Twenty years ago, the Adverse Childhood Experiences study established the association between traumatic childhood experiences and the leading causes of morbidity and mortality in the U.S. Researchers from Kaiser Permanente and the Centers for Disease Control and Prevention found a direct relationship between instances of trauma (defined in the study as sexual, emotional, or physical abuse as well as being raised in neglectful or dangerous households) and rates of chronic obstructive lung disease, lung cancer, heart disease, and liver disease as well as depression, substance abuse, suicide, and risky behaviors.
While traumatic experiences can affect the entire population regardless of income level or insurance status, certain groups of vulnerable patients, such as the poor, are more likely to experience trauma. The Medicaid program in Oregon found that more than half of its high utilizing patients had experienced trauma and a third suffered from PTSD. Patients that have experienced trauma can be difficult to engage in their healthcare and frequently are labeled as “difficult” or “non-compliant.”
Trauma informed care offers providers a new lens through which to view these patients that have been labeled as “difficult.” To help patients overcome this barrier to their own healthcare, providers work to identify the trauma and the parts of medical exams that may trigger anxiety or fear. Some practices utilize social workers or peer counselors to work with patients and help streamline the referral process for other services. Because trauma informed care is relatively new, it will take evidence to establish the effectiveness of trauma focused care. Some of these efforts are supported by The Robert Wood Johnson Foundation and led by the Center for Health Care Strategies, which launched a multi-site demonstration to test whether use of trauma-informed practice improves patient engagement, enhances outcomes, and reduces costs. One of its grantees, Bronx based Montefiore Medical Group is training all staff at its 22 ambulatory care clinics in approaches to trauma-informed care. The clinics already have behavioral health specialists working alongside primary care clinicians, helping to serve residents of the nation’s poorest congressional district. For more information about trauma focused care initiatives visit http://www.commonwealthfund.org/publications/newsletters/transforming-care/2016/june/in-focus