The Medical Minute: Trauma-informed care delves into root causes of health conditions

Traumatic events end, but for some, they leave ghosts behind. They hide in corners and wait for something to bring them to life again.

How people manage their own trauma – defined by the U.S. Centers for Disease Control and Prevention (CDC) as a “physical, cognitive and emotional response” to harmful or life-threatening events or circumstances – is intensely personal. What can trigger it varies widely, and the dangers of sparking a negative response, also known as re-traumatizing someone, are real.

Seventy percent of adults in the U.S. have experienced at least one traumatic event in their lives, according to the National Council for Mental Well-Being. The U.S. Department of Veterans Affairs estimates that five out of every 100 people have post-traumatic stress disorder (PTSD), a crippling, severe response to trauma that can linger for years if left untreated.

Health care professionals around the world are waking up to the fact that their patients’ experiences with trauma can weigh heavily on their medical outcomes. In fact, failing to recognize these needs sometimes leads to making matters worse.

Conversations about past trauma “need to be in a very safe and secure environment,” said Dr. Taffy Anderson, an obstetrician-gynecologist, addiction medicine physician, and certified clinical trauma specialist at Penn State Health, “and they have to be willing. They do not need to discuss their trauma, because that can lead to re-traumatization.”

Anderson is an expert in trauma-informed care, an approach to treating a patient that takes their experiences into account. In trauma-informed care, one size rarely fits all.

Anderson discusses trauma-informed care and the role patients can play in making sure they benefit from it.

What is trauma-informed care?

Trauma-informed care seeks to:

• Realize the widespread impact of trauma and understand paths for recovery
• Recognize the signs and symptoms of trauma in patients, families and staff
• Integrate knowledge about trauma into policies, procedures and practices
• Actively avoid re-traumatization.

At health care facilities around the country, trauma-informed care proponents are redesigning rooms to make sure they’re less likely to contain triggers, seeking to learn about other cultures and changing the way they approach the patients who come to see them.

Much of what they’re doing underscores practices that are already in place. For example, at Penn State Health practices, staff receive regular training in AIDET, an acronym for patient interaction that stands for Acknowledge (greet a patient), Introduce (introduce yourself), Duration (give an accurate assessment of how long the procedure could take), Explanation (describe what’s to come and take time to answer questions), Thank you (express gratitude to everyone – patients and their families).

Sound pretty basic? Maybe it is, but some heath care professionals say it can lead to better results. Patients are more at ease and more communicative. And providers like Anderson can find the root causes of health care problems that might have been missed because the entire history of a patients’ problem might not otherwise have been discussed.

How does it find root causes?

Anderson has worked as an Ob/Gyn for more than three decades. During the early part of her career, she helped mothers with substance use disorders deliver babies, and at the time, the general thinking was that their problem was one of willpower.

“We didn’t understand the neurobiology of addiction,” she said.

Years later, Anderson, driven by memories of those patients, received her certification in trauma-informed care. Today, medical science has found that issues like substance use disorders are often caused by past trauma. In many cases, the trauma – which could be physical or mental abuse, the death of a family member or even witnessing violence – may have conditioned a patient’s brain to react differently than someone unaffected by similar experiences.

Often the trauma has occurred during the formative years of childhood. Doctors call it an Adverse Childhood Experience (ACE), and that can have “long-term effects on health, opportunity and well-being,” according to the CDC. Among the problems they lead to are depression and heart disease.

More than 60% of adults have experienced at least one type of ACE before they turn 18. Seventeen percent report four or more.

That includes staff at health care facilities.

“Think about it,” Anderson said, “You’ve experienced trauma, and then, vicariously, you’re going to experience more trauma through the patients.” Health care workers and patients can trigger or re-traumatize one another.

“So, for the staff and for the patient, it’s important to have a trauma-informed approach to care,” she said.

I’m a patient. How can I help?

One of the tell-tale signs that your health care facility is taking a trauma-informed approach happens when you first meet your provider. Instead of asking patients, “What’s wrong with you?” a doctor taking a trauma-informed approach might ask, “What happened to you?”

Instead of simply focusing on the current condition a patient is experiencing, trauma-informed care takes into account a patient’s life history and what might have brought them to this point.

To help, staff often help patients communicate. They should be open about their own limitations. What do they find triggering? What makes them uncomfortable?

Anderson suggests getting better acquainted with your own history of trauma. Online screening tools are available that can help determine whether you have ACEs that might be affecting your health and well-being. Here’s one from the American Society for the Positive Care of Children.

But only if you’re ready for that. Patients should remember they’re in control and professionals like Anderson make sure not to delve into territory that can be harmful. The idea of delving into past traumas might sound frightening to some patients, Anderson said. “A lot of patients are still living their trauma,” she said.

A lot of the work in a trauma-informed care environment happens on the front lines – between nurses and other health care workers and patients who often get to know one another on a personal basis.

“The ideal patient would be open to the psychoeducation that we will be sharing with them,” she said.

Related content:

• The Medical Minute: Understanding post-traumatic stress disorder
• Penn State Health community nurse helps others process effects of trauma

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

If you're having trouble accessing this content, or would like it in another format, please email Penn State Health Marketing & Communications.