Children's Voice September/October 2007

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NCTSN Center Supports Rural Trauma-Informed Care

Establishing ongoing trauma-informed services is one of the most difficult challenges facing rural mental health programs. Schools, community groups, and natural helpers try to meet needs but often go unsupported. Health professional shortages are widespread in rural communities, and many caregivers find themselves trying to be all things to all people.

Consequently, health services are available typically from a "generalist," who may or may not target specific mental health issues like trauma. Rural and frontier helpers also may not be able to find time for continuing education. In general, rural providers work more hours, see more patients, and take fewer days off than do their urban counterparts.

Because they live in small towns, or are the only providers available, they may have to provide trauma treatment to people they know. And because rural people are more likely to be uninsured or on Medicaid or Medicare, reimbursements are generally lower than in urban areas, even with identical services. These challenges, coupled with provider shortages, severely challenge efforts to deliver quality care.

The National Child Traumatic Stress Network (NCTSN) is working to address these rural provider issues through its Center for Rural, Frontier, and Tribal Child Traumatic Stress Interventions, based at Idaho State University. The center has developed a complete training and technical assistance program-- the Health Services System Environmental Scan (HSSES, pronounced Hess)--that is available for individuals and organizations serving children in rural areas, including health and mental health facilities.

The purpose of HSSES is to strengthen, retain, and improve the quality of rural mental health care. HSSES implementation is a joint effort between the community seeking help and a team knowledgeable across trauma-focused mental health care, health service systems, geography, economics, and community development.

HSSES is a standardized intervention that reviews organizational and community characteristics, including provider number, type, training, and mental health; the economic health of the organization and the community; social and geographic characteristics; and many other traits.

HSSES involves a two-step assessment, beginning with a self-report form completed by the individual or organization requesting training and assistance. Once the applicant is accepted into the program, center staff completes a structured interview to learn more about the site and the applicant's community. Center faculty and staff then create a report for the applicant that summarizes the information gathered and provides suggestions for strengthening the program. Applicants may choose to work on their own or with the center faculty and staff to develop a plan to strengthen their sites.

To learn more about HSSES, visit the Rural Child Traumatic Stress Virtual Program Center website, or e-mail childts@isu.edu.

This article was adapted with permission from NCTSN's e-Newsletter, September/October 2006.

Residential Cottage Designed to Feel Like Home

The Hillside Family of Agencies' new AdaptaCare Cottage doesn't look much like a residential care institution. On a virtual tour, the ranch-style building looks more like an attractive single-family home, with green siding, red shutters, covered front porch, and flowering bushes lining the front sidewalk.

Inside, a living room and recreation room are painted in earthy reds, yellows, and browns. An "all seasons" room has large windows, deck-style furniture, and potted plants. A Yankees baseball team poster hangs in a boy's bedroom.

The cottage is a design the western New York state agency hopes it will never outgrow.

"Like most agencies, Hillside has facilities of various vintages that were originally intended for a specific client population and type of programming," says Paul Perrotto, Hillside's Chief Financial Officer. "As client needs, regulatory requirements, and programming have changed, we have renovated and retrofitted existing structures. Renovation is extremely expensive, however, and it isn't always cost-effective."

Fortunately for Hillside, an anonymous benefactor recognized the problem and donated $1 million to allow the agency to design a facility that can meet stringent federal and state child welfare, mental health, and developmental disability regulatory requirements, as well as easily adapt to meet new programming needs.

In keeping with their benefactor's wishes, Hillside is making the cottage blueprints and concept available at no charge to other agencies. Site visits to Hillside's first AdaptaCare Cottage in Bath, New York, can also be arranged by appointment, or Hillside can provide a virtual tour via CD. The cottage in Bath serves adolescent boys with sexually harmful behaviors.

During the development process, Hillside gathered input and feedback from staff. As a result, the cottages are designed with a homelike but therapeutic environment in mind. They include areas for group therapeutic activities, family visits, private space, and staff functions. Designed to accommodate 6-10 beds, the buildings are constructed with tamper-resistant materials and clear lines of sight throughout for safety. They can work as self-contained communities, or in the context of a campus environment.

Hillside staff say they've received significant interest in the AdaptaCare Cottage design from other agencies, but it's not something every agency can implement immediately. The cottage is more expensive to build than traditional residential designs--$100,000 per bed, depending on location, cottage configuration, and design specifications.

But Perrotto points out, "The savings in repairs and renovations will more than offset the additional cost. This design also makes an agency more nimble and able to respond to opportunities they might otherwise have to pass up. It's an investment that will continue to pay dividends for many years."

For a complete AdaptaCare Cottage information packet, contact Judy Newkirk at 585/394-5445, or jnewkirk@hillside.com.
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