INSTITUTE ALSO INPHOENIX BEGAN WITH THE TRAUMATIC BRAIN INJURY PROGRAM.WORKERS WERE TRAINED TO USE A TOOL CALLEDHELPS. WE KNOW THE STRONG CONNECTION BETWEEN DOMESTICVIOLENCE AND SEX TRAFFICKING, AND SO WE’RE ALSO SEEING SURVIVORS OF HUMAN TRAFFICKINGTHROUGH THIS PROGRAM. Inhabitants ARE OFFERED A VISIT TO THE BARROWINSTITUTE IF THEY SCREEN POSITIVE FOR THIS TOOL. EACH PATIENT SEES A NEUROLOGIST AND THE CLINICSOCIAL WORKER. ALL PATIENT CARE IS FREE OF CHARGE REGARDLESSOF 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 Service AND SO ON. THE LEAD OF THIS PROGRAM, DR. JAVIER CARDENAS IS HERE TODAY. I Urge YOU TO CONNECT WITH HIM IF YOU’DLIKE TO LEARN MORE. THE THIRD PROGRAM IS MERCY FAMILY HEALTH CENTERSHUMAN TRAFFICKING MEDICAL SAFE HAVEN IN SACRAMENTO. THE MERCY FAMILY HEALTH SERVICE IS A FAMILYMEDICINE RESIDENCY TRAINING FACILITY.IT’S BASED ON THE CAMPUS OF OUR METHODISTHOSPITAL IN SACRAMENTO. SO MERCY FAMILY HEALTH CENTER OFFERS COMPREHENSIVESERVICES FOR PATIENTS OF ALL AGES INCLUDING PRIMARY AND URGENT CARE, X RAYS, LAB, ACCESSTO HOSPITAL SPECIALISTS. DEVELOPING THE SAFE HAVEN AND SO THE SERVICESARE BEING PROVIDED THROUGH THIS PROGRAM, SURVIVORS OF BOTH LABOR AND SEX TRAFFICKING CAN RECEIVETHE SAME QUALITY CARE THAT ALL PATIENTS ARE RECEIVING AT THE MERCY FAMILY HEALTH CENTER.THE PHYSICIANS AND STAFF WHO ARE WORKING WITHPATIENTS THROUGH THIS PROGRAM WERE ALL EDUCATED ON Trafficking in human beings AND TRAUMA INFORMED CAREAND HERE ARE SOME EXAMPLES OF SOME CHANGES THAT WERE MADE FOR THESE PATIENTS. SO THERE’S A DIRECT PHONE LINE TO THE CLINICALCOORDINATOR, AND A PATIENT ADVOCATE, WHO IS TRAINED BY THE LOCAL DOMESTIC VIOLENCE SHELTERWHO PROVIDES SERVICES TO SURVIVORS OF Trafficking in human beings. WE Furnish Lengthened PATIENT CARE VISITS TO PATIENTSTHROUGH 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 OURSTAFF COMMUNICATE WITH PATIENTS BY TEXT MESSAGE SO WE’RE MEETING THE PATIENTS WHERE THEY AREAT. IF THEIR PREFERRED FORM OF COMMUNICATION ISTEXT THAT’S WHAT WE SET UP WITH THEM. SO I’M GOING TO READ A QUOTE FROM A SURVIVORWHO IS A PATIENT AT THE MEDICAL SAFE HAVEN, JENNA MACKAY.JENNA IS A SURVIVOR AND ADVOCATE AND SHE’STHE 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 RECOGNIZETHE SIGNS. AND FINALLY TREAT ME. UNTIL I SAW DR. CHAMBERS, I HAD NEVER GOTTEN THE CARE I NEEDED. HE Formed A SAFE PLACE TO SHARE MY STORYAND DISCOMFORT AND TREATED ME WITH COMPASSION. I FELT RESPECTED BY A DOCTOR, AND FINALLYFEEL THAT I WILL HAVE A SAFE PLACE TO RECEIVE CARE THAT I NEVER RECEIVED BEFORE. HIS PROFESSIONALISM AND KINDNESS TRULY ISWHAT DIGNITY HEALTH TALKS ABOUT. I CAN Tread 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 MEASURESYFAMILY HEALTH CENTER, RON IS ALSO HERE TODAY. RON RECOGNIZED THAT BY ESTABLISHING SUCH APROGRAM RESIDENT PHYSICIANS WITH NOT ONLY LEARN ABOUT Trafficking in human beings AND TRAUMA INFORMEDCARE IN A HANDS ON MANNER BUT UPON GRADUATION WOULD TAKE THE KNOWLEDGE WITH THEM TO OTHERPRACTICES, WE’RE CREATING A PHYSICIAN WORKFORCE ACROSS THE COUNTRY WHO ARE READY TO SERVEVICTIMS OF VIOLENCE AND ANYONE WHO IS IN A POSITION OF VULNERABILITY, INCLUDING SURVIVORSOF HUMAN TRAFFICKING.THANK YOU.[ APPLAUSE] >> HELLO. I’M RENEE ORNELAS, AND I’M SHOULD I HAVE WAITEDFOR SOMEBODY TO INTRODUCE ME? OKAY. ALL RIGHT. SORRY ABOUT THAT. I’M A CHILD ABUSE PEDIATRICIAN BY TRAININGAND BY BOARD CERTIFICATION. AND I GUESS I DO THIS. WHERE I Direct NOW IS THE TS HOOTSOO MEDICALCENTER. I WORKED IN ALBUQUERQUE FOR 28 YEARS AND STARTEDA 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 DEVELOPMENTALLYDISABLED OR DISABLED IN SOME WAY THAT THIS KIND OF APPROACH MADE SENSE. I WAS Banked TO COME TO NAVAJO NATION ANDSTART A PROGRAM FOR THEM. THAT’S WHERE I’VE BEEN FOR THE LAST THREEYEARS. AND I’M GOING TO TALK TO YOU ABOUT CULTURALCOMPETENCY, WHICH I Certainly HAVEN’T Frame IN THAT KIND OF A FRAMEWORK, BUT I HOPE I HAVESOME THINGS I CAN OFFER YOU.THIS IS THE DEFINITION OF CULTURAL COMPETENCY. DEVELOPED BY THE HEALTH AND HUMAN SERVICESDEPARTMENT, OFFICE OF MINORITY HEALTH. AND IT’S A VERY NECESSARILY BROAD DEFINITION. AND IT Embraces MANY Phase OF A PERSON’SBACKGROUND AND ENVIRONMENT, EXPERIENCES, EVERYTHING THAT GOES TO FORM THAT PARTICULAR PERSON’SCULTURE, AND INCLUDES THINGS SUCH AS AGE, ORIENTATION, SEXUAL ORIENTATION, RURAL VERSUSURBAN, ALL THOSE THINGS THAT GO INTO CREATING WHO EACH OF US ARE.ALL OF OUR EXPERIENCES ALTOGETHER. I Miss TO START BY SHOWING YOU A PICTURE OFWHERE 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 MEACCORDING TO THE CHAPTER HOUSE THERE’S 6000 PEOPLE IN THE FORT DEFIANCE AREA. IF YOU LOOK AT THIS, WHAT I WANTED TO SHOWWAS 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 THESEBUILDINGS THAT ARE WHITE, THAT’S THE HOSPITAL. AND THEN ALL AROUND YOU’LL NOTICE ARE BEAUTIFULHILLS, RED ROCKS, Blue air. I Made THIS Word-painting FROM THE TOP OF THE HILLBEHIND THE HOUSING WHERE I WALK MY DOGS. AS YOU CAN SEE, IT’S A VERY RURAL SETTING. AND ACCESS TO MEDICAL Assistance Is unlikely to. AND IT’S DIFFICULT BECAUSE OF MANY DIFFERENTKINDS OF FACTORS WHICH I LEARNED ONCE I MOVED THERE, I’M FORTUNATE TO LIVE IN THE HOUSINGI DO. I CAN Amble ACROSS THE STREET TO WORK, I HAVEA CAR.AND EVEN THINGS THAT YOU MIGHT TAKE FOR GRANTEDLIKE MEDICAL TRANSPORT IS VERY COMPLICATED THERE, IN THAT YOU CAN ONLY GET HELP, THEMEDICAL TRANSPORT, WHICH ACCESS PAYS FOR, WHICH IS A Use OF MEDICAID, IF YOU ARE GOINGTO AN APPOINTMENT AT A MEDICALLY AFFILIATED PLACE, A HOSPITAL, AND IF AND THIS REQUIRESA REFERRAL FROM YOUR PRIMARY CARE PHYSICIAN TO A CASE WORKER, WHO THEN SETS IT UP WITHA DRIVER AND YOUR PATIENT. AND ALL OF THIS MIGHT SEEM NOT SO DIFFICULTBUT WHEN YOU HAVE LIMITATIONS OF COMMUNICATIONS SUCH AS CELL PHONE SERVICE, WHERE YOU CAN’TEVEN GET SERVICE UNLESS YOU DRIVE FIVE MILES TO THE ROAD, IT BECOMES VERY DIFFICULT.AND JUST SIMPLE OBSTACLE OF NOT BEING ABLETO LEAVE A MESSAGE, NOT BEING ABLE TO PICK UP A MESSAGE, THINGS LIKE THAT, CAN REALLYINTERFERE WITH THE HEALTH CARE. SO, IT’S BUT IT’S A BEAUTIFUL PLACE. AND I Adore LIVING THERE AND I LOVE WORKINGTHERE. AND I’M LEARNING HOW TO DO A BETTER JOB BYPAYING ATTENTION. SO MY ADVICE IN TERMS OF PAYING ATTENTIONIS THAT BEFORE YOU GO TO WORK IN AN AREA, SUCH AS THIS, WHICH FOR ME WAS THE NAVAJONATION I THOUGHT I UNDERSTOOD THE WORK I DO, CHILD SEXUAL ABUSE PRIMARILY, AND I STARTEDSEEING ADULTS ONCE I GOT OUT THERE, SEXUAL ASSAULT. SO, I THOUGHT I UNDERSTOOD THE AREA BECAUSEI HAD BEEN IN ALBUQUERQUE FOR 28 YEARS, TWO AND A HALF HOURS AWAY, HAD SEEN PEOPLE FROMTHE PUEBLOS AND APACHE RESERVATION AND NAVAJO, BUT IT’S A TOTALLY DIFFERENT EXPERIENCE ONCEYOU GO AND LIVE THERE. AND IT’S IMPORTANT TO BE OPEN. AND LEARN ABOUT THE CULTURE, LANGUAGE, TRADITIONSAND CUSTOMS.THIS CAN HAPPEN IN A VARIETY OF WAYS. I HAVE THE WHAT IS IT IN THE NAVAJO LANGUAGE? IT Time WENT OUT OF MY HEAD. BUT IT’S LIKE, YOU KNOW, THE PROGRAM THATYOU PLUG IN AND CAN LEARN FRENCH AND SPANISH AND ALL OF THAT. SOMEBODY SHOUTS OUT THE NAME I’LL WHAT ISIT? YEAH, ROSETTA STONE. I HAVE ROSETTA STONE ON NAVAJO LANGUAGE. AND I HAVE TO SAY IT’S STILL IN THE BOX ANDI 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 YOUCAN ABOUT THESE DIFFERENT ESPECIALLY TRADITIONS AND CUSTOMS, MAKE YOUR SPACE CULTURALLY WELCOMINGAND FAMILIAR. YOU HAVE TO BE HUMBLE AND HONEST ABOUT YOURSTATUS AS A NEWBY TO THE AREA. IF YOU DON’T DO THESE THREE THINGS PEOPLEWILL NOT USE YOUR Works AND YOU WON’T HAVE ANY CREDIBILITY.SO, YOU HAVE TO GO GENTLY AND OPENLY INTOAREAS THAT YOU’VE PROBABLY NEVER NAVIGATED BEFORE. THE THING THAT I HAVE ON MY SIDE IS A CHILDABUSE PEDIATRICIAN, I WAS PROVIDING A SERVICE THAT HADN’T EXISTED ON THE NAVAJO NATION BEFOREAND THERE WAS A HUGE NEED. AND I GOT TO DO THE THING I’M REALLY GOODAT, THAT I Cherish, TAKING CARE OF KIDS AND ADULTS, NOW ADULTS, WHO HAVE BEEN EITHER SEXUALLYABUSED OR SEXUALLY ASSAULTED. I LEARNED ABOUT IHS 638, FORTUNATE TO WORKFOR A 638, WHICH IS A HOSPITAL WHICH HAS FORMED A BOARD, IN MY CASE THE FORT DEFIANCE INDIANHOSPITAL 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 THISBOARD. THEY DECIDE WHAT KINDS OF SERVICES ARE GOINGTO 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 PROGRAMOF ITS KIND ON THE NATION, AND MAYBE EVEN NATIONALLY. IF SOMEBODY KNOWS OF SOMETHING ELSE, PLEASELET ME KNOW. I WAS USE TO 24 HOUR HOTLINES, KNOWING WHODID THIS WORK, FINDING IT OUT, MAKING CONNECTIONS, GETTING CARDS FROM PEOPLE.THE KIND OF Business OUR PATIENTS NEED ARESPREAD 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’SWHERE THE ADVOCATES WHEN WE HAVE DOMESTIC VIOLENCE, CO OCCURRING PROBLEM, THAT’S WHOWE CALL, ALTHEA IS THE PERSON WHO COMES, AND TALKS TO OUR PATIENTS ABOUT RESTRAINING ORDERS, HELPS THEM GET TO A SHELTER. WE USE Service IN CHINLEY, I’LL SAY THE WORDADABE, 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 Edition OF DOMESTICVIOLENCE, AND THEY TRAVELED AN HOUR AND A HALF ONCE A WEEK ONE WAY TO COME AND DO THOSESERVICES BUT THEY WERE GREAT. THEIR MONEY RAN OUT SO WE LOST THAT SERVICE. IN OTHER WORDS WHEN YOU GO INTO THESE COMMUNITIES, THERE ARE Business THERE. THEY ARE NOT YOU Time HAVE TO ASK, INTRODUCEYOURSELF, GO TO MEETINGS, PASS OUT BROCHURES AND YOUR CARD, CONNECT WITH OTHER PEOPLE INTHE AREA DOING THIS KIND OF WORK. YOU’LL FIND TRIBAL AND LOCAL ORGANIZATIONSWHO PROVIDE SERVICES, AND A VERY IMPORTANT THING WHERE I WORKED ON NAVAJO NATION, PARTNERINGWITH TRADITIONAL HEALERS WHICH ARE A PART OF THE HOSPITAL STAFF, WE’RE BLESSED TO HAVETHAT.AND I WILL SHOW YOU, THIS IS A Image OFSOME OF THE THINGS THAT ARE AVAILABLE AT TS HOOTSOO MEDICAL CENTER. SO IN LINE WITH THE TRADITIONAL HEALING ASPECTOF PROVIDING SERVICES, I See A REFERRAL JUST LIKE YOU WOULD FOR DENTAL OR P.T. OR ANY OF THOSE THINGS, MAKE A REFERRAL FORA TRADITIONAL HEALER. THE Assistance, IF THEY ARE A VICTIM OF CRIMEAND MADE A POLICE REPORT, CRIME VICTIMS COMMISSION HAS A FORM YOU CAN FILL OUT AND THEY WILLPAY FOR THOSE Assistance FOR TRADITIONAL HEALING BECAUSE LIKE ANYTHING ELSE, THERE’S GOINGTO BE SOME KIND OF FEE.AND THEY WILL BE IN COMMUNICATION WITH THEFAMILY. WHAT YOU SEE, OH, THERE’S SOME THINGS. YEAH, I Really WANT TO Noted, DO YOU SEETHIS? WHAT YOU SEE ON THE RIGHT HAND SIDE OF THISSLIDE 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, ANDYOU CAN SEE HIS PARENTS IN THE BACKGROUND. THERE’S THIS BEAUTIFUL MURAL IN THE BACK THATTHIS SITS AGAINST. THAT’S WHAT THE AREA LOOKS LIKE. SO THINGS LIKE THAT ARE REALLY IMPORTANT INTERMS 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 THISSLIDE IS WHERE THE TRADITIONAL Work OCCUR. THIS IS ON YOU CAN SEE IN THE BACKGROUND THERE’SA WALL. THAT’S Role OF THE THE HOGON IS ON THE HOSPITALPROPERTY, ON THE VERY NORTH END OF THE HOSPITAL PROPERTY. THERE’S ANOTHER HOGON WITHIN THE HOSPITALWALLS IN THE ADOLESCENT CARE UNIT WHICH IS A PROGRAM, 10 WEEK PROGRAM FOR ADOLESCENTS1 3 17 YEARS OF AGE, TWO SWEAT LODGES ALSO FOR THE PATIENTS, ONE FOR THE MALES, ONE FORTHE FEMALES. IT’S A Curriculum THAT HAS SCHOOL, BUT THE MOSTIMPORTANT ASPECT IS SCHOOLING IN LANGUAGE, TRADITION, THEIR CLANS, THEIR CULTURE, ANDIT’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 THENAVAJO CULTURE IS THAT OF BALANCE, THAT HEALTH COMES FROM BEING BALANCED. AND THIS IS ONE EFFORT TO HELP THOSE TEENAGERSBECOME 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 CULPOSCOPETO DO OUR EXAMINATIONS, THE MURAL REPRESENTS NORTH, SOUTH, EAST AND WEST. I HAVE Shadows IN A CORNER, A RAINBOW OVERTHE DOOR, THE ROOM NEXT DOOR IS WHAT WE CALL THE FAMILY OFFICE, FAMILY ROOM, AND THAT’SALSO WHERE THE ADVOCATE SITS, AND THAT’S THE MURALS OF RED ROCKS AND PLATEAUS, AND Swine, 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 ENVIRONMENTTHAT FEELS WELCOMING TO THE INDIVIDUALS WHO COME TO US FOR SERVICES. WHEN I FIRST GOT THERE I ASKED ONE OF THETRADITIONAL 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 SHOULDWEAR 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 EASTL.A ., WENT TO ALBUQUERQUE, I HAVE STILL A LOT TO LEARN.THE MOST IMPORTANT THING IS TO I THINK CONNECTWITH 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 LONGARE YOU GOING TO BE HERE FOR. I “ve told them”, THE LAST PLACE I WORKED, I WORKEDFOR 28 YEARS, I DON’T KNOW. I MEAN, AT FIRST I THOUGHT, OH MY GOD, DIDI JUST I DID, I Ratified A CONTRACT FOR A Year. BUT WHAT IT IS Derives from the fact that YOU MAY BE DEALINGI WAS DEALING WITH A GROUP OF PEOPLE, A COMMUNITY WHERE PEOPLE COME AND GO, PROVIDERS COME ANDGO. AND IT’S IMPOSSIBLE TO FORM A BOND, IF THEYGET TO KNOW YOU, YOUR FAMILY, ALL THE PROBLEMS YOU HAVE, AND THEN THE NEXT TIME YOU GO TOA 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 PERSPECTIVEOF 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 COMPLETELYFAIR QUESTION TO ASK.AND IT’S SOMETHING THAT “Were having” TO THINK ABOUTAS WE GO INTO THESE COMMUNITIES, WHAT IS YOUR COMMITMENT TO THAT COMMUNITY? CAN YOU PUT THAT ACROSS? BE HONEST ABOUT WHAT YOUR INVESTMENT IS ANDWHY 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 Suppose WE DO WANT TO TAKE SOME TIME FORQUESTIONS. WE DID GET SOME QUESTIONS FOR EACH OF OURPANEL 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 QUESTIONSTHAT “Were having” 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 TOBE SURVIVOR INFORMED? AND HOW IS THAT IMPORTANT TO TRAUMA INFORMEDPRACTICE? >> SO LET’S Test THIS OUT. IT’S GOOD, IT’S WORKING. I’M GOING TO READ A DEFINITION THAT WAS DEVELOPEDIN 2017 BY THE Trafficking in human beings 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 INTENTIONALLEADERSHIP AND INPUT FROM VICTIMS AND SURVIVORS TO ENSURE THAT THE PROGRAM OR PRODUCT ACCURATELYREPRESENTS THE NEEDS, INTERESTS, AND Feelings OF THE TARGET VICTIM POPULATION. BEING SURVIVOR INFORMED IS KEY TO A TRAUMAINFORMED APPROACH BECAUSE NO ONE KNOWS OUR TRAUMA BETTER THAN SURVIVORS.SO FOR THOSE WHO DON’T KNOW ME, I’M A SURVIVOROF Trafficking in human beings. I WAS TRAFFICKED FOR COMMERCIAL SEX WHEN IWAS 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 Create A DIFFERENT KIND OF EXPERTISETO THE TABLE. AS A SURVIVOR, AS A VICTIM, AT 14, I HAD TOGO THROUGH AN EMERGENCY DEPARTMENT. I HAD TO BE Estimated BY AN OB/ GYN PHYSICIAN, ASSESSED BY AN EMERGENCY PSYCHIATRIST. THIS WAS ALL AFTER BEING INTERROGATED BY SIXDIFFERENT MALE DETECTIVES WHO WERE ALL TREATING ME IN A VERY NON VICTIM CENTERED, NON TRAUMAINFORMED MANNER. I BRING THESE EXPERIENCES TO THE TABLE, ANDWE’RE ALWAYS ACTIVELY REACHING OUT TO OTHER SURVIVORS OF SEX AND LABOR TRAFFICKING TOINFORM WHAT WE ARE DOING AT DIGNITY HEALTH.MOST RECENTLY, WE WENT TO DESIGN VICTIM OUTREACHPOSTERS, SO WE PROVIDED FUNDING TO THE NATIONAL SURVIVOR NETWORK TO HELP US CREATE POSTERSWHERE THE LANGUAGE AND THE IMAGERY IS SURVIVOR INFORMED. IF I MAY, I Miss TO ENCOURAGE ANYONE HEREWORKING 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 SURVIVORPUBLICLY, AND YOU WOULD LIKE TO SHARE THAT YOU’RE HERE AND AVAILABLE AS A CONSULTANT, IF YOU WOULDN’T MIND STANDING. THANK YOU.[ APPLAUSE] >> Thanks for coming, HOLLY, FOR SHARING. THAT WAS INCREDIBLY MOVING. OKAY. OUR NEXT QUESTION IS FOR DR. CHANG. WHAT WOULD IT TAKE TO SCALE THE INTEGRATIONOF PRIMARY CARE AND BEHAVIORAL HEALTH SERVICE FORCEFULLY INTO THE HRSA FEDERALLY QUALIFIEDHEALTH CENTER PROGRAM? >> THANKS.HELLO. THANKS FOR THAT QUESTION. I ACTUALLY PLANTED THAT ONE. SO, YOU KNOW, I Anticipate YOU HEARD FROM THE PRESENTATIONINFRASTRUCTURE IS THERE. WE HAVE THE PIECES. WE HAVE CAPACITY BUILDING. WE HAVE THE SOAR TRAINING. “Were having” WAYS THAT PEOPLE ARE LEARNING ABOUTHUMAN TRAFFICKING AND Issue, WE HAVE DIFFERENT SCREENING TOOLS AND ASSESSMENTS, WE HAVE THEPERSONNEL, RIGHT? WE HAVE SPECIALTY MENTAL HEALTH, “Were having” SOCIALWORKERS, “Were having” CASE MANAGERS AND CARE COORDINATION IN HEALTH CENTERS In different regions of the country. THIS IS ALL DONE IN PIECEMEAL FASHION, EVERYHEALTH CENTER IS TRYING TO FIGURE OUT HOW TO MAKE THIS DONE, PROBABLY DR. CHAMBERS AT DIGNITY AND YOUR CLINIC, HOW AREWE GOING TO MAKE THE LEADERSHIP WORK ON THE ORGANIZATIONAL LEVEL AND COUNTY LEVEL ANDSTATEWIDE LEVEL. SO OF COURSE THIS COMES DOWN TO A COORDINATEDFUNDING STREAM, WAYS TO MEASURE SUCCESS AND STANDARD MEASURES FOR SUCCESS, DIFFERENT DEMONSTRATIONPROJECT MONIES TO TRY TO SEE HOW WOULD THIS WORK IN DIFFERENT COMMUNITIES.YOU’VE SEEN ONE HEALTH CENTER, YOU’VE SEENONE HEALTH CENTER, RIGHT? EVERYONE IS DIFFERENT. Each community, EVERY UNDERSERVED POPULATIONIS DIFFERENT. THAT’S ONE PIECE OF IT. ON MY SECOND TO THE LAST SLIDE, THE FOURTHTO THE LAST SLIDE, SORRY, I TALKED ABOUT REMOVING POLICY BARRIERS AND REIMBURSEMENT, SAME DAYBILLING 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 CANONLY BILL OUT FOR ONE Call. SO Derives from the fact that PATIENT CENTERED WHEN I SAY COMEBACK TOMORROW AND YOU CAN SEE THE COUNSELOR? IT’S NOT, RIGHT? SO POLICY BARRIERS AROUND SHARING OF INFORMATIONBETWEEN MENTAL HEALTH AND PRIMARY CARE AND HIPAA BARRIERS ARE SOME POLICY BARRIERS. AND WORKFORCE TRAINING, “Were having” TO DO CAPACITYBUILDING AMONGST DIFFERENT SECTORS FOR THIS ISSUE AS WELL AS TRAUMA, AS WELL AS BEHAVIORALHEALTH CARE. >> GREAT. Thanks for coming. OKAY. CONTINUING, THIS QUESTION IS FOR DR.ORNELAS. WHAT ARE THE ISSUES THAT ARISE WHEN SCHOOLAGE CHILDREN OR ADOLESCENTS ARE IDENTIFIED AND ATTEMPTED TO INTEGRATE THEM IN FAMILYAND 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 JUSTMET, THE THREE OF US ARE CHILD ABUSE PEDIATRICIANS. I WOULD SAY ANY ONE OF US IF YOU WANT TO KNOWMORE YOU COULD SPEAK TO US ABOUT YOUR SPECIFIC QUESTION. BUT THE PROBLEM IS THAT IN MY EXPERIENCE OURRESPONSE HASN’T BEEN GOOD. IT HAS NOT BEEN OF THE QUALITY THAT YOU MIGHTSEE 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 WILLWHO DON’T KNOW ABOUT SITTING DOWN TO EAT DINNER, DON’T KNOW ABOUT GOING TO SLEEP AT 8: 00 ATNIGHT.THEY DON’T KNOW WHAT IT’S LIKE TO SIT IN ACLASSROOM AND LEARN THEIR MULTIPLICATION TABLES. A Mas OF THESE ARE THE SAME KINDS OF ISSUES. SO SOMEBODY WHO YOU HAVE A 14 YEAR OLD WHOHAS BEEN TAKING CARE OF HER LITTLE BROTHERS AND SISTERS, COUSINS AND THE OTHER SIBLINGSOF THE OTHER PEOPLE IN THE HOUSEHOLD, AND NOW YOU EXPECT HER TO ACT LIKE A NINTH GRADER, FRESHMAN IN HIGH SCHOOL, THEY ARE Disappearing TO THINK ALL THAT IS REALLY DUMB. AND, YOU KNOW, THEY ARE Use TO HANGING OUTWITH 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 AREMEANT FOR KIDS WHO HAVE HAD A MORE NORMAL UPBRINGING. SO, I Thoughts WHATEVER IT IS THAT WE DECIDETO DO, AND THERE ARE PROGRAMS OUT THERE, THERE’S MANY Matter THAT COME UP BECAUSE THEY CAN’TBECAUSE THERE’S DIFFERENT ISSUES BECAUSE THEY ARE MINORS, AND THEY HAVE RIGHTS, EVEN ASMINORS, ADDRESSING A VERY COMPLICATED SET OF CONCERNS FOR SOMEBODY WHO DOESN’T HAVETHE 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 Conceive WE HAVE TO GO CAREFULLY INTO IT, AND CONSIDER EACH INDIVIDUAL TEENAGER AND WHAT IT IS THEY WANT OUT OF THE PROGRAMS THATWE’RE PUTTING TOGETHER FOR THEM. >> GREAT. OKAY. I’M GOING TO ASK A QUESTION OF DR. LEWIS O’CONNOR, A QUESTION ON A NOTE CARDAND ANOTHER QUESTION THAT GO TOGETHER. ONE OF THE QUESTIONS WHAT ARE WAYS WE CAN PUSH OURSELVES FURTHER? YOU Determined SOME GAPS, SOME WAYS WOMEN’SAND BRIGHAM HOSPITAL IN BOSTON BUT HOW DO WE EXPLORE THAT AREA AND PUSH OURSELVES ALITTLE BIT FURTHER, THAT ALIGNS WITH THE QUESTION THAT CAME IN ON A NOTE CARD WHICH IS REALLYLOOKING AT QUANTIFYING EFFICACY AND PATIENT OUTCOMES. SO IF YOU CAN SORT OF INTEGRATE THOSE TWOQUESTIONS INTO HOW YOU SEE THAT, THAT WOULD BE HELPFUL. >> OKAY. THE FIRST QUESTION I THINK IS REALLY EASYTO ANSWER IN SOME WAYS THAT WE HAVE TO HOLD OURSELVES ACCOUNTABLE, AND BE COMMITTED TOLIFELONG 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 GOINGTO CHANGE.SO EVERYBODY WILL COMPLAIN ABOUT SORT OF THEDELIVERY OF CARE TO ANY OF THE POPULATIONS WE’RE TALKING ABOUT TODAY BUT NOBODY WANTSTO DO ANYTHING DIFFERENT. SO I Envision THAT’S ONE. THEN THE OTHER THING IS THOSE OF US THAT AREON OUR JOURNEY LEARNING AND EMBRACING THE CONCEPTS OF T.I.C. IS TO Certainly MODEL THAT. YOU KNOW, SO WHEN SOMEONE PRESENTS TO ME APATIENT 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 MODELTHAT 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 QUANTIFYINGEFFICACY IN PATIENT OUTCOMES. THE TOUGH QUESTION. >> YEAH, SO I MEAN I’M REALLY THINKING A LOTABOUT THE METRICS AND ANYBODY INTERESTED IN THE RESEARCH AND THE METRICS PLEASE LET’SDIALOGUE WHILE WE’RE HERE. I Suppose IT HAS TO BE WHAT’S MEANINGFUL TOPATIENTS.I USED TO THINK THAT THE A1c Is in fact 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 Exactly HAD A DUAL DIAGNOSIS PATIENT THAT ISNOW SITTING IN A DUAL DIAGNOSIS PROGRAM THAT WAITED IN OUR E.R. FOR THREE DAYS BEFORE SHECOULD GET THAT BED. AND WHEN I CONNECTED WITH HER YESTERDAY WHATSHE 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 PEOPLEHERE, 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, THATTHEY HAVE DONE SO MUCH FOR ME IN MY THINKING AND MY PERSONAL GROWTH, HOW I Picture ABOUTWHAT MY CLINIC SHOULD Was 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 WITHTHIS, THEY LIKED CARE. THERE’S A MILLION Maintenance CLINICS. BUT OURS IS DIFFERENT, COORDINATED APPROACHTO RESILIENCE AND EMPOWERMENT. >> THE QUESTION FOR HOLLY, PEOPLE WOULD LIKE TO KNOWHOW TO GET A COPY OF THE PEARR TOOL. >> DOWNLOAD IT FOR FREE FROM THE WEBSITE, DIGNITYHEALTH.ORG/ Trafficking in human beings RESPONSE. THERE’S AN EXTENDED DESCRIPTION, THE ACTUALTOOL IS AVAILABLE FOR DOWNLOAD THERE. YOU CAN LEARN ABOUT OUR OTHER PROGRAMS THROUGHOUR WEBSITE AS WELL. >> ARE THERE QUESTIONS FROM THE AUDIENCE ANYONEWANTS TO COME TO THE MIC. WE’LL TAKE ONE OR TWO QUESTIONS FROM THE AUDIENCEAND BE TONE TO BREAK. >> BILLING FOR NAVAJO IF IT’S NOT A REPORT, DOES 638 COME INTO PLAY, HOW DO YOU PAY FOR THE Work? >> LET’S SEE. THEY ARE PART OF MENTAL HEALTH SERVICES. THE ONLY WAY I’VE EVER SEEN THAT IT GETS PAIDFOR IS THROUGH WHAT THEY CALL ACCESS, WHICH IS MEDICAID PROGRAM.BUT, WHAT A Mint OF THE THING ABOUT THE TRADITIONALHEALERS THAT “Were having” AT THE HOSPITAL, THE INDIVIDUAL FAMILIES OFTENTIMES HAVE THEIROWN 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 HAVEAT 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 Time Demand TO SAY, HERE’S AN ASSUMPTIONI MADE WHEN I FIRST MOVED OUT THERE. THERE’S MORMONS, CATHOLICS, BORN AGAIN CHRISTIAN, EVANGELICAL, THERE’S A Bunch OF MISSIONARY WORK THAT WAS DONE IN THE VARIOUS NATIONS ACROSSTHE INDIGENOUS NATIONS, ACROSS THE COUNTRY. AND THE EFFECTS ARE THERE. AND SO TO ASSUME THAT SOMEBODY IDENTIFIESWITH TRADITIONAL Business Derives from the fact that. IT’S AN ASSUMPTION, SOMETHING THAT YOU HAVETO ASK AS YOU’RE PROVIDING Business, IS THIS SOMETHING THAT WOULD BE HELPFUL TO YOU BECAUSEWE HAVE THIS, “Were having” THIS.SO, THAT’S PROBABLY THE FIRST STEP. >> GREAT. NEXT QUESTION. >> YES, HI, I’M CHANDIA. I WOULD LIKE TO TALK ABOUT VICTIMS AND SURVIVORSHERE. ALL THE Performances, I DIDN’T HEAR SPECIFICTALK ABOUT PEOPLE THAT CAME FROM OUTSIDE THE UNITED Commonwealth, AND GOT TREATMENT, THE BESTTREATMENT That have already been. AND THEY ARE NOW I Obtain OUT THAT THE VICTIMSDIDN’T Do THE BEST TREATMENT THAT THEY NEED BECAUSE OF LANGUAGE, CULTURAL, YOU MENTIONEDABOUT HOW THEY WANT TO BE TREATED AS PEOPLE THAT DON’T KNOW ABOUT THE SYSTEM HERE. SO I WORK WITH SOME MEDICAL PRACTITIONERSIN NEW YORK, AND WE FIND OUT SO I HELP THEM TO DEVELOP HOW TO Working in collaboration with MULTI FOREIGNERSHERE, PEOPLE FROM AFRICA, PEOPLE FROM ASIA, PEOPLE FROM, YOU KNOW, THEY HAVE A DIFFERENTTHING HOW MEDICAL PRACTITIONERS CAN APPROACH THEM.IT’S DIFFICULT. DID YOU DEVELOP THAT PIPELINE AND IF YOU CANSHARE WITH US IT WOULD BE GOOD SO I CAN LEARN MORE ABOUT FROM YOUR PROFESSIONAL PERSPECTIVESINCE I HAVE MINE, AND I Working in collaboration 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 PATIENTCARE OVERALL FOR DIFFERENT FOR PATIENTS WHO ARE FROM DIFFERENT COUNTRIES OR SPEAK DIFFERENTLANGUAGES AND CULTURE. WE’RE MANDATED BY LAW TO HAVE A BOARD OF DIRECTORSTHAT IS 51% PATIENTS OR Useds OF THE Structure. SO AT ASIAN HEALTH Service WE HAVE BOARDMEMBERS WHO IN THE PAST HAVE SPOKEN KOREAN, TAGALOG, CHINESE OR VIETNAMESE, WE BRING INTERPRETERSFOR THEM WHEN THEY DO THEIR GOVERNANCE BOARD MEETINGS, SO THAT’S ONE LEVEL OF SORT OF MAKINGSURE THAT THE PATIENT’S VOICE IS HEARD.THE SECOND THING WE’VE DONE OPERATIONALLYIS DO A LOT OF AT OUR MEETINGS, ALL STAFF MEETINGS, WE DO A LOT OF HISTORY, TEACHINGABOUT 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 GENOCIDEAND THE CONFLICT, WHERE PEOPLE WERE COMING FROM AND WHAT DOES THAT MEAN HERE IN THE UNITEDSTATES WHEN THEY EMIGRATE OR RECEIVE REFUGEE STATUS. WE’RE DOING A Batch OF PROGRAMMING THAT’S NOTNECESSARILY MEDICALLY RELATED BUT IT IS ABOUT THE CONTEXT IN WHICH OUR PATIENTS COME TOHEALTH CARE TO ACCESS HEALTH CARE.SO WE ADDRESS INTERGENERATIONAL TRAUMAS ANDTHINGS LIKE THAT. YOU KNOW, WHEN I Study ABOUT HUMAN TRAFFICKING, IT’S MORE BROADLY IN THE CONTEXT OF PRIMARY CARE AND PATIENT CARE. SO THINKING ABOUT THE SOCIAL, HISTORICAL CULTURALASPECTS OF PATIENTS IS IMPORTANT AND FAMILY CONTEXT AND WE ALSO HAVE INTERPRETERS. >> I Crave TO ADD ONE THING. IF YOU REALLY LOOK AT GUIDING PRINCIPLES OFT.I.C ., THE AND APPLY THOSE AT ORGANIZATIONAL LEVEL AS WELL, CULTURAL, HISTORICAL, GENDERACKNOWLEDGMENT, VOICE, CHOICE, EMPOWERMENT, SAFETY, WHAT DOES THAT LOOK LIKE? I FIND THAT THOSE PRINCIPLES ARE GROUNDINGIN THE WORK AS WE THINK ABOUT IT .>> I THINK THIS WILL BE OUR LAST QUESTIONFROM THE AUDIENCE. >> SO AS A SURVIVOR ONE OF THE THINGS I THINKABOUT, A COUPLE PEOPLE MENTIONED CODING, INCLUDING INFORMATION ACROSS HEALTHCARE PROVIDERS SOTHEY ARE ON THE SAME PAGE, I Imagine THAT’S Truly important, MY CONCERN IS FOR SURVIVORSAND 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 COMPANIESARE GOING TO RESPOND. OFTENTIMES THERE CAN BE NEGATIVE CONSEQUENCESTO THAT. SO WHAT ARE THE CONSIDERATIONS THAT WE HAVEOR THAT ARE BEING TALKED ABOUT OR NEED TO BE TALKED ABOUT IN ORDER TO INCLUDE THAT ANDMAKE SURE THAT WE’RE BEING AWARE OF HOW THOSE THINGS CAN ACTUALLY HAVE NEGATIVE IMPACTSWHILE STILL TRYING TO MOVE FORWARD POSITIVELY? >> YEAH, DR. LEWIS O’CONNOR? >> THE ELECTRONIC HEALTH RECORD GOT WAY INFRONT OF US, WE’RE Approval 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 MEDICALRECORD? IF IT’S REALLY SENSITIVE WHAT YOU’RE WRITINGAND IF YOU THINK IT’S GOING TO BE A TENDER TOPIC FOR SOMEBODY, YOU’VE GOT TO WORK WITHYOUR EHR TO SEGMENT IT, TO PROTECT IT, TO BREAK THE GLASS FOUR TIMES BEFORE YOU OPENIT. BUT AGAIN I Guess THE PATIENTS NEED TO BEINCLUDED IN US MAKING POLICIES AND PROCEDURES. >> GREAT. OKAY. WELL, WE HAVE REALLY BEEN REWARDED WITH AWONDERFUL PANEL THIS MORNING. JUST A COUPLE CONCEPTS I PULLED OUT AND WE’LLBRING THIS FIRST PANEL TO A CLOSE. I Study WE’VE HEARD A LOT ABOUT CYCLICAL VERSUSLINEAR IN SYSTEMS. WE’VE HEARD SO MUCH ABOUT THE IMPORTANCE OFPATIENT AND SURVIVOR ENGAGEMENT. THEY ARE THE Experts. HEALTH PRACTITIONERS MAY HAVE FANCY DEGREESBUT WE AREN’T THE EXPERTS IN THIS SPACE. I LEARNED SOMETHING NEW ABOUT REFERRAL TOSPIRITUAL HEALING REALLY THINKING ABOUT CULTURAL COMPETENCE, INTEGRATING INTO THAT SYSTEMSOF CARE.WE HEARD ABOUT MEASUREMENT. WE’RE NEVER GOING TO HAVE ALL THE MEASUREMENTAND DATA ISSUES RESOLVED BUT WE STILL NEED TO KEEP WORKING ON THEM AND GET THOSE INTOSYSTEMS WHERE WE’RE MEASURING WHAT WE NEED TO MEASURE FOR THE RIGHT REASONS TO IMPROVEOUTCOMES. AND THEN I THINK ONE OF THE LAST THINGS IHEARD THAT I LIKED, ONE OF OUR PANEL MEMBERS SAID HEALTH COMES FROM BEING IN A BALANCEDWORLD, 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 Parish Act, WE WANT TO SEE ADAY WHEN THERE IS NO TRAFFICKING. SO IT DOES TAKE EVERYONE TO GET THERE. AND I Time WOULD LIKE TO CLOSE ALSO WITH SORTOF A PERSONAL COMMENT. AS I WAS SITTING, WAITING FOR THE SYMPOSIUMTO 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, ANDSO THERE’S REALLY VERY FEW TIMES WHEN YOU’RE A FEDERAL WORKER WHEN YOU HAVE AN OPPORTUNITYTO REALLY HAVE ONE OF THESE TIMES, YOU’RE HUMBLED AND INSPIRED BY PEOPLE.AND THE CAUSE WE’RE ALL STRUGGLING AND FIGHTINGFOR 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 OURPANEL. Thanks for coming ALL FOR THE COURAGE YOU BRING, THESTORIES, 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 FROMSOME 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 Thanks for coming AGAIN TOOUR 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 ].

As found on YouTube

Add Comment