Faces of Public Health: Margo DeMont, Memorial Hospital of South Bend

Oct 10, 2014, 1:40 PM

During a recent webinar held by Stakeholder Health, a learning collaborative of health leaders aimed at improving population health, Margo DeMont, PhD, head of community health enhancement at Memorial Hospital of South Bend, Ind., shared about the hospital’s recent efforts to build a trauma-informed community through several innovative therapeutic programs.

For example, using eye motion desensitization and reprocessing (EMDR), a trained practitioner takes a person through their traumatic experience, and then follows with a series of hand movements, asking the patient to follow the movements with their eyes. After the sequence of movements, the patients are asked to review the intensity of their feelings about the trauma, with the goal of reducing the heightened emotions. The goal is to reprocess the information from the incident in their brain from the right hemisphere, where emotional experiences can be locked up, to the left hemisphere, which is the more cognitive area of the brain. While EMDR is still quite new and studies are still needed, some use of the technique has been suggested by both the U.S. Department of Defense and the American Psychiatric Association.

The goal of the behavioral interventions is to reach people who have suffered through adverse childhood experiences (ACE). Studies have shown that without help dealing with those childhood experiences, people are more likely to face long-term health problems such as substance abuse, cardiopulmonary disease, diabetes and obesity. Memorial Hospital assessed the impact of childhood trauma on adults in the community through a community health assessment.

NewPublicHealth recently spoke with DeMont about the initiatives.

NewPublicHealth: When was the community health assessment done that indicated that there was a great deal of trauma in the community related to adverse events in childhood?

Margo DeMont: That was done in 2012 as part of the community benefit requirement for non-profit hospitals under the Affordable Care Act. And we saw that in terms of health issues perceived by the community, violence was rated pretty high, it was one of the priorities, and it came out as both street violence and relationship violence. I was familiar with the work done by Kaiser Permanente on childhood trauma, and we included eight questions from the U.S. Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance Survey that dealt with adverse childhood experiences in random phone surveys completed by 599 adults

We found that adverse childhood experiences are not a rare happening—that our children are suffering violence in many forms. As adults, they reported that 57 percent of the surveyed residents had at least one violent experience in their lives. Three or more is considered the predictive corollary for chronic disease, both physical and mental. And 21 percent of our population had three or more ACEs in their lives.

NPH: Did your have any hesitation about putting the questions into the health assessment?

DeMont: It was really a risk to put the abuse segment in. We were afraid that people would be offended by our asking questions such as whether they had been sexually touched by somebody five years older than they when they were children. It was somewhat surprising that people felt so free to respond, which has also been the experience of previous investigators. Of course, it was anonymous. It was a random sampling, but it parallels everything that other communities are finding with similar results that it’s not at all rare—it's pretty common.

NPH: What will you be doing to address the issue?

DeMont: Our intent is to become a trauma-informed community and be ready to respond. For example, EMDR is now considered by many experts to be one of the most effective therapies for Post-Traumatic Stress Syndrome. We found that there were only a handful of licensed therapists who used EMDR in our area, although it was developed within the past twenty years. It’s been used with veterans—perhaps more often than with children or young adults—but our decision was to train both children and adult-focused therapists to build capacity in the community.

Over thirty therapists were trained last year and then deployed to agencies serving vulnerable populations. For instance, we have three therapists working at our Center for Homeless, and we have a therapist at the YWCA, which has programs on addiction and domestic violence for women and their children. We have trained a therapist at Hope Ministries, which works with children and families as well as with the Youth Services Bureau, and at the Boys and Girls Club. And we’re partnering this fall with two elementary schools, and then in January, we hope to be adding a public charter school. We’re also working with the Juvenile Justice System and Community Corrections. We will be developing a diversionary program for juveniles entering the system, and this fall, we are training 58 additional therapists, but we’re also working with our local college campus and training both social workers and mental health students in their last year of internship.

NPH: Is it too soon to know whether you’re successful and how do you measure success?

DeMont: It’s really much too soon to talk about an individual client’s success or failure, because we’ve only had therapists in the field for about six months, although an integral aspect of the EMDR therapy includes two measurements. They are based upon values and beliefs and the amount of trauma a specific incident causes in the victims.

We’re also introducing the assessment and therapy in our emergency room, so that when somebody comes into the trauma center, and they have shallow breathing—they are more than crying, they're hysterical—we can help them employ deep breathing and find a safe space.

The concept is to move the terror, often relived daily or in the moment, from the portion of our brain that deals with our emotions to the prefrontal cortex where we do problem-solving, we deal with relationships and we learn to cope. Coping and resilience are actually some of the childhood training that is being facilitated with preschool programs across the country.

NPH: Have other communities been successful in implementing the therapies?

DeMont: Many communities are much further along than we are, so we’re not in this alone.

NPH: Does this have potential to turn around lives?

DeMont: The potential is huge for both adults and children. We are partnering with the University of Notre Dame to conduct a multiple-year study with a professor from the psychology department. We have assisted the professor in enrolling 400 low-income women through the St. Joseph County WIC program, which serves more than 1,800 women and children. The 400 women have had three or more ACEs in their lives.

Everything we experience is channeled through our previous experiences, and there is a growing body of evidence suggesting we are breeding pathological aggression and violence from generation to generation.

The investigation is looking at the women’s’ lifestyle behaviors, and will measure the birth outcomes and evaluate the child’s first year of life. Little has been done looking at how the stress and trauma these women have experienced affects their babies. Also, we’ll be measuring their parenting behaviors in the first year of the baby’s life. We’re anticipating at the conclusion of the study, there will be an opportunity to provide mental health treatment for the children and for the adults. But as you know, with scientific research we have to be very cautious and not contaminate the study prior to completion.

NPH: Any idea what the treatment would consist of?

DeMont: A great deal of the intervention will be teaching parenting. We have both a family practice and a vulnerable populations’ residency here at Memorial Hospital, with about 20 students in each, and we are now training all of them in ACEs. Adverse Child Experiences result in tragic circumstances. However, we can ameliorate and prevent the damage.

>>Bonus Link: Read more from NewPublicHealth and the Robert Wood Johnson Foundation on Adverse Childhood Experiences

This commentary originally appeared on the RWJF New Public Health blog.