developmental disabilities mental health and addiction

John R. Kasich, Governor Tracy J. Plouck, Director John L. Martin, Director

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Developmental Disabilities Mental Health and Addiction Services

What is Trauma?

Individual trauma results from an event, series of events, or a set of circumstances

that is experienced by an individual as physically or emotionally harmful or

threatening and that has lasting adverse effects on the individual’s functioning and

physical, social, emotional, or spiritual well-being

(SAMHSA)

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Prevalence of Trauma

Exposure to trauma is widespread

• Trauma can occur at any age • Trauma can affect individuals from all

walks of life

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What is Trauma?

The individual’s experience of these events or circumstances helps to determine whether it is a traumatic event. The long-lasting adverse effects on an individual are the result of the individual’s experience of the event or circumstance.

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Prevalence of Trauma

Exposure to trauma is especially common among individuals with mental illness, substance use disorders and developmental disabilities

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Trauma Affects…

Over one out of three females with mental health disorder; and About one out of five males with mental health disorder in Ohio

Source: Client Self-Reported Experiences of Trauma, SFY13, Ohio Behavioral Health Module

Trauma Affects Ohioans with Developmental Disabilities…

Ohio Department of Developmental Disabilities 2013 MUI Data

2 out of every 10 individuals with Developmental Disabilities experience trauma each year in Ohio

Individuals with Developmental Disabilities and Trauma

Increased risk for abuse as compared to the general population (Gil, 1970; Mahoney & Camilo, 1998; Ryan, 1994) • Over four times as likely to be victims of crime as

the nondisabled population (Sobsey, 1996)

• Two - ten times more likely to be sexually abused than those without disabilities (Westat Ind., 1993)

• Often experience rejection and loneliness (Pitonyak)

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Trauma Affects Ohioans with Developmental Disabilities…

According to the World Health Organization: Children with disabilities are 4 times more likely to be exposed to trauma than children without disabilities Adults with disabilities are 1 ½ times more likely to be exposed to trauma than adults without disabilities

Jones, et. al., 2013 (Children) Hughes, et. al., (Adults)

Interaction between DD and Trauma Bi-directional effects

• Abuse and neglect have profound influences on brain development. The more prolonged the abuse or neglect, the more likely it is that permanent brain damage will occur.

• Not only are people with developmental disabilities more likely to be exposed to trauma, but exposure to trauma makes developmental delays more likely.

-Joan Gillece, Ph.D.

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DD, MI and trauma

• Cognitive and processing delays that interfere with understanding of what is happening in abusive situations

• Feelings of isolation and withdrawal due to their differences, which may make them more vulnerable to manipulation because of their increased responsiveness to attention and affection.

-Joan Gillece, Ph.D.

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Cost of Trauma

• Trauma is a major driver of medical illness, including cardiac disease and cancer

• Addressing trauma can positively impact the physical, behavioral, social and economic health of Ohio and Ohioans

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What is “Trauma Informed”?

A program, organization or system that is trauma-informed: • Realizes the widespread prevalence and impact of

trauma • Understands potential paths for healing • Recognizes the signs and symptoms of trauma and how

trauma affects all people in the organization, including: • Patients • Staff • Others involved with the system

• Responds by fully integrating knowledge about trauma into practices, policies, procedures, and environment

• Not the same as treatment for PTSD 13

Outcomes with TIC

• Improved quality of care and impact of care • Improved safety for patients and staff • Decreased utilization of seclusion and restraint • Fewer no-shows • Improved patient engagement • Improved patient satisfaction • Improved staff satisfaction • Decreased “burnout” and staff turnover

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Ohio’s Trauma Informed-Care (TIC) Initiative

• Many mental health, addiction treatment and DD serving providers have already provided training and consultation in trauma informed practice

• Many clinicians are trained in Trauma-Focused

Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization training (EMDR); Dialectical Behavioral Therapy (DBT) and other treatment modalities

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Ohio’s Trauma-Informed Care (TIC) Initiative

• There continues to be a need for training for staff/facilities and community system partners

• The ability of all communities and providers to organize

trauma trainings internally is often beyond their finances, time and capabilities, yet the need of persons served has not changed

• The initiative will seek to provide additional resources

for agencies and programs in Ohio who may need this support

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• Since Summer of 2013, an interagency workgroup comprised of leaders from Ohio MHAS and Ohio Department of Developmental Disabilities (DODD) has been meeting to formulate plans to expand TIC across the state

• A portion of the “Strong Families, Safe Communities” funds

from the Governor’s Office have been earmarked for this purpose

• The National Center for Trauma-Informed Care

(NCTIC)/SAMHSA and Ohio Center for Innovative Practices (CIP) have also consulted formally

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Vision: To advance Trauma-Informed Care in Ohio Mission: To expand opportunities for Ohioans to receive trauma-informed interventions by enhancing efforts for practitioners, facilities, and agencies to become competent in trauma- informed practices

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Ohio’s TIC InitiativeTrauma-Informed Care • The TIC model assesses a service delivery system and makes

modifications based on the basic understanding of how trauma affects the life of an individual (those served and those providing the service)

• TIC means that every part of an organization or program understands the impact of trauma on the individuals they serve and promotes cultural and organization change in responding to the consumers/clients served

• This is not a service; rather it is an approach to interpersonal interactions that takes into account the potential scars of a person’s past experience

• The TIC Initiative is not about endorsing particular trauma-informed practices, treatment models, screening or assessment instruments or processes and takes an across-the lifespan approach

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Trauma-Informed Care (TIC) Promotes Cultural Change

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“What’s wrong with you?”

“What has happened to you?”

TIC Planning Framework

Interdepartmental Team (OhioMHAS and DODD)

Statewide Trauma Informed (TIC) Propagation Plan For MH, DD and AoD

TIC Training/Summit for Clinical and Administrative Leaders

Regional TIC Collaboratives

Community Agencies CO Partners , Specialty Groups

(Children, older adults, DD)

Internal Departmental

Implementation (Hospitals/community

support network, developmental centers,

therapeutic communities)

Collaboration with other departments

and agencies

Technical Support

Organization(s)

Advisory Committee

TIC Project Coordinator

OhioMHAS and DODD Leadership

Ongoing communications/Training for Regions, Boards, Agencies and

Providers

Interdepartmental Leadership Team

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• Dr. Mark Hurst, OhioMHAS, Co-Chair

• Kathy Coate-Ortiz, OhioMHAS

• Jody Lynch, OhioMHAS • Angie Bergefurd,

OhioMHAS • Trudy Sharp, OhioMHAS • Dr. Lisa Gordish, Twin

Valley RPH • Dr. Kraig Knudsen,

OhioMHAS • Latonya White, OhioMHAS

• Pam Berry, DODD, Co-Chair • Sarah Lawson, DODD • Patrick Kanary, CIP, Case

Western Reserve University • Joyce Starr, OhioMHAS • Dr. Tammy Collins,

OhioMHAS • Jackie Doodley, OhioMHAS • Dr. Afet Kilinc, OhioMHAS • Rob Robbins, DODD • Kim Kehl, OhioMHAS,

Project Coordinator













and agencies

Technical Support

Organization(s)

Advisory Committee




Providers

Framework for Ohio’s TIC Initiative

Progress so far: • June 2013: Initial training of ODMH/MHAS Central Office and

Regional Psychiatric Hospital (RPH) leadership in TIC • On site training of clinical and support staff at all RPHs, with

participation of DODD Developmental Centers, as available • Regular consultation with NCTIC on next steps • Plans for subsequent visits and consultation from NCTIC • Launch of TIC research study in collaboration with OSU

College of Social Work

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Progress: Statewide • November 2013: TIC Project Coordinator started (Kim Kehl) • Advisory Group formed (Co-chairs: Dr. Julie Gentile and Dr.

Patrick Palmieri) • Endorsed “Fundamentals of TIC” approach • Serve as “ambassadors” of TIC

• Submitted application to NCTIC for technical support in December 2013

• Train-the-trainers model • System infrastructure and infiltration

• Updated TIC Website: • http://mha.ohio.gov/traumacare

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TIC Advisory Committee:

• Survivors of Trauma • DODD • Ohio Hospital Association • Medicaid • PCSAO • OACBHA • Ohio Council • OACCA • ODH • Hamilton County Board of DD

• Wright State University :MI/DD CCOE

• Depart of Aging • Human Trafficking Commission • CIP • ODJFS • ODYS • Ohio Women’s Network • Board of Regents • Center for the Treatment and

Study of Traumatic Stress • Ohio Provider Resources

Association (DD)

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and agencies

Technical Support

Organization(s)

Advisory Committee




Providers


TIC Summit June 26, 2014 • Thematic fundamental training for clinical and

administrative leaders • AM session: Didactic by leaders from NCTIC • PM session: Regional breakouts to advance TIC locally

• Identify strengths, weaknesses, needs, champions • Identify initial plan to proceed, with support from

departments for communication, facilitation, etc. • Sustainability

Regional Collaboratives • Progressively transmit TIC and increase expertise within

regions • Topical workgroups (prevention, DD, child, older adult, etc.) • Department(s) continue to support, facilitate, communicate 29

Athens Region

Lawrence

Meigs

Gallia

Washington

Monroe

Scioto Adams

Brown

Hamilton

Butler Warren Clinton

Highland

Jackson

Ross Vinton Athens

Preble Greene

Fayette

Madison Clark

Miami

Darke Champaign

Franklin

Pickaway Fairfield

Hocking

Mercer Auglaize

Shelby Logan

Union

Hardin Allen

Van Wert

Paulding Putnam

Hancock

Wyandot

Marion

Delaware

Morrow

Seneca

Sandusky

Ottawa

Lucas Fulton Williams

Henry Wood Defiance Erie

Huron

Lorain

Wayne

Medina

Cuyahoga

Summit

Knox

Holmes

Licking

Coshocton

Muskingum

Tuscarawas

Guernsey

Perry Morgan

Noble

Belmont

Harrison

Carroll

Columbiana Stark

Portage

Mahoning

Trumbull

Ashtabula

Geauga

Lake

Crawford

Twin Valley

Region

Lawrence

Gallia Scioto

Adams

Hamilton

Pike

Jackson

Vinton Athens

Madison

Miami Darke

Fairfield

Hocking

Mercer Auglaize

Shelby Union

Hardin Allen

Putnam Hancock

Wyandot

Marion

Delaware

Seneca

Sandusky

Ottawa

Lucas

Wood Erie

Huron

Holmes

Guernsey

Perry Morgan Noble

Belmont

Harrison

Clermont

Jefferson

Richland Crawford Ashland

Montgomery

Lower Northeast

Central

Southeast

Upper Northeast

Southwest

Northwest

TIC Regional Collaboratives


Sustainability: • Based on the passion of those involved in the initiative • Encourage use and repurposing of existing resources • Technical support: NCTIC and deliverables of CCOEs • Encourage regions and state to develop internal expertise and

learning communities to transmit, maintain and advance our ability to respond to those with trauma needs

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TIC: Why is this important?

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TIC: Why is this important?

“What Happened to You?”

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• Ohio Department of Developmental Disabilities • National Center for Trauma-Informed Care • OhioMHAS Office of Research • Public Children’s Services Association of Ohio • Ohio Human Trafficking Commission • Ohio Department of Health • Ohio Domestic Violence Network • SAMHSA • Ohio MHAS Trauma Website:

http://mha.ohio.gov/traumacare

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Dr. Mark Hurst, M.D., FAPA Medical Director, OhioMHAS

30 East Broad Street, 36th Floor, Columbus, OH 43215 (614) 466-6890

[email protected]

Pamela Berry Senior Policy Advisor, Ohio Department of Developmental Disabilities

30 East Broad Street, 12th Floor, Columbus, OH 43215 (614) 301-2992

[email protected]

Kim Kehl TIC Project Coordinator, Office of the Medical Director

OhioMHAS 30 East Broad Street, 36th Floor, Columbus., OH 43215

(614) 644-8442 [email protected]

mailto:[email protected]



developmental disabilities mental health and addiction

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