With nearly 41% of Australians experiencing violence before adulthood, it is important to understand the impact of trauma on a patient’s healthcare journey.
Trauma-informed care recognises the widespread incidence and impact of trauma on patients. A trauma-informed environment is one where a patient feels safe, experiences choice in their treatment options and is empowered in their relationship with their health care providers.
Trauma-informed care is a type of ‘universal precaution’ that presumes that most people have experienced some form of trauma in their life. Physical, sexual and emotional abuse, witnessing violence, having a family member with a substance use disorder, experiencing a serious accident or the sudden or violent loss of a loved one are all examples of trauma.
Trauma can be defined by three Es: the event, how it’s experienced, which is affected by age and the context in which it was experienced, and the effect on the person, their family and their life.
Experiencing trauma, especially during childhood, is now recognised as common. It is linked to significant increases in the risk of health problems in adulthood such as mental health issues and cardiovascular co-morbidities.
Two key studies were influential in the development of trauma-informed care. The Adverse Childhood Experiences (ACE) study published in 1998 revealed ACEs as risk factors for physical and mental illness and early death. The greater the number of adverse childhood experiences, the higher the prevalence of negative outcomes. Physical and sexual abuse in childhood is associated with significantly higher rates of depression, suicide, substance use disorders and PTSD than other ACEs.
The Women, Co-Occurring Disorders and Violence study in 2005 focused on the role of interpersonal violence and traumatic stressors in women with mental health disorders and substance abuse issues. Further studies have found that 90% of public mental health clients have been exposed to multiple physical or sexual abuse traumas.
A trauma-informed approach does not see trauma as a past event but as one which can contribute to the patient’s current state. The focus is shifted from ‘What’s wrong with you?’ to ‘What’s happened to you?’.
Consider a young boy whose father suddenly dies and he and his mother must move to an apartment. His mother begins working at night, leaving him with his aunt whose boyfriend physically and sexually abuses him. Later as a young man, he suffers from anxiety and abuses illicit drugs. If his treatment focuses only on his symptoms and behaviours, the impact of the earlier childhood trauma will remain unrecognised.
A trauma informed approach aims to:
- Realise the widespread impact of trauma.
- Recognise the signs and symptoms of trauma in individuals, families, and staff.
- Respond by integrating knowledge about trauma into policies, procedures and practices.
- Resist re-traumatisation by not inadvertently triggering a person’s traumatic experiences.
In a trauma-informed organisation. all services are designed with an awareness of trauma and its impact. Becoming a trauma-informed organisation begins with being ‘trauma aware’ and progresses to a cultural shift at the systemic level with leaders, managers and all staff working together in a trauma-informed way.
Six core principles of trauma-informed care are:
- Safety: Understanding that a ‘sense of safety’ must be experienced and is determined only by the patient.
- Trustworthiness: Decision-making is transparent. Processes are designed to build and maintain the trust of patients, families and staff.
- Choice: Informing patients regarding treatment options so they can choose the options they prefer.
- Collaboration: Among health care staff, patients, and their families, collaboration is prioritised in treatment planning.
- Empowerment: Using individuals’ strengths to empower them in their treatment.
- Cultural and gender issues: The organisation offers gender responsive services which recognise cultural stereotypes and address historical trauma.
A place to start is to behave as if every patient has experienced trauma. For example asking a patient “Is there anything I can do to make your consultation easier?” Provide explanations as to why certain questions need to be asked and be sensitive that undergoing a physical examination may be difficult for a patient.
Being aware of the potential impact of trauma on a patient allows health care professionals to improve their delivery of care and enhance patient outcomes.
Key messages
- 41% of Australians experience trauma before adulthood
- Trauma-informed care recognises the impact of trauma in a patient presentation
- Start from the premise that every patient has experienced trauma.
– References available on request
Author competing interests – nil