Five steps to a trauma-informed practice
A 2012 Huffington Post article described the Adverse Childhood Experience (ACE) studies conducted by Vince Felitti and Rob Anda as “the most important public health study that you have never heard of.”1
In brief, Felitti and Anda surveyed over 17,000 adults insured by Kaiser Permanente about adult health and ACEs (including childhood emotional, physical, or sexual abuse and neglect; violence against one’s mother; parental separation or divorce; and living with household members who were substance users, mentally ill, or suicidal, or who had been imprisoned). The studies documented that ACEs were prevalent in this largely Caucasian, educated sample, with approximately two-thirds of adults having at least 1 ACE and one-third having 2 or more. In addition, the more adversities experienced, the greater the risk for poor adult health.2
In the 3 years since the Huffington Post article, knowledge of the ACE studies has increased substantially, and the recognition of the impact of childhood adversity on adult health has become more commonplace among primary care providers. However, important questions remain about how best to change primary care to effectively address the needs of patients (and families) with histories of traumatic events.
What is “trauma-informed care”?
Indeed, “trauma-informed care” has become a buzzword for providers, policymakers, and researchers. The Substance Abuse and Mental Health Services Administration (SAMHSA) has a National Center for Trauma Informed Care, which delineates the following 6 key principles of trauma-informed care3:
2. Trustworthiness and transparency;
3. Peer support;
4. Collaboration and mutuality;
5. Empowerment, voice, and choice; and
6. Cultural, historical, and gender issues.”