Almost two-thirds of ACE study participants
reported at least one adverse childhood experience of physical or sexual abuse, neglect, or family dysfunction
Trauma-informed patient care: Steps for health system leaders and providers
Contributor
Laura Mueller
Essential Insights contributor, healthcare writer
Featured experts
Kyle Fischer, MD, MPH, FACEP
Clinical Assistant Professor, University of Maryland School of Medicine, Department of Emergency Medicine
Lana Herteen, MA, LMHC
Behavioral Health Consultant and Child Health Advocate, Blank Children's Hospital
The concept of "trauma-informed care" has received increased attention lately, with celebrities like Oprah underscoring the impact of trauma in our world.
It's an important topic, as a history of trauma is more common than many healthcare providers may realize. Almost two-thirds of participants in the Adverse Childhood Experiences (ACE) study, published in 1998 but still considered a guiding force in understanding the pervasiveness of trauma and its long-term effects, reported at least one adverse childhood experience of physical or sexual abuse, neglect, or family dysfunction. More than one in five participants reported three or more such experiences.
Here, we take a deeper look at trauma, the trauma-informed care model, and steps that healthcare systems and providers can take to incorporate trauma-informed care into their work.
Understanding trauma
The Substance Abuse and Mental Health Services Administration defines trauma as "an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being."
Those who have experienced trauma are 15 times more likely to attempt suicide and four times more likely to become an alcoholic. There are physical consequences of trauma, too. “Trauma has been linked to depression, anxiety and schizophrenia," said Dr. Kyle Fischer, a clinical assistant professor in the University of Maryland School of Medicine’s Department of Emergency Medicine. "And it's also been linked to things like heart disease and stroke."
In addition to physical and mental health ramifications, trauma can also have a marked effect on how patients perceive their healthcare providers, as well as their willingness to accept treatment. The more providers understand about a patient's trauma—both its roots and its lingering effects—the better care they can provide.
The trauma-informed care model
Addressing patients from a point of compassion, both for their current situation and the situations they may have faced in the past, is at the heart of trauma-informed care. The goal is to provide better treatment by addressing the traumatic roots that are so often to blame for certain types of patient behavior, including avoidance, irritability, and distrust of healthcare providers.
“Patients with a trauma history may get triggered by benign circumstances, therefore it's important that providers and staff not jump to interpret patient resistance as defiance or noncompliance," said Lana Herteen, a behavioral health consultant and child health advocate with Blank Children's Hospital in Des Moines, Iowa. The hospital has partnered with The Trauma-Informed Care Project, an organization that provides resources and training for providers on the trauma-informed care model.
“Providers and staff need to understand that even when providing excellent care, a patient may react to an element in the environment—a particular scent, physical touch, or even the sound of someone's voice—that sparks a trauma reaction," Herteen added.
An example, she said, might be a sexual abuse survivor who views something as simple as a physician examining her heart with a stethoscope to be invasive and triggering, and who may in turn act out aggressively.
“Human beings are complex," Fischer said. “When you learn more about trauma-informed care it becomes something that you can address and talk to the patient about. You can make sure you're delivering care in a way that makes sense to the patient and doesn't trigger these traumatizing symptoms."
Steps for health system leaders and providers
Here are four actionable steps that health system leaders and providers can take to incorporate trauma-informed care into their work.
Bring trauma-informed principles into training. “A healthcare organization needs to educate providers and staff at all levels and in all roles as to what is meant by trauma-informed care," Herteen said. Cover not just the method itself, but ways that it can be incorporated into daily work.
Make it manageable. Don't get overwhelmed thinking you have to learn everything about all types of trauma. “Even though individuals’ traumatic events may be very different, the way the human body responds to them can often be quite similar," Fischer said. Take a patient area of interest to you, he added, and study how to make care better for those patients. Most of the principles will apply broadly to all types of trauma.
Have a script. Talking about trauma is difficult. Fischer advised that hospitals come up with pre-planned questions providers can ask that help determine which patients are coming from a place of trauma. Scripted questions should be supportive and open-ended, Fischer said, for example: “I've noticed that you seem a little anxious. Is there anything you'd like me to know to improve your care?"
Collaborate outside the clinic. Trauma-informed care is generally collaborative in nature, with a team-based approach that may include not just front-line physicians but nurses, social workers, case managers, and others. While the trauma ward may be the place to screen patients and assess their willingness for additional care, it's important to partner with community organizations that can help patients get the peer support and mental health services they need after they leave the hospital.
Fischer and Herteen emphasized that trauma-informed care is not only important in helping to empower and respect patients, but also to promote positive health outcomes — the ultimate goal of health system leaders and providers.