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The future: Patient-centered and trauma informed

October 14, 2015
by Jill Sederstrom
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Patient-focused philosophies have been shown to not only produce better patient outcomes, but experts say they can also help improve retention rates, lower costs and make successful providers more attractive partners for payers.

Both patient-centered and trauma-informed care strategies focus on the needs of the individual. By seeing behavioral healthcare through the eyes of the patient, providers are able to create an environment that fosters collaboration and promotes a feeling of safety and security—something that some in the behavioral healthcare field believe is lacking in the industry today.

And the need is great. As many as 70 percent of U.S. adults have experienced trauma, according to experts, so tailored care for this special population is becoming a necessity for treatment programs.

Deni Carise, PhD, chief clinical officer of Recovery Centers of America (RCA), says she believes the reason more people with behavioral health needs don’t seek help is because they don’t anticipate much benefit from the services that are currently available.

“They don’t want what we have to offer, and a part of that is because we don’t pay attention to the patient as an individual,” Carise says.

Patient-centered addiction treatment

Addiction treatment is one segment that has a clear opportunity to build on its legacy of individualized programming. Many substance abuse and addiction recovery services began initially as one person with addiction helping another through the 12 Steps.

Moving the industry away from what Carise calls a “tough love” approach, to a more consumer-driven approach, to full patient-centered care is a long process, but one she feels is well worth the effort.

“People come into treatment, but they have ideas about what they want to get out of it,” she says. “They have ideas about how they could be helped, and we owe it to them, of course, to introduce ways we think we could help as well. We can’t just put them into this cookie-cutter program where everybody gets the same thing.”

Instead, patient-centered care takes into account the patient’s goals for treatment and creates an environment that is respectful and responsive to the individual patient’s needs and desires. Some might be looking for harm reduction, for example, while others might be looking for full abstinence.

“It’s a little tough when the goal of the patient may be to drink socially when they’ve never been able to do that,” she says. “But if you meet the patient where they are at and offer them suggestions—as opposed to demands—and explore with them what would work, you are going to get a lot more responsiveness from the patient. It’s better than what you get if you bang them over the head with, “You can never drink again.’”

It’s a significant shift in philosophy for many facilities and clinicians, who may have no experience in trying to meet patients where they are at.

RCA is opening eight new addiction treatment centers in the Northeast that are specifically designed to be patient-centered. Carise says she has the luxury as a new organization to hire staff who fully embrace the idea of patient-centered care. Starting with a blank slate is the easiest way to get employee buy-in, but, she says, existing facilities can move in a deliberate way toward more patient-centered approaches as well.

“It takes an enormous amount of training,” she says. “You have to get staff buy-in at every level.”

One of the most important things to watch as facilities move toward a more patient-centered approach to care is the language being used by staff and therapists. Instead of saying, for example, “He’s just in denial,” Carise recommends asking more pointed questions, such as “Why don’t you think this is a problem for you?”

For facilities to succeed in making the shift, providers need to model the new patient-centered approaches, train staff and make resources available to employees.

Carise says choice is another important element to patient-centered care. For instance, offering daily schedules with built-in flexibility that allows the patients to decide whether they want to spend a given hour in a women’s group, LGBT group, yoga or a home budgeting class, for example, allows patients an opportunity to exercise their personal preferences.

“There are some services that every patient will get, but everybody doesn’t need the exact same thing,” Carise says.

She also recommends involving patients in the development of their own treatment plans, listening to patient’s ideas about their own treatment and transitioning patients between levels of care by explaining what’s coming next and why it’s being done.

Getting to know the individual patient, including their hopes, their fears and their goals, is another essential element to patient-centered care. Carise says getting to know the patients on an more individual level can improve patient engagement, which will increase the likelihood that they will make behavioral changes.

Trauma-Informed Care

Whether it’s a recent tragedy reported on the television news or more hidden abuses such as rape or physical abuse, it’s clear that trauma has become a prevalent part of today’s society. Increasingly, programs are responding to the need in their communities.

“It’s estimated that 70 percent of adults in the United States have experienced some type of traumatic event in their life,” says Jim Clarkson, the chief executive officer of Via Positiva, a behavioral health consulting firm. “When it comes to behavioral health, unfortunately, it’s almost a universal phenomenon.”