Improving Communication Between Trauma Patients and Primary Care Providers

Green, Bonnie; Saunders, Pamela; Dass-Brailsford, Priscilla; Schelbert, Kavitha Bhat; Giller, Esther; Wissow, Larry; Mendoza, Alejandra Hurtado de

doi:10.1037/e533652013-356

Cited by 6 publications

(7 citation statements)

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“…One is to train PCPs about trauma and its effects on mental health; the range of ways in which individuals with trauma backgrounds, disturbed attachment, and mental disorders may present and perceive PCPs; along with practical suggestions for how better to support and engage these individuals in collaboration. Based in part on the present study and the one mentioned above with PCPs, our research group recently adapted a training for mental health professionals working with trauma patients to be appropriate for PCPs, who see patients for a much shorter time (Green et al, 2010). This training engages the PCP in taking the perspective of the patient, appreciating the myriad effects of having a serious trauma history, and thinking of new approaches to difficult patients based on this knowledge, with specific examples and suggestions.…”

Section: Discussionmentioning

confidence: 99%

“…This training engages the PCP in taking the perspective of the patient, appreciating the myriad effects of having a serious trauma history, and thinking of new approaches to difficult patients based on this knowledge, with specific examples and suggestions. To date this approach appears promising based on ratings of trained PCPs’ interactions with standardized patients and on feedback from their actual patients (Green et al, 2010). Screening for trauma exposure and symptoms of mental disorders may give PCPs a “heads up” to potential concerns and mental health symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Attachment and Health Care Relationships in Low-Income Women with Trauma Histories: A Qualitative Study

Green

Kaltman

Chung

et al. 2012

Journal of Trauma & Dissociation

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Few studies have examined the relationship between low-income, traumatized women and their health care providers. In this study we interviewed 23 women from primary care and social service settings for the underserved about trauma, attachment, psychiatric symptoms, and reports of their interactions with primary care providers. Nearly all reported trauma exposure, and 17% had current posttraumatic stress disorder. About half were categorized as Unresolved with regard to attachment state of mind. Analyses of a health experiences interview showed that women with Unresolved attachment reported significantly more negative interactions with providers. Attachment may play a role in the relationship between trauma and health care interactions with providers, indicating the need for further study of this relationship and suggesting intervention strategies to help both parties contribute to a more collaborative process.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Attachment and Health Care Relationships in Low-Income Women with Trauma Histories: A Qualitative Study

Green

Kaltman

Chung

et al. 2012

Journal of Trauma & Dissociation

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“…Unfortunately, many primary care providers are uncertain how to screen for suicide (Grimholt et al, 2014;Palmieri et al, 2008), screening in primary care settings remains infrequent and imperfect (Bostwick & Rackley, 2012), and certain demographic groups (e.g., men and individuals of color, as found in the current study) are more likely to deny suicidality when asked about it in primary care settings, even if they are actively suicidal or die by suicide soon after the assessment (Cukrowicz et al, 2013;Denneson et al, 2010). Similarly, despite the high prevalence of trauma exposure in the current sample, primary care clinicians frequently report a lack of confidence in their ability to work with patients in a traumainformed manner (Green et al, 2015). Trauma exposure can predispose patients to mistrust authority and power, which can disrupt the patient-provider relationship (Green et al, 2012) and make trauma-informed care especially important for patient outcomes.…”

Section: Discussionmentioning

confidence: 56%

Models of Trauma Exposure, Depression, and Suicidality in Safety‐Net Primary Care

Mladen

Williams

Griffin

et al. 2021

Journal of Traumatic Stress

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Suicidality is a major public health concern, particularly for low‐income, trauma‐exposed patients with limited access to mental health providers. However, limited research has modeled pathways of suicidality in safety‐net primary care samples. Patients (N = 207) in a safety‐net primary care clinic completed measures of childhood and adult trauma exposure, depression, and suicidality. Participants (M age = 44.8 years, SD = 11.6), were 60.4% male, 63.8% Black/African American, and predominantly low‐income (i.e., 69.1% reported an annual income less than $5,000 USD). Half of the sample reported at least four childhood traumatic events (M = 3.9 events, SD = 3.0) and approximately three adult traumatic events (M = 3.0 events, SD = 2.1). Most participants (82.1%) reported significant depressive symptoms, and 43.5% endorsed recent suicidality. Models showing the mediational effect of depression on the association between trauma exposure and suicidality, β = .20, B = 0.23, SE = 0.05, 95% CI [0.16, 0.32], and the moderational effect of trauma exposure on the association between depression and suicidality, β = .16, B = 0.20, SE = 0.08, p = .007, were both supported. These results underscore the high prevalence of trauma exposure, depression, and suicidality in a safety‐net primary care sample. They also highlight the pervasiveness and complexity of suicidality in low‐income primary care patients, emphasize the importance of trauma‐informed suicide assessment, and identify trauma sequelae and depression as potential treatment targets to reduce suicidality.

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“…Training both students and practitioners of chiropractic will help increase the profession's competency and reduce the likelihood of negative incidence related to implementation of trauma screening and subsequent care, and is being implemented in other healthcare professions [65,123,124,[124][125][126][127][128][129][130][131]. Outcomes of such training have also begun to be measured, adding credibility to TIC and the addition of ACE awareness in regular practice [46,62,64,125,128].…”

Section: Recognize Signs Of Trauma and Triggered Personsmentioning

confidence: 99%

Adverse childhood experiences and trauma informed care for chiropractors: a call to awareness and action

Baca,

Salsbury

2023

Chiropr Man Therap

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Background Trauma is an emotional response to distressing events where coping and subsequent recovery are absent. Adverse Childhood Experiences (ACEs) are traumas, occurring before the age of 18 years, such as child abuse or neglect, caregiver instability, and household dysfunction. Sixty-four percent of the U.S. population report experiencing at least one ACE, with over 1 billion children experiencing abuse and neglect annually worldwide. Chronic exposure to stressful circumstances or multiple traumatic events has negative physiologic impacts. Persons who experience 3 or more ACEs in childhood are at greater risk of poor mental health outcomes and may be more likely to engage in high-risk behaviors, predisposing them to long-term health impacts, such as metabolic diseases, anxiety, depression, substance use, and chronic pain. Trauma informed care (TIC) is a recommended approach to healthcare delivery across professions, especially when a trauma history is suspected. This commentary aims to increase awareness of the impact of ACEs on health outcomes and introduce TIC concepts as they may apply to chiropractic care for adults with a history of ACEs. Discussion This commentary reviews an introductory model (4R's: realize, recognize, respond, resist re-traumatization) as one TIC framework used by healthcare practitioners. Prior trauma can lessen trust, alter perceptions of physical touch, and hands-on examinations and chiropractic treatments may trigger stress responses. Using TIC after appropriate training, includes referrals to multidisciplinary providers to address trauma-related concerns outside the scope of chiropractic, and screening for ACEs if deemed appropriate. Creating safe spaces, communicating clearly, avoiding victimizing language, explaining procedures, asking for consent before physical contact, and giving patients choice and control in their own care may avoid triggering prior traumas. Conclusion Given the high worldwide prevalence of persons experiencing 3 or more ACEs, TIC principles are practical adaptations to chiropractic care for use with many patient populations. As TIC and ACEs are emerging concepts within chiropractic, students and practitioners are encouraged to undertake additional training to better understand these complex and sensitive topics. Exploratory research on the incidence, presentation, and impacts of various trauma types, including ACEs, to support adoption of TIC in chiropractic settings is essential.

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Improving Communication Between Trauma Patients and Primary Care Providers

Cited by 6 publications

References 0 publications

Attachment and Health Care Relationships in Low-Income Women with Trauma Histories: A Qualitative Study

Attachment and Health Care Relationships in Low-Income Women with Trauma Histories: A Qualitative Study

Models of Trauma Exposure, Depression, and Suicidality in Safety‐Net Primary Care

Adverse childhood experiences and trauma informed care for chiropractors: a call to awareness and action

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