What Is Trauma-Informed Care? Here's What a Patient Can Expect From This Approach to Health Care
More doctors are practicing this supportive type of patient care—here's what it's all about.
At some point in our lives, most of us will live through a traumatic event or environment. Trauma affects everyone differently, and for some people, health care settings can be triggering. That's where trauma-informed care (TIC) comes in. Research shows that both patients and physicians believe TIC is important, but what exactly is it? Here's what to know about TIC, including what it looks like, why it's important, and how to get it.
What does trauma mean, exactly?
To understand what TIC is, it's important to know what trauma is.
In the TIC context, trauma is "a singular or recurring event, or environment, that disrupts a person's coping mechanisms, or inhibits their ability to develop coping mechanisms," Elizabeth Lanphier, PhD, an assistant professor at the University of Cincinnati and a medical ethics researcher, tells Health.
That trauma can happen through an adverse childhood event (ACE)—like experiencing abuse, witnessing domestic violence, and living with a parent with mental illness—or in adulthood.
Trauma experienced at any age is widespread. The Centers for Disease Control and Prevention reports that 61% of adults have had at least one ACE, and women are more likely to have gone through an ACE than men. Overall, it's believed that 70% of adults in the US have experienced some type of traumatic event at least once in their lives, according to the National Council for Behavioral Health.
But the event or environment isn't always traumatic to everyone who experiences it, Lanphier points out. "You and I could experience the same exact event (like a natural or human-made disaster) or the same kind of event (like witnessing violence) and we will each experience it in our own way," she explains. "We will probably both be significantly impacted by the experience, but we might each react really differently. Maybe the experience disrupts my coping mechanisms, but not yours, for example."
What is trauma-informed care?
Simply, TIC is an approach to care that keeps patient's trauma in mind so that they can receive safe, competent treatment.
The concept of TIC is based on a set of four assumptions, laid out by the Substance Abuse and Mental Health Services Administration (SAMHSA). When a trauma-informed approach to care is in use, all people at all levels of an organization or system operate under "the four R's." In a health care setting, staff will:
- Realize what trauma is and how it works.
- Recognize the signs of trauma.
- Respond to that trauma by applying the principles of a trauma-informed approach.
- Resist re-traumatization by recognizing and avoiding practices that may trigger painful memories for patients and staff with trauma.
There's no set rulebook for how health care workers should react to their patients' trauma and resist re-traumatization. Instead, TIC is guided by six key principles set by SAMHSA:
- Developing physical and emotional safety
- Fostering trust and transparency
- Offering and creating opportunities for peer support
- Creating practices that are inclusive, collaborative, and that level out the power balance between patient and provider
- Encouraging empowerment, voice, and choice
- Understanding cultural, historical, and gender issues
"Trauma-informed care isn't designed to predict how a person will act or react in response to trauma. Instead, it invites awareness that trauma plays a role in shaping people's experiences," Lanphier says. And it's so vital "because it works to create an environment for people to feel safe, supported, and empowered to voice their concerns, needs, or preferences."
What does trauma-informed care look like?
Basically, TIC is about you and your doctor working together, "as opposed to me [as the doctor] just telling people what to do," Eve Rittenberg, MD, a primary care physician at Brigham and Women's Hospital in Boston, tells Health.
She gives this example: Say you're due for a pap test, and you tell the doctor that you really hate getting them and that you don't want to go through with it. A provider without a trauma-informed approach to care might say something along the lines of, "Don't worry, it's not a big deal," or, "Don't worry, I'm really good at doing it." Those types of responses aren't actually helpful, according to Dr. Rittenberg. Instead, it might "be more helpful to ask something like, 'So have you had any bad experiences with that exam in the past that you think would be helpful to tell me about?'" she says. "Or I might ask, 'Is there anything I can do that might help you feel more comfortable during it?'"
Dr. Rittenberg also explains to patients what she will be doing before she does it, another key part of TIC. It shows respect for the patient's boundaries and gives them an opportunity to consent or say that they aren't comfortable with something.
And TIC doesn't necessarily mean that you'll have to share all the details of your traumatic experience. (Although, theoretically, in an environment that's working on being trauma-informed, you should feel supported and safe in sharing these details if you think they're important to your story and care.) Rather, TIC recognizes that patients might come to an appointment with traumatic experiences in their history, and that those experiences might affect how they react to a situation in the present moment.
Why is trauma-informed care important?
For more than two decades, research has shown a clear relationship between trauma and later mental and physical health consequences—including depression, anxiety, cancer, heart disease, and stroke, according to Dr. Rittenberg. In fact, people who who've had at least six ACEs have a 20-year decrease in life expectancy compared to those who do not have any ACEs.
Not providing TIC to people who've experienced trauma can be harmful, Dr. Rittenberg says. For one, "health care itself can be very retraumatizing to people," she explains. That can be due to the power differentials between patients with provider, as well as the small rooms and lack of privacy in a medical setting. People can also be retraumatized from having to share their stories over and over again to health care workers, or just from having to take off their clothes for an exam.
Dr. Rittenberg believes that "people who have experienced a lot of trauma may have a lot of difficulty engaging in care, so we risk sort of keeping away people who could really benefit from what health care has to offer."
The need for TIC might be as present as ever. The COVID-19 pandemic has brought on individual trauma (staying in the intensive care unit, as many people who've recovered from COVID had to do, can be traumatic), interpersonal trauma (rates of intimate partner violence increased during the pandemic), and collective trauma (we've all lived through this life-altering event together).
"From all of these experiences in the pandemic in the last couple of years, the importance of trauma has now been recognized in our hospital systems in ways that I've never heard before working in the field. And [TIC] is really our way of responding to that challenge," Dr. Rittenberg says.
How can you get trauma-informed care?
TIC should be "used as a universal precaution in all encounters with patients or clients," according to Lanphier. And it's an approach to care that should run throughout the health care system—from the front desk staff to the person drawing your blood. So really, the responsibility is on the health care system to give TIC to everyone rather than you to find it.
Until that time comes, though, there are things you can do to advocate for it. One is encouraging your providers and their institutions to understand that TIC is valuable to all parties involved. If you are on the hunt for a new doctor, for example, Lanphier suggests asking if the office is familiar with the care approach, and if the specific doctor you're looking at practices it.
You can also make sure to know your rights before an appointment, including tests you don't necessarily have to take, or modifications your provider is obligated to make if you request it. "So it's OK to say, 'I need a little bit more time to think about that,' 'Can we find we find a way to slow down, or, 'I prefer not to change into the hospital down before I meet you,'" Dr. Rittenberg explains.
Ultimately, TIC is "not to come away with the idea that people are just their traumas and they're damaged and that's it, but really to focus on people's ability to come through very, very difficult circumstances and experiences with resilience and strength," Dr. Rittenberg says. It's a way to get your providers to understand your history, how it's affected you, and how you can work together to get the care you need and deserve.
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