Funder: Robert Wood Johnson Foundation
May 2018 | Case Study
The Stephen and Sandra Sheller 11th Street Family Health Services (11th Street), which serves roughly 5,000 patients, is situated in one of Philadelphia’s most underserved neighborhoods. To better address the needs of this vulnerable population, 11th Street has pursued an organization-wide culture shift dedicated to the principles of trauma-informed care and mindfulness.
11th Street has aimed to provide trauma-informed care since before most providers had even heard of it. “Today, it is in every fiber of what we do,” says Patricia Gerrity, PhD, RN, FAAN. However, it was not always that way. When the clinic was established in 1998, its leadership was aware that its patient population was burdened with above average rates of conditions like diabetes and heart disease. They were shocked, however, by the ubiquity of patients’ exposure to traumatic experiences such as abuse and neglect. “We didn’t have the language for it back then,” says Gerrity, “but we knew things like adverse childhood experiences (ACEs) were impacting our patients’ health, and our ability to care for them.”
“Once you’ve learned about trauma-informed care, you feel this moral and ethical obligation to do something with that information.”
In response, 11th Street sought advice from the community on how to improve care for those with histories of trauma. In 1998, the Partnership for Community Based Care (PCBC) was created with the goal of giving patients a voice within the clinic.
One particularly dedicated group of patients (who nicknamed themselves “The Backbone”) even provided input on the design of the clinic’s newly renovated space to help make it more welcoming to visitors. The PCBC continues to meet quarterly, and over two decades has spearheaded numerous changes to clinic procedures and policies.
One of 11th Street’s latest initiatives is the creation of a Mindfulness Team, a group of staff dedicated to promoting a culture of reflective awareness within the clinic. Gold stars are posted on walls throughout the clinic as a reminder to staff to constantly “notice, shift, and rewire.” The practice is meant to encourage providers to leave past stressors and issues at the exam room door, and treat each patient as an individual. This collaborative, patient-centered approach is a key principle of trauma-informed care, and has been transformative for 11th Street staff and their patients.
Select Features of 11th Street’s Trauma-Informed Approach
Based on ingredients of trauma-informed care outlined above, following are select aspects of 11th Street’s approach to addressing trauma.
Creating a Safe Physical and Emotional Environment
Principles of trauma-informed care directed the design of 11th Street’s physical remodeling to help patients feel more comfortable and at ease. Patients now enter through the building’s atrium, which is light and airy—everything is white, glass, or uses natural textures like wood or stone, and the entire area is bathed in sunlight. The space is open, but also provides privacy for personal conversations. 11th Street has also enhanced its clinic walls with pictures and murals painted by members of the community. These additions give people from the neighborhood a sense of belonging and ownership when they visit the clinic.
Training Clinical and Non-Clinical Staff
11th Street is pursuing Sanctuary Certification to build awareness of trauma and its consequences, equip staff with tools to manage trauma, reduce the risk of re-traumatization, and promote mindfulness across staff at every level and the clinic’s various departments. To introduce the Sanctuary Model, 11th Street included all employees in an intensive, two-day training on trauma, how it affected them, and how they could be part of the solution by transforming the way care is delivered. The clinic established a core group of staff at every level to support clinic-wide adoption of the Sanctuary Model. Additional ongoing trainings include regular in-service learning to increase staff capacity to address trauma, and working groups committed to open dialogue and mission-oriented change.
Creating a Healthy Workforce: Staff Self-Care
11th Street prioritizes staff satisfaction and wellness, and offers creative arts therapies and other evidence-based mind-body practices, including yoga, dance/movement therapy, and stress reduction courses. The building has areas for staff to be alone or socialize in small groups, an on-site fitness area, and a kitchen that hosts nutrition classes both for patients and staff. Employees are encouraged to participate in social groups, which meet to discuss topics such as racism, mindfulness, and coping with grief. 11th Street also screens for staff burnout using the Professional Quality of Life tool, which assesses employees on compassion satisfaction and fatigue, burnout, and secondary trauma.
Screening for Trauma and Providing Trauma-Specific Treatments
Staff provide trauma-specific treatments including: Mindfulness-Based Stress Reduction; trauma-informed yoga; creative arts therapies (dance/movement therapy, music therapy, and art therapy); behavioral health consultations (integrated brief talk therapy) in primary care; and talk-based psychotherapy modalities in outpatient behavioral health care. 11th Street has provided some of these treatments for years, while others were incorporated as an extension of clinical work performed by partners at the College of Nursing and Health Professions at Drexel University.
Next Steps for Trauma-Informed Care at 11th Street
Maintaining up-to-date practices within a field as quickly developing as trauma-informed care requires constant reassessment and fresh ideas. The clinic is committed to continuing to train staff and refine its approaches to improve care and build more meaningful relationships with patients who have experienced trauma. For example, 11th Street is expanding its creative arts therapies treatment program to support more patients and is exploring potential reimbursement mechanisms for these services.
11th Street is also wrapping up its Sanctuary Model implementation, and will be assessed for Sanctuary certification in June 2018. Lastly, 11th Street will continue training their Community Advisory Committee about trauma and trauma-informed practices so they may educate additional communities within Philadelphia.