Trauma-informed care is about using what we know about the impact of harm to better care for ourselves, our colleagues, and those we serve. At the core of this work is compassion, grace, and hope. Becoming trauma-informed involves all of us and it includes a spectrum of changes, from how we fund services and workforce wellness, to offering a blanket while someone waits in the emergency department. This work is not just about a moment in time, but about building relationships and trust for future needs and generations.
The trauma-informed approach recognizes that people often know what they need to heal — time, caring supports, cultural practices, basic needs — but policies and procedures often hinder these needs. This approach uses knowledge about the impact of trauma and adversity to prevent or lessen harm to those served and to the workforce. It is infused into policy, procedures, and practices across all aspects of a program, from human resources to the physical spaces we work in, to the first point of contact. Trauma Informed Oregon’s Director Mandy Davis says, “The goal is a trauma-informed environment that is welcoming, representative and where people feel they belong and will be cared for.”
Trauma Informed Oregon (TIO), supported by OHA since 2014, is the hub for Oregon’s work on trauma-informed care. Its evolving work is driven by the trauma-informed vision for Oregon, created by more than 400 participants at a 2019 statewide conference. TIO is viewed as the national expert on trauma-informed care for organizations and systems and on how to implement trauma informed and healing focused approaches. They work collaboratively statewide focusing on four areas:
- Training and education
- Policy and procedure review
- Implementation resources
- Community building.
The organization is a collaborative effort, composed of five paid staff members, a young persons’ advisory council, a steering committee, student interns and the many providers and communities doing this work around the state. It is housed at the Portland State University School of Social Work.
Highlights of trauma-informed work in Oregon include:
- A total of 196 people who have completed the Train the Trainer course, including 20 who completed a bilingual and bicultural Latinx cohort, enabling greater reach in statewide training
- Online modules for accessible training and onboarding
- COVID-19-specific resources (see Vaccine Fear through a Trauma-Informed Lens)
- Partnership with Children of Incarcerated Parents to center youth voices in the Bill of Rights for Children of Incarcerated Parents
- Culturally specific disaster learning collaboration
- 12 sessions on trauma and trauma-informed care for health care professionals provided via Oregon ECHO
The work of TIO is guided by the needs of families, organizations, and systems. In response to surveys and listening sessions across Oregon, the focus during 2021-2023 is on:
TIO is constantly developing new resources and has a series of blogs. Notable topics include:
Creating trauma informed spaces and places takes time and will take patience. When it feels overwhelming, TIO Director Mandy Davis reflects on the words of Desmond Tutu: “Do your little bit of good where you are; it's those little bits of good put together that overwhelm the world.”
Davis says, “I know we can create healing spaces where people can flourish if we keep doing our ‘little bit of good.’”
To reach out to TIO directly email info@traumainformedoregon.org.
Mobile Response and Stabilization Services (MRSS) Community Conversations
Work on MRSS is underway. Join an informational conversation to understand and contribute to the vision of creating a customized statewide mobile response model for youth, young adults and their families.
Dates and times:
- Feb. 14, 2022, from 11 a.m. to 12 p.m.
- Feb. 24, 2022, from 8 a.m. to 9 a.m.
- March 2, 2022, from 2 p.m. to 3 p.m.
How to join:
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) trainings in 2022
TF-CBT is a highly rated, evidence-based therapy designed to treat children ages 3 through 17 who have experienced trauma. TF-CBT treats children with an array of trauma experiences, including children with multiple and complex traumas in their lives. This course will be provided virtually and is designed for Oregon master’s level mental health professionals who work with children who have experienced trauma. It is an intermediate-level course.
This training is sponsored by OHA, is free to participants and includes up to 20 hours of virtual training and up to a year of consultation. Up to 13 Continuing Education Credits will be provided. Participants are responsible for pre-training expenses of approximately $75 and post-training certification expenses.
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March 17-18, 2022 (2 days): 8 a.m. to 4 p.m.
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May 12-13, 2022 (2 days): 8 a.m. to 4 p.m.
Open clinical consultation with National Association of Dually Diagnosed (NADD)
OHA sponsors quarterly open clinical consultation with experts from the NADD, which focuses on supporting youth and families of youth with an intellectual or developmental disability (I/DD) and mental health condition. This is a great time for clinicians or other professionals working with this population to ask questions and get consultation around best practices.
Question Persuade Refer (QPR): Suicide prevention and intervention trainings
Apply to become a QPR trainer: Trainings are offered online at no cost, from 9 a.m. to 4 p.m.
Choose from the following Quarter 1 2022 dates:
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March 16, 2022: Prioritizing Wasco, Wheeler, Sherman, Gilliam, Morrow, Umatilla, Union, Wallowa, Grant, Baker, Harney, Malheur counties.
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April 20, 2022: Open to all.
QPR in Spanish
QPR is available for Spanish speakers. Reach out to Crystal Larson at Lines for Life to be connected to a Spanish-speaking trainer to find training dates.
There is also a need for more trainers who speak Spanish. If you are interested in becoming a trainer in QPR and speak Spanish, please contact QPR@linesforlife.org or 503-575-3759.
System of Care Learning Collaborative
Each second Tuesday of the month from 3 to 4:30 p.m., the Oregon Family Support Network, Youth ERA and OHA facilitate a time for anyone involved with System of Care work. Come with questions, a desire to learn and unlearn on topics such as how to develop skills that center youth and families, how to be culturally and linguistically responsive and how to ensure services and supports are community-based.
Contact Nat Jacobs at nat.jacobs@dhsoha.state.or.us for more details.
A Time for Families
A Time for Families is a weekly drop-in discussion hour for parents and family members hosted by Chelsea Holcomb and OHA’s Family Partnership Specialist, Frances Purdy. Please note that the Zoom link changed for 2022.
Warmline
Reach Out Oregon, funded by OHA, is a part of the Oregon Family Support Network, has a warm line at 833-732-2467, a website, a chat room for any family member needing support and a weekly virtual support group.
Children’s System Advisory Council – help needed
The Children’s System Advisory Council (CSAC) serves as an advisory council for the CFBH Unit to support system planning, coordination, policy and fiscal development and the evaluation of service delivery and functioning.
CSAC is looking for new members who represent each of the following categories to join the council:
- Child and adolescent psychiatry, preferably a member of the Oregon Council of Child and Adolescent Psychiatry
- Primary care
- Rural coordinated care organization
- Early childhood system
- Community-based prevention or early intervention program
- Youth who have received behavioral health services (four people wanted)
- Oregon Department of Human Services, preferably from a Child Welfare field office
- Juvenile justice system or Oregon Youth Authority
Please contact Nat Jacobs to apply, or with any questions: nat.jacobs@dhsoha.state.or.us.
OHA received the Secretary of State audit in September 2020, which outlined broad recommendations for the CFBH Unit and more broadly for behavioral health across the lifespan. We are proud that we have been able to continue essential work to reform our system, with work on all 22 recommendations progressing over the past year. While the COVID-19 pandemic has slowed some of the work, elements such as workforce development, consumer feedback, and monitoring emergency department use have been even more critical through our current crisis.
More information on 2021 progress can be found in the 2020 Secretary of State audit report update.
Emergency department usage:
There is ongoing concern about the overuse of emergency departments (EDs) as the pathway to inpatient psychiatric services and the number of young people who wait for long periods in EDs for these beds. As part of the 2020 Secretary of State Audit recommendation, OHA completed an analysis of how long individuals stay in an ED and shared it widely.
Data reports moving forward will focus on young people who stay more than 24 hours in an ED, known as ED boarding. This data will now be updated regularly, and the next data set is expected to be available in the spring.
Restraint and seclusion:
The use of restraint and seclusion in mental health intensive treatment facilities is an important metric for the children’s system. OHA’s Children’s Seclusion and Restraint Report 2018-2020 documents these data, with the 2021 report being issued shortly. These numbers are compiled as rates per 1,000 patient days, allowing for cross-facility comparison.
If you have specific questions around these data, please email shannon.karsten@dhsoha.state.or.us.
State law also requires the Oregon Department of Human Services to submit to the Oregon Legislature quarterly reports about abuse, use of restraints and involuntary seclusion in licensed child-caring agencies. Beginning February 2022, the quarterly reports generated by Children’s Care Licensing Program can be found at the Child-Caring Agency (CAA) Licensing Reports page.
Capacity in the children’s psychiatric and substance use disorder residential system:
The CFBH Unit has been closely monitoring capacity at all Oregon Health Plan child behavioral health facilities since the spring of 2021. The ultimate goal is to develop a centralized access process so we will know how many children and families are in need of services and we can increase capacity so that children get the right service at the right time.
Mental health services satisfaction surveys:
OHA's Mental Health Statistics Improvement Program (MHSIP) collects data for children and families who received Medicaid-funded mental health services in outpatient, psychiatric residential or day treatment settings using two surveys:
- The Youth Services Survey (YSS) for youth ages 14 to 17, and
- The Youth Services Survey for Families (YSS-F) for caregivers of children and youth under the age of 18.
The 2020 MHSIP survey report is available, and the 2021 version will be released soon. More details can be found on the MHSIP page.
Oregon currently has seven homes that specialize in providing residential treatment to young people ages 17.5 through 24. These homes are spread across the state and provide a total of 34 spots.
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Albany: Sender House (operated by Trillium Family Services)
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Eugene: Tempo (operated by Kairos)
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Grants Pass: Momentum (operated by Kairos)
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Pendleton: New Roads (operated by Columbia Care)
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Portland: Firefly (operated by Cascadia Behavioral Health)
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Salem: Cadenza (operated by Kairos)
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Tigard: Zenith House (operated by Lifeworks NW)
In 2021 OHA sent out 79 total referrals to providers, a slight increase from 2020.
Referrals ranged in age from 17.5 to 24 with 49% of the referrals between 17.5 to 18 years of age.
Race/ethnicity (this is an open-ended question on YAT RTH application)
- White/Caucasian — 57%
- Hispanic — 7%
- Biracial (this includes any that had more than 1 race/ethnicity listed) — 3%
- Native American — 3%
- Chinese — 3%
- Unknown/Not Reported — 5%
Gender identity (this is an open-ended question on YAT RTH application)
- Male — 5%
- Female — 7%
- Transgender — 4%
- Non-Binary — 3%
- Gender Fluid — 5%
- Unknown/Not Reported — 5%
OHA is looking to expand YAT RTH capacity by up to 20 more beds and develop a 10-bed YAT Secure Residential Treatment Facility. A Request for Proposals (RFP) has been developed in collaboration with the Intensive Services, Housing & Social Determinants of Health Unit with health equity as a core component. The RFP will be available on Oregon Buys.
Mobile Response and Stabilization Services $6.5 million
MRSS will be a statewide model for Oregon’s crisis response system focused on providing 24/7 connection for youth and their families. The MRSS model includes immediate face-to-face response and up to eight weeks of stabilization services. Two-person teams will respond to the community and may provide screening and assessment; stabilization and de-escalation; and coordination and referrals and warm hand-offs to other community-based services and natural supports.
In anticipation of the rollout of 988 later this year, the CFBH team is working closely with interested parties and county leadership to ensure that county mobile response teams receive specialized training and best practices for assessment and intervention strategies when responding to children, youth, young adults and their families in the community. To focus on 988 coordination and implementation, the CFBH team is pleased to welcome Brian Pitkin. Brian has spent the last 10 years working as a project manager for health care systems, focusing on patient access and electronic medical records.
Brian Pitkin
We hope that readers of this newsletter will join the MRSS Community Conversations listed above. An MRSS webpage will launch in February with more information, materials, and ways to engage with the development of this new service.
Psychiatric Residential Treatment Services $7.525 million
Requests for Grant Proposals (RFGPs) are in development with language focusing on health equity, and with the enhancement and expansion of this much needed service in Oregon. Due to the focus on emergency COVID-19 response and staffing needs for our Psychiatric Residential Treatment Services providers, the current anticipated release is March 2022.
An additional RFGP has been released for housing and infrastructure in Oregon. This includes expansion of levels of care including Subacute, Secure Inpatient Programs and Psychiatric Residential Treatment Services in Psychiatric Residential Treatment Facilities for children and youth. You can access this RFGP on Oregon Buys, Bid Number S-44300-00001642 for the acquisition / renovation of licensed residential facilities and homes. The closing date for this RFGP is Feb. 14, 2022, at 5 p.m.
Young Adult Residential Treatment Homes $9.2 million
As referenced in the article above on Young Adult Residential Treatment Homes, the RFP developed in collaboration with the Intensive Services, Housing & Social Determinants of Health Unit with health equity as a core component is planned for release this month. You can access this RFP once it is posted on Oregon Buys.
Interdisciplinary Assessment Teams $5.7 million
A broad-based workgroup is forming to determine needs and review options that meet current statewide needs for interdisciplinary assessment of youth and young people with complex and high needs, in the most effective way. SB 1 (2019) laid out priorities for this work and the group recognizes that that the population of focus, assessment needs and the service array have changed in the past three years in part due to COVID-19. The group will develop a revised implementation plan for this work in partnership with the System of Care Advisory Council.
For feedback and suggestions for our newsletter and information: kids.team@dhsoha.state.or.us
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