Why All Healthcare Should be Trauma Informed Care

Trigger Warning: This piece will mention various types of trauma.

This June, Ezi Health will be having a series called Talk to Me about TIC on Trauma Informed Care. This piece will be the first of the series and offers a short intro to Trauma Informed Care and Why it Matters

Trauma informed care, or TIC, is a healthcare approach that provides care with the acknowledgment that any patient may have experienced trauma at some point in their life. TIC based providers are trained to address how the traumatic experiences their patients have can influence health ailments they experience. Trauma informed care involves health care providers taking a more patient-centric approach to their practice and emphasizing patient comfort, understanding and autonomy with the goal of healing the whole person and avoiding practices that cause re-traumatizing.

A staggeringly high proportion of Americans have been subjected to trauma in their lives. Trauma in the form of sexual assault is a terrifying reality for many. Each year there are over 300,000 victims in American who report experiencing sexual assault. 1 in 6 American women have reported being subject to sexual assault. 1 in 33 American men have reported being sexually assaulted. Physical abuse — particularly in the context of domestic violence and child abuse is also incredibly prevalent. In 2017, there were over 4 million cases of child abuse reported to Child Protective Services agencies, and 1 in 3 women and 1 in 4 men have experienced violence from an intimate partner. These numbers don’t include the hundreds of thousands of people that, out of fear that they won’t be believed or lack of reporting options, never disclose the abuse they’ve experienced. They also don’t reflect those that are killed as a result of these attacks or killed when trying to speak out against their abusers. Other forms of trauma — particularly mental, emotional, and racial– are difficult to quantify into statistics as reporting options are limited, but happen just as frequently. The common occurrence of trauma in American lives and the lack of treatment many survivors receive makes clear the need for widespread trauma informed care services.

One would think that with the high rate of assault and abuse many people face all healthcare providers would be trained in addressing trauma. Unfortunately, for a long time there’s been a lack of acknowledgment that traumatic experiences can and do directly impact physical and mental health trajectories. Because of this disconnect care providers often aren’t given the tools for how to navigate conversations that actively address trauma with their patients. These factors, along with the drastic decrease in time health care providers are allotted for patient visits, can result in instances of trauma going unacknowledged, providers missing a crucial piece of health history information, and patients potentially leaving their visit re-traumatized.

With the rise in evidence-based studies, such as the ACE study and the formation of the Minority Stress Model, the connection between traumatic experiences and the onset of chronic health conditions is becoming more commonly accepted. More and more providers are being trained to provide services that are cognizant of the possible traumas patients may have experienced. Examples of practices by trauma — informed providers can involve:

• Lengthening the time of appointments with patients
• Fully explaining each aspect of the appointment to patient
• Giving the patient time to ask questions intermittently through the appointment
• Letting the patient fully know their options with regards to procedures
• Giving patients screening questions, such as the depression screening
• Respecting that there may be things patients aren’t comfortable discussing
• Acknowledging that even past traumas can directly impact their present physical health and explaining the connection to patients
• Allow patients to enter appointments with whomever makes them feel most comfortable
• In the case of appointments that can be traumatizing (such as gynecological, urological or psychiatric appointment visits) taking care to ask patients respectfully of any traumas they may have

Trauma-informed care is a necessity because it helps to change the dynamic of providers and patients in a way that can lessen the dissatisfaction many have with the healthcare system. Too many individuals — particularly people who are from non-white backgrounds, who belong to the LGBTQ community or those with a non-cisgender identity — do not feel adequately cared for in the medical community. Many people have faced unspeakable traumas and report going to providers and feeling uncared for and alienated. Healthcare providers should be cognizant of this disparity in care services and work to make sure their practices ensure the comfort of anyone who may walk into their office.