Treatment of Clients Experiencing Trauma A Collaborative Approach to Care May 9, 2018 * Tex-CHIP Training Series

Medical Management of Symptoms

Understanding Provider Role in Treating Trauma – Trauma Informed Care To begin with, it is important to understand what trauma is for purposes of “Trauma Informed Care.” It can be thought of as an event or series of events that involve a direct or perceived threat of death, severe bodily harm, and/or psychological injury that a person at the time of the event finds deeply distressing. Trauma can be experienced by being a witness to trauma, such as when a child sees domestic violence. Trauma can occur at any point in the lifespan (Huckshorn & Lebel, 2013; Trauma Informed Care Resource Guide, 2017). Purkey et al. (2018) support having all who work in healthcare, from the receptionist and the nurse to allied health professionals as well as physicians, understand and apply the principles of Trauma Informed Care (TIC), principles which have been recommended as “universal precautions” (Bruce et al., 2018). Epidemiologic studies estimate between 36% to 81% of the general population have experienced trauma (Huckshorn & Lebel, 2013). It is challenging to accurately determine the extent of trauma within the population if it is unassessed and allowed to remain invisible. Not all who experienced trauma will have the same manifestations – thus the idea of “universal precautions”- that is, approaching each individual using TIC principles.

Considerations when Interacting with Clients Trauma Informed Care (TIC) is a form of care that takes the whole person into account. TIC is a framework which incorporates the realization of how widespread trauma is, knowledge about different kinds of trauma and how it can manifest. TIC is an approach to healthcare which is strengths-based and congruent with person-centered care; care that is collaborative, supportive and focused on helping an individual reclaim control (Isobel & Delgado, 2017; National Center for TIC, 2015). Trauma Informed Care can be implemented in any healthcare setting.

Our Treatment Plan Goal: Implement Trauma Informed Care Healthcare Domain: Primary Care Provider: This applies to the direct care provider as well as support staff Goal: Implement Trauma Informed Care as a universal approach to care for all patients.   Principles:  Acknowledge the ongoing effect of trauma, validating current relevance. External forces shape internal experiences. b)  Recognize the need for physical and emotional safety. Clean, soothing environment with individual seating in waiting area. Provide consistency, anticipatory explanations, and predictability. Establish and work to develop trust, respect, and acceptance.  c) Give the patient control and choices in the context of building an alliance (not demanding compliance). d) Support the patient in building skills and believe in the patient’s strengths and resilience. e) Incorporate cultural considerations (Purkey et al., 2018)

Measuring Outcomes/ Success From one year of confirmed cases of child maltreatment, there is an estimated $124 billion costs for healthcare, special education, productivity loss, criminal justice, and welfare over the lifetime of those children (Stevens, 2012). With this in mind, when TIC is implemented universally, one would anticipate overall better health outcomes across the lifespan with a reduction in direct and indirect costs to society.

Communication from Counselors Epidemiologic studies estimate 36% to 81% of the general population have experienced trauma. It is challenging to accurately determine the extent of trauma when trauma is unassessed and allowed to remain invisible. Not all who experience trauma will have the same manifestations. Counselors are potentially in a position to educate primary care providers about steps to take to implement TIC as a universal strategy. When an individual is identified as having experienced trauma, the Counselor can help strategize and collaborate as to what individualized approaches to primary care would be beneficial, support and “coach” the individual patient to advocate for their needs.

References Bruce, M.M., Kassam-Adams, N., Rogers, M., Anderson, K., Sluys, K.P., & Richmond, T.S. (2018). Trauma provider’s knowledge, views, and practice of trauma-informed care. Journal of Trauma Nursing, 25(2), 131 – 138. Huckshorn, K., & Lebel, J. (2013). Trauma-informed care In Yeager, et al. (Eds) Modern community mental health: An interdisciplinary approach (pp. 62-83). Oxford, UK:Oxford University Press. Isobel, S., & Delgado, C. (2017). Safe and collaborative communication skills: A step towards mental health nurses implementing trauma informed care. Archives of Psychiatric Nursing, 32, 291-296. National Center Trauma Informed Care (2015). Trauma-informed approach and trauma-specific interventions. Accessed: https://www.samhsa.gov/nctic/trauma-interventions Purkey, E., Patel, R., & Phillips, S.P. (2018). Trauma-informed care: Better for everyone. Canadian Family Physician, 64, 170-173. Stevens, J. E. (2012). ACE study, child abuse, child trauma, chronic disease, neurobiology comments. Daily Archives: October 3,2012, Accessed: https://acestoohigh.com/2012/10/03/