Photo Credit: VectorMine
A two-part conversation with Alex McDonald, MD, and Erika Roshanravan, MD, about trauma-informed approach to healthcare.
PW Editorial Board member and columnist Alex McDonald, MD, spoke with Erika Roshanravan, MD, medical director at CommuniCare+OLE, for a podcast episode about trauma-informed approach to care. A trauma-informed approach to care acknowledges that healthcare organizations and care teams need a complete picture of a patient’s life situation—past and present—to provide effective healthcare services with a healing orientation. Adopting trauma-informed practices can potentially improve patient engagement, treatment adherence, health outcomes, and healthcare professional and staff wellness. For those interested in learning more about trauma-informed approaches, here are the first four pillars from their conversation.
1. What is trauma-informed care?
“Trauma-informed care is how we approach caring for our patients, but also a cultural shift for our organizations,” explains Dr. Roshanravan. “It highlights that trauma and toxic stress are common amongst our patients. And common amongst our staff and ourselves. Trauma-informed care realizes the effects trauma and toxic stress have on health, both physical and mental. The Substance Abuse and Mental Health Services Administration (SAMHSA) developed the Six Guiding Principles of Trauma-Informed Approach to help physicians understand what that means. The principles include safety, transparency, trustworthiness, empowerment, voice choice, and cultural, historical, and gender issues. Those frame the considerations around trauma-informed care, and some use an additional principle called strength-based or resiliency. I like using that because that’s where the sort of extension of trauma-informed care into trauma-informed resiliency-oriented healing came from to highlight that aspect of focusing on strengths and resiliency.”
2. Trauma-informed care is not just patient-focused, but staff and physicians as well.
“Yes, that is correct,” agrees Dr. Roshanravan. “Oftentimes, we say trauma-informed approaches instead of trauma-informed care. The change in wording takes into consideration that all of us are humans. These things do not stop with our patients. They affect all of us.”
3. Did this grow from the research on adverse childhood experiences, or did it come from the physician wellness realm?
“Trauma-informed approach has been around for a long time,” says Dr. Roshanravan. “What we learned about adverse childhood experiences (ACEs) and from the original study at Kaiser is part of that. In California, for example, when we ask about other childhood experiences, we have an expanded questionnaire called the Pearls Tool that asks about other forms of trauma, such as community, racism, and bullying. Trauma-informed approach also acknowledges trauma experience later in life, adults also experienced trauma. It is absolutely what we know about the health effects of ACEs is central to this, but it also includes a wider bucket of how we treat each other and what affects our health.”
4. How does trauma-informed approach translate into practice?
“The first thing that I want to highlight is the principle of universal precautions,” explains Dr. Roshanravan. “What that means is this is not a care approach that is reserved for a few unique patients who may be severely traumatized. This is an approach to care that we apply to everyone who walks through the door: patients, staff, and colleagues. We may not know someone’s history, so we always assume that there could be trauma or toxic stress. We take that assumption into consideration and treat patients according to the principles of trauma-informed care. That is how we create the safety and trust that are core to trauma-informed approaches. It can include little things:
- Creating a safe environment for patients.
- Not slamming doors.
- Being mindful when we do physical exams.
- How we ask patients if it’s okay to touch or to lift a shirt.
- Ask for permission before talking about certain topics or even with more sensitive exams.
- Be mindful of informing patients.
- Give patients control.
- Empower them to say something if they want exams to stop.
However, it goes much further into all we do. The culture of an organization affects more than the staff and physicians. We need collective care. There is a lot of talk about self-care, and there’s cynicism, especially amongst US physicians. How can we be asked to go and spend all this time doing self-care when there is no time or energy? What we consider collective care is creating this environment where we help each other create the space and energy to take care of ourselves and each other. That is a core piece of trauma-informed approach on the organizational level. There’s a physician, named Sandra Bloom, she created the Sanctuary Model, and one of my favorite quotes comes from her is, “trying to implement trauma specific clinical practices without first implementing trauma-informed organizational culture change is throwing seeds on dry land.”
“I think many of us as physicians feel like we always have to be perfect and leave all of our emotions and trauma at the door when we come into the clinic,” adds Dr. McDonald. “But that’s not possible. We’re all human beings. That’s a core piece in my mind to this trauma-informed approach. We’re all humans, we’re all here together, and we’re all not perfect.”
If you haven’t listened to PW’s episode on trauma-informed approaches yet now’s your chance. And stay tuned for part two!
