The ACH Winter Course is an annual event reserved for ACH Faculty and those currently enrolled in the FIT or RCF program to spend time in intensive communication skills training and personal awareness development in a retreat-like setting.


January 27 - February 1, 2019
Franciscan Renewal Center
Scottsdale, Arizona

Course Directors: Michael Marcin & Tim Gilligan

Course Goal:
The 2019 Winter Course participants will understand how institutional and systemic biases deeply impact susceptible patients and feel sufficiently empowered to advocate for effective systemic changes in their home institution’s engagement of these vulnerable patients.

Course Objectives:
​Upon completion of this course, participants will be able to:

  1. Summarize the difference between personal and institutional obstacles to engagement of diverse patient populations in the health care setting

  2. Provide several daily scenarios that trigger systemically traumatized patients.

  3. Identify real examples of policy and protocols that inadvertently contribute to marginalization of diverse patient populations and name the initial steps that need to be taken to change these practices.

  4. Speak to what the provider needs to support the triggered patient without “catching” the trauma him/herself.

  5. Using core relationship-centered communication skills, engage with policy and protocol decision makers to effect change

The Winter Course Planning Committee strongly believes that 2019’s WC should continue the excellent direction set forth by the three-year focus on diversity and implicit bias. Additionally, we would like to see it transcend the individual to the larger systemic setting. We see a natural progression to focusing on how health care teams and institutions inadvertently propagate and exacerbate trauma experiences in our most vulnerable patients. We would like to build on the past WC’s foundation and establish the course goal of moving providers and systems to understand how to implement trauma informed systems at their home institutions. The focus will be on the ways complexities of health care delivery can activate a trauma-reactive patient or family member and feedforward additional trauma downstream. Biases play a huge part of this. So does institutionalized and societal discrimination.

While there are many examples that come to mind, a very real example is how our police and subsequent health care systems feed forward trauma to people of marginalized and disadvantaged backgrounds. It is not overly controversial to say that these groups as a whole likely experience police very differently from cis-gender, heterosexual, middle-to-upper class Americans. This is not to say that good and bad interactions with the police are solely driven by race, ethnic or socioeconomic phenotypes. It is also not too difficult to acknowledge that being aggressively apprehended by police in the community for forced physical and mental health evaluations can actually be traumatizing for someone who has more often than not felt targeted by police. Hand cuffs, spit bags, and forced injectable chemical restraints promote fight, freeze and flight responses in those patients brought into the Emergency Department. Our health care teams engage these same traumatized patients in their vulnerable heightened state and subsequently remove personal rights via involuntary treatment protocols and procedures. Well-meaning teams evaluate patients brought into the ED, while these patients are still in this traumatized and activated state. The evaluating clinicians use the same behavioral standard references as they apply to the patient in the next room who walked in voluntarily seeking help for his/her troubles. It is here that we can inadvertently divert traumatized patients into different treatment tracks. Once an involuntary form is completed, the momentum of this involuntary treatment flow is very hard to stop and challenge. This patient is now labeled as dangerous and unable to freely direct his/her care.

While this is a blatant example in many ways, there are more subtle types of institutional re-traumatizing that occurs much more frequently across health care systems in ambulatory care. Our systems can easily divert patients who show up late, don’t return our calls, miss appointments, etc. into the “non-adherent” patient population. Yet, these very same behaviors can be seen in a highly dedicated grandmother bringing her grandchildren in for care across town using two to three forms of inefficient public transportation. We then run the risk of treating this well-meaning grandmother who came late to her appointment by 20 mins very differently than those caregivers with better access to resources. Many outpatient clinics have a late policy that would cause this dedicated grandmother to be labeled as a no-show. One can imagine why this caregiver would demonstrate frustration and irritation after making the trek across town to a less-than-embracing health care system. She may even demonstrate unpleasant behavior and then be labeled as a “disruptive patient.”

Another influence of our health care system’s inflexibility with traumatized patients is the contagious nature of trauma. These triggered and traumatized patients in turn activate and burn out dedicated and compassionate providers who are trying to meet their clinical needs. Understanding this cycle in terms of provider burn-out may allow for addressing the needs of both patients, their families and their providers.

In sum, the 2019 Winter Course Planning Committee believes training heath care teams in taking the leap from “What is wrong with you?” to “What has happened to you?” is a logical next step in understanding how societal, systemic and individual biases affect patients’ access to and engagement in effective, compassionate and supportive health care.