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I recently went to interview at a FQHC that had all these components of integrated care.   I felt they were incredibly lucky to have so many resources because rural areas don't have any of these, but there is a big problem here and it is big.....



When Wendy talks about her depression the doctor gets on the phone to call a psychiatrist --- who "increases Wendy's medications."    



The traditional psychiatric care as has been done - 10 minute medication management visits." don't cut it or fix the  problem for incredibly complex patients like Wendy who likely have experienced a ton of trauma.   Everything in the video all sounds marvelously glowing but many folks with these complex issues ---


have problems with transportation, not quite enough money to buy those medications (which I don't think they actually probably need ---- at least many of the psyche meds) AND this is where the problem is



Where is the discussion/screening for Wendy's ACES, exposure to toxic stress both childhood and current -- Wendy needs a safe environment now to in anyway become healthy.  Does Wendy have safety?  Noone knows; no one asked.   (I have realized that as an adult I have lived the same 10 ACEs that I experienced before I was 18).   Without this piece --- the new integrated care model -- will be an improvement but if it shows only small to modest improved compliance and symptom resolution that if they are not maintained long term these systems will disappear, this model too will be abandoned.   


The Trauma Screening and Trauma-Informed Care piece was no where in this model video.   The FQHC I interviewed at had no idea of what ACES where, had never heard of toxic stress or the ACE study and thought that what I was wondering about --- did they know about this important information -- well, was just strange, odd, unusual and unnecessary --- so maybe I was strange, odd and  unusual too.  


Integrated care is important --- It cannot be done everywhere unless there is a cash infusion (It couldn't be done in Alpena, Michigan where you cannot go to CMH unless you are on Medicaid and are suicidal or homocidal and we only have 14 ---- kids getting trauma-focused CBT. ) 


More work needs to be done and significant education for state and federal policy makers is needed to move this important needle in the right direction PLUS educational systems need to change -- that's why I think attack community colleges.  Give those young students the education on ACEs, toxic stress, the negative effects of this exposure on altered neurodevelopment.   That is why I am talking at ACC's Psyche nursing course.  Hopefully (though I know --- this doesn't generally sink in long term after one talk) those nurses will be better more compassionate nurses and will have a better understanding of the behaviors they may otherwise find annoying or down right repugnant in the patients they are supposed to be there to serve.   


Thanks Tina

Last edited by Former Member

Jane, Thank you so much for posting this great video! CityLife Neighborhood Clinics are working hard to establish a network of fully integrated healthcare clinics here in Philadelphia to improve the overall health and wellness of our seniors, block by block.  I will share this video with our care team and will try and incorporate it into our community education events as much as possible.  Thanks again!!!

Last edited by Aniela Zygmont Glinski
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