This Friday, August 16, 2024 at 12 MST I’ll be providing an Arizona Perinatal Psychiatry Access Line (APAL) Grand Rounds on Trauma-Informed Care in a Gynecological Setting. In the talk, I introduce the Substance Abuse and Mental Health Services Administration’s (SAMHSA), Concept of Trauma and Guidance for a Trauma-Informed Approach. For this week’s blog I’m going to discuss it further: noting what’s great about it, its limitations, transparency as a practical element to focus on.

To join the lecture, learn more about Trauma-Informed Care specific to OB/GYN settings, and get CEs click here. P.S. It’s free!

Six Key Principles of Trauma-Informed Care

The Concept of Trauma and Guidance for a Trauma-Informed Approach reviews what trauma is, how it impacts people, and how that impact may manifest in a healthcare setting. It also acknowledges the reality of staff having their own trauma histories that may be activated in the workplace, as well as, the potential for secondary stress. The guide provides a framework for healthcare facilities to understand, recognize, and respond effectively to trauma-responses, and strive to avoid re-traumatization. It also emphasizes the following six key principles of trauma-informed care:

1. Safety
2. Trustworthy and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice, and choice
6. Cultural, historical, and gender issues

These concepts are fairly self-explanatory. However, actual implementation is an entirely different story. What does it mean to have “collaboration and mutuality?” How do you account for historical issues? SAMHSA provides “questions to consider when implementing a trauma-informed approach.”

Here are a handful of the questions they pose:

1. How do the agency’s written policies and procedures recognize the pervasiveness of trauma in the lives of people using services, and express a commitment to reducing re-traumatization and promoting well-being and recovery?
2. How does the agency address the emotional stress that can arise when working with individuals who have had traumatic experiences?
3. Is there a system in place that monitors the agency’s progress in being trauma-informed?
4. What funding exists for peer specialists?
5. How does the agency incorporate attention to culture and trauma in agency operations and quality improvement processes?
6. What mechanisms are in place for information collected to be incorporated into the agency’s
   quality assurance processes and how well do those mechanisms address creating accessible,
   culturally relevant, trauma-informed services and supports?

These are excellent, excellent questions. And, given the demands of managed-care, post-pandemic effects, national burn-out, limited resources, etc., how realistic are they to put into action? Also, the majority of the questions are systems-level. They are aimed towards leadership who have the ability to enact policy-level change, with a solid budget to boot. I find these questions are the ideal to which we, at a societal level, should aspire. And in the meantime, what do we do as clinicians to provide trauma-informed care to the client sitting in front of us?

Transparency

Transparency is one of the tools immediately available to us. I talk about transparency under the umbrella of validation (a topic for a future post!) Validation is acknowledging the truth of another’s experience. When we are transparent, meaning clear in our actions, communications, and intent, we are inherently validating. This is because we are acknowledging one’s right to information and the right to make informed choices with that information.

Clarity

In clinical practice, transparency looks like spelling out what you are doing and why. In therapy this can take the form of saying “I want to introduce X tool because it will help with Y goal in Z ways.” It can also look like anticipating discomfort; “I’m going to ask you a tough question, bear with me” or “I know this is difficult, I promise it is for a reason” (and then explaining said reason when appropriate).

Confirmation

Transparency also means seeking confirmation that your message is being received. “What’s your understanding of why I just had you do X?” “How are you hearing what I’m explaining?” This ensures you are both on the same page. And that you are actually communicating what you think you’re communicating! Lastly, it gives the opportunity to clear up misunderstandings and provide additional clarification. This is needed more often than you may think. When folx are having a trauma response, they are less able to be fully present and engaged in the moment. Rather they may be going into well-worn coping strategies of distraction, withdrawal, numbness, dissociation, etc. And need your guidance and support to regroup and revisit needed clinical information.

Kindness

Lastly, and arguably most importantly, transparency allows you to meet your client where they are at. Many folx who have experienced trauma don’t have the words to say how their trauma has impacted them and may not know the nuances of their trauma triggers and trauma responses. For some, their trauma was so “normal” to their lives, they struggle to even label their experiences as trauma. As such, they are not likely to present to, for example, a gynecology appointment immediately disclosing a trauma history, being able to label how it may be triggered during a physical exam, and what they need for grounding and safety. As such, operating from a place of offering transparency, rather than waiting to be asked, is an act of clinical skill and kindness.

For Clinicians: I hope that you work in an agency that supports trauma-informed care. If not, I hope this gives you some inspiration for seeking change in your agencies. In the meantime, be transparent! Run the risk of over explaining. Ask for confirmation and feedback. Open the door for clients to say what they need to say. This approach takes more time than many of us have, and I am confident it will be worth it for you and your clients!

For Those Seeking Care: I hope this helps you see that your right to trauma-informed care is seen! Our healthcare systems have a long way to go. I hope for this blog to be a step in the right direction.