Upstream thinking at Klinic Community Health

CACHC Webinar

January 14, 2016

Linda Dawson Kiri Shafto

Overview

• Klinic (Then & Now)

• Upstream Thinking

• The Project

– Social Justice Roots– Social Justice Roots

– Decision support

– Trauma-informed?

• Next steps & Challenges

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Klinic (Then & Now)

Klinic – 1970s

• Takin’ it to the streets

• Student docs start seeing people on the street and in the park – sex, drugs and rock n’ rollrock n’ roll

• Move into the crypt (church basement)

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Klinic

Crisis

Response

Acute Medical

Care

Klinic – 2015

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Klinic Service Delivery

• Medical services – Community*

• Counseling services – City

• Crisis lines & education – Province

• Manitoba Trauma Information and • Manitoba Trauma Information and Education Centre – North America (www.trauma-informed.ca)

• Calm in the storm app – World

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Klinic Innovation

• Calm in the Storm - http://calminthestormapp.com/

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Upstream Thinking @ Klinic

“…community health centres face the

challenge of transferring knowledge of

trauma and the social determinants of health

into policy and practice” into policy and practice”

– Excerpt from Klinic’s application to PHAC

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Public Health Agency of Canadaand Community Health

What is the Canadian Public Health Service (CPHS)?• Created as part of the 2006 Avian and

Pandemic Influenza Preparedness Treasury Board Submission, intended to:

– Focus on surveillance (infectious/chronic), – Focus on surveillance (infectious/chronic),

EPR and health promotion

– Work on specific projects in jurisdictions

across Canada, for short-term (1-4year)

placements

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Who are the PHOs?

• Qualified public health employees, trained in epidemiology, policy analysis and nursing

• PHOs offer a variety of expertise:– Infectious disease– Chronic disease– Chronic disease– Vaccine preventable disease– Injury prevention– Health promotion– Public health policy– Environmental health

• Not involved with delivery of front-line patient care

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CPHS Accomplishments

14 –Active federal Public Health Officers (PHOs) across Canada

5 – Currently placed with northern and/or First Nations organizations First Nations organizations

63 –Different projects across Canada since 2006 (F/P/T/local and NGOs)

60 –Co-op students

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Innovative Partnership

Klinic & the Public Health Officer

• PHAC annual call for placements

• Klinic proposal

– Develop a strategy/framework to become a

trauma-informed organizationtrauma-informed organization

– Integrate knowledge of trauma and SDH into

policy, procedures, practices, and settings

– Share learnings

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Benefits of the partnership

• PHAC strengthens its public health capacity by building: – Workforce

– Infrastructure

– knowledge & networks– knowledge & networks

• Klinic– Time

– Naivety and Curiosity (new eyes)

– Deadline

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The Project

The Project…

1. Decision support – Develop and implement a decision support tool to inform program and policy development

2. Trauma-informed – Develop and 2. Trauma-informed – Develop and implement a strategy to guide Klinic as we become a trauma-informed organization

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Rooted in Social Justice

Position Papers

• Mark a commitment to Klinic’s social justice roots

• Encourages staff to speak with one voice

• Allows staff to speak on behalf of Klinic• Allows staff to speak on behalf of Klinic

• Protects staff who are speaking on behalf of Klinic

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Process

• Representatives from different program areas and the board

• Priorities Identified by:

– Individual staff members– Individual staff members

– Program area

– Current events

– Community

– Board

• Feedback sessions with staff and board21

Progress

• Refugee Health – Complete

• Access – Feedback

• Poverty – Feedback

• Trauma – Feedback • Trauma – Feedback

• Violence – Feedback

• Indigenous Health – First draft

• Sexual Exploitation – In progress

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Part One: Decision Support

Decision support tool

• Develop and implement a decision support tool to inform program and policy development that addresses:

o the social determinants of healtho the social determinants of health

o the root causes of disease

o community development

o concepts of trauma-informed practice

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Goals

• Develop a tool to use to evaluate how a proposed program or service fits with Klinic’s priorities

• Form the basis for future ongoing program • Form the basis for future ongoing program evaluation

• Build capacity among Klinic staff

• Expand to help evaluate existing programs

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Process

• Invited representatives from across program areas to act as advisory group

• Regular meetings to brainstorm, share knowledge, provide feedback to create knowledge, provide feedback to create decision support tool

• Participate in piloting tool

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Logic Model

Resources/Inputs Activities Outputs/Products Outcomes/Results

Decision-making support

tool that accurately

reflects the current

priorities of Klinic, staff

and clients, and the

community

Staff from each program

area and management

Materials and equipment

Information technology

Increased ability to quickly

and systematically assess

project

Collaborate with Increased staff

understanding of planning

Learn, brainstorm, and

provide feedback on the

components of the

decision-making support

tool

Information technology

and social media

Research/Best practices

Partnership with Public

Health Agency of Canada

Participate in a pilot test

of the tool

Provide a link to other

staff at Klinic for

additional input and

feedback

Collaborate with

representatives from

program areas across

Klinic

understanding of planning

process

Increased capacity for

evaluation

Presentation for

management team, the

board, staff describing the

tool and the process

Write-up of process to

share with other

organizations

As collaboration is an essential part of Trauma-Informed Practice, this collaborative process will strive to embrace principles of Trauma-

Informed Practice and will be guided in this effort by the Trauma experts on the advisory group.

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Schematic

Physical Mental

Social

Justice

Trauma-

Informed

Gender-

Based Community

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Physical Mental

Emotional

Community

Development

Klinic

History

Klinic

Individual

Health

Equity

Spiritual

Culture

Tool

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Part Two: Trauma-Informed

Trauma-Informed Strategy

• Develop and implement a strategy to guide Klinic as we become a trauma-informed organization

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Goals

• Develop a tool based on emerging literature and local experts in the field to guide Klinic in becoming a trauma-informed organizationinformed organization

• Share tool and learnings across the organization and externally

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WHAT IS TRAUMA?

Background

Trauma defined

• Defining trauma

– severe emotional shock and pain caused by

an extremely upsetting experience

(Cambridge dictionary)

– a deeply distressing or disturbing experience

(Oxford dictionary)

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What is Trauma?

“…out of control, frightening experience that

has disconnected us from all sense of

resourcefulness or safety or coping or resourcefulness or safety or coping or

love”.

- Tara Brach

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Types of trauma

1. Single incident trauma

2. Developmental trauma

3. Complex trauma

4. Intergenerational trauma4. Intergenerational trauma

5. Historical trauma

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Adverse Childhood Experiences Study

• Kaiser Permanente and Centers for Disease Control

• Over 17,000 participants (1995-1997)

– Mostly middle-class, employed, educated, – Mostly middle-class, employed, educated,

insured

• Link between childhood trauma and long-term health and social outcomes

http://www.cdc.gov/violenceprevention/acestudy/

http://www.research4children.com/data/documents/ACF1114.pdf

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WHAT IS TRAUMA-INFORMED?

Context

Trauma-informed defined

• Concept of service delivery influenced by understanding the impact that trauma mayhave on an individual’s life and development

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Trauma-Informed Services are…

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Trauma-Informed Organization

• Commitment to providing services in a manner that is welcoming and appropriate to the special needs of those affected by trauma

• Integrating an understanding of the impact of trauma and violence into the organization’s policies, procedures, and interactions.

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Trauma-Informed Staff

Communication

• Curiosity

• Vulnerability

• Listen compassionately

• Connect meaningfully

Self-care

• Burnout

• Emotional fatigue

• Mindfulness

• Self-compassion• Connect meaningfully

• Appreciate silence

• Tolerate uncertainty

• Develop mindful

presence

• See the patient as a

person

• Self-compassion

• Social supports

• Exercise

• Trauma exposure

response

• Eating and sleeping well

• Communities of practice

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Trauma-Informed Space?

• Calming and welcoming

– Waiting and treatment rooms have space

for people to move

– Confidential space available for intake– Confidential space available for intake

• The space inside the building is safe

– Common areas are well lit

– Bathrooms offer privacy

• The space around the building is safe

– Parking lot and sidewalks well lit

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Klinic’s space needs work!

• Cluttered

• Public washroom visible

• Harsh lighting• Harsh lighting

• Dying plant

• Utilitarian

• TMI!

Assessment tool

• Trauma-Informed Organizations

– policies and procedures

Plus:

• Trauma-Informed Staff • Trauma-Informed Staff

– individual practice

• Trauma-Informed Space

– environment

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3. TRAUMA-INFORMED ORGANIZATIONFor an organization to be trauma-informed, the commitment must be imbedded in the service delivery model, and must incorporate aspects of trauma-informed practices related to staff and space.

3.1 Overall Policy and Program Mandate

A commitment to trauma-informed practice may represent a shift in culture and values. This wide spread commitment to trauma-informed practice increases the liklihood that all people who come into this service setting, regardless of where/how they enter the system, will encounter services that are sensitive to the impact of trauma.

PhilosophyFully

achievedIn progress

Not

achieved

Not

applicableComments

The organization recognizes the value of trauma-informed practice

as part of its mandate.

The organization has a policy or position statement that includes a

commitment to trauma-informed principles and practices.

The policy/position statement identifies the relationship between

trauma and recovery.

The policy/position statement identifies the implications for service

access and design.access and design.

The policy/position statement is endorsed by leadership.

3.2 Policies and Procedures

The policies and procedures of the organization should reflect their commitment to trauma-informed practices and be based on available evidence.

OverallFully

achievedIn progress

Not

achieved

Not

applicableComments

The organization ensures that all current policies and protocols

are respectful, promote safety and flexibility, and are not hurtful or

harmful to the individual who has experienced trauma.

Privacy and confidentialityFully

achievedIn progress

Not

achieved

Not

applicableComments

There are established processes that support client awareness

and understanding of informed consent.

All staff and clients understand the informed consent process (e.g.

the extent and limits of confidentiality, what records are kept, and

where records are kept).

Next steps & Challenges

Piloting

• Decision support tool

– Started this week

• Trauma-informed checklist

– Starting next week– Starting next week

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Project Challenges

• Kiri’s time with Klinic is limited

• Information sharing

• Integrating Trauma Informed with SDOH?

• Defining physical and psychological • Defining physical and psychological trauma differently

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Project Summary

• What is Klinic left with when Kiri leaves?

– Staff understand the tool and the process

behind the tools

– Klinic Quality Lead is left with a structured – Klinic Quality Lead is left with a structured

evaluation plan

– Share information broadly

– Integrate Trauma Informed with SDOH into

one tool

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Linda DawsonDirector of Health Services

Klinic Community Health Centre (204) 784-4063

ldawson@klinic.mb.ca

Kiri ShaftoPublic Health Officer

Klinic Community Health CentrePublic Health Agency of Canada

204-784-4207 kshafto@klinic.mb.ca

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