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!

There are alternatives to trauma treatment using Medicaid. Most regions have domestic violence sexual assault (including survivors of childhood sexual assault) programs who offer services free of charge regardless of income. They are based on empowerment, non-deficit models of treatment and their staffs are seasoned professionals well versed in trauma informed care. They are specialists in what they do and offer an array of services from resource brokering (finding housing, food, medical care, etc.), counseling, social advocacy, forensic rape kits performed by nurse practitioners who are sensitive to sexual assault survivors (too often hospital-based tests are performed by residents who may approach the survivors from a blaming stance), child care, temporary shelter, special programming like mindfulness, yoga, creative expressions and other similar activities, therapy for trauma-exposed children, legal counsel, career counseling and support groups.

These programs are funded through a variety of public and private sources. 

Ashlie Torres posted:

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!

Thank you for sharing your experience. I agree that the system falsely assumes the cause of the struggles that families are facing as pathology. What I find so hopeful about the trauma-informed approach is that the assumption about behavior and symptoms is that they are adapting to the stress in their lives. This may be the trauma from their childhood or from their current situation/s. When we approach people with stabilization first, educating and supporting them in identifying and meeting their basic needs, then they can move toward a deeper understanding of how they are adapting (which are often the symptoms used to diagnose disorders). True healing should absolutely be moved to the forefront of the health care system. 

In Kansas, the State Department of Health and Environment is leveraging Medicaid Administrative Match funding to contract with our team at Wichita State University to provide training and technical assistance to public health organizations who are interested in becoming more trauma-informed in their approach to care.  Through that contract, we work primarily with local health departments, safety net clinics, and other health care organizations who serve the Medicaid population to improve policies and practices at the organizational level.

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Andi Fetzner
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