Moving toward trauma-informed practices


By Sue Cody

Giving children a good start in life begins with parents and prenatal care. Childhood trauma affects parents’ ability to give their baby a healthy start. Learning about those experiences provides information critical to the future health of their baby, say Teri Pettersen and RJ Gillespie, pediatricians at the Children’s Clinic in Portland.


In May 2017, Columbia Memorial Hospital (CMH) began giving Adverse Childhood Experiences (ACEs) questionnaires to parents in its pediatric clinic. After talking about ACEs, patients feel more comfortable sharing their experiences with staff and providers than they did before, says Misty Bottorff, resource coordinator at CMH.


One year later, CMH staff gathered partners to discuss trauma-informed practices, including ACEs and Resiliency screening. More than 20 people, including parents, therapists, health care workers, physicians, social workers, county employees, and Way to Wellville and Columbia Pacific Coordinated Care Organization (CCO) representatives, attended the luncheon May 26 in Astoria.


“This is wonderful,” says Trina Robinson, public health nurse. “CCOs, hospitals and the county all have a passion and desire to see children have the best possible start. The first 1,000 days are so important. This is fabulous that we are sitting here, sharing ideas. This is what we do for the best start for our kids in Clatsop County.”


Trauma-informed care at CMH

 CMH trauma-informed FB

CMH Care Management Supervisor Mark Muse says moving from one social worker one day a week to a full-time social worker that meets with patients and offers daily support has expanded resources for patients and helped introduce trauma-informed care.


Columbia Pacific CCO funded the ACEs screening. Bottorff was hired as a social worker who offers to meet with all 28-week gestational moms, providing resources as needed. She works with obstetricians, pediatricians and staff connecting to therapy, social services, housing, finances, drug and alcohol treatment, etc.


Not everyone is willing to meet with Bottorff, but there is a sense of relief from parents, knowing there is a backup, says Nurse Practitioner Misha Caldwell. “I tell them, ‘It takes a village, and Misty’s just an extension of our village now.’”


Those who have high trauma scores are strongly encouraged to meet with Bottorff at prenatal and pediatric clinic visits.


Screenings are done during pregnancy and at pediatric visits beginning at 4 months and continuing at 9, 12, 15, 18 and 24 months, expanding to 3 and 4-year-olds.


Success stories


Bottorff relates a couple of success stories of helping women get off drugs and being able to keep their babies:


One mom had a meth addiction and had children removed from her home. She was two-years clean. She was about 4 months pregnant and afraid Child Protective Services (CPS) would take away her baby. Bottorff was able to meet with her early on and guide her through pregnancy, so she had support. The woman got to go home with her baby and is doing phenomenally well.


Another woman had a traumatic background and had CPS calls because a substance test was positive. She was very fearful her baby was going to be taken away. All these things were piling up. Bottorff was able to intervene and work with CPS. The mom is now going to Clatsop Community College, and the 9-month-old baby is doing well.


Moving forward


“We are only scratching the surface,” says Nurse Kendra Gohl.


She would like to see more community awareness and treatment of trauma. Ideally, she’d like   birthing centers, emergency rooms and all primary care providers to implement trauma-informed care.


“WellSpring (Community Network) and The Way to Wellville are all about trauma-informed care in our county,” Gohl says.


Gathering the data and having a list of community resources is a great start, says Robinson.


The overall consensus at the gathering was that community partnerships are essential to implementing trauma-informed care.


Bottorff says, “I was so amazed by the turnout and support from community partners. It was great to get together and share ideas and receive feedback on next steps.”