Friday, January 10, 2014

Understanding trauma-informed care

Sometimes secret and often ignored, past trauma can dramatically influence a patient’s experience while at the hospital. Liz Speakman, LICSW, director of HAVEN, explains how a new trauma-informed care initiative is underway that will shape the delivery of care at the MGH and across the Partners HealthCare system.

Q. What is trauma-informed care?

A. Trauma-informed care is a new term that has become more common in the past several years. It helps health care providers understand the prevalence of domestic violence, sexual violence or other types of traumas. Good care is approaching every patient with the assumption that at some point in their lives they may have experienced trauma and tailoring their care based on that knowledge. One in four women will experience domestic violence in their lifetimes; one in three will experience sexual assault. For a caregiver to be mindful of that – telling the patient what they are going to do, telling the patient they can stop at anytime, having someone else in the room with them – is giving more ownership to the patient rather than just going through the motions.

Q. How are you educating the hospital community?

A. About a year ago, we met with domestic violence prevention and intervention leaders across Partners to update each other and explore areas for collaboration. What we found is that we are all trying to incorporate trauma-informed care. Soon after, we formed a committee and began planning a conference, which was held in October, to raise awareness of the role trauma plays in the life of patients. We had a wonderful guest speaker – Dr. Carol Warshaw, a leading expert in trauma-informed care – who also helped facilitate a panel of clinicians that discussed how to integrate trauma-informed care into a practice. Going forward, the planning committee is going to create a needs assessment and a framework to look at opportunities and challenges. We will then bring that back to our own institutions to review.

Q. How can clinicians reinforce trauma-informed care?

A. There is a lot of work being done at the MGH around disability awareness – educating staff that we cannot always see a disability but not assume that someone doesn’t have one. I think it’s similar with trauma. When someone starts getting angry with a provider, there may be a lot of blaming rather than understanding. This person may have had their power taken away from them in many different ways; their body may not have felt like their own. It’s important to attend to the emotional aspect of being in a medical setting. We don’t necessarily know what someone has been through. Trauma-informed care is not about getting a disclosure but more about empathy, compassion, care and understanding.

Q. Where do you see this initiative going?

A. My hope is that we will get together on an annual basis. I hope next year we will have another conference or just a check-in where we come together so that we maintain the connections among the different institutions. For the longer term, my hope is that all providers across our system continue to see patients as whole people with all the complexities they bring.

Read more articles from the 01/10/14 Hotline issue.


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