Trauma Informed Care Principles

June 25, 2018

Current events are bringing awareness to trauma and its lasting effects on the mind and body.  But few are talking about the implications this has for trauma survivors in seeking care and the lack of trauma informed care in medicine.

Trauma Informed Care: when every part of a service is assessed and potentially modified to include an understanding of the emotional issues, expectations, and special needs that a trauma survivor may have in a healthcare setting.[1],[2]

Trauma informed care needs to be a central aspect of these discussions as trauma lasts a lifetime but few health care providers are well trained in the trauma-informed care approaches. This means that many with a history of trauma – which can include medical trauma, domestic violence, childhood abuse, sexual assault, and more – can face retraumitization when seeking care. Unfortunately, this population often needs more care as trauma brings chronic physical and psychological illnesses or to address injuries caused by trauma (even long after the traumatic incident).

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Trauma Informed Care During COVID-19

April 16, 2020

Trauma Informed Care (TIC) is the idea that care should be sensitive to patients’ trauma (disclosed or undisclosed) and should ensure treatment is careful, kind, and compassionate. Given the high prevalence of trauma and the potential for retraumatization in health care, implementing TIC should be a competency of every health care system, including its extensions into the community. As COVID-19 spreads across the world, health care is mobilizing personnel, equipment, information, and policies to care for the victims of this pandemic. This article puts forward that these preparations must also include and achieve TIC.

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Validation

September 14, 2019

I’ve shared information on validation in other posts but decided to make an infographic to make the information more accessible. Along with holding space, reaching in, and allowing folks to express themselves, validation can be a powerful way to help others and show you care.

I’ve but this in a pdf form in case you’d like to print it out to share: Validation Infographic


On Self-Expression, Holding Space, and Reaching In

February 20, 2019

I wrote a thread the other day on Twitter addressing the issue of people not being able to hold back with their “helpful” comments and how holding space is often what folks who are going through difficult times need. It seemed to strike a chord with many, so I’m reposting it below (with additions).

Before I repost, I will say that offering unsolicited advice is a common problem people in patient and disability communities face. People who think that they are being helpful by telling you what worked for them. Or people who want to interject with problem solving. Or people who want to turn the discussion to fit their needs – their need to be seen as knowledgeable/right, their need to be seen as helpful, their need to have their experiences and emotions validated first. This is not okay.

I think many disabled people are becoming more assertive in saying unsolicited advice is not helpful and it crosses boundaries. But when we do, we are met with backlash of those who are “helping” as not being grateful enough or as complaining too much.  Essentially, “well why are you saying anything if you don’t want to fix it?” or the versions of those “helpful” people  saying that hearing someone relay their experiences is “too much” for them. This dynamic needs to change. People need to respect boundaries of those expressing themselves, validate those experiences, hold space, and reach in with humility.

Thread:

Dear Twitter users, It is perfectly ok for you to read someone’s expressions of frustration, obstacles faced, upset, or other emotions without jumping in with “solutions.” It is healing and healthy for people to express themselves as they process their realities.

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Post-Hospital Syndrome is Real

February 17, 2019

Post-Hospital Syndrome (PHS) is a period of time after discharge from the hospital where patients enhanced vulnerability to disease as well as an elevated risk for adverse events, including hospital readmission, generalized dysfunction with new cognitive impairment, mobility disability, or functional decline, and even death.[1],[2]

In 2013, I came across a perspective article by Dr. Harlan Krumholz in the New England Journal of Medicine entitled: Post-Hospital Syndrome – An Acquired, Transient Condition of Generalized Risk.[3] It was the first time over years of hospitalizations that I felt that someone had finally hit on part of the hospital experience no one talked about – going home. It finally put a name to something I’ve experienced but could never put a name to – something I wanted to explain to my doctors (both inpatient and out) to help improve my care.

I wanted them to understand that while hospital stays are coded as “events” – as singular points in time with a beginning and end, distinguished “episodes” unique from ongoing care, they aren’t singular events for any patient. Our story starts long before and continues long after. And that part in between, the hospital stay itself, has long lasting effects. Post-Hospital Syndrome is one of those effects.

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Possible Changes to HIPAA – What’s this RFI All About (A Summary)

January 14, 2019

Over the past month, I’ve been tweeting and blogging about possible HIPAA changes that may be in store after the OCR (Office for Civil Rights – HIPAA enforcers) published a Request for Information (RFI). With the deadline for comments about a month away (February 12, 2019), I thought I’d distill the information into a bit of a summary – a sort of tl;dr version of my last 5 posts.

I’d encourage anyone interested in your healthcare privacy rights to read over the information here. I’ve suggested questions at the end of each section for you to consider and will follow up in my next post with how you can submit comments on the RFI.

What is this RFI?

This is NOT a chance to comment on everything we don’t like about HIPAA. While we all know there are many places where HIPAA can be improved, this RFI is about 5 specific areas of HIPAA. The OCR has proposed very specific questions in each area for people to answer and those are what they want feedback on (those questions can be found here).

The 5 areas include:

  • Sharing information between doctors
  • Sharing substance use and mental health information with friends and family
  • Accounting of Disclosures
  • Notice of Privacy Practices
  • HIPAA “burdens” that prevent policy goals around Value-Based Care

There’s a lot here and you certainly don’t have to address every part of the RFI. You can pick and choose what is most important to you.

The rules they are interested in are primarily part of the HIPAA Privacy Rule found at 45 CFR 164, Subpart E (for the nerds who would like to catch up on the current language). In each of my previous posts I’ve taken these areas one by one and answered the questions in detail. I’ve given background on why they matter, examples of how they work now, and concerns as to why and how potential changes will harm patients.

To be clear: Changes suggested in each part will hurt patients.

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Trauma Informed Care – Non-Clinical Staff Encounters

September 12, 2018

Trauma Informed Care: when every part of a service is assessed and potentially modified to include an understanding of the emotional issues, expectations, and special needs that a trauma survivor may have in a healthcare setting.[1][2]

Below is a discussion about trauma informed care practices for non-clinical staff, an important and often overlooked area of trauma informed care.  This is the 4th in a series of posts I’ve written on Trauma Informed Care. Before reading, you may want to go back and look at the others in the series:

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Trauma Informed Care – Disclosures and Care Transitions

August 23, 2018

Trauma Informed Care: when every part of a service is assessed and potentially modified to include an understanding of the emotional issues, expectations, and special needs that a trauma survivor may have in a healthcare setting.[1][2]

Trauma informed care should be a foundation of all healthcare interactions. Disclosure is the first step in helping health care providers practice trauma informed care. Understanding the importance of disclosure, what inhibits or facilitates disclosure, when and how to ask about disclosure, and how to respond can help develop a strong and trusting doctor-patient relationship. Knowing how to help patients transfer care to new providers can continue strengthening these relationships and promote healing for the survivor.

Before reading this post, I suggest going back and reading earlier posts on this subject:

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Common HIPAA Issues – Health Records Edition

August 7, 2018

Every year, I endeavor to get medical records from my healthcare providers and every year I run into several issues in getting those records. As a result, I am forever fighting the same battles with staff ultimately wasting their time and mine, ruining relationships with staff, and unfortunately involving the Office for Civil Rights (OCR; aka the folks that enforce HIPAA). I thought I’d share a few common issues I see arise again and again to educate patients on their rights and to educate providers on the provisions where they often have compliance issues.

HIPAA – the Health Information Portability and Accountability Act – is the law that requires healthcare providers to keep your personal health information private and secure. It also gives patients many rights to their records. The law should be empowering and helpful to patients but because it is often misinterpreted or provisions are not known to staff, the law too often puts barriers in the way of patients getting their records.

Below I present common HIPAA issues including:

And then I go over filing complaints, why these issues happen, and why this all sucks.

I hope this will be helpful to patients and providers everywhere (just remember that none of this is legal advice).

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Trauma Informed Care in Practice

June 25, 2018

Trauma Informed Care: when every part of a service is assessed and potentially modified to include an understanding of the emotional issues, expectations, and special needs that a trauma survivor may have in a healthcare setting.[1],[2]

Trauma survivors have unique healthcare needs. For various reasons – including time pressures, lack of awareness of these needs, lack of education about trauma informed care techniques, and stigma that labels survivors as “difficult” – these needs are often not met in the current healthcare system. While I’ve discussed previously the implications of trauma-informed care, many providers may not know what to do to help survivors. Below are some practical trauma informed suggestions offered by experts that can be taken to help survivors in medical encounters.

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