Brain & Behavioral Science Informed Pilot Grants
Proposal Submitted by Central City Concern
Interest
· Please describe your social enterprise or organization’s
o Interest in brain and behavioral science informed interventions;
Central City Concern is Portland, Oregon’s largest human services agency serving homeless and at-risk populations. CCC’s 30 health, recovery, housing, and employment programs serve more than 14,000 individuals annually. The agency’s 31 properties encompass 1,735 units of very low-income housing as well as thirteen Federally Qualified Health Center sites—including the Old Town Clinic (OTC--primary and behavioral health care) and Old Town Recovery Center (OTRC--community mental health.) CCC’s employment programs include social enterprises designed to offer populations that have been impacted by poverty and trauma a path back into the workforce. In order to better serve and understand these populations, it is imperative to have a knowledge base of interventions informed by brain and behavioral science. With this understanding CCC’s Social Enterprises and Employment Services will integrate knowledge about trauma into policies, procedures, and practices and be able to recognize, acknowledge, and respond to clients who have experienced trauma.
o The current level of knowledge and capacity in this arena and where this knowledge or capacity sits within the social enterprise or organization; and
Central City Concern’s staff includes Dr. Lydia Bartholow, DNP, PMHNP, CARN-AP. Lydia is the Associate Medical Director for Outpatient Substance Abuse Disorder Services and the resident Trauma- Informed systems trainer and expert at OTRC. Lydia’s doctoral work at Oregon Health and Science University focused on the intersection of trauma and addiction, and she brings this knowledge into her role as medical director and beyond. Lydia serves as an educator for employees of Central City Concern on a monthly basis, offering trainings on topics such as Trauma Informed Care, Compassion Fatigue and the neuroscience of trauma and addiction. Moreover, she operates as consultant and liason across the organization to boost trauma-informed care and services. She has been with Central City Concern for five years and has been training CCC staff on the impact of trauma for the past three years.
o Any efforts made to date or planned to increase knowledge or capacity.
On November 1, 2017, over 50 Social Enterprises staff, Employment Specialists and Drug Counselors attended a 2-hour course on TraumaInformed Care taught by Dr. Bartholow. The class description was:
We will follow the physiological narrative oftraumain the body for a greater understanding of the impact oftraumaon the brain and body. Special emphasis will be placed ontraumaanatomy, as well as the long term thinking changes that occur withtrauma. We wrap up with an interactive overview of how translate this new knowledge into relationships with clients,and boosttraumainformed systems.
Challenge and opportunity
· What challenge(s) or opportunit(ies) experienced by the social enterprise or target population workers do you believe brain and behavioral science informed interventions may hold promise for addressing?
Individuals with histories of trauma can be difficult to engage in employment services, and employment specialists and social enterprises staff sometimes find it hard to know how to respond effectively to their clients’ needs. Brain and behavioral science provides important insights into why it can be difficult for trauma survivors to engage in and benefit from needed services, as well as important implications for a more effective response. Histories of trauma, combined with workplace stress and the likelihood of secondary trauma, also affects the workforce across many fields of practice. As more information has come to light from epigenetics and neuroscience, as well as the ACE study, the employment services area is seeking ways to incorporate an understanding of ACEs and trauma in day-to-day work.
o What do you believe to be the potential impact and value of addressing the challenge(s)/opportunit(ies) described above?
With what we know about the potential impact of trauma on patients and the workforce, the outcomes we might hope to see over time include:
· Increased participation in CCC’s employment services and social enterprises
· Improved outcomes of clients as indicated by:
o Rates of engagement with the “Path to Employment”, that include an assessment, creation of a cover letter/résumé, interview skills, career mapping, and job search.
o Participation and success rates in social enterprises
o Wage increase post participation in services
o Reduction in recidivism and relapse
· Improved client satisfaction with CCC’s employment services and social enterprises.
· Improved conditions for the workforce, as indicated by:
o Increased staff confidence in their knowledge and skills.
o Increased staff satisfaction
o Reduced absenteeism and turnover
o If you described multiple challenges or opportunities, please rank or categorize them in order of priority relative to their potential for helping the social enterprise or transitional workers achieve key outcomes.
The following are the top 4 challenges/opportunities:
1. Increased participation in employment services and social enterprises
2. Rates of adherence to the “Path to Employment”, that include an assessment, creation of a cover letter/résumé, interview skills, career mapping, and job search.
3. Rates of adherence in social enterprises
4. Improved client satisfaction with the employment services and social enterprises.
Pilot Idea
· Please describe your preliminary ideas for a brain and behavioral science informed pilot. Please include description of:
o The intervention
This grant proposal is a collaboration between the CCC’s Employment Services/Social Enterprises and Trauma Informed Oregon (TIO) to develop and implement a trauma informed plan to increase knowledge and capacity of the staff regarding trauma informed care, executive skills, cognitive behavioral interventions, and behavioral economics. The proposed steps to develop and implement the plan include:
STEP 1: Pre-Consult Meeting
· TIO consultant will plan and facilitate the meeting. CCC representative staff will attend.
· During this meeting TIO will discuss historical and current organizational factors that will influence the trauma informed implementation plan
· Complete initial plan and identify general timeline.
STEP 2: Training
It is important to ensure that all staff have a shared and common knowledge about Trauma Informed Care (TIC). TIO will provide training course that builds off the 2-hour training completed on November 1, 2017. The training course will provide foundational training about Trauma Informed Care.
· Training content
o What TIC is and why it is important
o Activity to generate staff feedback about challenges (hotspots) they have experienced
o TIO will provide collected staff feedback to CCC following the training and make recommendations
· Training Logistics
o TIO facilitates the training and provides materials.
o At a minimum there will be a consultation meeting prior to the initial training and again after the initial training is complete.
STEP 3: Develop a Self-Assessment
· Creation of a workgroup consisting of TIO consultants, Dr. Bartholow and ~6 staff members from multiple roles and levels within Central City Concern’s Employment Services and Social Enterprises that will take responsibility for an agency self-assessment process.
· The workgroup, in collaboration with TIO, will determine how best to assess the organization
STEP 4: Complete Assessment
· The workgroup will complete the self-assessment, which could be approximately seven 2-hour meetings for a total of 14 hours. TIO will facilitate the self-assessment.
· TIO will translate the data from the self-assessment into a plan for staff review.
· TIO will present the plan and incorporate feedback from employment services and social enterprises staff.
STEP 5: Complete a Plan
The plan could recommend creation of Trauma Informed Services that:
· Realizes the widespread impact of trauma and understand potential paths for recovery;
· Develops overarching framework that recognizes, acknowledges, and responds to clients who are exhibiting the signs and symptoms of trauma
· Integrates knowledge about trauma into policies, procedures, and practices that may include the following:
Trauma Informed Approach / Behavioral InterventionsEmphasis on safety / Alarms
Clear roles and boundaries / Appointment reminders (email, text, calls)
Peer support / Checklists and reduce unnecessary verbiage
Consumer choice / Detail the steps required
Collaborative decision-making / Streamlined processes
Strengths based / Highlight most important information
Future-focus / Color-coding binders
Respect and address culture, gender, and historical issues / Target job opportunities matched to executive skills profile
· Supports the capacity of employment specialists and social enterprises staff to cope with their own responses to trauma.
· Incorporates Motivational Interviewing to reduce ambivalence and motivate desire to make change
· Builds Executive Skills through
o Coaching
o Setting SMART goals
o Supporting participants in pursuit of goals that have a short time horizon as a way to help sustain motivation to achieve a longer term goal
o Use thoughtfully designed incentives to support motivation by increasing the perceived benefit of completing a tsk
o Break tasks into small steps
· Integrates processes for review and reflection into the program
STEP 6: Evaluation
· TIO will collaborate with CCC to capture pre/post outcome data, document action steps, gather data at the all staff training, and collect self-assessment data.
· TIO will share results with CCC. CCC will share results with REDF.
o The timeline for planning and implementation
Estimated Timeline
· January 2018 - STEP 1: Pre-Consult Meeting
o Pre-Training planning meeting for finalized timeline and priority setting
· February 2018 - STEP 2: Training
o All-Staff training with data gathering
o Prep meeting for Workgroup formation process
· March 2018 - STEP 3: Develop a Self-Assessment
o Workgroup formation and initial meeting
o Discussion of process options and anticipated outcomes
o Self-assessment process defined
· April - May 2018 - STEP 4: Complete Assessment
o Self-assessment completed
o Recommendations for action steps
o Discuss on-going communication to management and staff
o Discuss priorities, process and implementation
o Present to staff and incorporate feedback
· June - August 2018 - STEP 5: Complete a Plan
o Develop final yearly plan
· September 2018 - STEP 6: Evaluation
o Co-present final yearly plan to Leadership
o TIO and CCC develop sustainability plan
o The scale (e.g., number of applicants or workers involved)
· Approximately 1,200 clients that enroll in CCC employment services
o Within these 1200 clients, 100 clients will participate in social enterprise
o The type and amount of resources and investment required
Estimated Total Hours and CostsService / Hours / Full Cost
STEP 1: Pre-Consult Meeting
TIO will plan and facilitate the meeting, complete initial plan and identify general timeline. / 2 / $300
STEP 2: Training
Trauma Informed Care Training for All Staff / 3.5-4 / $1,000
Train the Trainer Series for Two staff members / $700
Post-Training Consultation / 2 / $300
STEP 3: Develop a Self-Assessment
Workgroup Formation / 12 / $1800
STEP 4: Complete Self-Assessment
Self-Assessment completed / 20 / $3,000
TIO to co-present to staff, incorporate feedback and present final plan / 10 / $1500
STEP 5: Complete a Plan
TIC Project Manager (not TIO) / $14,600
STEP 6: Evaluation
Data Translation for Staff Review / 6 / $900
Additional TIO Consultation ($150/hour) / 6 / $900
Est. Costs for Implementation of a Pilot / $25,000
Flexible “Award” funds (ex. Curriculum Development, SMART Goals forms, Motivational Interviewing questions/procedures, etc.) / $25,000
Total Award Request / $50,000
o Any potential partners / consultants (specific names or general categories)
· Trauma Informed Oregon
· TIC Project Manager (not currently identified) to lead and develop trauma informed services identified in the plan.
o Any resources that you anticipate leveraging (beyond grant funding from REDF)
Additional resources have not been identified at this time.
· Please describe how the proposed pilot will be informed by brain and behavioral science.
In 2014, as part of efforts to better integrate behavioral and physical healthcare, the Oregon Health Authority contracted with the Regional Research Institute (RRI), in collaboration with Oregon Health Sciences University (OHSU) and the Oregon Pediatric Society (OPS) to establish Trauma Informed Oregon (TIO). The overarching purpose of TIO is to improve the quality of physical and behavioral healthcare and related services for children, adults and families by:
· Increasing understanding of the impact of adverse childhood experiences and trauma on health and wellbeing;
· Assisting providers to incorporate this understanding in their work and to develop strategies to more effectively serve individuals impacted by trauma.
TIO provides training, consultation and resources to partners around the state, as well as assistance with the design and evaluation of innovations in health care and other settings. More information about the background, mission, staff, partners, and activities of Trauma Informed Oregon can be found at the website, http://www.traumainformedoregon.org.
Trauma Informed Oregon’s consultation services, as well as their educational services, construct interventions based on the current neuroscience of trauma and adverse childhood experiences. TIO seeks to translate what we know about the neurological impacts of ACES and trauma into best practices in service provision. By centering the neuroscience of trauma in all of their work, the interventions utilized will be in direct response to brain and behavioral sciences.
Leadership and Staffing
· What are the staff roles anticipated to be involved in planning and implementation of the pilot? How and to what degree do you expect work on the pilot to integrate with, supplement, or supplant existing responsibilities?
· TIO will assist with the creation of a workgroup consisting of TIO consultants, Dr. Bartholow and ~6 staff members from multiple roles and levels within Central City Concern’s Employment Access Center and Social Enterprises. The workgroup will be supported by the organization to implement the TIC process. The workgroup will take responsibility for the self-assessment process, setting priorities, planning for change, and serving as a conduit to the entire staff.
· Continuous improvement of services is a component of all employees’ responsibilities
· How will leadership support and facilitate efforts related to the pilot? What changes, if any, may need to happen at the organizational or social enterprise level to make pilot implementation feasible?
· CCC’s Chief Executive Officer is very supportive of incorporating Trauma Informed practices throughout the organization.