Trauma-informed Care Delivery

Recognizing Trauma to Deliver Informed Treatment

The simplest step in delivering trauma-informed care is acknowledging how common trauma is in our modern world. Many patients have been brought to facilities to seek medical care as a result of trauma, while others have developed trauma-related health issues or maladaptive tendencies, such as using drugs and alcohol, as a way to cope.

However, in many healthcare settings, the health issues that brought the patient into the facility may be unrelated to the traumatic experience. This is not to say that the traumatic experience will not influence the patients’ experience in a health care setting. Harvard Health Publishing of Harvard Medical School summarized that, “The first step is to recognize how common trauma is, and to understand that every patient may have experienced serious trauma.” Further, they explained that, “We don’t necessarily need to question people about their experiences; rather, we should just assume that they may have this history, and act accordingly.”¹

It sounds easy enough to be cognizant of others’ pasts and possible sensitivities while treating everyone with a mindful and gentle approach. However, generations of standardized medical approaches and delivery have ingrained in physicians how to conduct their care. The unfortunate truth is that not all of their patients will be receptive to this and effectively heal; some may even revert or relapse to old behaviors from the traditional standardized approach in the appointment room.

Asking the Difficult Question to Identify the Core of the Problem

What is this newer approach to healthcare delivery and how does it offer more comfort and consideration in the appointment room? It is advised in a trauma-informed care delivery that the healthcare professional begins by explaining why they are asking certain questions, as they may be triggering to a select few or the majority of patients. For example, you would explain why you are asking sensitive questions regarding topics like sexual history, family history, mental illness diagnosis, body image, or current relationship with drugs or alcohol.

When it comes to ensuring a trauma-informed care delivery for a sexual assault survivor, you would explain why you are asking specific questions. This approach might sound something like, “I need to ask you about your sexual history, so I know what tests you may need.” In regards to emotional trauma, when you are asking for more information or greater detail, although it is difficult for them to share, you would frame it as, “I want to know more so I can best assist you.” Explaining the “why” behind motives of care gives patients the feeling of ownership over their personal matters and provides an understanding for all patients alike that consideration has been incorporated into the health professional’s prompting.²

Adopting a Patient First Approach

Dr. Lincoln has experienced the difficulty of patients holding in helpful information to their care plan because of discomfort disclosing their personal matters. Lincoln soon learned that patients often refrain from volunteering such information about prior experiences due to a sense of guilt or shame. This makes it challenging to learn about a patient’s history, which is often crucial to understanding their health. Trauma-informed care addresses this issue by leading appointment conversations with questions like, “Is there anything in your history that makes seeing a practitioner or having a physical examination difficult?” or “Is there anything I can do to make your visit and exam easier?” Inviting this empathetic and accommodating practice into the appointment allows the patient to feel cared for and connected to the provider.

It is critically important, especially for individuals with sexual assault trauma, that it is explained why any physical exam or close touch is occurring. This is a non-negotiable when the physical exam involves the breasts, buttock, or genitals.²

Patients that feel like the appointment room is an invasive environment or are self aware and know that they need the extra support and security of another person when receiving healthcare of any form, may choose to bring in a loved one to simply be present in the room with them and the health professional.

How to Establish a Safe Space

According to the American Medical Association (AMA), efforts are made to “provide a comfortable and considerate atmosphere for the patient and the physician are part of respecting patients’ dignity.” The AMA is referring to the expected protocol in a healthcare setting, such as:

Providing appropriate medical gowns
Privacy when undressing
Knocking before entering the appointment room
Sensitive use of draping
Clearly explaining various components of the physical examination
Having medical chaperones available

The Option of a Medical Chaperone

There is also the requirement in many states that a medical chaperone be present in the appointment room during certain examinations or at least offered at the patient’s discretion. This even applies early on in pediatrics, which sets the standard for how children should view the right to their body and the privacy and respect they deserve. The AMA explains that “having chaperones present can also help prevent misunderstandings between patient and physician.” The AMA’s outline of incorporating medical chaperones into the healthcare environment promotes physicians to:³

Adopt a policy that patients are free to request a chaperone and ensure that the policy is communicated to patients
Always honor a patient’s request to have a chaperone
Have an authorized member of the healthcare team serve as a chaperone
Physicians should establish clear expectations that chaperones will uphold professional standards of privacy and confidentiality
In general, use a chaperone even when a patient’s trusted companion is present
Provide opportunity for private conversation with the patient without the chaperone present
Physicians should minimize inquiries or history taking of a sensitive nature during a chaperoned examination

Building a Trusting Relationship with Patients

One of the most important aspects of trauma-informed care is meeting the patient where they are at. This means communicating with empathy while demonstrating understanding and validation of their feelings. For example, “If someone refuses outright to have a certain exam or test, or if they’re upset about something (like having vaccinations), we can respond with compassion and work with them, rather than attempting to force them or becoming annoyed.”³

At Boardwalk Recovery Center, our healing process is rooted in the patient opening up and processing their past. Our clients will not share with their provider unless they feel supported and have a foundational relationship with them. With that said, the traumatic experiences our clients have been through are only discussed with time and consistent support. Our clients’ traumas may not all be physical, but they are all emotional traumas, as any addiction stems from or is the catalyst to these trauma.

Boardwalk Recovery Center’s Integration of Trauma-Informed Care

An article from Harvard Health Publishing of Harvard Medical School which discussed trauma-informed care declared that, “Providers need to recognize that many, many patients have a history of physical, sexual, and/or emotional abuse, as well as serious illnesses and negative experiences in the medical setting, and we need to learn to respond with empathy and understanding.” It is possible for anyone to have an experience that negatively impacts their interactions with particular institutions, such as the healthcare system.

Simply said, through trauma-informed care at Boardwalk Recovery Center, our health care providers learn to always deliver care cautiously and compassionately to every patient, without making judgments or assumptions about their histories and their comfort level with the medical interaction or sensitive subject. In turn, providers will be able to learn more about their patients and patients will be able to heal in a way that best supports their personal recovery.

Resources

Monique Tello, MD. “Trauma-Informed Care: What It Is, and Why It’s Important.” Harvard Health, 16 Oct. 2018, https://www.health.harvard.edu/blog/trauma-informed-care-what-it-is-and-why-its-important-2018101613562.
Rittenberg, Eve, et al. “Trauma-Informed Care – Reflections of a Primary Care Doctor in the Week of the Kavanaugh Hearing: Nejm.” New England Journal of Medicine, 29 Nov. 2018, https://www.nejm.org/doi/10.1056/NEJMp1813497?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov.
“Use of Chaperones.” American Medical Association, https://www.ama-assn.org/delivering-care/ethics/use-chaperones.