PHC has had intensive care management programs in many of our FQHCs since 2012. These care management programs will be evolving into our health homes programs in 2017. Health Homes is an evolution of the patient centered medical home with an increased focus on substance abuse, integration of mental and behavioral health with medical care and a more intense effort to work with homeless members.
One of the new components in patient assessments will be a look at how trauma has affected the lives of our patients. How serious is this problem? Here are a few statistics:
- Over half of women (55 to 99%) in substance abuse treatment report trauma
- Nearly all women in the public mental health system (85 to 95%) have had trauma
- Nearly all homeless veterans suffer PTSD
- Trauma exposed youth have arrest rates 8 times that of same age peers
- The economic costs of untreated trauma-related alcohol and drug abuse are estimated to have been $161 billion in 2000.
The Substance Abuse and Mental Health Services Administration (SAMHSA) concept of the trauma informed approach defines a trauma informed system of care:
- Realize the widespread impact of trauma and understand paths to recovery
- Recognize the signs and symptoms of trauma
- Respond by integrating policies and procedures in your practices
- Resist re-traumatizing patients
The goal is recognizing the effects of trauma on our patients is to provide an emotionally and physically safe environment for our patients.
How can you know if trauma is playing in a role in your patient’s behavior or choices? You might start by asking about his or her childhood or how things are going at home. Once you get a feel for whether trauma has affected your patient you may be able to be more direct in your questioning. The Life Events Checklist has 17 specific traumatic events, but you can consider a shorter list that we will be implementing into our PHC health risk assessments.
Have you been involved in or exposed to:
- A natural disaster such as a flood, fire or earthquake?
- Combat or a warzone?
- Physical or emotional abuse?
- Sexual abuse or assault?
- Sudden violent death or unexpected death in someone close to you?
- Any serious harm, injury or death caused by you?
Trauma is treatable. There are many evidence-based models and practices to help heal our patients and improve the behavioral manifestations of trauma. A history of trauma is often hidden or denied and we don’t often ask about trauma in our patients with problematic behaviors.
How will this play out in your practices? The next time someone acts out in your practice, consider asking “Can you tell me what happened to you?” instead of “What’s wrong with you?” You may be surprised at the answer.