Addressing Intimate Partner Violence Within the Healthcare System

The “3 Es” of trauma‐informed care in a federally qualified health center: TraumaticEvent‐ andExperience‐related predictors of physical and mental healthEffectsamong female patients

“…Notably, approximately 36% of the sample reported an IPV history, whereas 30% reported experiences of sexual harassment and 17% reported experiences of sexual assault during adulthood. As women's healthcare often involves intimate and invasive procedures (e.g., breast or pelvic examinations), failure to consider the rate of interpersonal trauma exposure among female patients may lead to retraumatization and subsequent healthcare disengagement (Langhinrichsen-Rohling et al, 2021;Richie et al, 2020). Future research should examine the relations among patients' interpersonal trauma histories, the nature of their relationships with individual providers and the greater healthcare system, and their healthcare avoidance behaviors.…”

“…Various sources have put forth recommendations for healthcare providers regarding when and how to screen primary care patients for trauma exposure as well as ways to appropriately adjust practice based on the patient's sensitivities, needs, and expectations (Langhinrichsen-Rohling et al, 2021;Menschner & Maul, 2016;. While the debate about best trauma screening practices is ongoing, experts generally agree on the following: to best resist retraumatization, (a) treatment setting should help guide screening practice, (b) trauma screening should be beneficial to the patient, (c) appropriate follow-up resources (i.e., mental/behavioral health resources within the clinic, community referrals) should be available, (d) healthcare providers should be adequately trained in trauma screening and able to have culturally sensitive follow-up discussions, and (e) attempts should be made to minimize screening frequency.…”

“…Without trauma screening, it is likely that PCPs remain unaware of a patient's trauma history and fail to incorporate aforementioned Event-and Experience-related factors into treatment plans as key therapeutic targets, despite their documented influence on outcomes. From the patient's perspective, health providers' failure to screen for trauma exposure may contribute to increased hopelessness, feelings of institutional betrayal, and future healthcare avoidance (Langhinrichsen-Rohling et al, 2021). Ultimately, current gaps in the literature preclude the development and implementation of a comprehensive trauma-informed approach to patient care that is tailored to the specific intersectional identities and needs of FQHC patients.…”

“…Because patients with and without trauma histories cannot be immediately differentiated from one another and in light of the fact that medical settings have the potential for triggering trauma reactions, treating all patients as trauma survivors is considered best practice (i.e., universal precaution; Elliott et al, 2005). Accordingly, healthcare providers and organizations are being increasingly encouraged to incorporate a trauma-informed approach to patient care into existing patient-centered medical home (PCMH) models to reduce the risk of retraumatization and improve patient health outcomes (Ashby et al, 2019;Langhinrichsen-Rohling et al, 2021;Lewis-O'Connor et al, 2019;Machtinger et al, 2015).…”