STAR² Center Talks Workforce Success Podcast

In this episode, Michelle Fernández Gabilondo is joined by Aniela Brown, Trauma-Informed Care Coordinator at the Texas Association of Community Health Centers (TACHC) to discuss TACHC’s Trauma-Informed Care (TIC) Program as they prepare for their fifth cohort to dive into their curriculum designed with the help of ACU STAR² Center at the intersection of workforce, TIC, and Justice, Equity, Diversity, and Inclusion (JEDI) as well as efforts to connect TIC and Value Based Care in Texas.


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Full Transcript

Michelle Fernández Gabilondo: Welcome, everyone, to season five. This is STAR² Center Talks Workforce Success. My name is Michelle Fernández Gabilondo. I’m the Associate Director of Workforce Development at the Association of Clinicians for the Underserved. We’re really honored and excited to have Aniela Brown today. She is the Trauma-Informed Care Coordinator at the Texas Association of Community Health Centers. Welcome, Aniela.

Aniela Brown: Hi. Thanks so much for having me today.

Michelle Fernández Gabilondo: Of course. We’re so excited to have you here and have you go through all of these questions. Just to start off, for our audience, could you introduce yourself? Tell us a little bit more about your professional journey, your role, and specifically the program that you work with, which is the TACHC Trauma-Informed Care Program.

Aniela Brown: Yeah. Thanks so much for having me today. I actually have a relatively unique background. I grew up in Philadelphia, Pennsylvania, and went to a magnet high school, Central High School, in Philadelphia. Proud member of the Class of 263. The importance for my high school is actually because it was such an incredibly diverse experience that I had there. The students really wanted to be at the school. It was an incredibly diverse space. Everyone was coming from all across the city and really interested in learning and connecting with one another. Hindsight, it was a really great experience while I was in high school, but it really set a incredible foundation for where I was going to go and what my interests were after that.

I actually went to the University of Rochester in Western New York for college. Initially, I was going to be an astronomy and physics major, and very quickly changed. My family laughs about this. I wanted to work for NASA initially, but I very quickly changed and actually double majored in political science and African and African-American Studies, with a minor in dance. That was specifically in movement, culture and community. Really, the way that I like to summarize my undergrad career was, in having hard conversations about race and how people identify, but then how we connect and build community, specifically through the arts, through food, through community development.

I didn’t really see how that was going to play out as far as work or employment when I was in college. But then my first job out of college was teaching a special summer learning intensive with a nonprofit organization based here in Philly. It was really to stem learning loss for elementary school kiddos in second and third grade. The entire curriculum, oddly enough, was all focused around community development, democracy, and being who you are. So really, it was an immediate application of what I had studied in college in the summer work experience.

Then I ended up working at this organization that I had the position with. I ran an afterschool program and in-school team. It was for an organization that employed and focused on AmeriCorps members who were doing a year of service and community-based organizations. I was at one of the lower-performing schools in the school district of Philadelphia. Just a lot of challenges academically for the kids. But primarily, the kiddos had a lot of challenges just with where they came from in their community. A lot of challenges with nonmedical drivers of health or SDOH. Nearly 100% of our students were receiving free or reduced lunches. A lot of community violence in the particular neighborhood.

Our role for the afterschool and the in-school program was really to provide positive supports for the kids to engage with after school. We developed a dancing and drumming program. Had a couple performances throughout the course of the year that really got our families involved in positive things that their kids were doing. We had an afterschool chess team. All of that really laid a fantastic foundation for how we, again, go about building community and propping up our students, and also having me see in real life what different challenges our kids had, but then the positive things of what they could do, and just absolutely incredible resilience.

I also quickly learned that majoring in liberal arts in college taught me how to think critically, but it did not teach me practical skills and how to help the kids that I was working with. So when I was confronted with a first-grader in my program who was threatening to kill herself with safety scissors, I was quickly above my skillset and realized that I needed to go back to school to get the skills to be able to help these kids. So I ended up going for my master’s in social work at Temple University, and really focusing on macro practice and how we, again, do sustainable community development for children, youth, and families.

I took a little bit of a detour. I did the program for a year. Then I ended up applying and joining and doing two and a half years of service with the US Peace Corps. With my African and African-American Studies undergrad, I had actually done study abroad in Ghana, in West Africa, and had been thinking and really reflecting on how I could get back. I had an absolutely incredible and life-changing experience as an undergrad. But knowing that study abroad experiences really are more for the student to learn and grow and less about service, that’s really what I wanted to do, was do some sort of additional service.
I ended up being a community education specialist in the Peace Corps in Zambia, in Southern Africa. We worked on sustainable community development, was co-teaching in the school, so really trying to help the teachers adopt learner center teaching practices. We did a big HIV education and outreach program with a local nonprofit organization in my community, so educated approximately 2,500 students throughout the course of my district on HIV prevention. At the time, they were doing healthy living because access to medication was not available in our community.

Then we actually worked together with my village and built the first community preschool in my community. It was truly a sustainable community-led effort. It took the entirety of the time that I was there, to the point where we opened the preschool two days before I left my village, because we were going slow, and we were doing it together. It was not a top-down approach. It was really what assets do we have in the community, how do we leverage them, and myself just serving as, really, the project coordinator to keep things moving. But my community was just absolutely fantastic. The school is actually, excitingly, still going. I have provided no support or guidance or nothing. It has been all them since I left in 2013. So that has been a really, really incredible thing to see and watch and hear about them doing.

When I returned from the Peace Corps in May of 2013, I continued working with an organization for the National Health Corps in Philadelphia as a coordinator, so helping young people, primarily kids or young adults who were just graduating from college, who were interested in doing a year of service with AmeriCorps. They were serving in federally qualified health centers here in Philadelphia. That was really my first entry into FQHCs and that world, and very quickly realized that intersection of public health and social work and community health was where I wanted to be in some way, shape, or form. The service that they were doing, prescription assistance program enrollments, health education, really being able to support and build capacity within their health centers, it was so incredible to see them help their community through that and then go on to be physicians.

While we were there, we were also developing training. I was organizing these trainings. We were able to embed training principles, so talking about nonmedical drivers or social determinants of health, talking about trauma-informed care, talking about biases and cultural humility for young people who were going on to be providers. Even at the end of the day, if we didn’t know what their medical training or their nursing training or their social work training was going to be, we at least knew at the end of the day that, fundamentally, they were going to have that core training background that was part of our program.

I was working with the National Health Corps in Philadelphia and going to graduate school part-time. I was doing both. I was interning at a local drop-in center for mostly unhoused youth at the same time. My second internship was my first entree, really, into trauma-informed care. We were able to do a TIC messaging campaign, so really educating community members on the ACEs study and on how we talk about trauma in our experiences and how we propel people to action to actually do something about getting upstream and prevention.

After that work, I went and worked for a startup organization doing fully integrated primary care mostly for older adults and seniors in the North Philadelphia and West Philadelphia communities. So really, the absolute perfect job for a new social worker who was interested in building community, establishing those relationships, really at the intersection, again, of social work and public health. Did a lot around food access and how food is such a critical piece to overall health for individuals, how they move forward, how they take their medicine, how they build community, how they become empowered to manage their own health, and do so in a way that feels culturally appropriate for them, that they can still make the yummy things that their grandmom used to make or they love to make, but do so in a way that was a little bit modified with a little bit less salt, or a little bit less sugar, or something along those lines. Had a great time working with them.

Then ended up meeting someone who is an active duty naval officer and went out to San Diego, California. Worked for Rady Children’s Hospital in their Center for Healthier Communities. Again, working with young people, specifically high school students who were interested in pursuing careers in healthcare. We did a two-week summer camp for those students that they were able to listen to healthcare providers and learn about cardiothoracic surgery and learn about what it’s like to be an emergency medicine doctor and the schooling that’s required, or to be a nurse or to be an MRI tech. They spent two weeks with us really learning and listening and then were able to make those decisions about what they wanted to go into college or what they wanted to go into a technical school program about, a bit more educated than just, “I want to be this,” and “This is where I’m going to go,” and then getting to the end of that schooling and being a little confused that that’s not really what they thought it was going to be. So they got to go into this workforce piece with full eyes open.

As per the military, we move a fair amount. So after San Diego, we came to College Station Texas for my husband to go to Texas A&M. I started actually working with TACHC at that point as a clinical intern, is what my position was, working on an HPV Vaccination Uptake Grant in a collaborative partnership between TACHC and the American Cancer Society. So we worked with 15 health centers to increase HPV vaccination rates. Then the pandemic hit, so we went full virtual. We still continued on that HPV Initiation Grant, but did a lot of work, then, subsequently with each COVID vaccine. The fascinating piece with that was there was so much work that we had done learning about how people make decisions about vaccines, what drives them to become vaccinated, what drives hesitancy or questions, what drives people to say, “No, I would not like a vaccine,” and how you communicate as providers in a way that is empathetic and keeps the conversation, the door open. The work that we had done around the HPV vaccine became incredibly pertinent around the COVID vaccine because there was a lot of those conversations happening.

Then we started thinking about how we do this work in a trauma-informed way. Again, I had tried to thread through trauma-informed care from my work as a graduate student in each one of my positions. TACHC had a Trauma-informed Care Program, which I’ll talk a bit about. Eventually, I was able to come on board with the TIC program in July of 2021 and have been with the TIC program ever since. It really is an absolute dream intersection of community development, public health, medicine, healthcare, working on advancing equity, advancing all of the things that I learned as a high school student, and dealt with and believed in as undergrad. Really, all of it has come full circle.

Michelle Fernández Gabilondo: That is so amazing. Thank you so much for that introduction. I just have to say I’m a fellow social worker, also macro level, so I always get excited when I get to talk to other social workers. But I think, also, we have a lot of overlap. I actually grew up going to magnet schools when I was in Florida. My undergrad was in studying the arts, and then interested in going into, like you said, more practical applications. Thank you so much for sharing that. That was such a wonderful journey. It was just so easy to visualize you, from being in Pennsylvania all the way to where you are now. We’re definitely excited to learn more about the Trauma-Informed Care Program.

I just wanted to also ask you as we go into our other questions, as you know, and I think so much of what you described, especially in the area of trauma, there’s so many things that are affecting our workforce. Could you share with the audience some of those workforce challenges that you feel are really front of mind with the work that you do with health centers in Texas?

Aniela Brown: Absolutely. I guess, as well, I want to give a little bit of a description about who we are as TACHC. That might help the audience, too, to visualize even more. TACHC is the Texas Association of Community Health Centers. We’re actually the federally designated primary care association for the state of Texas. We serve 73 FQHCs with over 650 clinic sites in 137 counties across the state of Texas. We serve urban, rural, frontier areas. I mean, Texas is a huge, huge state. We have health centers in just about every area of the state of Texas. We’re actually in our 40th year, which is really exciting, of being able to advance this work for our health centers and communities. Our mission is really to strengthen and support community health centers, to be able to speak in a unified voice and drive healthcare transformation by exemplifying innovation, access, and equity. That’s really something that we prioritize across all of our programs, but especially within our Trauma-informed Care Program as well. Our TIC program, again, if I could just describe that a little bit.

Michelle Fernández Gabilondo: Of course. Please. Go ahead.

Aniela Brown: In 2018, as many of you can recall, there were a lot of challenges at the border with Texas and Mexico. A lot of family separation, unfortunately. A lot of challenges with what that looked like, how that was playing out, and just, frankly, a lot of trauma across the board for a lot of individuals. Our TACHC CEO at the time saw that and really wanted to do something to be able to help, as did our Director of Medical and Clinical Affairs, Doctor Roxana Cruz. So they traveled down to the border. We have a number of health centers that are right along the border with Mexico. They started to ask questions of how they could directly help, what assistance they could provide.

Unfortunately, they weren’t able to provide right in realtime assistance, but the more people that they got to talk to, the more they realized that not only were the individuals who were experiencing the trauma, who were migrating to the border, having those experiences, but the staff at the health centers, particularly that they were engaging with, were also really traumatized because of what they were seeing, the stories that they were hearing, the helplessness, potentially, that they were experiencing by not being able to change a lot of the things that were going on. When they came back to Austin, they had a renewed sense of, “Okay. We figured out our purpose. We need to be able to provide support to our health center staff.” That was going to be the intervention.

At the time, they did a lot of research. They started connecting with experts from across the country on what is this? We know this has to be trauma-informed something. So they ended up connecting with a group up in Buffalo. They said, “Hey, we actually have a recent graduate who lives in North Texas, who is trained with us. Let’s get you connected with them.” That’s my colleague, Aimee Rachel. She is a licensed master social worker. That is where her role came in, is really to develop this absolutely incredible curriculum. She worked together with a colleague who was a longtime experienced teacher, developed an inquiry-based model of teaching about trauma-informed care as a framework. That’s the curriculum that we use today. It is evidence based. I mean, it’s all based in SAMHSA domains and our pillars and current brain science research.
The way that we teach it and the way that we engage with our health centers and that, it’s done in a way that is applicable to all sectors. But we’ve specifically tailored all of the examples to our health center because our health centers and FQHCs, broadly speaking across the country, are such a unique space. The patient population that we serve is very unique. Specifically with Texas, we are serving a lot of individuals who do not have health insurance as a result of a number of things. I think about 38% of the patients that we serve in Texas are uninsured, so navigating resources for and with them is very challenging. The health conditions that they’re navigating are also very challenging, so our program has really had to be tailored to meet their needs, to help them navigate what this looks like within their health center, and then to help propel that change that we want to see.

Excitingly, we’ve actually been collecting data since the program got started and are really excited to share with our partners at the University of Texas, the School of Public Health, that we’ve actually seen statistical significant change in both workforce retention by about four months, even in the height of the pandemic. We’ve seen statistical significant change in workforce knowledge retention about trauma-informed care. We actually, and surprisingly, have seen statistical significance, changes in patient health outcomes, specifically uncontrolled diabetes, asthma and asthma with exacerbation, and a number of behavioral health indices as well. It’s only been a few years. Like I said, we started in 2019. It’s been within a short period of time, and it’s been the pandemic, so we’re really excited to continue this work and share this with additional folks.

Specifically, the workforce challenges that are our front of mind for our health centers, we actually meet with our health centers just about every month. We speak with health centers almost on a weekly basis in one way, shape, or form. Our program is a train the trainer model, so we stay in contact with our cohorts throughout the course of this process. It is an ongoing relationship. So we have a pretty good pulse, I think, of what the health centers are experiencing, at least from the trainer perspective. The three top things that I think are front of mind would be workforce retention. How do we keep staff for longer? How do we support them for longer to stay? We know that the health centers, and for patient outcomes, that’s really going to be a big driver for the relationships and driving trust and transparency within the organization is that staff retention.

Staff wellbeing, just overall health, is huge. We’ve all experienced this collective trauma around COVID. But our staff, especially our health center staff and our healthcare workforce staff writ large, has experienced a lot. There’s been a lot of change. There’s been a lot of just frontline challenges that they’ve had to navigate, and have done so pretty remarkably. But it has taken its toll on them. So overall wellbeing is huge. Then, also productivity, and I hesitate to use that word, but our health centers are also businesses. They’re also nonprofits, and they’re navigating a number of financial constraints. Like I said, 38% of Texas’s health centers are uninsured. Texas is not a Medicaid expansion state. That has presented a number of challenges that our policy and advocacy team is actively working on. But productivity and how to frame that, how to navigate it, especially in light of the retention and the wellbeing challenges that I shared, has been a particularly difficult thing to walk through.

Michelle Fernández Gabilondo: Absolutely. I have to say, I think what you were saying with that balance between wellbeing and productivity, we’re probably hearing that from every state. But then, as you said, Texas is a state that is not a Medicaid expansion state. It gets a lot more complicated with the statistics that you gave. But I’m also so happy that you described the program. I think sometimes people don’t realize how fundamentally important trauma-informed care is and building trauma-informed organizations. It is so much of the root of so many things. I’m just so happy to have you here and to be talking about this very important issue and sharing what the health centers in Texas are facing. Thank you so much for that.

I think, in many ways, actually, the response that you gave to that previous question goes very well into this next question that I’m going to ask. You all in Texas, as being a Primary Care Association, us at ACU, we’re one of the National Training and Technical Assistance Partners. That work together and collaboration between the PCAs and NTTAPs are so important. As you know, our goal is to develop training and technical assistance for health centers. Where do you think that focus should go right now? When you’re talking about these immediate and emerging workforce issues, where should we really hone in as we’re developing and providing T&TA? I have a feeling you may say trauma because of your focus. The only reason I say this, because that, to me, is always top of mind. I feel like it’s one of the first things that needs to be addressed in order to work so much in these other spaces. But yeah, I just want to get your perspective on that.

Aniela Brown: Yes. I think we foundationally think trauma-informed care, it is not a quick fix. It is not writ large, if you do TIC and implement this framework, then all of your problems will go away. We are optimistic, strength-based social workers who are training in this program, but we are also just very eyes wide open and realist as well. I think we foundationally think trauma-informed care and engaging in this full center transformation is absolutely critical to helping address those three main issues that we see with our health centers. We’ve seen, again, the data that we’ve been collecting actually bear that out, especially with the workforce retention and the wellbeing areas. But in addition, our organization, TACHC, over the last few years, and we’re continuing to advance this, are really trying to get our health centers to a place to advance value-based care, because it really is in such alignment with being trauma-informed and helping address the productivity, helping to address the wellbeing, helping to address the retention challenges.

Our organization had done a big VBC assessment. We had gone through and said, “Where does TIC actually align with value-based care? We looked at the domains and the pillars that value-based care was advancing. I mean, looking at how you advance safety, patient data and HIPAA protocols, that is something that’s critical for value-based care. But that’s a safety challenge, which is one of the TIC pillars. How do you establish trust and transparency? Actually getting staff feedback for data governance and those policies, clarifying roles and responsibilities for all team members, that’s how you go about creating the stage for VBC. But again, it’s in complete alignment with trauma-informed care, collaboration and empowerment, training your board members to know what to fully expect for value-based care and what that transition could mean, and could not mean, that it may be a bumpy road to get there, but that we’re in it together. We have a plan.

Also, navigating historical, cultural, and gender factors is also a big TIC pillar and that you’re continuously reflecting on how change is communicated and whose voice is at the table and included, and genuinely included in those conversations and acknowledged, are all really foundational to advanced value-based care. But then, also, with that, change management supports and how you go about doing change management, I think could be another big thing that both the PCAs and the NTTAPs can continue to support. I know I’ve been on a number of webinars that both your organization, that ACU has done, and we’re continuing to do this from a TACHC standpoint, but there’s ways that you can do change management that is trauma-informed, and then there’s ways that it’s just, “Here’s how we’re moving. Take it or leave it.”

So there’s different ways that we can incorporate and do this a little bit differently that incorporates that cognizance of people have gone through a lot over the course of the past couple of years, and people had gone through a lot prior to the pandemic. How do we be mindful of taking that experience and those experiences, acknowledging people’s stress responses and the cortisol levels that are induced when you say, “Hey, we’re going to embark on this new whole system funding source,” and doing so in a way that brings them along and empowers them, and does it in a transparent way. We can do it. It will help for productivity and financial sustainability of our FQHCs. But there’s a bit of a different way that we can.

Michelle Fernández Gabilondo: Absolutely. Again, thank you for that response. I think one of the things that really stood out to me, too, as you were going through this plethora of issues, is that none of it also exists in a silo, and why it’s so important to look at this so holistically. I think that’s something, like you said, trauma-informed care, lining it up with value-based care, and really looking at these connections, can be so powerful to support the workforce. Obviously, then it also means how you support your patients and the community and the productivity of the health centers. Thank you for that because none of this exists independent from anything else. Also, thank you for bringing up the justice, equity, diversity, and inclusion piece. We love to say JEDI here at ACU. That’s something, both the wellbeing piece, the JEDI piece, that we actively really try to put at least foundationally in some way in our resources.

That brings me to the next question. It’s always been great to collaborate with TACHC. Just working with everyone there, it has always been such a pleasure. What I was wondering, because I know that there’s a lot of overlap in some of the stuff that we’ve done, could you tell us about some of the STAR² Center resources that the Trauma-Informed Care Program has used and found helpful?

Aniela Brown: Actually, after two years and about three cohorts, the TACHC TIC Program went through a curriculum realignment in the fall of about 2021. One of the critical pieces that we wanted to ensure was intentionally present was JEDI. We worked together with Sabrina Edington, who’s the ACU Senior Director of JEDI Initiatives. She came to our TACHC Annual Conference and presented on the intersection of workforce and TIC and JEDI. We co-presented, but it was really we’re so grateful to her, and we’re so grateful to ACU and the STAR² Center for putting realistic and usable toolkits and resources together for us to take these incredibly important, very big, very real, and sometimes very hard conversations to have, in very real, very relatable, very timely ways, because again, there are lots of ways to do TIC work. There’s lots of ways to do JEDI work. The intersection between the two of them oftentimes can get a little sticky sometimes.

Oftentimes, people think that, “Oh, they’re two separate programs.” But as I had shared historical, cultural, and gender factors as one of the TIC pillars, and I mean, frankly, racism and discrimination and inequity are experiences of trauma, so you can’t separate the two of them. So we really appreciated the work that we did with Sabrina and the work that ACU had done in the STAR² Center. We used those resources to directly impact our curriculum, to the point where our second in-person meeting that we have with our TIC cohorts is specific and explicitly JEDI and TIC, and how you do this work, how you explicitly do it, how you intentionally do it, and how you sustainably do it, because that is one of the big challenges, as we’ve felt, I think, across the country since the summer of 2020, after George Floyd, is a lot of well-intentioned initiatives, but maybe not the most sustainably or intentionally thought-out of how we go about advancing this work. We thought very hard.

Again, just want to once again echo how critical the resources were from ACU and the STAR² Center to do this in a way that was not sugarcoating, not thinking about this in a way that minimized the necessity, but did so just really intentionally. The other piece, too, that we’ve really been relying on more recently was the organizational leadership and resiliency toolkit that was released earlier this year. When we saw it, we just got so excited because, first off, the first sentence of the toolkit was talking about defining trauma-informed care and setting that as the foundation, so of course, Aimee and I got very excited because TIC being directly addressed in how we talk about organizational leadership and resilience right off the bat was really exciting and something that we see every day and talk about. But seeing an organization like yours actually say this explicitly was really great.

I mean, the toolkit really sets the foundation for how organizations find stability, how they grow, how they thrive. The definitions are incredibly accessible. The outline is really simple. It’s all grounded in science, which we really also appreciate. But I think the most powerful part of this toolkit is the fact that organizational responsibility for burnout prevention and resiliency is just as important as the individual self-care work that you outline as well. That’s something that we advocate for in our program. You can’t have, “Just take a yoga class,” as the way that you’re going to encourage self-care for individuals without taking off a little bit from their plate or their caseload or their panel. This is a dual street that we have to navigate carefully, but just saying, “One is important,” without addressing the other is not how you go about addressing the retention and the wellbeing and the productivity challenges that our health centers are experiencing.

We’ve actually just last week had a conversation with one of our health centers that’s talking about, “How do we talk about self-care with our employees and wellbeing?” We just shared the organizational leadership and resiliency toolkit with that particular health center. It was perfect for that exact conversation in, “Hey, we’re talking about change management.” You all are experiencing change, so you want to talk about self-care, but you also really want to talk about the grief that comes with change, and people moving to different health centers, or having panels be reshuffled and not seeing that patient anymore. Or your coworker left to pursue another opportunity, but now my friend and colleague and lunch buddy isn’t there anymore. How do you navigate that? The definitions for just stress were fantastic and that kind of continuum. We can’t harp on that toolkit enough. It’s such a fantastic resource.

Michelle Fernández Gabilondo: Thank you so much. I mean, that makes us so happy to hear because we do try to be very intentional in what we’re creating. We always love to hear, like, “Wow. People are really using this.” This is something they can take and apply. So that is just so wonderful to hear from you. At the same time, we are going to be releasing another publication fairly soon, also on trauma-informed care. As soon as we have that out, I will make sure that you all have a copy of that and can access it because, again, these are very complex problems that require a really multi-level way of looking at it. There’s so many things that go into it. I think the work that you all are doing is just so fundamentally important for helping the workforce, but also helping the patients, the community. Just overall, the information you’re putting out there and the education is amazing. So I just wanted to also give that praise.

Aniela Brown: Thank you.

Michelle Fernández Gabilondo: Yeah. Absolutely. I think, actually, you answered my next question, which was just going to be if you’ve received any feedback from health centers on the STAR² Center resources that they may have used. If you have anything else to share about that, please feel free to share it. But I also feel, like I said, you did a great job, I think, of answering that question in the previous response. Is there anything else you would like to share regarding that?

Aniela Brown: Yeah. We actually are really excited that a couple of our TIC trainers have become members of the ACU JEDI Committee. From a Texas standpoint, we’re really excited that the voice of our Texas health centers are being heard on the national level. But they’re also bringing back the information to their work here as well. One of the health centers in particular stands out because early on in the pandemic, they created a wellness survey for their staff to genuinely ask how they were doing. At the time, the answer wasn’t great. But instead of just sitting on the information or being hesitant for how to proceed, they had an absolutely amazing provider and TIC trainer who championed this work. His training was as an integrated and lifestyle medicine provider. He stepped into a leadership role at the organization and has since even taken on additional leadership roles at the health center. But this health center really does an inordinate amount of information.

Not only has this health center really taken this information and synthesized it in the way that we haven’t seen before, but they’ve really done such incredible work on supporting their staff wellbeing and improving patient outcomes. But it’s all grounded in TIC and JEDI. Again, just echoing, we’re seeing this play out with their health center, with other ones, that they’re following up with opportunities that ACU and the STAR² Center has to offer. They’re definitely playing an active role with our TIC Program here in Texas and really paving the way for what this looks like for integrated medicine and improving patient outcomes.

Michelle Fernández Gabilondo: That is such a wonderful story, and so happy to hear that with the health center that you were mentioning. Also, having and supporting those champions in the health centers is so fundamentally important. We always love to hear stories like that because we really advocate for your workforce. They really are your strongest talent. They’re the people who are going to advocate for you inside and outside of the health center. So identify those champions who are doing this work and really be able to elevate them. Thank you for sharing that.
As we begin to wrap up today, I have to tell you, I could talk about this for hours, especially trauma and trauma-informed care. That’s definitely my background, so we’ll have to bring you back for some more in-depth trauma talk. But I feel like you put two social workers together and that’s what happens.

Aniela Brown: Yes.

Michelle Fernández Gabilondo: Especially macro level. Yep. I do want to say again, just thank you so much. I also want to just give you some time as we end today’s interview, if there are any other workforce efforts or resources that you want to share with our audience from the TACHC Trauma-Informed Care Program.

Aniela Brown: Yeah. Thank you for that. Like I had mentioned at the beginning, our TIC program with TACHC has been around since 2019. We’re actually recruiting for our fifth cohort, which is really exciting. We are going to be launching that, but we really are interested in continuing to partner not only with our Texas-based health centers, but other health centers across the country, and additionally, PCAs that are interested in taking this work and this model back to their states, and seeing if we can replicate it. We really have the data to say that the model works and the curriculum works, and us, Amy, and I as guides on this long journey, but one that has been really fruitful for our health centers and for us as a PCA. So we’re open and excited to hopefully partner with other PCAs and health centers to go about and using this model that really works. That’s one thing.

We also are available as speakers as well. I mean, we’re happy to help and engage. We’ve done a number of trainings at this point, most recently for Alash and the Southwest SAMHSA region. We’re going to be partnering with a few other folks. We can do personalized or customized trainings, but really, our heart is in this TIC Program curriculum that we’ve developed. For folks that are interested in starting this journey, I think a couple words is that it is hard. It is longterm. That’s a big piece. We’ve talked with content experts on how long organizations need to really think about when they would start to see results. We’ve heard estimates from between five and eight years. So when we’re thinking about that productivity piece on when are we going to see the changes, knowing that we’re in it for the long haul. But that’s one of the exciting things about our particular model on the data that’s coming back. We’re already seeing changes within our workforce, within our patient population. So it is moving in the right direction.

Lastly, and probably the most important, as a social worker, I’m sure you can empathize. This work is 100% relational. Trying to do so quickly that we’ll get results in a short timeframe or within a grant cycle is hard. That is financially. We can empathize in that way to our provider systems with the fee-for-service model. That is not the best way to get better patient outcomes. Value-based care is really how things are going to change and how we’re going to address nonmedical drivers of health, or SDOH. It’s how we’re going to build in our TIC models or get those ongoing therapeutic services. It’s going to take time, so really hoping that leaders and innovators in different spaces, especially within our health centers, are thinking about this as relational based. We’re happy to partner and be creative in thinking through those solutions to get us at the patient outcomes and be the health center workforce outcomes that we really know are possible and that all of us deserve.

Michelle Fernández Gabilondo: Thank you so much for everything that you shared. I do want to let our audience know that all of you in the Trauma-Informed Care Program at TACHC, you really are experts in this space. I think you’re so innovative and just really leading the way because, like you said, this is a longterm process, so it does take a lot of investment in it. But I do feel it’s something so fundamentally important for the work we do because whether we’re looking at just workforce issues, we’re still dealing with the complexity of human beings, the same with the way when we deal with our patients. So I just appreciate so much all of the work that you all are doing, Again, I just want to thank you one more time.

Today we were talking with Aniela Brown, Trauma-Informed Care Coordinator for the Trauma-Informed Care Program at the Texas Association of Community Health Centers. If any of you have any trauma-informed questions, I definitely recommend them as the place to go. Again, I am Michelle Fernández Gabilondo. Aniela, thank you so much.

Aniela Brown: Thank you.