Introduction to Trauma-Informed Care PDF

INTRODUCTION TO TRAUMA-INFORMED CARE PT 700 – Fall 2024 Cameron Brown, PT, DPT, PCS 1  THERAPEUTIC ALLIANCE Patient care is a partnership between the patient and the healthcare practitioner The development of a positive therapeutic alliance...

INTRODUCTION TO TRAUMA-INFORMED CARE PT 700 – Fall 2024 Cameron Brown, PT, DPT, PCS 1  THERAPEUTIC ALLIANCE Patient care is a partnership between the patient and the healthcare practitioner The development of a positive therapeutic alliance is consistently correlated with improved patient outcomes and experiences. It is the responsibility of the clinician to meet the patients where they are— physically, emotionally, and psychologically—to empower them to reach their goals. Patients should never be asked or manipulated to serve the physical, emotional, or psychological needs of the clinician. 2 THERAPEUTIC ALLIANCE Physical therapists are likely to (knowingly or unknowingly) work with patients who have experienced trauma in their life o Abuse/neglect, medical trauma, firearm violence, adverse-childhood experiences (ACEs), and others The effects and sequelae of trauma can impact patient outcomes and reduce their feelings of safety during physical therapy Therapists must be informed on how to identify and respond to patient behaviors and attitudes that may be attributed to traumas 3 TRAUMA-INFORMED CARE Trauma-informed care (TIC) addresses survivors’ needs based on individualized risks, history of trauma, and social determinants of health. TIC recognizes the effect of a patient’s history of cumulative stress or trauma on their experience of health care in an attempt to prevent mistrust of the medical team and unmet needs. TIC encourages healthcare providers to acknowledge negative consequences of trauma, identify, and better manage posttraumatic symptoms, such as hypervigilance, heightened fear, or concern for safety. 4  ABUSE SEQUALAE Long-term sequelae that detract from feeling safe: Hypervigilance, need for control Fear and anxiety, shame, guilt, self-blame Objectification, disassociation Disempowerment, being passive Difficulty with trust Ambivalence about the body Experience of bodily pain, sleep disturbances 5 6 PRINCIPLES https://www.hhs.texas.gov/sites/default/files/documents/six-principles-trauma-informed-care.pdf 6 PRINCIPLE 1: SAFETY People are at their best and most productive when they feel emotionally and physically safe. When threatened, the stress response system is activated, causing a more reactive response instead of a thoughtful response. By prioritizing the physical and emotional safety of employees, clients, friends and family, people are empowered to be more responsive and less reactive. Types: Physical, psychological, emotional, and social safety Learn about personal triggers and how to avoid or minimize them 7 T R U S T A N D T R A N S PA R E N C Y Trustworthiness involves providing clarity and establishing rules and expectations. It also involves ensuring accessibility to information. Informed Consent! Thorough patient education must be provided. Maintain respectful and professional boundaries, prioritizing privacy and confidentiality, and building strong patient rapport. Establish a partnership – patient as active participant Give permission to say “no”, and be willing to try alternatives Do not question experiences or accuracy of memories 8 PEER SUPPORT People with shared common experiences or challenges come together as equals to give and receive help Can be informal or via support groups Builds healing relationships, providing individuals the opportunity to process and learn from their own lived experiences and the experiences of others. Develop and honor community agreements or rules to safely engage in peer support 9 C O L L A B O R AT I O N Creating an environment of “doing with” someone rather than “doing to or for” someone. Collaborative goal-setting and treatment planning Engage in advocacy on behalf of those served, when appropriate Work with colleagues/leadership to make systemic improvements to organizational cultures and processes Offer ongoing invitations and different methods to give feedback – can be given when they are ready 10 E M P O W E R M E N T, V O I C E , C H O I C E Help the patient recognize and build on individual strengths and skills. Documentation using strength-based language. Highlighting supportive cultural, community or spiritual practices and connections. Communicating a realistic sense of hope for the future. Fostering an atmosphere of validation and affirmation. 11 HUMILITY AND RESPONSIVENESS Respond respectfully and effectively to people of all backgrounds in a manner that recognizes, affirms and values their worth. Involves critical self-reflection, lifelong learning and growth, a commitment to recognizing and sharing power, and a desire to work toward institutional accountability. Actively recognize and address racial and cultural stereotypes and biases and provide culturally responsive and culturally affirming services. Ask open-ended questions Ensure that your shared environment is accessible Present information in ways to accommodate language and learning needs and preferences 12 SCOPE OF PRACTICE It is our job to correctly identify and respond to signs of distress and trauma in our patients and to foster positive outcomes with intentional action We also need to recognize when the needs of our patients are beyond our scope of practice and make appropriate referrals to other behavioral health professionals 13 REFERENCES 1. Schachter, C, Stalker, C, & Teram, E. (1999). Toward Sensitive Practice: Issues for Physical Therapists Working With Survivors of Childhood Sexual Abuse, Physical Therapy, Volume 79, Issue 3, 248–261, https://doi.org/10.1093/ptj/79.3.248 2. Johansson C, Chinworth SA. Mobility in Context, Third edition. Philadelphia, PA: F.A. Davis Company; 2022 3. Texas Health and Human Services: The Six Principles of Trauma-Informed Care https://www.hhs.texas.gov/sites/default/files/documents/six-principles-trauma-informed- care.pdf 4. Kim D Dao, Angela Spontelli Gisselman, Michael B Siegel, Eric J Hegedus, Liana C Wooten, Firearm Violence as a Public Health Crisis: A Call to Action for Physical Therapists, Physical Therapy, Volume 104, Issue 1, January 2024, pzad143, https://doi.org/10.1093/ptj/pzad143 14