In health care settings across the nation, patients bring their experiences of trauma — either past or present — into their health care encounters. Researchers from across national health care institutions published an article demonstrating how health care providers and larger organizations can practice patient-centered, trauma-informed care. Samara Grossman, MSW, LICSW, is a clinical social worker at the Brigham and the study’s lead author. She told us more about the team’s publication in this Q&A.
What does this paper reveal about the influence of trauma-informed practices on the provider-patient relationship?
SG: We sought to show that trauma-informed care (TIC) is first and foremost about a shift in relationships. TIC tenets are critical practices that help build stronger, fuller, and deeper patient-provider relationships. In a sense, TIC is a universal precaution, for when you look at the data you see that a very high percentage of the U.S. population and the world has had adverse events happen, whether in childhood or adulthood. However, as a clinician, not every patient will inform you of their past or current adverse events. Therefore, for providers, using a trauma-informed lens is quite important. Trauma-informed care requires transparency, honest collaboration, increased trustworthiness, and a focus on empowerment. It also asks for an understanding of the influence of history, culture, gender, and, importantly, the impact of structural factors like racism on patient health, functioning and well-being.
What do you want the public to know about trauma and more specifically, re-traumatization in health care?
SG: When we talk about trauma, it involves patients and us, the providers. We are living in difficult times; it is now easier to see how trauma and re-traumatization are occurring. We can see this in the ways the COVID pandemic is wearing on, with unequal impact on communities of color, in the environmental catastrophes that are happening more frequently, and in the racial reckoning occurring in the U.S. since 2020. It is very important to acknowledge this. There is an acronym for this in TIC called the ‘4 R’s’. The 4 R’s stand for the need to realize trauma is occurring, recognize trauma as it arises, respond to this trauma, and resist re-traumatization. Trauma is now in the collective; we are all recognizing this together.
How did the interdisciplinary nature of this collaboration inform your work?
SG: One of the values of the Brigham is “We are Stronger Together.” I love this statement, as it is also a value of trauma-informed care. A cornerstone in this model is collaboration, with patients and with each other. In writing about TIC, it is crucial to diversify authorship. In our paper, we used an interdisciplinary approach to strengthen our work. At the Brigham, this included me, a licensed clinical social worker, Annie Lewis-O’Connor, a nurse practitioner and researcher, and Zara Cooper, Kessler Director for the Center for Surgery and Public Health. Other experts brought representation nationally, from the stances and disciplines of a master’s level counselor, residents in psychiatry, medicine, and surgery, as well as surgeon leaders in the field. We all brought our unique perspectives to the work.
What questions remain unanswered?
SG: A question that remains is how we can help our institutions move towards understanding and implementing TIC. I am part of a TIC initiative across the Brigham and Mass General Brigham. Our work has allowed many to see the intersectional nature of trauma and learn how to use TIC to respond. We still need to answer the question: Is the time for the implementation of TIC at the Brigham now? Are we ready?
Moving forward, how can clinicians help to build patient-centered, healthy, trauma-informed organizations?
SG: Clinicians can use a layered approach to build this kind of care, which starts by slowing down and taking more of a patient-centered — rather than problem-centered — approach in treating patients. Clinicians can advocate for trauma-informed care at the organizational level, ensuring that everyone is operating from this empowering stance. This will really change the way health care is delivered.
To read Grossman’s full paper, visit: https://tsaco.bmj.com/content/6/1/e000815