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Introduction: With a relentless focus on excellence in healthcare, Pullman Regional Hospital presents The Health Podcast,

Bill Klaproth: Trauma informed care, recognizes the presence of past traumatic events and how that may be impacting a patient's health and treatment today. This is really interesting. So let's find out more about trauma informed care with Elizabeth Hillman, Director of Social Work and Care Coordination at Pullman Regional Hospital. Elizabeth, thank you so much for your time. So please explain this to us, what is trauma informed approach to care?

Elizabeth Hillman: Sure. Well, individual trauma results from an event or series of events that are experienced by an individual as physically or emotionally harmful or even life threatening. So, these experiences have a lasting effect on an individual's functioning and wellbeing. And a trauma informed approach offers us a way to gain the knowledge and skills needed to promote healing, recovery, and wellness. We frequently associate this with the adverse childhood experiences, and how those experiences affect us into adulthood, not determinable health, but physical health as well.

Host: So Elizabeth, then what you're doing is you're trying to find out the level of trauma that this person may have had in their past and then that guides you and informs you for better treatment. Is that right?

Elizabeth Hillman: Well, we don't really need to understand past trauma. We just need to treat everybody as this. They're bringing more with them than what we're seeing.

Host: So can you expound a bit on that? What do you mean when you say that?

Elizabeth Hillman: We all carry our entire history with us, so we don't know what people have experienced in their past. And when we are viewing people through a negative lens of being noncompliant or not following health recommendations to treat chronic illnesses, we need to take a step back and wonder what's driving those health behaviors, and not have a judgmental lens, but a lens of how do we view this whole person and what do we need to do to help them address those health issues. Assuming that it's not, there's a reason they're not taking the medicine, that they're not cutting back on their sugar, whatever it is that is driving their illness.

Host: So much of this stems from the ACEs study. ACEs stands for Adverse Childhood Experience. Can you tell us more about the ACEs study?

Elizabeth Hillman: Yes. It was done between 1995 and 1997 by Dr. Vincent Felitti, who was running a bariatric clinic for Kaiser Permanente, and he was seeing that health behaviors were really interfering with people's success after bariatric surgery. So he undertook this study of 17,000 adults and was really surprised by everybody, was really surprised by the results that 15% of these people, and these are middle class people with private insurance. So financially stable, well-educated, 15% had two or more ACEs and 10% had three or more ACEs. And so what we learned from that, that the adverse childhood experiences are common, they're threatening to wellbeing. And unfortunately in our society they're too often denied, which is one reason that they have led to such chronic health issues, health risk, disease, premature death. What they really took away from this study was traumatic events in childhood are a leading determine of health and social wellbeing, and makes them major factor underlying addiction. So it's pretty consequential study and it was done 20 years ago and we are still talking about it and not acting on it quite in the way we should. And we here at Pullman Hospital are trying to change what we're doing with that information and trying to become more proactive.

Host: Okay. Okay, that makes sense. So then when it comes to abuse, I'm just trying to figure out how wide spread is this. So can you tell me about Washington state child abuse and or neglect statistics?

Elizabeth Hillman: So in 2016 which is the last year, they're complete statistics available. There were 93,000 referrals in Washington State for child abuse and neglect and almost 11,000 children in out of home placements. Those are indicators of some pretty serious adverse childhood experiences. And 26% of Washington State adults report that they have three or more ACEs, and Whitman County is on par with the rest of Washington State. So that's what we're looking at and that's a lot of kids and that's a lot of adults. And if you have six or more adverse childhood experiences, that makes you 4,000 times, 4,000 times more likely to become an IV drug user, 3000 times more likely to attempt suicide and it reduces life expectancy by up to 20 years.

Host: Wow. Those are really alarming stats. And earlier you said 26% of the adults in the State, that's over a quarter of the adults in the State. That is alarming and a lot higher than I would have thought. So how does all of this translate to patient care in the healthcare setting?

Elizabeth Hillman: So medical professionals to be talking about and addressing how chronic stress affects the body. And it results in higher incidents of autoimmune conditions and chronic health conditions. Studies have linked a greater number of ACEs to heart disease, cancer, chronic lung disease, liver disease, diabetes, and those with an ACE score of four or more also tend to have higher rates of mental illness.

Host: So what happens to our bodies during these traumatic events?

Elizabeth Hillman: What happens to your body in a stressful event is you release cortisol and adrenaline. You know, it's the fight or flight response we have to a dangerous situation and that is a normal and protective response. But what happens when it's chronic is that those hormones stay too high. And when you have consistently high blood sugar, for example, sets you up to get diabetes, there is a clear correlation between chronic stress from traumatic events in childhood to poor health outcomes in adulthood.

Host: Well, you just laid out a full roadmap for us right there. Trauma leads to stress. Stress leads to poor health outcomes. It's very easy to understand the relationship between trauma and healthcare. So then what is Pullman Regional Hospital and Clinic Network doing to address these issues?

Elizabeth Hillman: You can experience stress and trauma in childhood and not have poor health outcomes, right? What you need is resilience and you need adults surrounding you to help you recover. And so what we are trying to do here is some primary intervention, which is with children. So the Whitman County Health Network, which is a group of agencies including Pullman Regional Hospital, a couple of years ago, secured grant funding to bring a prevention program to Sunnyside Elementary, training the staff there to work with children who have behavioral issues in the school. So teaching them to respond in a trauma informed way. This just in 2019 again got grant funding to bring the Strengthening Families Program to the entirety of Whitman County, which is an evidence-based program that improves family functioning and increases resilience in the family.

So those are couple of ways we're doing the primary intervention with children. With adults, we are implementing currently in our hospital and Clinic Network, a health coaching program. We believe in interdisciplinary care. We believe that you provide people better care when you have multiple professionals working together to provide that care. We have a nurse and a social worker who are being trained as health coaches and in motivational interviewing to do health coaching with our patients to address those health behaviors that are affecting their chronic illnesses. We're training our staff so that all of our staff can be working with our patients in a way that is proactive, respectful, and engaging them in their own healthcare.

Host: I like how you put that, engaging them in their own healthcare. What an interesting program. Thank you so much for explaining this to us and keep up the good work, Elizabeth. We appreciate it.

Elizabeth Hillman: Yeah, thank you very much.

Host: That's Elizabeth Hillman. And to get hooked up with a provider or to learn more about trauma informed care, please visit PullmanRegional.org, that's PullmanRegional.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Health Podcast from Pullman Regional. I'm Bill Klaproth. Thanks for listening.