Trauma Informed Care Interview on KER Cast

I had the pleasure of joining Victor Montori to talk about trauma informed care (TIC) for the Mayo Clinic’s Knowledge and Evaluation Research (KER) Unit’s KERCast series. You can find the discussion below as well as on the KER Unit youtube channel and on any podcast platform by searching for the KER Unit. You can learn more about KER and find links to other a wealth of other interviews on everything from shared decision making to reducing the burden of research to particpatns to artificial intelligence here.

In this interview we cover everything from how I came to writing and teaching about TIC to why love is an important part of providing trauma informed care. We discuss concepts of gentle curiosity and universal precautions that can help transform health care into a healing space. 

Of course this was only a jumping off point and will hopefully will bring others to want to learn more about TIC. For further reading, the following series gives a comprehensive overview of TIC:

• Trauma Informed Care Principles
• Trauma Informed Care in Practice
• Trauma Informed Care – Disclosures and Care Transitions
• Trauma Informed Care – Non-Clinical Staff Encounters
• Trauma Informed Care During COVID-19
• Betrayal Trauma in Health Care

I also quote Dr. Montori’s book Why We Revolt during the interview and highly recommend you give it a read as many of the concepts overlap with trauma informed care. 

A transcript for the video can be found here.

Betrayal Trauma

I think a lot about betrayal trauma lately. Specifically betrayal trauma in health care. When most people come upon this term, their reaction is usually an astonished, “There’s a name for that?” because many patients understand this type of trauma but never had the words with which to convey the painful occurance. In fact, it seems all too common in health care, a place where we’re supposed to find help and healing. But because patients have not had a common language to talk about betrayal trauma, we haven’t had all the tools we need to address it. Only through exploring this concept can we start to process the harm caused by betrayal trauma and begin to change health care to address its harmful effects.

What is Betrayal Trauma?

“Betrayal trauma occurs when the people or institutions on which a person depends for survival significantly violate that person’ s trust or well-being” (Freyd. 2008).

Trauma Informed Care During COVID-19

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.

My Care Concerns Document

A few years back, I started working on my appointment primers – documents to bring to each appointment that give my history, symptoms, and a little bit about me. I posted a template of these primers here for others who might be interested in making their own.

As part of the primer, I took time to outline My Care Concerns – using bullet points to hit the highlights of what is most important to me, in fact, the issues I most often face when seeking care. I put these care concerns on every primer that I give to every new provider. Then a year ago, when I was facing surgery for my c-spine, I wanted to transmit this information in a more universal way and with a view toward Trauma Informed Care. And so I developed the document below.

Post-Hospital Syndrome is Real

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.

Trauma and Psych Wards

[CN: Suicide, Psych Wards, Self Harm]

Tomorrow will be the 16th anniversary of my first stay in a psych ward. I was placed on a 72-hour hold after a suicide attempt. The second semester of my second year in college and while I’d attempted and had suicidal ideation before, this was my first time actually admitted. I’ve been in 6 psych wards total and I’ve written a bit about my experiences in the past.

Today, though, I want to write about how psych wards create trauma and what truly terrible places they are when you are really struggling.

Marsha Linehan, who created Dialectic Behavioral Therapy (DBT), said it best when she said:

“You know there isn’t a single shred of evidence that any hospitalizations ever kept anybody alive five extra minutes.”[1]

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

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.

The Doctor and Nurse Who “Got It”

Content Warning: Self Harm, Suicide

Note: The story that follows is very personal and quite difficult. Please proceed with caution and compassion.

_______________________________________________________________________________________

This is the story about a doctor and nurse I once had and how they “got it.”

Trauma Informed Care – Non-Clinical Staff Encounters

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:

• Trauma Informed Care Principles
• Trauma Informed Care in Practice
• Trauma Informed Care – Disclosures and Care Transitions
• Trauma Informed Care During COVID-19

Trauma Informed Care – Disclosures and Care Transitions

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:

• Trauma Informed Care Principles
• Trauma Informed Care in Practice