Improving Patient Retention by Creating a Trauma-Informed System of HIV/AIDS Care
A-13
August 23, 2010
Have you ever considered the impact of trauma on your clients? Dr. Susan Lawrence and Darrell Lind of Catalyst Foundation in Lancaster, California helped participants to identify and describe trauma in order to develop and implement a trauma informed system of care for our clients with HIV/AIDS.
A single incident or ongoing exposure to trauma can result in high-risk behaviors, including those that can lead to HIV/AIDS, as well as other behaviors that can be detrimental to health. While helping those suffering from trauma to address the impact can require a specialist, health care providers can take steps to make their services more accessible to people who have experienced trauma.
Principles of trauma informed care include safety, trustworthiness, choice, collaboration, and empowerment. In order to implement trauma informed care in your agency, there are five requisite components that are necessary:
- Administrative commitment to change,
- Universal screening for trauma for patients,
- Training and education for staff,
- Adopting new hiring practices, and
- Reviewing policies and procedures.
The Catalyst Foundation in Lancaster, California, a Part C grantee, is dedicated to decreasing the impact of unhealed emotional pain and trauma. It operates the Bartz-Altadonna Memorial Clinic, which provides comprehensive primary medical care for low-income, uninsured, and homeless persons and treatment of all stages of HIV and HCV. The clinic has taken findings from Adverse Childhood Experiences (ACE) study and applied them to its own services. The ACE study included 17,000 enrollees of Kaiser Permanente in San Diego and is perhaps the largest scientific research study analyzing the relationship between multiple categories of childhood trauma and health and behavioral outcomes later in life.
The Bartz-Altadonna clinic uses the 10-question ACE assessment with all consumers and the scores are maintained in consumers’ medical records. A “high” ACE score is an indication of significant trauma. For those consumers with a high score, their provider will refer them to a specialist in trauma. Steps are also be made to accommodate these consumers’ needs during the provision of health care.
There are some challenges to incorporating a trauma-informed approach. For example, it can be difficult to balance client responsibility with accommodation. Staff, both professional and ancillary, buy in can be difficult to obtain. Finally, self care for staff cannot be overlooked.
While it has only been using this approach for a few months, Bartz-Altadonna has already seen results. The no show rate for consumers with HIV has dropped by 5 percent. The clinic is planning on investigating the relationship between ACE scores and viral load (a marker for adherence) in the future.
For more information on trauma informed care and how to create a new paradigm in your agency, please go to the National Center for Trauma-Informed Care or contact Dr. Susan Lawrence at catalyst@Qnet.com or the Catalyst Foundation Web site.
Many Hands Make Light Work: A Network-Wide Approach to Addressing Health Literacy
B-14
August 23, 2010
This workshop featured a Part D project’s efforts to increase HIV health literacy among HIV-infected women and youth. The two-pronged approach focuses on increasing the capacity of providers to serve clients with low literacy and on increasing the level of health literacy among their clients.
Providers within a network were trained in order to broaden outreach and to strengthen provider relationships with both clients and each other. The flexible consumer curriculum modules are based upon existing resources, including a HRSA product, Unified Health Communication 101. However, tools which were HIV-specific or in Spanish had to be newly-developed for this project. Twenty nine, mostly non-clinical, providers were trained, and 97 clients received education at 4 sites. Analysis included comparison of pre- and post-test results of client knowledge, CD4/viral load values, and retention measurement as reflected by attendance at routine HIV medical visits. Contact Katelin Thomas, Project Coordinator for the Stoneybrook Project for AIDS Resource Coordination, at kathomas@notes.cc.sunysb.edu to obtain the curriculum modules, testing materials, and other health literacy resources on a CD.
Successful Retention Interventions in International Settings
A-16
August 23, 2010
HRSA’s Global HIV/AIDS Program (GAP) pre-dates PEPFAR and has been around since the late 1990s in the form of special projects at HRSA—way back in the days of Titles. The program was consolidated in more recent years as a formal office at HRSA working under the umbrella of PEPFAR. HRSA GAP supports international programs that provide care and treatment to 11 countries including Nigeria, Botswana, Kenya, Tanzania, and Zambia. Presenting in this workshop were Harvard University AIDSRelief director Professor Phyllis Kanki (a virologist and public health expert in West Africa) and Dr. Martine Etienne (an epidemiologist specializing in developing programs through innovative strategies utilizing data collection and analysis).
Presenters shared training resources, called Clinical Assessment for Systems Strengthening (ClASS), what are designed to help countries transition and take ownership of their HIV/AIDS programs as they move forward to implement activities in collaboration with nongovernmental organizations and Ministers of Health within their countries.
Learn more about HRSA’s Global HIV/AIDS Program and PEPFAR.