Economic benefits of trauma informed care

I want to follow this question, because it is something I have thought about many times. 

Indeed, most of us, as carers -- lay, family, or professional -- are not used to, or trained to, think in such terms. More's the pity. Only somewhat related to the topic -- in terms of overall childhood mental illness, and not adult, or physical illness, is the paper by Smith and Smith DOI: 10.1016/j.socscimed.2010.02.046

"Long-term economic costs of psychological problems during childhood"

Still pretty gobsmacking in its implications, especially when one considers people like van der Kolk call childhood trauma the #1 Public Health Problem (not just mental health problem -- understandably, when one considers the physical illnesses it's linked to).

Attached is a report that Laura Porter, Rob Anda and Kimberly Martin wrote about self-healing communities. It provides information about the costs saved (millions of dollars) when these communities integrated practices based on ACEs science.

I'm also finishing up writing an article about a primary care clinic for a low-income community that has integrated the ACE survey, and is seeing a reduction in ER use and an increase in keeping medical appointments.

Wow, awesome! One couldn't want anything more current. Again Jane, you've really got the contacts. Information like this makes it so much easier for the rest of us trying to bring about changes in this area. This group, and I, owe you so much thanks.

Thanks heaps!! 

ACEs Connection had a 2 hour presentation by Dr. Felitti in Alaska, that has since been taken down, were he states that a division of Kaiser Permanente crafted a 10 page patient history questionnaire with ACEs awareness built in and they saved 2 billion dollars. 

That would be interesting to see, and to do the sums oneself.

Russell Wilson posted:

That would be interesting to see, and to do the sums oneself.

Felitti states that Kaiser had 6 billion budgeted and saved 30%. I'll paraphrase his response to why Kaiser was reluctant to continue the program. "The Ordeal of Change: The reason for change to be so difficult is it induces a crisis in self-esteem. You have to admit you have been doing it wrong all this time."

Here's a blog post by Dr. Felitti about the system he set up at Kaiser's Health Appraisal Center (which no longer exists, unfortunately) -- https://www.pacesconnection.com/...manente-in-san-diego

as I said, if you could produce the original source for the quote ....

thank you, Jane, you must be getting to know me -- giving the link to the original source 

that really is an excellent post -- I recommend everyone in the field reads it.

From the viewpoint of a therapist it brings a couple of things to mind, but most folk here aren't therapists, so if people wonder what I mean, they can contact me personally.

Thanks Jane for re-posting this excellent article which I've either not seen or not remembered.   I'll be sharing it with medical colleagues who are beginning to integrate ACEs question into their practice and often struggle with what to say.

Leslie, the NEAR@Home ACEs Toolkit has a GREAT section devoted to dialogues. Although it was designed for home visitors, it's easily applicable to health care.

Leslie Lieberman posted:

Thanks Jane for re-posting this excellent article which I've either not seen or not remembered.   I'll be sharing it with medical colleagues who are beginning to integrate ACEs question into their practice and often struggle with what to say.

I guess one of the classics in the field (in some ways -- I suspect the author has personal "lived experience", but his view tends to be limited to that sort of adversity) is John Read's article (2007) (sent via PM) "Why, when and how to ask about childhood abuse" which recommends a "funnel technique", (DOI: 10.1192/apt.bp.106.002840) asking questions more and more directly related to the abuse.

One of the reasons the comprehensive examination is no longer in use, apart from its cost, might be that these days there's a lot more concern that clients / patients have the resources before asking about the "abuse", trauma, adversity. Such direct approaches used previously may simply not be allowed these days -- foolishly, I consider. Some years ago there was an issue of American Psychologist which examined the question of whether or not victims of abuse had the resources to be subjects / participants in research about abuse, The consensus was that they could be, provided "emotional safety" was assured.

Jane, looking at the comments, I presume that post by Zorrah was in 2015 -- is that right? How things have changed!