Trauma-Informed Care

A individual is turned away from the camera with their face down.

WHAT IS TRAUMA?

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as "an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being." Examples may include physical or psychological abuse, sexual assault, intimate partner violence (IPV), adverse childhood experiences (ACEs), neglect, loss, poverty, war, racism, community violence, medical trauma, natural disasters, and vicarious trauma. Trauma increases the risk of many physical and mental health conditions, as well as overall mortality.

A hand reaches out for the sunrise.

WHAT IS TRAUMA-INFORMED CARE (TIC)?

TIC is a well-established framework that for supporting survivors of physical, sexual, psychological, and transgenerational trauma. It fosters healing through safe and collaborative relationships. Trauma-informed principles should be applied universally to all clinical interactions and can translate to numerous professional domains. According to SAMHSA, a trauma-informed practice follows these 4 Rs:

  1. Realizes the widespread impact of trauma and understands potential paths for recovery;

  2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;

  3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and

  4. Seeks to actively Resist re-traumatization.

Trauma-Informed Physical Examination

The physical examination is a crucial part of most medical encounters, helping clinicians to diagnose and monitor disease. While the examination can help to establish rapport, it also has the potential to expose patients to shame, vulnerability, and trigger memories of prior abuse. Healthcare professionals have a responsibility to be cognizant of this and strive to ensure patients’ comfort in the examination room. A trauma-informed physical examination incorporates specific language and behaviors that aim to enhance patients’ sense of safety, autonomy, and trust.

Dr. Elisseou demonstrates how to safely perform a trauma-informed physical exam, by conducting a trauma-informed examination of a woman’s thyroid.

WHAT WE DO

Key principles of a trauma-informed physical examination include respecting patients’ personal space, being mindful of draping and comfort, standing within patients’ field of vision, and avoiding potential triggers of trauma. In the photo shown on the left, Dr. Elisseou examines the thyroid using a traditional approach. She stands directly behind the patient with her hands wrapped around the neck, which can simulate strangulation. This is contrasted with a photo of Dr. Elisseou standing at the patient’s side, within the patient’s peripheral view, and the fingers fully extended on the neck.

Two lists are displayed side by side, with appropriate trauma-informed phrases listed under a large green checkmark and potentially triggering language is listed under a red strikeout mark.

WHAT WE SAY

Trauma-informed language is simple, clinical language that aims to minimize the power differential between provider and patient. Trauma-informed phrasing is professional rather than personal and avoids any potentially triggering imagery. Communicate with the patient throughout the exam to enhance mutual understanding and collaboration.