Developing Care Models for Patients Living with Trauma

By Luci deHaan

People who are high utilizers of healthcare services account for a small percentage of the patient population. They often have significant physical, behavioral and social needs and find it challenging to navigate our complex healthcare system. It is not uncommon for patients to have experienced deep trauma including various forms of violence, poverty and abuse which make it difficult for them to engage in their own care.

Social determinants of health drive more than 80 percent of health outcomes, yet up to 88 percent of the U.S. healthcare budget goes to providing medical services. As key factors that drive poor health are left unaddressed, patients become caught in the cycle of requiring more and more clinical care.

Bronx Partners for Healthy Communities (BPHC), SBH’s DSRIP Performing Provider System, is piloting several programs that look to bridge the gap between patients’ medical, social and emotional needs with a focus on those who have lived with trauma.

“DSRIP is moving us to redefine what health care means so that we look at the totality of our patients’ lives and recognize the many interrelated factors,” says Dr. J. Robin Moon, BPHC Senior Director of System Integration. “True health care is not just ‘sick care,’ but a deeply integrated approach that works with and complements medical care. It is whole-person care.”

One pilot, launched by the Fortune Society, provides transitional case management to people who are released from Rikers Island, are chronically ill and at high risk of substance use relapse. Fortune staff works directly with clients while they are still on Rikers to create a customized plan that links them to post-release health care and community-based support services.

According to Ronnald Harriotte, Fortune’s Transitional Specialist Coordinator, “Clients coming out of incarceration who have a history of addiction often need a specialized type of case management with focused medical and behavioral health services and coordinated community-based support. If those needs are unaddressed, the person is at risk of continuing the cycle of relapse, deteriorating health and the need for acute care.”

Care plans are personalized and can include an array of services like connection to a primary care provider, substance use treatment, specialists and pharmacies, and transportation to appointments. Fortune can help clients resolve insurance issues and identify organizations to help with needs like housing, legal assistance, etc. Harriotte says engagement has so far been positive with the 100 clients enrolled in the pilot.

A pilot, led by Services for the UnderServed (S:US), has introduced a variation of yoga, called “yoga for healing,” into the course of treatment with women at Starhill, its residential substance use treatment program in the Bronx. A recent evaluation found that 85 percent of residents had histories of traumatic events and 70 percent displayed symptoms of post-traumatic stress disorder. The program has been well received with a majority of residents reporting they have better awareness of their coping skills and are more open to participating in treatment, accepting help and engaging with peers. In its second year, the program is expanding to include the men at the Starhill shelter as well.

At its conclusion, residents’ physical health (hypertension and cardiovascular health) and mental health (trauma symptomology; depression and anxiety evaluated through Post-traumatic Diagnostic Scale, PHQ-9 and other tools) will be measured against pre-pilot assessments.

A third pilot through the Osborne Association is addressing patient trauma through programming that builds resilience and self-care among its clients and links them to primary care.

Osborne provides substance use treatment and a host of support programs to people and families involved with the criminal justice system. “Exposure to violence is a nearly universal experience among the people we serve,” says Michelle Howard, its director of Operations.

The main component of the pilot is the Social Resilience Model (SRM), a neuroscience-based approach to coping with stress, distress and trauma. SRM helps people learn how to understand, redirect and regulate the way the body reacts to stressors to reduce anxiety and impulsivity. SRM has been integrated into individual and group interactions with clients. Osborne also introduced two movement and meditative practices – yoga and Qigong – to its on-site programming.

Howard reports that as people become more focused on self- care, they are more accepting of being connected to primary care providers.

Adds Moon, “Programs like this speak to what we mean by ‘providing the right care at the right time and right place’ to benefit patients and the healthcare system.”