Samara Grossman, MSW, LICSW, social worker in the Department of Psychiatry

Members of the Partners Trauma-Informed Care Steering Committee. From left: Annie Lewis-O’Connor; Eve Rittenberg, MD; Hanni Stoklosa, MD, MPH; Samara Grossman; Nomi Levy-Carrick, MD, MPhil.

Trauma is often a key factor in health care experiences. A study by the Centers for Disease Control and Prevention and Kaiser Permanente showed that traumatic childhood experiences are a root cause of many social, emotional, physical and cognitive impairments that lead to increased incidence of health risk behaviors, violence or re-victimization, disease, disability and premature mortality. For those on the front lines of caring for patients with adverse childhood experiences (ACEs), secondary traumatization and job burnout are common.

Two new care initiatives seek to bring staff together to foster healing  – individually, professionally and socially  – through a trauma-informed lens.

Supporting Social Workers in Applying Trauma-Informed Principles

I recently launched a monthly Trauma-Informed Care (TIC) forum to support BWH social workers in gaining the confidence and skills to apply TIC both with their patients and in their practice settings. The forum focuses on how trauma affects patients, staff and the hospital community. During these conference calls, social workers can ask questions about how to apply trauma-informed principles, organize a trauma-informed team response and get support in advocating for trauma-informed practices in their settings.

A recent call focused on helping social workers navigate patient feelings toward using the pre-visit depression and suicide questionnaire. When we talked, it became clear that patients would feel more comfortable with the tool after an open discussion with their social worker as to the meaning and use of the tool by their care team.

During the same call, social workers also discussed how to recognize the connection between migraines and trauma through review of one patient case. The focus was on understanding how the effects of ACEs could help this patient and their care providers understand how the expression of physical symptoms can correlate to trauma history.

Using a Trauma-Informed Approach in Case Huddles

Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN, a senior nurse scientist, founder and director of the Coordinated Approach to Recovery and Empowerment (C.A.R.E.) Clinic and co-director of the Partners Trauma-Informed Care Steering Committee, has created innovative approaches in executing interdisciplinary and organizational implementation of TIC. For many patients affected by trauma, violence and abuse, their care team extends outside BWH, including community and state agencies dedicated to substance use treatment, behavioral health, criminal justice and law enforcement. To better support the patient and care team in improving health outcomes, the C.A.R.E. Clinic coordinates case huddles that include these agencies along with members of the clinical care team, the patient and his or her family.

Using a trauma-informed approach in these initiatives helps create a feeling of safety, empowerment, engagement and confidence for our patients and our providers. We also believe that using a trauma-informed approach can help mitigate secondary trauma that providers may experience. As noted by the Substance Abuse and Mental Health Services Administration, “Everyone has a role to play in advancing a trauma-informed approach.”