Brooke Paskewich from the Philadelphia Headquarters sits down with Dr. Theodore Corbin, Medical Director of the Healing Hurt People Program in Philadelphia and Co-Director of the NNHVIP Philadelphia Headquarters to get his insight on the concept of Trauma Informed Care.
1. What is Trauma Informed Care and how is it different than standard practice?
A trauma informed approach to treatment goes beyond just treating the physical wound that can result from a traumatic event such as interpersonal violence. Instead, it recognizes that when patients come to us in the hospital, they have often been trapped for many years in a cycle of traumatic experiences and symptoms of trauma, and their entrance into the hospital offers us a critical moment to treat that trauma. Trauma Informed Care recognizes that many different forces impart certain things on patients, causing them to be interpreted as ‘bad’ or ‘sick,’ but what patients really need is our recognition that they are ‘hurt’ and need to be healed.
2. So, in this approach, when you refer to trauma, you consider it to be far greater than just suffering a physical wound?
Absolutely. Physical wounds certainly exist as the result of traumatic experiences, but we want to focus on the unaddressed, more continuous trauma behind that experience before it leads to chronic disease or full-blown Post-Traumatic Stress Disorder (PTSD). Patients coming into EDs with physical injuries have also been exposed to chronic traumas such as interpersonal violence, racism, poverty, and adverse childhood experiences including child abuse, childhood neglect, domestic violence, substance abuse, mental illness, parental discord and crime. These experiences culminate in symptoms such as chronic hyperarousal, re-experiencing the traumatic event, emotional numbing or avoiding anything that reminds you of the stressful event, memory problems, emotional dysregulation, guilt, and maladaptive coping. To treat just a physical injury would overlook all of these other important issues.
3. What are the key components for Trauma Informed Care?
There are four tenets of Trauma Informed Care (TIC). The first is SAFETY, which speaks to the importance of helping patients to recognize how they view safety, create a safety plan to reduce threats, and think through how they can become safer physically, psychologically, socially, and morally. Trauma Informed Care also involves EMOTIONAL MANAGEMENT, in which providers help patients become less reactive, develop trust, think more clearly, and develop adaptive coping strategies. TIC also recognizes that many patients have suffered an enormous amount of LOSS throughout their lives which must be addressed. Finally, Trauma Informed Care involves looking to the FUTURE, to help patients envision what they want for their future so they may rise above the status quo. TIC providers support patients as they name, define and move toward achieving their goals.
4. Is research being done to determine the effectiveness of Trauma Informed Care?
Research and practice in the area of Trauma Informed Care is definitely warranted, as studies show that 77% of patients who suffer physical injuries resulting from interpersonal violence have full-blown PTSD and 50% of that same population has had adverse childhood experiences. This is clearly a major public health concern. To that effect, research is currently ongoing at Drexel University through the Healing Hurt People Program of the Center for Nonviolence and Social Justice. As part of the study, patients receive the tenets of Trauma Informed Care, including case management and weekly treatment groups, with measurements done at baseline and over the course of treatment. Researchers will examine the effects of TIC on symptoms of PTSD, depression, exposure to community violence, and personal mastery (perceptions of how good you are at something).
5. How could someone learn more about Trauma Informed Care?
There is a toolkit and 4 online webinars on trauma and TIC available through the National Network to Eliminate Disparities (NNED) in Behavioral Health. They can be accessed here. Aside from getting familiar with the literature on trauma, it’s important to get hands on experience with TIC to learn what to do and how to do it, for example, by visiting programs such as the Healing Hurt People Program of the Center for Nonviolence and Social Justice at Drexel University.
6. What else would you like to tell us about Trauma Informed Care and what it means to you?
First, I want to recognize that many people, such as social workers, case managers, and community intervention specialists, practice Trauma Informed Care but often times they don’t have a name for what they do. By infusing TIC into hospital-based violence intervention programs, this gives the approach a name, a common language, and a better understanding of how to practice it. Second, people may think of this approach as community service, but it’s important to recognize that this is hard work! It’s also an evidence-based practice. Finally, TIC is particularly relevant for young men and boys of color, a population that is often marginalized and disproportionately affected by interpersonal violence.
