The state of the science on trauma inquiry

Abstract

Within the context of longitudinal medical care for adults, health care providers have a unique opportunity to inquire and respond to the traumatic life experiences affecting the health of their patients, as well as a responsibility to minimize retraumatizing these patients during medical encounters. While there is literature on screening women for intimate partner violence, and there is emerging data on pediatric screening for adverse life experiences, there is sparse literature on inquiry of broader trauma histories in adult medical settings. This lack of research on trauma inquiry results in an absence of guidelines for best practices, in turn making it challenging for policy makers, health care providers, and researchers to mitigate the adverse health outcomes caused by traumatic experiences and to provide equitable care to populations that experience a disproportionate burden of trauma. This state of the science summarizes current inquiry practices for patients who have experienced trauma, violence, and abuse. It places trauma inquiry within an anchoring framework of trauma-informed care principles, and emphasizes a focus on resilience. It then proposes best practices for trauma inquiry, which include tiered screening starting with broad trauma inquiry, proceeding to risk and safety assessment as indicated, and ending with connection to interventions.

The impact of lifetime interpersonal and intentional trauma on cognition and vulnerability to psychosis in bipolar disorder

“…Our findings suggest that experiencing multiple lifetime types of traumas may exacerbate the clinical course of bipolar disorder and lead to poorer outcomes. These findings also highlight the need for trauma inquiry 46 in patients with bipolar disorder, and consideration of how trauma-focused or trauma-informed treatments may be integrated into treatment planning to improve outcomes.…”

A Trauma-Informed Approach to the Medical History: Teaching Trauma-Informed Communication Skills to First-Year Medical and Dental Students

“…One limitation of the session is that the field has moved away from trauma screening and now embraces trauma inquiry. 25 One main difference between screening and inquiry is that when pursuing trauma inquiry, the goal is not a disclosure of trauma. Trauma inquiry focuses on the symptoms and impacts of trauma experiences on one's health and well-being and seeks to prevent the retraumatization that may accompany the act of recounting a traumatic experience.…”

Helping Primary Care Patients Heal Holistically via Trauma-Informed Care

“…Deciding between universal and targeted screening should be informed by the most recent evidence and resources available. 16 Under the model of targeted screening, observation of a potential sign or symptom of trauma would trigger an objective assessment of the patient's trauma history. When initiating screening, consider the distinction between trauma exposure and trauma impact; trauma exposure does not guarantee adverse health impacts.…”

“…If time constraints prohibit lengthy measures, a less structured screening approach may be more feasible. Lewis-O'Connor and colleagues 16 recommend the use of 2 key questions: "Have you had any life experience that you feel has impacted your health?" and "How do you feel this event(s) impacts you?…”