When a young mother steps off a city bus, crosses a parking lot in the summer heat and arrives significantly late to Wellness 360 Pediatrics with a sick child in her arms, she doesn’t get turned away. Her child is seen.
That philosophy of meeting patients where they are now carries formal recognition. The Ecumenical Center has certified UT Health San Antonio’s Wellness 360 Pediatrics practice as a Level 1 Trauma-Informed Care organization, placing it among a select cohort of Bexar County providers committed to delivering care that heals without causing further harm.
Do no further harm
Karen Walker Schwab, PhD, APRN, CPNP-PC
Trauma-informed care is less a clinical protocol than an organizational commitment. It asks every person in a healthcare setting, from the receptionist answering phones to the provider in the exam room, to consider that patients may carry histories that make routine interactions feel unsafe, and to restructure those interactions accordingly.
At Wellness 360, the School of Nursing’s clinical practice, that can mean seeing all four of a family’s children in a single visit, so a parent doesn’t have to miss multiple days of work. It means training staff to hear a patient’s frustration without judgment, and to understand that a parent who seems short-tempered at check-in may have just spent hours struggling with an outside system before ever walking through the door.
“The point is to understand and connect,” said Karen W. Schwab, PhD, APRN, CPNP-PC, director of Wellness 360 Pediatrics. “That’s always the goal.”
Years in the making
Certification is a primary goal of the South Texas Trauma-Informed Care Consortium, a multi-sector coalition of more than 200 Bexar County organizations. In 2019, the Ecumenical Center was selected through a competitive process to serve as the certifying entity. Wellness 360 Pediatrics’ path to certification began before the COVID-19 pandemic and crossed the finish line thanks in large part to Lauren Ryder, BSN, RN, RNC-NIC, the practice’s New Braunfels clinic manager, who also served as project manager for the certification’s application.
Ryder helped develop clinic-wide policies and procedures, created training modules now available to all UT Health San Antonio employees through the UT Health Learns catalog and launched the Trauma-Informed Care Tribune, an employee newsletter that keeps trauma-informed principles front of mind for pediatric staff. Patient surveys, available via QR code, on paper and online, give families multiple ways to share feedback about their care as well.
“It’s because we have access to all of this training and education, and also the policies, that we have been able to earn the certification,” Ryder said.
Continuity of care
Karen Walker Schwab, PhD, APRN, CPNP-PC, clinical associate professor and director of Wellness 360 Pediatrics at the School of Nursing, is shown aboard the school’s mobile nursing unit, which extends her team’s Foster Care Center of Excellence offerings beyond its current six locations in South Texas.
Wellness 360 Pediatrics operates as a Foster Care Center of Excellence and its providers put these skills to use by serving children whose lives are often marked by instability. Because the practice spans multiple clinic locations, a child moved between residential treatment centers can often continue seeing the same provider, a small logistical fact that carries profound clinical weight, according to Ryder.
“There’s so much evidence about how continuity of care is so important,” Ryder said. “We’re able to maintain that and provide a safe environment for those kids wherever they go.”
For foster children who have recently been removed from their homes, Wellness 360 structures its required three visits so that trauma history is gathered in the first appointment, largely through existing documentation, and never revisited unnecessarily. Subsequent visits focus on wellness, extracurricular activities and behavioral health referrals, rather than asking children to recount painful experiences at each visit.
Reaching beyond the clinic
Free continuing education resources on trauma-informed care are available through the Foster Care Center of Excellence website, open to nurses and healthcare workers across the community, courtesy of the coordination of Brittany Lents, MSN, APRN, CPNP-PC. Faculty at the School of Nursing have also begun incorporating the modules into student coursework, extending the reach of the training to future clinicians.
Wellness 360 Pediatrics joins a cohort that includes child welfare agencies and community partners working toward the consortium’s shared vision of a fully trauma-informed Bexar County.
“Health and resiliency can be built through relationships,” Schwab said. “We have to be trustworthy, we have to be safe and we have to be there consistently for our patients.”
Learn more about the Wellness 360 practice and its services at wellness360.uthealthsa.org.