In Sickness and in Health

Chicago Hospital Learning Collaborative Aims for a Culture Shift

When Chicago physician Audrey Stillerman first read the 1998 Adverse Childhood Experiences (ACEs) study, she felt gut-punched.

“I had been taking care of patients for over twenty years. I always had a sense that people’s experiences and relationships were really important in terms of their overall health,” said Stillerman, associate director of medical affairs for the University of Illinois Office of Community Engagement and Neighborhood Health Initiative.

For years, she’d felt like an outlier in her field—a Western-trained family practitioner who was interested in integrative medicine and social determinants of health, a doctor who resisted the “pill for every ill” approach. The research on ACEs made her think, “Oh, this is what I’ve been noticing and couldn’t articulate.”

Stillerman connected with the Illinois ACEs Response Collaborative, a broad range of organizations and individuals committed to expanding the awareness of how ACEs and trauma impact Illinois children, families and communities.

She helped to plan the first Midwest Regional Summit on ACEs and arrange local screenings of Paper Tigers. Now she co-chairs a cadre of like-minded practitioners and administrators—the Healthy Chicago 2.0 Trauma-Informed Hospital Collaborative, a work group launched in January 2017 that aims to bring trauma-informed care to hospitals and medical systems across the metropolitan area.

The work group includes representatives of 16 hospitals—mostly mid-level managers in policy, community relations, program development and behavioral health. It’s a subset of a larger hospital collaborative kick-started by the city’s Department of Public Health (CDPH) as part of Healthy Chicago 2.0, a plan to address traditional health issues along with systemic factors including education, housing, transportation and access to care.

That group’s focus on the dearth of mental health care led to an interest in trauma. Some members of the work group—for instance, Frank Belmonte, chief medical officer at Advocate Children’s Hospital—were already champions for trauma-informed change, while others were just discovering the research on the pervasive reach of ACEs.

Maggie Litgen, former manager of the ACEs program for the Health & Medicine Policy Research Group (HMPRG), which helped found the ACEs Collaborative, helped bring influential leaders including Stillerman, Marlita White from CDPH and Margie Schaps from HMPRG to educate the group on the biology of trauma and the foundations of trauma-informed care. She invited MARC advisor Sandra Bloom to speak and hosted a webinar with staff from Children’s Hospital of Wisconsin, which is using the Sanctuary Model to bring trauma-informed change to its 40 locations and 5,000 employees.

While members of the work group represent different types of hospitals and a range of departments, they found immediate common ground, Litgen said. “Everybody was worried about their staff. They viscerally understood that their staff were in pain because of the trauma they’re steeped in.”

And once work group members understood the outlines of ACE and resilience research, they were eager to put that knowledge into practice. “Everybody wants a tool kit, a clear road,” Litgen said. “But we’re not going to have a one-size-fits-all.”

You can’t just do a lunch-and-learn on this…We are starting a social movement, a cultural movement. It will take time.

Instead, work group members have shared questions, obstacles and initiatives. One hospital conducts “resiliency rounds” for staff who work with cancer patients. The University of Illinois Hospital is piloting a Housing First program, using $250,000 to provide apartments for “superutilizers”—that is, frequent users of the emergency room who suffer physical and mental health issues compounded by homelessness—thus saving thousands of dollars per patient.

At Advocate Children’s Hospital, Belmonte said, small teams of doctors, nurses and managers go on three-day paid retreats to talk about vicarious trauma and resiliency; the hospital also plans to pilot new screenings for trauma and social determinants of health in its pediatric and perinatal clinics.

“We have 9,000 employees and 12 acute care hospitals,” he said. “You can’t just do a lunch-and-learn on this…We are starting a social movement, a cultural movement. It will take time.”

But members of the work group also share a sense of urgency. The University of Chicago Medicine will open an adult trauma center next spring, and Max Clermont, chief of staff to the center’s director, said the trauma-informed collaborative has helped him gather ideas and prepare for an influx of patients with complicated, long-term needs.

Members of the hospital collaborative said that while buy-in from top hospital administrators is ideal, having mid-level managers and practitioners foster change in their own departments is also effective. “It’s been extremely helpful to have hospitals of different sizes and situations,” Clermont said. “We’re…learning about people’s challenges and using those to course-correct. We don’t have to start from scratch, and that’s a great opportunity.”

Litgen and members of the ACEs Response Collaborative believe learning groups are key to advancing trauma-informed awareness and practice; they included a recommendation to create learning collaboratives in the conclusion of their recent environmental scan.

For members of the Chicago group, the learning collaborative means feeling less alone in the gradual effort to shift hospital culture and practice. “I think this collaborative does pave the way for colleagues across institutions to pick up the phone and have more honest dialogue,” said Leif Elsmo, executive director for community and external affairs at University of Chicago Medicine. “Part of that is because we’ve been in the room together.”

“It’s nice to come together with people who understand,” said Belmonte. “When you’re in that room with other folks, you feel like you’re part of a movement.”

This article is part of a community update series following the ATR networks participating in the MARC 1.0 Initiative. Read the other updates from Illinois:

• Managing the Groundswell of Interest in ACEs (2016)
• From Awareness to Action (2015)

This article is also part of the Community Voices series.