The Need for Trauma-Informed Care
Moving further and further toward the forefront of healthcare, trauma-informed care (TIC) is an effort to acknowledge the context of a patient's total experience. First, TIC recognizes trauma that has occurred in a patient's life, actively addresses the trauma and adopts an approach to working through it. TIC provides tremendous benefits for improving patient care and community engagement.
Most people associate the phrases "trauma recovery" and "trauma care" with emergency situations or helping veterans and abuse survivors work through anxiety, depression and post-traumatic stress disorder (PTSD). Although these are aspects of trauma-informed care, the concept has a much wider scope and significance.
Supportive healthcare approaches
The Substance Abuse and Mental Health Services Administration (SAMHSA) website outlines the core principles of trauma work: safety, trustworthiness, transparency, peer support, collaboration, empowerment as well as cultural, historical and gender issues, noted Sheela Raja, Ph.D., a licensed clinical psychologist, author and associate professor of health communication and behavioral medicine at the University of Illinois Chicago.
"In terms of healthcare implementation, I think of the setting as needing to be trauma-informed," Raja continued. "Everyone is involved: serving clients at the front desk…to the administrators and everyone in between, including clients. With the prevalence of trauma, [it's important to be] aware of how to sensitively interact with people who might have been traumatized and also avoid retraumatizing people."
Raja's research studies the effects of trauma on a person's physical health; more specifically, her work focuses on the utilization of healthcare, such as preventive healthcare, by trauma survivors.
According to the research thus far, survivors less often seek procedures such as mammograms, colonoscopies and even regular dental appointments, Raja said.
In a related effort, Raja trains healthcare professionals both locally and nationally in trauma-informed care.
"[We discuss] how to sensitively interact with people when you have only a limited amount of time, and how [to] collaborate and make [the experience] as patient-centered as possible, given the [time] constraints," she explained. "My team and I published an article in 2015 that we use as a framework [for our] trainings."
Asking the right questions
Raja said the first part of TIC initiatives is good patient-centered care. Professionals should implement strategies to make people feel more comfortable, such as detailing the steps that go into an appointment and trying to give people as many choices as possible. If patients look anxious, they're asked how they have dealt with anxiety in the past and are encouraged to bring a supportive person into their exam room.
"Stress and trauma impact our physiology and our coping," Raja noted. "A lot of people don't necessarily put it all together…that what we've been through impacts how we cope. [Trauma] isn't just an isolated thing. Sometimes it is, but sometimes it's part of a larger pattern of prolonged stressors. Things like overeating, high-risk sexual behavior, smoking, drinking doesn't always have to do with a person's history, but sometimes it does."
'A lot of people don't necessarily put it all together…that what we've been through impacts how we cope.'
Raja recently encountered a patient who had not recognized the impact of trauma on her health.
"She was talking to me about how she lived in a community that has a really high rate of community violence," she said. "I asked her, 'Do you feel like that impacts your health and the way you take care of yourself?' And she looked at me and she said, 'You know, no one has ever asked me that question before. I look at my phone alerts and when there's been another shooting in my community…I go pick up a candy bar and I eat it. And I'm diabetic and I'm hypertensive.' And she looked at me and she said, 'This can't be good for me, can it?'
"And I think it's those moments where you realize we're missing opportunities [to understand patients]," Raja said.
How we see ourselves and the world
"One of the core concepts of being trauma-informed is understanding what's called self and world views," said Samantha Koury, co-director at the Institute on Trauma and Trauma-Informed Care at the University at Buffalo in New York. "What that means is that we know that individual, family and community historical narratives and past experiences shape our core beliefs about ourselves and other people in the world. Then that, in turn, provides the lens or filters experiences.
"Folks who've experienced trauma, they oftentimes tend to interpret even neutral gestures or words as threatening because this is what they've learned," she continued. "Recognizing that we each come to the here and now with a different self- and worldview and nobody is the same plays into why we need to understand that people are different. We need to not make assumptions that we know more than [patients]. We take the position that everybody is the expert of their own lived experience."
Koury said your worldview, self-view and experiences shape how you think about the system of care and medical professionals. Those professionals, in turn, recognize that patients probably have some sense of what has worked for them before and, importantly, what hasn't worked.
"[By] consistently thinking about healthcare as a whole [and] responding in ways that are promoting physical and emotional safety, trustworthiness, choice, collaboration, empowerment, especially with diversity, equity, inclusion, accessibility, this lends the opportunity for healing and growth," she said.
Supporting our healthcare providers
The second piece of TIC initiatives looks at the welfare of healthcare providers. The current strain on healthcare from the continued challenges of the COVID-19 pandemic has brought to light a number of systemic failings. Raja emphasized the necessity for healthcare providers like herself to "understand our own histories, not only with self-care but from organizational support."
At the Institute on Trauma and Trauma-Informed Care, Koury helps implement organizational changes concerning policies and procedures, the work environment and hiring practices. She underscores the need of instituting "practices or supports to address things like compassion fatigue or burnout or moral distress for all healthcare providers."
The future of trauma-informed care programs
While there are no universal initiatives for trauma-informed care, many states and institutions are exploring smaller-scale approaches. In the past 10 years, this relatively new perspective of healthcare has moved toward the forefront of patient-centered treatment. Whether you are a trauma survivor, have experienced adverse childhood experiences or deal with high-stress environmental and social issues, these programs are a welcome addition for patients and providers alike.
For more information regarding trauma treatments and informed-care initiatives, Raja and Koury suggested taking a look at these websites: PACEs Connection, the Trauma Informed Community Initiative of WNY, the National Child Traumatic Stress Network and the National Center for PTSD. They also recommended "What Happened to You?" a book written by Bruce D. Perry, M.D., Ph.D., and Oprah Winfrey.