Opinion: All Doctors Should Practice Trauma-Informed Care

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“Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today,” Dr. Robert Block, former president of the American Academy of Pediatrics, has been widely quoted as saying.

According to the Adverse Childhood Experiences Study, conducted in the 1990’s by the Centers for Disease Control & Prevention and Kaiser Permanente, adverse childhood experiences are common, and the resulting health and behavioral health issues span a lifetime.

What are adverse childhood experiences, commonly referred to as ACEs? The study identified three types: abuse, neglect and household dysfunction. Since the study, the list of ACEs has been expanded to include living in unsafe neighborhoods, food insecurity, homelessness, bullying, income insecurity, discrimination and racism.

A report released earlier this month by the Centers for Disease Control found that at least 60 percent of the population in America had at least one ACE, while 16 percent had four or more different types of traumatic experiences. 

Finally, children of different ethnicities do not experience ACEs equally. About 61 percent of African American children, 51 percent of Latino children, 40 percent of white children and 23 percent of Asian children had experienced at least one childhood traumatic experience, according to the report.

The physical and mental health toll of these traumatic experience is staggering. People who experienced trauma are 15 times more likely to commit suicide, four times more likely to become an alcoholic or inject drugs, and two and a half times more likely to smoke tobacco.  In addition to the harm caused by these high-risk behaviors, ACEs are highly correlated with health issues including depression, heart disease, cancer, autoimmune disorders, chronic lung disease, liver disease and shortened life span.

According to The National Council for Behavioral Health, trauma-informed care is “the expectation, not the exception in behavioral health systems.” Yet most American physicians are unaware of this data and do not use ACE surveys to assess their patients.

Even for those clinicians who are aware, there are a multitude of reasons why issues are not routinely addressed in primary care settings. These include lack of time, tools, training, misconceptions, discomfort, lack of administrative support or the fear that they “just don’t want to open Pandora’s box.”

What medical professionals do not realize is that their medical setting is full of potential “triggers” for people with traumatic experiences. Invasive procedures, the removal of clothing, physical touch, the power dynamics of the relationship, the gender of the healthcare provider, vulnerable physical positions, and lack of privacy may be distressing for patients, and keep them from seeking medical services.

We need to make trauma-informed care a universal precaution, just as we do with infectious diseases. Thus, it should be standard practice for medical professionals to screen and assess for trauma in a safe environment. It is critical that primary and behavioral health systems have communication channels to inform each other about a person’s trauma and its effect on their mental health and physical wellbeing.

In order to achieve this outcome, we are proposing state legislation to mandate trauma-informed care education in all California medical, dental and nursing programs. In addition, we propose that all major medical groups undergo similar training of their administrators, staff and clinicians.

It is time that the major hospitals in our communities take a multidisciplinary approach to improve health care, locally in Sacramento and throughout our state.

California has led the way with many great initiatives, and health care should be no exception. We call upon all elected officials and their staff to be trauma informed in order to raise awareness of the pervasive effects this has throughout our communities, especially in the crisis areas of homelessness and poverty.

Bob Erlenbusch is the executive director of the Sacramento Regional Coalition to End Homelessness. Dr. Drew Factor is an internal medicine physician at Sutter Medical Group in Sacramento.

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