Over the past two years, the COVID-19 pandemic and a renewed emphasis on issues surrounding racial justice have brought the need for trauma-informed healthcare into greater focus. Trauma-informed care is based on a framework that recognizes people’s lived experiences can affect how they engage with the healthcare system.
Trauma-informed care programs have been in place for a decade at Brigham and Women’s Hospital but are now expanding across more areas. The emphasis on this type of care has contributed to a greater awareness of societal issues and the development of clinical programs and policies that minimize the chance of retraumatizing patients.
“Many people have experienced traumas of a variety of sorts, even if they don’t have a diagnosis of post-traumatic stress disorder,” says Nomi Levy-Carrick, MD, MPhil, a consultation-liaison psychiatrist in the Department of Psychiatry at the Brigham. “Through training of providers and staff, we can help ensure these patients get healthcare that takes their individual histories into consideration. This need is often amplified for people with chronic illnesses who require ongoing care.”
Guiding Principles for Patient Resilience
As Dr. Levy-Carrick explains, the difference between trauma-focused care and trauma-informed care is an important one. “We are not talking about care that’s focused on the specific trauma content itself,” she says. “Rather, this is care that is mindful about recognizing how a patient’s past experiences, whether individual, interpersonal or community-based, can impact their current engagement in healthcare.”
The Substance Abuse and Mental Health Services Administration within the U.S. Department of Health and Human Services has created six guiding principles for trauma-informed care, which aim to restore feelings of safety and self-worth in patients while promoting healing. These principles are:
- Trustworthiness and transparency
- Peer support and mutual self-help
- Collaboration and mutuality
- Empowerment voice and choice
- Cultural, historical and gender issues
“As a consultation-liaison psychiatrist, I work with colleagues across the institution to make sure everyone who has contact with patients is aware of these principles and how to apply them. We see this as a clinical component of overall health equity efforts,” says Dr. Levy-Carrick, who serves as co-chair of the Mass General Brigham Trauma-Informed Care Initiative. This includes not only clinical staff, but also those who handle patient check-ins, scheduling requests and other issues.
Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN, is a nurse scientist and the other co-chair of the Trauma-Informed Care Initiative. She also founded and directs the Brigham’s Coordinated Approach to Resiliency & Empowerment (CARE) Clinic, which provides coordination of care for individuals impacted by interpersonal violence and trauma.
“What I love about the trauma-informed care model is that it addresses issues of equity and allows patients to provide input about their preferences and desires,” Dr. Lewis-O’Connor says. “Instead of having a system where you do things ‘to’ or ‘for’ the patient, trauma-informed care means doing ‘with’ the patient. It’s a very different way of delivering healthcare.”
Impact of Care Model Spans Many Departments
From 2018 to 2020, Drs. Levy-Carrick and Lewis-O’Connor were members of an interdisciplinary team that received funding through the Robert Wood Johnson Foundation Clinical Scholars Program to create, implement and evaluate a trauma-informed care model in the Brigham’s Department of Emergency Medicine. The other team members were Samara Grossman, MSW, LICSW, of the Department of Psychiatry; Eve Rittenberg, MD, of the Fish Center for Women’s Health; and Hanni M. Stoklosa, MD, MPH, of the Department of Emergency Medicine.
The emergency department is one area where this care model is so important because trust with patients must be established quickly. “Transparency is a really valuable way of doing that,” Dr. Levy-Carrick says. “Our communications with patients must be very clear. We want to empower them to share information about their history in a way that makes them comfortable.”
Dr. Levy-Carrick has also collaborated with pulmonary and critical care medicine specialists Daniela J. Lamas, MD, and Gerald Lawrence Weinhouse, MD, along with social worker Stacey Salomon, LICSW, to include a trauma-informed framework for the Critical Illness Recovery Program to improve the lives of patients with post-intensive care syndrome.
Dr. Lewis-O’Connor adds that this care model has been invaluable in supporting staff, both in terms of how workers across the Brigham relate to each other and how they have coped with trauma, stress and racism over the past two years.
“For the first time, it’s probably more uncomfortable for the people in the room if we don’t talk about these things,” she says. “There’s been a real shift. People are finding their words and finding safe spaces to talk about their past experiences.”