Lindsey Peters, PharmD, BCPS
CPNP Program Committee Member
Given the high prevalence of exposure to trauma, it is important for health care providers to recognize the complex interactions between trauma, mental health, and a range of medical conditions in order to provide effective patient care. While trauma-informed care models are often incorporated into other disciplines, pharmacists are seldom provided with formal training in this area. Dr. Carole Warshaw discussed the impact of trauma on health outcomes and provided a framework for applying trauma-informed approaches to improve patient care.
Dr. Carole Warshaw is the Director of the National Center on Domestic Violence, Trauma & Mental Health. Dr. Warshaw has been at the forefront of developing collaborative models and building system capacity to address the mental health, substance use, and advocacy concerns of survivors of domestic violence and other trauma, and to create accessible, culturally responsive, domestic violence- and trauma-informed services and organizations. Additionally, she has maintained a private practice in psychiatry and is an adjunct faculty member in the Department of Psychiatry at the University of Illinois.
So, what is trauma and how common is it? To begin, Dr. Warshaw provided some key definitions and statistics that highlighted the widespread impact of trauma on health and mental health. Individual trauma is defined as the unique individual experience of an event, series of events, or set of circumstances. This may include adverse childhood experiences, domestic violence, or intimate partner violence. In a national comorbidity study, over 60% of men and over 50% of women experienced a lifetime trauma exposure. Additionally, there are high rates (40-90%) of trauma among people who develop psychotic disorders. Not only is trauma pervasive, but trauma has significant health, mental health, and social consequences and may impact a patient’s access to adequate care. In fact, trauma has been shown to affect neural architecture and developmental trajectories. Therefore, utilizing a trauma framework can help normalize the human response to traumatic experiences, help providers respond in more empathic ways, and ultimately improve patient outcomes.
So, what is a trauma-informed care or a trauma-informed approach? Trauma-informed care is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. Dr. Warshaw challenged attendees to not only consider the impact of trauma or stress on survivors, but also on providers and organizations. Trauma is a cyclical process; the effect of stress on organizations affects the staff who work there and therefore the people accessing the services.
So, how does this translate to my practice and what can I do to help create a trauma-informed culture? Due to the widespread incidence of trauma, one interesting approach urges caregivers to assume that all patients have had trauma in their history and as health care providers, we should act accordingly. Dr. Warshaw provided some suggestions of how we can incorporate a trauma framework into our workplaces. Examples include creating a welcoming environment with opportunities for patients to talk about their experiences, incorporating questions about trauma into the routine health history, and developing collaborative strategies to address concerns. To help create a safe and secure environment for patients to discuss what is important to them, providers should consider the physical, relational, and clinical atmosphere they create for their patients. Health care providers should ensure privacy and physical safety and never ask about trauma history in the presence of someone not identified as safe. Keep in mind that a situation may not seem abusive but may correlate to a memory of past abuse or trigger a painful memory for that patient. A trauma informed approach involves a genuine interest and openness and the ability to relate with empathy, validation, and respect. Consider creating an opportunity to participate in give-and-take relationship without risk of judgment and sharing your concerns without imposing your own point of view.
These are just a few of the suggestions that Dr. Warshaw provided. For more examples of ways to incorporate a trauma informed approach at your practice site, please visit the training and resource center at: http://www.nationalcenterdvt.