A Trauma-Informed Care Approach

A trauma-informed care approach recognizes that many people have experienced or witnessed traumatic events and that this can continue to affect many areas of their lives – including how they access and experience healthcare. As practitioners, while we do our absolute to protect our patients from physical and emotional, we acknowledge that our healthcare system is inherently flawed. Survivors attempting to engage with their health care team find themselves in settings that too often re-traumatizes and marginalizes individuals with trauma histories. Learning to interact with survivors in ways that encourage their resiliency and growth is simply not a part of the medical training model.

For example, someone who has experienced trauma may be in a state of chronic hyper-arousal and hyper-vigilance that causes them to constantly assess surrounding threats. Because of this, going to the doctor can be re-traumatizing as it often entails meeting in a closed room, having to disrobe, being attended to by masked and gowned providers, being touched, lying down, and lying still.

Another way a person’s trauma history can affect their experience of going to the doctor is by causing them to not be fully present. Many survivors develop coping strategies to emotionally and mentally handle their experiences of abuse, such as numbing themselves or “spacing out.” However, once the acute or chronic experience of trauma has ended these strategies can make it difficult to be aware of one’s body and present enough to process the information given when going to the doctor because they are mentally somewhere else in their mind.

A trauma-informed care approach aims to be sensitive to peoples’ experiences of trauma and how these experiences affect their healthcare encounters by encouraging interaction with patients in a manner that promotes choices and empowerment. This means following the lead of the care seeker and helping them find choices, no matter how small. This creates opportunities at all levels of the healthcare system for survivors to rebuild a sense of control. Here are some of the ways we do this:

Begin by asking open-ended questions that allow the patient to tell their story instead of starting with yes-or-no questions.
Always ask for consent. Ensure continued consent at each step.
Explain what will be done, how it will be done, and why it is necessary.
Ask whether the patient would like someone to be with them.
Do not assume that any procedure or examination is routine.
Observe body language. Ask, “Is there anything I can do to make you comfortable?” and “If you want me to stop at any point, you can put your hand up or tell me to stop.”
Avoid false reassurances. Offer specific suggestions on how to relax if needed. Discuss in advance. Write things down.
If the patient is triggered, speak in calm voice and let her/him know where they are, that they are in a safe place, and encourage her/him to look at you, focus, and take breaths.

Trauma Resource Guides (PDFs)

For more information and examples of how to engage in trauma-informed care, please visit the following resources:

Vicarious Trauma/Compassion Fatigue

As health care professionals, we are placed in an incredibly unique and rewarding, yet challenging, field of work. We are the ones our patients come to when something is ailing them, and we are faced with the potential unsettling realization that we are being perceived by our patients as the one with all the answers. We are fixers. We are expected to remain fully vigilant and attentive when our patients reveal to us pieces of their lives that may have never been spoken out loud before; stories of trauma, pain, and suffering that shake us to our core. For some, these stories can very well get stored in the attics of our minds and we learn (consciously or unconsciously) that numbing ourselves to our patients’ pain is what helps us get through the day. However, for many health care professionals, this is not the case. We keep pictures in our minds and intense feelings in our bodies. We experience the trauma vicariously ourselves. Some signs of vicarious traumatization include:

Reduced sense of efficacy at work
Concentration and focus problems
Apathy and emotional numbness
Withdrawing from family and friends
Intrusive thoughts about clients
Disturbing dreams about clients
Sense of reliving client’s trauma
Isolation and withdrawal
Exhaustion
Jaded, bitter pessimism
Secretive additions and self-medicating
Avoidance of clients
Difficulty sleeping and concentration

Vicarious Traumatization does not only happen on the individual level; it can seep into the organizational levels as well. Moreover, terms like vicarious trauma and fatigue are not yet part of the organizational culture in many health care agencies. Organizational symptoms of Compassion Fatigue include (Compassion Fatigue Awareness Project, 2017):

High absenteeism
Constant changes in co-worker’s relationships
Inability for teams to work well together
Desire among staff members to break company rules
Outbreaks of aggressive behaviors among staff
Inability of staff to respect and meet deadlines
Lack of flexibility among staff members
Negativism towards management
Strong reluctance toward change
Inability to staff to believe improvement is possible
Lack of vision for the Future

Self-care for Health Care Providers

As providers in health care, we are trained extensively in how to screen and treat for a wide variety of illness. However, this does not mean we are prepared to take notice of what is going on for ourselves physically, mentally, emotionally, spiritually, etc. as we find ourselves diving deeper into the lives of those with histories of trauma. The question of how to recognize and respond to these triggers in a trauma-informed manner has yet to be understood for many in health care. Work-life balance is essential in sustaining our passion and commitment to the work we do. First, we must acknowledge our own personal needs and take the time to do so – those of us struggling with these issues often have lost energy and the creativity to take care of ourselves.

Practice empathy with yourself – our feelings and reactions are normal
Honest self-reflection
Develop and nurture interests outside of work
Identify values and define boundaries for yourself so that you are comfortable at work
Learn to say no – your professional life should not compromise your well being

For more information on vicarious trauma and self-care, please visit the following resources:

Compassion fatigue: What is it? Why does it matter? Recognizing the symptoms, acknowledging the impact, developing the tools to prevent compassion fatigue, and strengthen the professional already suffering from the effects (American Journal of Hospice and Palliative Medicine)
Self-Care Handout
Beyond the Cliff | Laura van Dernoot Lipsky | TEDx Washington Corrections Center for Women

In this talk, Laura offers us a window into the cumulative toll that can occur when we are exposed to the suffering, hardship, crisis or trauma of humans, other living beings, or the planet itself. Held within a larger context of systematic oppression and liberation theory, we’ll dive into what gets hard and how to work toward reconciling it both individually and collectively.

Trauma stewardship: An everyday guide to caring for self while caring for others

Videos

The Power of Empathy - Helen Riess, MD

Dr. Riess is an Associate Professor of Psychiatry at Harvard Medical School. She directs the Empathy & Relational Science Program, conducting research on the neuroscience of emotions and empathy, and is Co-Founder, Chief Scientist and Chairman of Empathetics, LLC. She is also a core member of the Research Consortium for Emotional Intelligence and is a faculty member of the Harvard Macy Institute for Physician Leaders.

How Childhood Trauma Affects Health Across a Lifetime - Nadine Burke Harris

Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.

Better Living: Domestic Violence Prevention Program

When a woman is a victim of domestic abuse, she can find assistance through the Brigham and Women’s Hospital Passageways and the Women’s After Care Clinic.

Impact of Trauma, Violence and Abuse on Health Video - Brigham and Women’s Hospital

Annie Lewis-O’Connor, PhD, Director, Coordinated Approach to Resilience and Empowerment (C.A.R.E.) Clinic at Brigham and Women’s Hospital, explains the impact of trauma, violence and abuse on long-term health.