Clinic Spotlight
Megan Kelly loves what she does for a living.
Her infectious humor, dogged optimism, and penchant for finding fun in one of the most challenging of clinical disciplines—caring for those with severe mental illness and substance-use disorders—have made her a hot commodity over the years. While Kelly takes her responsibilities seriously, she consistently finds rewards in challenges that others simply find daunting.
Kelly left Rochester, New York, where she’d been clinical director of a children’s home for eight years, in 2008, uprooting herself for a new opportunity in Yakima, Washington. Comprehensive Healthcare, a large behavioral health organization in eastern Washington, had invited her out to help design and open a short-term residential evaluation and treatment center for youth in crisis.
“I loved that job,” says Kelly. “I had the opportunity to develop a trauma-informed care program from the ground up.”
Kelly’s efforts achieved a milestone in crisis-treatment services for Washington youth. The center was the first of its kind in the state that did not include a seclusion and restraint room—a design decision reflecting Kelly’s expertise in trauma-informed care.
People in the region began learning about her work. Among them was David Johnson, Chief Executive Officer of Seattle-based Navos, the largest behavioral health-care provider in the state. Johnson met Kelly at a conference, liked what he heard, and extended an open invitation for her to move her talents farther west.
“After the facility in Yakima was up and running, I thought, ‘Now what?’” Kelly remembers. “So I called David.”
CHAMPIONING TRAUMA-INFORMED CARE
Initially brought on board to implement trauma-informed care across the organization, Kelly has now served as Navos’s Chief Clinical Officer for the past two years.
Trauma-informed care recognizes and responds to the widespread impacts of traumatic experiences on patients’ health. Such experiences range from domestic violence, sexual assault, and emotional abuse to growing up with a parent struggling with addiction.
Approaches to trauma-informed care emphasize partnering with patients in their recovery, promoting transparency and safety, and preventing further experiences that could inadvertently harm those who have already experienced trauma.
“Trauma-informed care involves setting up a system that accounts for the neurobiology of trauma and strives not to retraumatize individuals,” says Kelly.
Various efforts going back more than 40 years have contributed to the development of what we now call trauma-informed care, but Kelly maintains that the discipline’s principal catalyst was the Adverse Childhood Experiences (ACE) study conducted by the Centers for Disease Control and Prevention and Kaiser Permanente in the mid-1990s.
“The research team gave every employee at Kaiser Permanente a simple survey,” says Kelly. “They asked questions like, ‘Did you witness physical abuse?’ ‘Was there alcoholism in your family?’ ‘Were you sexually abused?’”
For each affirmative answer—that is, for each self-reported adverse childhood experience—the respondent received one point. Correlating the respondents’ total scores with their health histories, the researchers made an astounding discovery.
“They realized that, if you reported more than four adverse childhood experiences, you either were at risk for one of the major diseases, or already had one,” says Kelly. “Patients who reported zero ACEs were, for the most part, extremely healthy.”
Most people with severe mental-health or substance-use issues have experienced multiple traumatic events during their lifetime. Some of these events may have been inappropriate responses to their illnesses, such as incarceration or isolation within a behavioral health facility.
That’s why Kelly’s expertise is so vital to Navos. By implementing trauma-informed training and clinical practices, she’s making sure that the provider’s clients have a positive experience with mental health care and can make real headway on the road to recovery.
INTEGRATING BEHAVIORAL AND PHYSICAL HEALTH
With facilities throughout King County, Navos comprises a remarkable range of programs across the continuum of care, from psychiatric hospitalization, housing, and outpatient services to resources in schools and nursing homes. It even has an onsite cafe staffed by its clients in West Seattle.
Most of the people Navos serves struggle with multiple chronic conditions, the combination of which makes them not only highly vulnerable but also difficult to care for effectively. To streamline care and make necessary services easier to access, Navos created an integrated health clinic in partnership with King County Public Health, offering outpatient clients one-stop shopping for all of their behavioral and physical care needs.
The integrated health clinic emphasizes collaboration across disciplines, bringing generalists and specialists together to discuss and understand how a patient’s physical and mental health conditions interact. “Because you can’t separate the two, especially for folks who have serious mental illnesses,” says Kelly.
The approach has vastly improved care coordination, since virtually everyone supporting a client is in the same building. If a physician diagnoses someone with asthma, for example, the clinic not only treats the asthma, but tries to identify stress factors that could be exacerbating the condition. Perhaps a client needs help with housing or food stamps, or needs to see a therapist to address underlying depression. Instead of having to make a new appointment, the client can simply walk down the hall.
People with severe mental illnesses and substance-use disorders typically have a hard time concentrating and processing information. Keeping track of several appointments in the same week can be extremely challenging for these patients, if not impossible. The convenience of having all the services they need in one place, possibly available in a single visit, makes a world of difference.
“If we can encourage a client to come in on a Tuesday and see a physician, therapist, and case manager in just a couple of hours, coordinating their needs while they’re onsite, we are providing excellent customer service,” says Kelly. “It’s highly effective, and one of my favorite programs at Navos.”
A COMMUNITY OF RECOVERY
Recovery lies at the heart of Navos’s mission. It’s a matter not simply of managing the symptoms of chronic mental-health issues, but of doing what it takes to restore hope and help clients reclaim their lives.
“Navos really believes in recovery,” says Kelly. “We live it and breathe it. We believe people can get well and have jobs and live on their own, and we make that happen.”
Integrating case management with mental and physical health care has been a vital component of Navos’s trauma-informed strategy. Supporting recovery means understanding how all of the different aspects of a person’s life influence health—behavioral and physical conditions as well as social determinants like housing, food, transportation, and access to a support network outside care settings.
Equally important is making sure clients understand that they’re not second-class citizens in the Navos community. “We are a community of healing,” says Kelly. “We don’t separate. It’s not us against them.”
For example, Navos offers what Kelly calls a “hospital without walls” program, where clients live in townhomes adjacent to the administration building. Every day, nurses pay visits to these clients in their homes to give them their medications. Clients can also move freely throughout the Navos complex, essentially making their recovery experience a preview of the independent lives they’ll lead once they’re better.
It’s a remarkably compassionate and humanizing medical-home model—one that fosters trust, safety, and patient empowerment. While it can be intimidating at first for providers used to swimming in their own lanes, it’s the right thing to do for patients.
And if you asked Megan Kelly, she’d also likely tell you it’s fun.