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How UCSF launched the Trauma Recovery Center and cut costs by one third

October 16, 2019

    In June, we discussed three key components of trauma-informed care. Some of you emailed us thoughtful feedback about what constitutes the scope of trauma. Specialized care can promote resilience among patients who've endured many types of trauma, including patients who have parents with substance use disorders, refugees from war zones, and survivors of the AIDS epidemic. However, traumatic experiences widely vary, so a one-size-fits-all approach risks re-traumatizing patients and interfering with recovery. Instead, providers should tailor each patient's treatment plan to the type of trauma endured.

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    How UCSF provides patients with tailored trauma-informed treatment plans

    The University of California San Francisco launched their Trauma Recovery Center (TRC) in 2001 to provide comprehensive mental health services to survivors of violent crime, particularly from underserved communities. Staff meet the diverse needs of patients by dedicating appointment time for relationship-building and deploying a multidisciplinary staffing model, while achieving significant performance metrics:

    • Reduced costs: 34% lower costs compared to a traditional fee-for-service model
    • Improved health and functioning: PTSD symptoms decreased by 44%, depression symptoms decreased by 43%, physical pain decreased by 12%
    • Increased satisfaction: Self-reported quality of life increased by 16%. Satisfaction above 94%

    Here are two things we learned from UCSF's approach.

    1. Dedicate time to develop trusting relationships with trauma survivors before launching a treatment plan.

    Survivors often have complex psychological needs and have historically faced barriers (e.g., chronic homelessness) to accessing clinical and psychosocial care. Recovery won't be possible if staff can't determine the scope of patient's needs.

    On average at the TRC, patients have already experienced 5-6 traumatic events before they receive care. Clinicians use a client-centered approach to create a sense of safety and trust during the first session. Clinicians focus on clients’ strengths, rather than their challenges, and offer psychoeducation about trauma and coping. Clients’ preferences determine care plan goals.

    Clinicians conduct a comprehensive biopsychosocial intake interview to assess psychosocial needs, mental health, and other previous trauma. Throughout, clinicians explain the reasoning behind their questions and encourage clients to only provide as much information as feels comfortable. Based off the responses, clinicians indicate clients’ levels of need on a scale of 1-5 to prioritize next steps.

    Sample patient care plan

    2. Deploy multidisciplinary staff to offer specialized support based on patient need.

    TRC mental health clinicians use assertive outreach techniques to engage clients and offer comprehensive services across a 16-session evidence-based treatment program. Sessions include a balance between clinical case management and therapy, which is determined by the unique needs of each client. Clinicians assist clients with addressing a wide range of needs, including accompanying them to court, filing restraining orders or police reports, filing for disability entitlements, and submitting housing applications.

    The TRC offers comprehensive mental health care, including evidence-based trauma focused therapies and medication evaluation and management. Clinicians give patients the tools to deal with the impact of their trauma, including panic attacks, nightmares, and insomnia. Clients can also participate in group therapy, some of which target specific types of trauma (e.g., drug facilitated sexual assault).

    Clinicians reassess clients every eight weeks to determine progress across treatment goals, including help with PTSD, depression, pain, and sleep. Clinicians then adjust the treatment path, extend clients' timeline for care as needed, or transition clients who need it into long-term therapy with a broader focus.

    In the next installment of our series on trauma-informed care, we'll overview how to center community input into programming and offer ongoing staff training. Are you using these principles? If so, email Darby Sullivan at sullivada@advisory.com to share your efforts.

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