Vermont seeks to bridge gap between mental, physical health

Vermont’s focus on integrating mental and physical health along with an eye toward Adverse Childhood Experiences informed practices has led to pilot projects across the state and more in the works.

Since last fall, a number of volunteer groups have been looking at childhood trauma and discussing ways to better bring its impact on overall health to the forefront.

A follow up video conference is scheduled in April to see what progress has been made.

“It bridges a gap that we weren’t bridging,” said Kathleen Hentcy, M.S., mental health and health care integration director at Vermont’s Department of Mental Health, speaking about the engagement of medical personnel in the process. “We want to get conversations going.”

Hentcy explained that medical doctors tend to regard patients solely in terms of physical injury while there may be other factors at work. For example, an individual with a chronic health problem like diabetes may not be adhering to proper self care or monitoring because of suffering from depression or another mental health issue. Getting to the core of the whole person is crucial in order to provide appropriate treatment, she said.

“The fact that there is no health without mental health is really fundamental. You can be fit and eat well but if you have mental health issues, your physical condition goes downhill,” Hentcy said.

“Telling a person to exercise is not going to work if the patient is depressed. Exercise is very low on the priority list…We’re working to bring the focus on both (mind and body) forward. It’s time to talk about whole health instead of keeping an artificial split. You don’t have one without the other.”

An education group in Barre has a goal of “shining a light on trauma” to the extent that it can be eradicated in the community. Its tasks include building a public education campaign and developing a survey for school staff to determine their level of knowledge and awareness to identify the kinds of training they need.

Hentcy spoke about a group conducting a pilot that uses a four-question PTSD screen for patients 18 and older to garner information about life experience. A resource person is available for those people who screen positive and the mental health clinician is co-located in the primary doctor’s office so there is a direct “hand off” referral.

Activities in St. Albans, Springfield and St. Johnsbury also involve setting up screenings in primary care, while in Bennington, one group’s focus is to connect with school systems and bring in models and programs to support kids with trauma.

Workgroups are also in the process of mapping resources, a necessity discovered, Hentcy said, when volunteers spoke about the lack of specific services only to discover that they existed. “If other agencies and people don’t know what services are actually there, how would the patients?”

The basis for the initiatives, the Adverse Childhood Experiences Study, is one of the largest investigations undertaken to assess the connection between childhood trauma and later life health and well being. Initially conducted in 1995-1997, the research continues, conducted by the Centers for Disease Control and Prevention in Atlanta, Georgia and Kaiser Permanente in San Diego, California.

Seventeen thousand patients taking a Health Maintenance Organization physical exam agreed to participate in a screen that used a questionnaire.

Hentcy said that she doesn’t support that questionnaire as a clinical tool because she believes it detrimentally triggers people with trauma backgrounds. Her sentiment is shared by Margaret Joyal, MA, director of adult and children’s outpatient services at the Community Mental Health Center in Burlington, Vt.

Joyal feels that because the questionnaire is “retrospect,” was done by phone and had a lack of available follow up, it could be “de-stabilizing,” for patients.

She is a long-time member of a child and family trauma work group that is developing more “functional,” screens and programs at primary care and pediatrician’s offices. Joyal said, however, that treatment of complex trauma should not take place in a primary care office but rather at appropriate facilities.

Collaboration with medical doctors to integrate physical and mental issues can be helpful, she added.

Miriam Voran, Ph.D., a psychologist in Montpelier, Vt. and also New Hampshire, has a specialty in early childhood and said that it is her job to “help parents get it right the first time.”

Although she does not belong to any workgroup, Voran is in the process of arranging May appearances by Allan Schore, a neuropsychologist on the faculty at UCLA David Geffen School of Medicine. His Vt. and N.H. workshops include the topics, “Relational Trauma and the Development of the Right Brain” as well as “Early Relationships and Life Long Health.”

“Vermont kind of gets it,” Voran said, of the state’s commitment to erase the lines between mental and physical health as well as recognize the correlation between early trauma and health effects.

“It’s changing culture and I think that’s a gradual process,” she said.

Added Hentcy, “The question is, ‘how do we thrive and flourish?’ Just getting through life is not enough. To flourish, we need to address physical health and mental health in the same way.”