Trauma-Informed Care: Opportunities for High-Need, High-Cost Medicaid Populations

Davis R, Maul A
Publication Year: 2015
Patient Need Addressed: Behavioral health, Chronic Conditions, Trauma
Population Focus: Complex care, Medicaid beneficiaries
Type of Literature: Grey


Insights Results

Overview of brief

  • This brief provides an introduction to trauma-informed care and describes how it can be adopted to better serve high-need, high-cost Medicaid populations, including examples from 3 innovative programs across the country
  • Trauma-informed care seeks to change the clinical perspective from asking, “What is wrong with you?” to “What happened to you?” It recognizes that much of the behavior demonstrated by these individuals developed as coping mechanisms to deal with trauma and posits that appropriate treatment can retrain the brain to respond to situations in a healthier way. It also acknowledges that the care delivery setting itself can unintentionally retraumatize individuals, and strives to create an environment that is sensitive to this for both patients and staff

    Key takeaways/implications

    • The following case studies highlight ways that 3 participants in the in the Center for healthcare Strategies’ Complex Care Innovation Lab are using trauma-informed care to address the effects of trauma on their patients at both the organizational and individual levels: 1) Southcentral Foundation (SCF), a nonprofit healthcare organization that is owned by and serves Native Alaskans, has redesigned the way that it provides care by placing physical, mental, emotional, and spiritual wellness at the forefront of its work. SCF considers relationships to be at the core of its service delivery system, and an integral part of a patient’s physical and behavioral health. SCF’s model, known as the Nuka System of Care, is created, managed, and owned by Native Alaskans and informed by their cultural values and beliefs. SCF emphasizes customer-owner (its term for patient) empowerment and organizational transparency, both of which are key aspects of trauma-informed care; 2) CareOregon is a non-profit health plan that serves low-income Oregonians. Its Health Resiliency Program, which focuses on providing care coordination services for high-utilizing members, has made trauma-informed care a core tenet of the plan’s operations. Health Resilience Specialists (HRS), CareOregon’s term for its case workers, are embedded within Care Oregon’s clinic-based teams and receive in-depth training; and 3) The Camden Coalition of Healthcare Providers (CCHP) seeks to improve the quality of care for residents of Camden, New Jersey, while reducing healthcare system costs. Several years after its founding, CCHP began to focus on trauma-informed care after finding that many enrollees in its Care Management Program had experienced significant childhood trauma. Since then, 10 Camden-based organizations are obtaining ‘Sanctuary Certification,’ a designation given to entities that complete an intensive 3-year certification process in a trauma-informed approach known as the Sanctuary Model
    • Moving forward, organizations can consider adopting evidence-based clinical interventions to address trauma-related symptoms. The evidence regarding the efficacy of trauma treatments is modest but growing. Healthcare organizations looking to incorporate trauma treatment into their services can choose from a variety of existing individual or group-based approaches
    • Many opportunities exist for further exploration in this field, including: 1) Assessing which models are most effective in a healthcare setting; 2) Rigorously measuring the impact of trauma-informed care on cost and outcomes; 3) Identifying strategies to successfully engage community stakeholders; and 4) Exploring ways to prevent and reduce the risk of trauma and intervene earlier when it occurs