Many provider organizations tell us about how they're addressing social determinants of health to reduce total cost of care, improve patient outcomes, and advance health equity. However, few of those we talk to understand the extent of the impact trauma has on many medically and socially complex patients. Here's what you need to know.
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What constitutes trauma, and how does it impact health?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma includes any experience that is "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." This can include enduring:
- Natural disasters;
- Childhood abuse or neglect;
- Interpersonal or community violence;
- Systemic oppression; and/or
Trauma in childhood, also called Adverse Childhood Experiences (ACEs), can lead to long-term health consequences. According to a landmark study, people with four or more ACEs are four times more likely to have COPD, 10 times more likely to use intravenous drugs, and 12 times more likely to attempt suicide. People with six or more ACEs die on average 20 years earlier than those without ACEs. And patients with post-traumatic stress disorder (PTSD) experience increased hospitalizations, length of stay, and mental health visits. If underlying trauma isn't adequately addressed, triggers can interfere with care plan adherence for even well-managed patients.
What does a trauma-informed approach to care look like?
The Population Health Advisor team spoke with Dr. Leigh Kimberg, Professor of Medicine at the University of California, San Francisco (UCSF), who works closely with the San Francisco Department of Public Health and Futures Without Violence. In response to growing research about the long-term impact of trauma on health—and the potential for health care settings to re-traumatize patients (and staff)—Kimberg studies care delivery models that incorporate a trauma-informed approach. To deliver trauma-informed care, embark on an institution-wide cultural shift that prioritizes the well-being of staff, develop training and tools to ready staff for successful patient interactions, and connect patients with holistic follow-up care.
- Start with an internal cultural shift that protects and uplifts the dignity and emotional well-being of all staff. Patient/staff relationships don't exist in a vacuum, but in the ecosystem of the entire organization. When staff feel valued and engaged with their role and organization, trusting and empowering relationships with patients will follow. Nurture a positive work environment that mitigates stress and burnout so that frontline staff are emotionally prepared to support patients who have experienced trauma.
- Equip staff with the skills and tools to effectively provide education, screen, and care for patients with underlying trauma. Distribute baseline surveys to identify staff's and new hires' abilities to deal with stress and conflict. Then, launch an educational campaign to explain the foundational components of trauma-informed care and its importance. Train clinical staff on how to provide education about the effects of trauma on health and screen for and discuss traumatic events. Provide scripting when helpful to guide the conversation.
- Connect patients with follow-up support to address comorbid mental health, clinical health, and social needs stemming from traumatic experiences to engender patient trust and begin addressing root causes of patient complexity. Explain options for next steps, but allow patients to decide and take ownership over their care. Resources should meet the full range of clinical and non-clinical needs. In particular, staff should partner with community behavioral health providers taking referrals to expand access to necessary treatment.
For our next post on trauma-informed care, we'll outline a few best-in-class examples of how to incorporate trauma-informed care into care delivery. Are you using these principles at your organization? We’d love to learn more! Reach out to Darby Sullivan at firstname.lastname@example.org to share your efforts.