Bridging Access to Care (BAC) is a community-based organization that provides an array of services to the homeless, substance user, mentally ill and previously incarcerated in Brooklyn, New York. It’s perhaps best known for being the oldest and largest HIV/AIDS organization in Brooklyn, but in the past few years it has expanded its scope of service to include licensed mental health and substance abuse clinics. In 2012, it was designated as a health home care coordination team.
Needless to say, BAC works with high need individuals in Brooklyn who experience difficulty coordinating their significant healthcare needs; the agency provides services to approximately 3,500 individuals each year. Not too long ago, BAC leaders recognized the socio-cultural and organizational cultural perspectives of trauma, which significantly affects clients’ lives and health outcomes. The agency also realized that many of its clients have histories of trauma, but often do not recognize the significant effects on their lives. What’s more, BAC staff struggled to deliver care to populations impacted by trauma and also had trouble in understanding how trauma-informed care is linked to better health outcomes, its officials say.
As such, the recent project from BAC— “Leveraging Technology to Integrate Trauma-Informed Care in Everyday Practice”—had the overarching aim to routinize trauma-informed care using trauma-sensitive approaches into daily service activities. The purpose was to facilitate trauma-informed care by enhancing care delivery and augmenting plans of care to incorporate trauma-specific objectives.
Indeed, the project plan included developing a systematic approach using the electronic health record (EHR) system to inform and guide staff in delivering trauma-sensitive activities; developing an electronic tool that could capture specific data and trend changes in consumer health outcomes; identifying validated tools that were simple to use, met industry standards and were recognized by payers; and creating a system for sharing information in real-time to facilitate access to treatment and retention in care. The work done by BAC in this pilot program was worthy of semifinalist status in Healthcare Informatics’ 2017 Innovator Awards Program.
According to Nadine Akinyemi, deputy executive director at BAC, “We wanted to design a system that would facilitate delivering trauma-informed care in our work environment and routinize it across our agency. So at any point of entrance for a person coming into the agency, they would be assessed for trauma and then the appropriate referral would be made.” Akinyemi adds that BAC also wanted to align its goals with the national HIV/AIDS strategy that involved looking at different areas of how to enhance delivering care services to those individuals. “So we took that scope and broadened that to all of our clients, HIV-positive or not,” she says.
The agency’s implementation strategy included incorporating best practices and various tools into an “electronic trauma wizard.” The BAC facilities were assessed for trauma readiness; providers and management received trauma-informed care training; and the physical environment was adjusted to become trauma sensitive, notes Akinyemi. To ensure it was using the “gold standard” of tools in the mental health sector, Akinyemi says, the agency researched trauma screening and assessment tools that were approved by the Centers for Medicare & Medicaid Services (CMS).
BAC then determined the matrix for decision tree assessments, service referral and linkages and collaborated with its vendor to design this in the system. The matrix included the trending of trauma results and health outcomes for clients, sharing of client trauma profile and defined the decision support mechanisms that included ticklers and prompts, Akinyemi says. In all, there were 22 clients in this pilot project, though BAC has plans in place to expand the program to all sites across the agency, she notes.
In the end, BAC realized its goal of routinizing trauma-informed care using the harm reduction program as a pilot to enhance care delivery and augment plans of care with trauma-specific objectives. The project revealed that systematizing trauma informed care can improve consumer health outcomes, Akinyemi attests.
Specifically, data analyzed prior to the implementation of the treatment wizard for trauma-informed care showed that not a single client were screened for trauma; 18 percent of clients were receiving seeking safety intervention; and only 23 percent of clients were receiving mental health services. But, post-implementation data revealed that 100 percent of clients were screened for trauma, with 37 percent of them were screened positive for trauma. What’s more, 92 percent of clients screened were referred to, and are receiving seeking safety interventions, and 42 percent of clients that were screened were referred to and are receiving mental health services post-deployment. Further, there was a correlation between clients’ functionality and PTSD (post-traumatic stress disorder) severity and symptoms. It was observed that as clients' symptoms and severity of trauma decreased—while receiving mental health treatment—there was improvement in their functionality, Akinyemi notes.
According to Akinyemi, additional benefits of the project included awareness of the impact of trauma on treatment, increased referrals to mental health services and evidence-based practices, and increased linkage, retention, and maintenance in care. In fact, she says that many clients with mental health issues would fall off the care path after an initial visit, meaning they were not getting the mental health care they would need. “But the trauma wizard would help these patients stay in the program since the tool developed that treatment plan,” says Akinyemi.