Exposure to trauma, violence and abuse can have profound mental and physical health consequences. Trauma-informed care aims to heal the wounds of the past by asking not “What’s wrong with you?” but “What happened to you?”
Catherine* hit rock bottom in the emergency department in Boston. Anxious and feeling helpless, the tearful young woman met Annie L. O’Connor, NP, PhD, who cares for victims of domestic and sexual violence at Brigham and Women’s Hospital.
Dr. Lewis-O’Connor sought to understand the root cause of Catherine’s struggles. “Have you had any life experiences that may have impacted your health and well-being?”
The woman buried her head in her hands, then looked up and said, “When I was a teenager, I was in a car accident. Three of my best friends died.”
The link between trauma and health consequences
According to a pioneering study in the mid-90s, known as the Adverse Child Experiences (ACE) Study, this decade-old traumatic event increased Catherine’s odds of smoking, abusing substances and attempting suicide.
The results of the ACE Study showed that people who were exposed to the following kinds of childhood trauma had significantly more health consequences in adulthood than those who didn’t.
- Abuse (physical, emotional or sexual)
- Neglect (physical, or emotional)
- Household dysfunction (parental mental illness, substance dependence, incarceration, separation or divorce, or domestic violence)
“The ACE Study opened our eyes to how traumatic events in childhood were linked to health consequences in adults. Study participants with higher levels of childhood trauma were much more likely to suffer from obesity, smoking, heart disease, alcoholism, depression, and illegal drug use,” says Dr. Lewis-O’Connor, Founder and Director of The C.A.R.E. Clinic (Coordinated Approach to Resilience and Empowerment) at the Brigham.
A definition of trauma
Most people think of trauma as an accident or an injury. However, trauma is also emotional, such as violent episodes or abuse. A car accident, loss of a family member, or a shooting fall under the larger category of trauma.
Other examples of trauma include:
- Exposures to serious injuries
- Intimate partner abuse
- Social betrayals
- Community violence
Medical settings may retraumatize patients
According to Dr. Lewis-O’Connor, people with histories of trauma often struggle when accessing health care services, and can find these services re-traumatizing.
Medical settings may be distressing for people with a history of trauma due to:
- Invasive procedures and vulnerable positions (e.g., removal of clothing and physical touch)
- Asking of personal questions
- A possible power dynamic between the provider and patient
- Loss of privacy
Trauma-informed care, a safe space to discuss trauma
“The trauma-informed approach to care works from a strength-based perspective that acknowledges the patients’ strengths,” says Dr. Lewis-O’Connor.
Trauma-informed care avoids pathologizing and attempts to creates a safe space for patients to disclose their trauma by asking questions such as:
- Have you had any life experiences that you feel have impacted your health and well-being?
- What would be helpful to make you feel comfortable during this visit?
- What type of health care do you think you need?
The C.A.R.E Clinic offers a trauma-informed approach to help patients have more meaningful encounters with their care providers by:
- Establishing a collaboration between provider and patient
- Allowing the patient to have input on all decisions
- Empowering the patients to make choices
Making sure a patient ends up in the right hands
Like Catherine, many patients are referred to the C.A.R.E. Clinic from the emergency room, though some self-refer from the community. These patients want help, but they hope to work with healthcare providers who understand their trauma, violence or abuse.
The staff at the C.A.R.E. Clinic develops a trauma-informed plan for each person, making sure they end up in the right place, at the right time, with the right provider.
Dr. O’Connor worked with Catherine to find doctors and mental health providers who met her needs. Catherine found a primary care physician and psychiatrist she liked as well as a group for patients with histories of similar trauma.
“Before Catherine ever set foot in a doctor’s office, her providers knew about her trauma history and had some context before meeting,” says Dr. Lewis-O’Connor.
Catherine’s trauma-informed treatment
During Catherine’s visits at the C.A.R.E Clinic, each trauma-informed care provider explained what procedures or tests would be conducted, how they would be carried out and why they were necessary.
Catherine was free to decline any test or procedures, and questions were welcomed. Trauma-informed providers asked questions, including:
- Are you comfortable?
- Is it OK for me to continue?
- Would you like me to stop?
“A plan of care shouldn’t be decided forthe patients; it should be decided with them,” says Dr. O’Connor.
Seek first to understand, a moral obligation
Catherine has come a long way since her visit to the emergency room. She now regularly attends group therapy, and meets weekly with her psychiatrist. She’s 90 days sober, no longer using alcohol to numb the emotional pain of her past.
“When we truly care about people, we should meet them where they are, not where we think they should be. We should give them what they seek, not what we think they need. We should respect them for who they are as a human being. That is our moral obligation. Seeking to understand rather than making assumptions or drawing quick conclusions is the trauma-informed care philosophy, says Dr. O’Connor.
*names have been changed
– By Dustin G.
What’s Your ACE Score?
10 Ways to Help Overcome Trauma
- If you have an emergency, dial 2-1-1 on your phone. This is a confidential helpline that connects people to health and human services.
- Journal about childhood memories in five-year increments
- Talk to your doctor about Cognitive Behavioral Therapy (CBT), or Eye Movement Desensitization and Reprocessing (EMDR)
- Create stable environments (at work and home)
- Build strong family bonds
- Volunteer (get involved with community projects)
- Exercise (3-4 times a week for 30 minutes)
- Play more (What makes you happy? Do it.)
- Set reasonable goals (to avoid burnout)