Understanding and caring for patients affected by toxic stress
Trauma-informed care recognizes and responds to the signs, symptoms, and risks of trauma to better support the health needs of patients who have experienced Adverse Childhood Experiences (ACEs) and toxic stress.
- Understanding the prevalence of trauma and adversity and their impacts on health and behavior;
- Recognizing the effects of trauma and adversity on health and behavior;
- Training leadership, providers, and staff on responding to patients with best practices in trauma-informed care;
- Integrating knowledge about trauma and adversity into policies, procedures, practices and treatment planning; and
- Avoiding re-traumatization by approaching patients who have experienced ACEs and/or other adversities with non-judgmental support.
The following key principles of trauma-informed care should serve as a guide for all health care clinicians and staff:
- Establish the physical and emotional safety of patients and staff
- Build trust between providers and patients
- Recognize the signs and symptoms of trauma exposure on physical and mental health
- Promote patient-centered, evidence-based care
- Ensure provider and patient collaboration by bringing patients into the treatment process and discussing mutually agreed upon goals for treatment
- Provide care that is sensitive to the patient’s racial, ethnic, and cultural background, and gender identity
Anticipating Emotional Responses & Avoiding Re-Traumatization
ACE screening can induce a spectrum of emotional reactions in patients. Screening requires patients to reflect on and revisit upsetting parts of their lives, which may activate distressing feelings or thoughts for patients and for providers conducting the screenings.
Some people who have experienced ACEs or other adversities may feel shame, blame, anger, sadness, and/or embarrassment. However, some patients find the experience empowering and report a positive emotional response to being able to make important connections between ACEs, toxic stress, and their current health, and to receiving appropriately focused care.
Patients with higher ACE scores with an identified screen were more likely to have strong emotional reactions, both positive and negative, according to pilot data. De-identified ACE screening was much less likely to elicit a strong emotional reaction for patients, either positive or negative.
Therefore, it is important for providers to administer screenings in a trauma-informed manner that avoids re-traumatization. There are several ways providers can avoid re-traumatization:
- Maintain emotional safety by approaching patients who have experienced ACEs and other adversities with non-judgmental support. Assess for, recognize, and integrate patient strengths and experiences into a jointly formulated treatment plan.
- In the primary care context, providers can provide supportive, compassionate responses to trauma histories of ACEs or other adversities without eliciting specific details.
- Empower patients by providing education on simple things they can do every day, at home, to recognize how stress shows up in their bodies and help regulate their stress response system and buffer the negative impacts of toxic stress. Find these strategies to regulate the stress response.
- Refer patients to mental health providers who are trained in evidence-based trauma-specific therapy, if necessary.
- Practice compassionate resilience to maintain provider well-being while caring for patients to be able to combat compassion fatigue, burnout, secondary traumatic stress, vicarious trauma, and related concerns.
- California’s Mandated Reporting Requirements and ACE Screening
- National Council for Behavioral Health – Fostering Resilience & Recovery Change Package
- American Academy of Pediatrics – Trauma Toolbox for Primary Care
- Center for Health Care Strategies – Implementing Trauma-Informed Care in Pediatric & Adult Primary Care
- Center for Health Care Strategies – Trauma-Informed Care Champions: From Treaters to Healers (Videos)