guiding principle of intervention trauma directed care

GUIDING PRINCIPLE OF INTERVENTION TRAUMA DIRECTED CARE SERIES

Trauma-informed care (TIC) is a framework that aims to prevent re-traumatization in the healthcare setting and promote resilience for both patient and clinicians. 19 – 21 There is evidence to suggest that non-clinical staff also experience STS from witnessing acute care. About 11.9–16.8% of emergency physicians screen positive for PTSD and STS symptoms at any one time, 13 – 18 and these rates may be even higher in emergency nurses with 33–64% of nursing staff screening positive for at least one symptom of STS.

5, 6 The combination of direct trauma and secondary trauma likely contributes to the high rates of post-traumatic stress disorder (PTSD) and secondary traumatic stress (STS) experienced by emergency clinicians. 4 Staff practicing in the ED also experience high rates of workplace violence (ie, direct trauma). The COVID-19 pandemic demonstrated the toll secondary trauma exposure can have on frontline healthcare workers and staff. The ED setting, by virtue of its emergency-level care, presents multiple potential sources for both direct and secondary trauma (ie, indirect exposure to traumatic events) to clinicians and non-clinical staff. 12 Similarly, hypervigilance could make the often-hectic environment of the ED, as well as interventional procedures, harder to tolerate. 12 The close interplay between executive functioning and emotional regulation may impact both the patient and the care team’s navigation of the encounter. 11 Survivors of trauma may experience emotional dysregulation (ie, trouble controlling strong emotions) or hypervigilance (ie, increased threat perception and reactivity). 10įor some survivors of trauma, the experience of the ED may be re-traumatizing or trigger past experiences.

9 These previous traumatic experiences are not equally distributed, with those self-identified as female, American Indian/Alaskan Native, and Black being more likely to experience several types of adverse childhood experience than those self-identified as male or White. 3 Patients presenting with acute trauma often are survivors of previous traumatic experiences a survey of survivors of community violence participating in a hospital-based violence intervention program found that 100% of participants reported at least one adverse childhood experience. In the United States, the yearly incidence of these events range from 1.7 million ED visits for assault-related injury 1 to 88,000 due to firearm-related injuries, 2 and over 28,000 ED visits attributed to IPV. Patients frequently present to the ED with the types of trauma defined above: individual (medical traumas/injuries) IPV and societal traumas (gun violence and community violence). Newer publications have expanded this definition to explicitly address structural trauma (eg, racism, sexism).

GUIDING PRINCIPLE OF INTERVENTION TRAUMA DIRECTED CARE SERIES

1 – 6 The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” 7 This definition of trauma encompasses experiences that range from individual (eg, car accident, death of a loved one), to interpersonal (eg, interpersonal violence, discrimination, abuse), to societal (eg, natural disasters, pandemics, terrorist attacks).

U.S.Trauma exposure is a highly prevalent experience in the emergency department (ED) for both patients and clinicians.

The training provided by CPR and NCTIC was the first step for CDC to view emergency preparedness and response through a trauma-informed lens. On-going internal organizational assessment and quality improvement, as well as engagement with community stakeholders, will help to imbed this approach which can be augmented with organizational development and practice improvement. It requires constant attention, caring awareness, sensitivity, and possibly a cultural change at an organizational level. Participants learned SAMHSA’s six principles that guide a trauma-informed approach, including:Īdopting a trauma-informed approach is not accomplished through any single particular technique or checklist. The training aimed to increase responder awareness of the impact that trauma can have in the communities where they work. The CDC’s Office of Readiness and Response (ORR), in collaboration with SAMHSA’s National Center for Trauma-Informed Care (NCTIC), developed and led a new training for CPR employees about the role of trauma-informed care during public health emergencies. 6 Guiding Principles To A Trauma-Informed Approach

Guiding principle of intervention trauma directed care