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Healthcare following psychological trauma: A new perspective on medical care

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Psychological trauma can have a powerful impact. It can affect core beliefs, emotions and relationships. It even affects physical health, as well as how trauma survivors interact with health-care providers and the health system.

That’s why a new field of study is looking at ways to improve care for people with a history of psychological trauma. Trauma-informed care addresses some of the effects that make it difficult for trauma survivors to get the best possible health care.

A traumatic event is defined as experiencing or witnessing a situation in which you or another person were injured or threatened, resulting in intense fear, helplessness or horror. It’s more common than many people realize. In fact, childhood trauma alone – including sexual, physical or emotional abuse and neglect – affects as many as one in five to one in three people.

The long-term effects of those traumatic experiences often include health issues, in addition to psychological issues. Research has shown that people who have survived childhood trauma are at greater risk for physical health problems. However, trauma survivors may be less likely to get the care they need.

“People who have trauma histories are especially sensitive to interactions within health care,” explains Dr. Catherine Classen, director of the Women’s Mental Health Research Program at Women’s College Research Institute. “Because in seeking health care, there’s a real power differential. So it’s easy for a person with a trauma history to feel unsafe, to feel powerless, to feel like they don’t have a voice and sometimes to even feel re-traumatized.”

As a result, trauma survivors may avoid seeking health care, despite the fact that they are more vulnerable to health problems. That means that their condition may deteriorate and become more serious by the time they eventually get care.

“We want to educate health providers about how to work with patients so that they feel safe and thus more likely to seek health care and follow treatment recommendations,” Dr. Classen says.

Among mental health professionals, there is a growing awareness of the need for trauma-informed care. However, this awareness must extend to the entire health system.

“Health providers need to have some rudimentary knowledge of trauma and its impact, and how to work sensitively with patients,” Dr. Classen says. “We need to reach out and educate those health providers who are not aware of the incidence and long-term effects of psychological trauma and how that impacts health care delivery.”

The goal is to develop a self-assessment tool that health-care providers can use to gauge their knowledge of trauma-informed care.

“This tool will help them identify gaps in knowledge, and point them to where they can get information to fill those gaps,” Dr. Classen says.

In June, international trauma experts came together in Toronto to begin developing such a tool at a meeting funded by the Canadian Institutes of Health Research. The meeting was followed by a conference called Trauma Talks: Advancing the dialogue on trauma-informed care.

“The feedback has been overwhelmingly positive,” says Dr. Classen.  “With more than 260 attendees clamoring for more information about trauma and trauma-informed care, there’s clearly a growing sense of excitement and optimism.”

Health professionals don’t necessarily need to know the specifics of a patient’s trauma history, or even whether the patient has trauma in their past, to provide trauma-informed care. Although providing trauma-informed care may take more time, its principles include creating a sense of safety, collaboration, choice and empowerment, and can be applied to all patients.

“It’s really about universal precautions. Because the odds are pretty good that a lot of patients have trauma histories we just don’t know about,” adds Dr. Classen. “Our hope is to create a paradigm shift similar to that with HIV.  Today, every health-care provider knows they must wear gloves when exposed to bodily fluids.   We hope our work will help facilitate a similar shift regarding the universal application of trauma-informed care.”


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