Nnhvip conf 2014 bmo c presentation v6

Linnea Ashley

National Training and Advocacy Manager, Youth ALIVE! Nicky MacCallum

Clinical Director, Youth ALIVE! Anne Marks

Executive Director, Youth ALIVE! Vincent Chong, MD

Surgery Resident, Highland Hospital/UCSF-East Bay John Rich, MD

Director, Center for Nonviolence and Social Justice Ted Corbin, MD

Medical Director, Healing Hurt People

Screening Tool for Awareness and

Relief of Trauma

Purpose of our trauma research project

Research design

Focus group results

Piloting & Survey results

What START looks like

Next steps

Q&A

Purpose of our trauma research project

Research design

Focus group results

Piloting & Survey results

What START looks like

Next steps

Q&A

Some people have symptoms from trauma

Those symptoms are often undiagnosed

Symptoms make people vulnerable to violent trauma

Young men of color are disproportionately exposed to violence and trauma

People See: What it is:

Hostility

Callousness/

coldness

Anger

Hyperarousal Numbing Reliving

Understand BMoC experiences with systems ◦ How and where do they seek care?

◦ What helped them heal from trauma?

Learn appropriate language to use/avoid

Create a trauma symptoms tool

Provide short but effective interventions

Goal: a practical application of Trauma-Informed Care

Even if you don’t have PTSD, trauma symptoms disrupt your life.

Create “aspirin” for the

daily aches and pains of trauma

Purpose of our trauma research project

Research design

Focus group results

Piloting & Survey results

What START looks like

Next steps

Q&A

Assembled/convened the research team and Advisory Board

Prepared a literature review

Conducted 4 focus groups with GSW survivors

69 structured survey and intervention pilot interviews with local young men of color

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

Youth ALIVE!

Alameda Health System / Highland Hospital

Center for Nonviolence and Social Justice

Consultants & volunteers

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

Advisors represented: Study population Public hospital system Private hospital system Children’s hospital Public health department Courts Probation School district Service provider Policy advocate Subject matter experts

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

Purpose: To summarize research related to the health challenges facing BMoC, where they seek care, and how they can better be served, specifically as it relates to their trauma symptoms.

Topics:

Portals of Care

PTSD

Screening Tools and Interventions

SBIRT

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

4 Focus Groups with:

18-25 year olds

Current/former clients (GSW survivors)

African-American and/or Latino

Topics:

Where they seek care

Who they trust to provide care

What support they would want after trauma

How they experience and talk about trauma symptoms

What interventions work for them

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

69 interviews with: 18-30 year olds African-American and/or Latino Snowball sample Survey: 2 versions each of screening

questions for 6 trauma symptoms Where and with whom they would

answer screening questions Pilot: How they experience and talk

about trauma symptoms What interventions work for them

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

6 screening questions:

Focus

Re-experiencing

Dissociation

Hyperarousal

Physical manifestations

Sleep issues

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

7 brief interventions:

Common symptoms of trauma Psychoeducation handout on Every day ways trauma is impactful

Belly breathing Calming/Grounding exercise

Domino Grounding exercise

Progressive relaxation Relaxation/Grounding exercise

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

Continued..

Hand massage Relaxation/Grounding exercise

B.E.T.T.E.R. Sleep Psychoeducation handout on healthy sleep hygiene practices

Safety or “S.O.S.” plan Booklet of self-care activities utilized to develop an individualized plan for symptom management.

Advisory

Board

Literature

review

Focus

Groups

Structured

Interviews

5

9

5

8

9

5

7

5

3

4 4

2 2

0

2

4

6

8

10

18 19 20 21 22 23 24 25 26 27 28 29 30

Age

Participant Age

African-

American,

48

Latino, 15

Mixed, 5

Racial Breakdown

Oakland Neighborhoods by Zip Codes

94603

= Areas with most participants

Purpose of our trauma research project

Research design

Focus group results

Piloting & Survey results

What START looks like

Next steps

Q&A

Larger Themes ◦ Provider-patient

misalignment of expectations

◦ Different provider characteristics i.e. “Children’s treats

you…” i.e. “Highland treats

you…” ◦ Nontraditional

providers i.e. Cannabis Clubs

◦ Issues of trust

◦ Manifestations of Trauma and Stress What patients need

to seek for help Coping mechanisms How young people

talk about stress

Re-experiencing ◦ Replay

◦ Surviving

◦ Scars

◦ Déjà vu

Avoidance ◦ Staying under

(the radar) ◦ Laying low

Hyperarousal ◦ Mental pain ◦ Insomnia ◦ Being on Ps

and Qs

Self medication (Smoking weed)

Disrupted sleeping patterns

Discomfort waiting in the same spot

“And I don’t gang-bang or anything like or have any enemies. That’s why I still living…I still live in the location where I got shot and it’s a trauma just passing by like every time. It’s crazy. I don’t even want to talk about it.”

“Sometime you do need a prescription and just by how you acting, how you look, the doctor would be like, ‘No, you need it because you wanna get high.’ I’m gonna get high if I need it. You haven't been knowin’ what I went through.”

“Let me holler at you, let me see your paperwork. How you feelin’? Good. Alright, bam. Throw it back out. Do whatever you gotta do.

Come back. “Oh, you still here” “Yeah, you haven't seen me.” “Ok. Let me see you.’ Bam, bam, bam. “Okay you cool. Come back in two- three weeks.”

Say what the fuck? (cont.)

They just write stuff on the paper. This what was wrong with you last time. This what’s wrong with you this time. This is getting better.

Okay. Bam. Two week check-up, see how you’re doing’. Come back and that’s it.

Ain’t nobody gonna come back because you didn’t do nothin’ while I was there.”

M4: We can talk to him, everyone, like in the slang or in our accents like how we is -- M3: Straightforward -- M4: And then he can still talk to us cool. Not like everybody else. Not like these guys came from somebody else. After listenin' to him, getting advice or stuff. I'm gonna help you out.

They never call you back or nothin'. You call at four shit and forget about you. All that. He don't. He just be, "Alright, I'm gonna try to do this.” And if not then he'll just give you a call back. "Oh, I can't do it today. Just give me two, three more days or somethin’ and I'll get back at ya'.”

Male3: 'Cause he cool. You ain't gotta be nobody different, man. You just be yourself. No matter if you bad, good, sick, green, purple, ugly, man. If you know how to talk, he understandin'. He gonna talk to you. If not, he's just gonna be like,"I can't help you."

Or he gonna tell you why he can't help you because this person is being a cat or this, this, this. He ain’t speakin' down to you he just said, "Well we can't do it because of this reason." If you can be the bigger person like okay, that's it, then when the next time maybe it be better for you.

Moderator: When you went back, what would you expect or would you want out of the doctors or the nurses who were helping you? M5: Shit, just to check me. Check me. Check my injury. Check it right M4: Do it faster, huh.

M5: Not faster, but take care of it. M4: Not to check it faster but take care of business faster. M5: Yeah.

Sometimes you do need a prescription and just by how you actin', how you look, the doctor would be like, "No, you need it because you wanna get high." I'm gonna get high if I need it. You haven’t been knowin what I went through. You seen it or I gotta get to know you. What do you gotta get to know me for? You already seen my record that’s all you need to know about me.

Shit, just tell them man, we was born to live. One day we gotta die. So today's your day, shit, you gotta die. There's nothin' you can do about it. If it's your day, it's your day. M1: For real.

M3: For real. If it is, it's gonna come how it's gonna come -- M4: That's how your destiny is M3: 'cause you kickin' it with us you gonna make your bed and lay in it in the same time. So if this what you doin' wrong, this is what's gonna come wrong.

P1: Because I’ll be up all night. Yeah.

P2: If you sleep during the day.

P1: If I take a nap during the day, I’ll be up. I ain’t going to sleep ‘til late.

P2: What’s strange is babies sleep all day and night, but as you grow older, you sleep, like you said, during the day. Nighttime is when you’re not gonna sleep.

P1: The effects. Effects. P2: It’s probably like when it just flashes in and out like every now and then. P1: Yeah. When you just have flashbacks and stuff… P2: Dreams.

Nightmares… ooh, I’ve been having nightmares… I have a lot of nightmares too. That ain’t no joke. Nightmares… they be causing you cold sweats.

Purpose of our trauma research project

Research design

Focus group results

Piloting & Survey results

What START looks like

Next steps

Q&A

No Symptoms,

3% 1 symptom, 6%

2 symptoms,

20%

3 symptoms,

17% 4 symptoms,

25%

5 symptoms, 9%

6 symptoms,

20%

Number of moderate to severe trauma symptoms

in study population

97% had at least one moderate trauma symptom

never

3%

rarely

26%

someti

mes

54%

often

17%

1. focus

never

12%

rarely

39%

someti

mes

27%

often

22%

3. dissociation

never

7%

rarely

32%

someti

mes

34%

often

27%

2. re-experiencing

never

10% rarely

10%

someti

mes

30%

often

50%

4. hyperarousal

never

23%

rarely

41%

someti

mes

27%

often

9%

5. physical

never

15%

rarely

17%

someti

mes

29%

often

39%

6. sleep

Trauma Screening Results

never

3%

rarely

26%

someti

mes

54%

often

17%

1. focus

never

12%

rarely

39%

someti

mes

27%

often

22%

3. dissociation

never

7%

rarely

32%

someti

mes

34%

often

27%

2. re-experiencing

never

10% rarely

10%

someti

mes

30%

often

50%

4. hyperarousal

never

23%

rarely

41%

someti

mes

27%

often

9%

5. physical

never

15%

rarely

17%

someti

mes

29%

often

39%

6. sleep

Trauma Screening Results

0 0 0 0 0

4 4

2

6 6

4

11

5 5

7

3

2 1

3 3 3

0 0 0 0 0 0

4

2

5

4

5

4

6

5

8 8

5

0 2

5

4

1 1 0

2

4

6

8

10

12

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Trauma Symptom Screening Scores

Version A # of responses Version B # of responses

Yes, no

matter

what

55%

Yes, if

they're

trying

to help

36%

No

9%

mentor

Yes, no

matter

what

29% Yes, if

they're

trying

to help

49%

No

22%

social worker

Yes, no

matter

what

33%

Yes, if

they're

trying

to help

56%

No

11%

psychiatrist

Yes, no

matter

what

40%

Yes, if

they're

trying

to help

41%

No

19%

counselor

Yes, no

matter

what

47%

Yes, if

they're

trying

to help

47%

No

6%

therapist Would you answer these questions if this person asked you?

Answer

1-on-1,

57%

Answer

alone,

14%

Don't

Know,

1%

Either,

23%

Not at

all, 3%

Would you prefer if someone asked you these questions, or to read and answer by yourself?

30%

37%

29%

60%

62%

57%

64%

54%

45%

46%

31%

30%

38%

32%

Domino

Hand Massage

Tensing

Breathing

Common

Symptoms

Sleep

Safety Plan

Was This Intervention Helpful?

a lot some-what

=96%

=95%

=92%

=91%

=75%

=84%

=82%

SOS Plan

Progressive Relaxation

a lot

64%

some

-

what

32%

not

at all

4%

SOS Plan

a lot

56%

some

-

what

38%

not

at all

6%

Sleep

a lot

60%

some

-

what

31%

not

at all

9%

Breathing

a lot

62%

some

-

what

31%

not at

all

7%

Common Symptoms

a lot

37%

some

-

what

45%

not

at all

18%

Hand Massage

a lot

30%

some

-what

54%

not at

all

16%

Domino

a lot

29%

some-

what

46%

not at

all

25%

Prog. Relaxation Was this relaxing/ useful/ helpful?

Yes

77%

No

16%

Maybe

7%

Domino

Yes

90%

No

6%

Maybe

4%

Hand Massage

Yes

78%

No

16%

Maybe

6%

Prog Relaxation

Yes

90%

No

4%

Maybe

6%

Breathing

Yes

99%

No

1%

SOS Plan

Would you feel comfortable doing this exercise again?

Purpose of our trauma research project

Research design

Focus group results

Piloting & Survey results

What START looks like

Next steps

Q&A

Screening Tool for Awareness and

Relief of Trauma

Universally applied:

Six-question screening questionnaire (2-3 minutes)

Brief psycho-education and a handout on common trauma symptoms (3-4 minutes)

Potentially applied, based on screening score:

Structured discussion of sleep hygiene tips and patient selection of next steps (3-5 minutes)

Short breathing/relaxation or hand massage/grounding exercise (2-4 minutes each)

Patient creation of a personalized stress reduction (S.O.S.) plan (10-18 minutes)

Referral to mental health assessment for PTSD

Each of the START interventions can be done discreetly at home

START kit materials provided free to patient

We are working with partners to create a START smartphone app

Purpose of our trauma research project

Research design

Focus group results

Piloting & Survey results

What START looks like

Next steps

Q&A

Disseminate completed research

Prepare START Kits – training and implementation materials ◦ Conduct trainings for others to use START ◦ Create smartphone app

Pilot START at multiple locations ◦ Health clinics ◦ Schools ◦ Juvenile justice ◦ HVIPs

If you are interested in participating in the expanded pilot please contact: