Ive been working with the Medicaid population for over 8 years and the last 3 years Ive become much more aware of the significant impacts of trauma. I have seen hundreds of clients make little to any progress with their traditional therapy due in part to many therapist not understanding the true impact of trauma (ACEs). I think a lot has to do with with agencies not providing proper training opportunities and oversight to clinicians who treat clients impacted by trauma, which in turn ends up being years of therapy in which clients make very little to no progress on true healing. There needs to be a better screening process for clients that are impacted by trauma to be matched with the most qualified therapist and not just who is available and willing to take a case. I think a lot of agencies in the Medicaid circle have a good framework for how they would like to treat clients who have trauma histories, but rarely are actually able to put that into practice, at least from what I have seen in my area.
I have always felt that if Medicaid provided more coverage options to other methods of healing, such as Trauma Focused Massage Therapy or Parent Coaching or even therapeutic mentoring for children and adults. These methods would in the long run save much more money, as these are shorter term options that provide a greater level of healing than traditional "talk therapy". The science is already out there on how trauma affects brain development and how physical activities and movement greatly help the healing process and "rewire" the brain, yet that is not often something I see Medicaid therapist incorporate into their treatment plans. Most therapy is focused on a cognitive perspective and trauma or toxic stress is an emotional experience. I see often therapist teach great coping skills, but those skills are rarely utilized by the client's because they often do not realize in times of stress, thinking becomes confused and distorted and the short term memory is suppressed, which prevents the client from even being able to access that part of the brain when they need it most. Trauma work involves a deep understanding of brain development and how stress impacts behavior. Medicaid should have some type of incentive for providers who are truly trauma informed. I also think there needs to be a much bigger emphasis on family therapy rather than individual therapy in trauma cases involving children to have long term success.
There is such a lack of true understanding of ACEs within the Medicaid community!