Trauma does not recognize boundaries. Health care that acknowledges and responds to the damaged emotional and physical boundaries of traumatized patients is called Trauma-Informed Care (TIC).
The study of the impact of trauma began in a systemized way in the 1970’s with returning veterans of the Vietnam War. The term “shell-shocked” was used previously to describe the moral and physical injury suffered by combatants of war. A new term, “Post Traumatic Stress Disorder (PTSD),” became commonplace to describe the symptoms of those who suffer trauma through war, violence, and other forms of abuse.
Trauma is ubiquitous in the United States and around the world. War, poverty, natural disaster, domestic terrorism, intimate partner violence, childhood abuse, and predation of the vulnerable of any age are common ills of our society. Social trauma like racial, cultural, and gender bias occur daily, beating down mental health, and too often, physically beating up women, children, and men.
The Centers for Disease Control and Prevention (CDC) paint dark numbers for the incidence of physical, emotional, and sexual abuse. One in four women experience domestic violence, one of every six women have suffered rape, or attempted rape, one in 71 men have been raped at some point in their lifetime. One in every seven children suffer abuse or neglect each year.
Trauma-informed care is a patient-centered approach that seeks to integrate the experience of the patient into their health care. Research indicates trauma or violence of any kind can predispose an individual to lifelong health problems and emotional difficulties. TIC shifts the diagnostic question from “what is wrong with the patient,” to “what happened to this patient?”
TIC is an institutional approach crafted to provide empathetic health care to patient populations that commonly include traumatized individuals. The six basic tenets of TIC include:
- Safety: Patients and staff interact in a physiologically and psychology safe environment.
- Trustworthiness: Emphasis is placed on transparency, while information is offered to build and bolster trust.
- Peer support: Patients can identify with providers and personnel with similar experiences.
- Collaboration: Decision making is leveled between patient and providers to minimize power differences.
- Empowerment: TIC practices are built on a foundation of resilience and a belief in healing from trauma.
- Cultural, racial, and gender issues: Biases and trauma are acknowledged and incorporated, not ignored and dismissed.
While there are many modes by which TIC can be delivered, there are four fundamental goals common to all programs. These include:
- Realize the frequency and impact of trauma
- Recognize the signs of trauma at all ages
- Respond by using TIC best practices
- Resist Re-traumatization
Those who have been traumatized at any age are more likely to be victimized again or engage in high-risk behavior. Trauma-informed care seeks to stem the tide of loss, provide physically and emotionally safe health care, and work to restore trust in those (patients or providers) whose boundaries have been ignored, abused, and lost along the way.
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