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Embedding trauma informed care into your practice: Tips for providers

In the U.S., 34 million children have experienced an “adverse childhood event,” or ACE – a stressful or traumatic event that is strongly related to a wide range of health problems. Prolonged, pathological stress disrupts healthy brain development and creates significant lifelong implications for learning, behavior, health and adult functioning.

By understanding the widespread impact of trauma, as well as the potential paths for recovery, practitioners are empowered to respond by fully integrating knowledge about trauma into their practice. This is known as “trauma-informed care.”

Trauma-informed care understands the impact of trauma and the potential paths for recovery, and aims to respond by adapting certain practices. By viewing patients through a “trauma lens,” practitioners better understand that traumatic experiences may be contributing to somatic symptoms or challenging behaviors.

CHOC has worked diligently to embed trauma-informed care into the treatment and interaction with patients and families across locations and specialties, says Dr. Dani Milliken, director of the Cherese Mari Laulhere Mental Health Inpatient Center at CHOC.

Dr. Dani Milliken, director of the Cherese Mari Laulhere Mental Health Inpatient Center at CHOC

Here, Dr. Milliken offers three simple things providers can do routinely to begin to integrate trauma-informed care into their practice:

1. Ask “What happened to the patient?” instead of “what’s wrong with the patient?”

Changing your mindset while evaluating patients is one of the most effective ways providers can implement trauma-informed care. A shift from the typical thought process during patient evaluation to a trauma-informed thought process includes:

  • “The patient is sick, ill or bad” becomes “the patient is hurt and suffering.”
  • “Patient behaviors are immoral and need to be punished” becomes “patient behaviors are survival skills developed to live through the trauma, but are maladaptive in everyday society.”
  • “Patients can change and stop immoral destructive behavior if they only had the motivation” becomes “patients need support, trust and safety to decrease maladaptive behaviors.”
  • “We need to manage or eliminate patient behaviors” becomes “we need to provide opportunities for patients to heal from their trauma.”
  • “System of care should be created to minimize short term costs and contain immoral behaviors” becomes “system of care invests in healing trauma, saving money over the long term.”
  • “The patient is manipulative” becomes “The patient is trying to get their needs met”

2. Adjust what you say

There are certain words that can be avoided when describing patients and their behavior, such as “refused,” “resisted,” “non-compliant,” “unmotivated” and “low functioning.” By shifting away from words and phrasing that portray a patient as having difficult or non-ideal characteristics, providers can promote recovery.

Words and phrases that encourage this recovery include:

  • Declined
  • Chose not to
  • Experiencing
  • Has a history of
  • Has difficulty with

3. Adjust what you do

The way providers interact with patients matters, and a few key changes can support children who have experienced adverse childhood effects:

  • Ask before touching
  • Introduce yourself each time you enter the room
  • Explain procedures prior to performing
  • Offer choices as often as possible
  • Create a therapeutic relationship
  • Alter the environment

Learn more about the Cherese Mari Laulhere Mental Health Inpatient Center at CHOC.