“What we know is that trauma, and its associated long-term medical consequences, is a severe public health crisis.”
These words from host Jermine Alberty kicked off Alive & Well Communities’ (A&WC) recent webinar on the importance of centering trauma-informed care in health equity, and vice versa. While the medical community grows more accustomed to the concepts and conversations surrounding trauma-informed care models, social determinants of health, and the impacts of systems of oppression on intersectional identities, synthesizing these three juggernauts of abstract knowledge into a cohesive understanding of why it matters in day-to-day care is a difficult task necessary for the well-being of both patient and provider.
Christin Simpson, director of health care activation at A&WC, spoke more on the meaning of equity-centered trauma-informed care (EC-TIC). “This is basically a new practice of care delivery that addresses the consequences of trauma,” Simpson said. “By understanding how trauma affects someone across the lifespan, finding multiple pathways to recovery, and then us understanding, when we know that trauma exists and impacts people in such a way, we can then start to practice how not to re-traumatize people when they come into our space.”
The EC-TIC model includes the standard of acknowledging and accounting for the impact of health outcomes and access to care which are reduced or impeded because of individual or community characteristics. “For so long, the way that we delivered health care was that, hey, we’ll treat everybody the same — when, really, we need to have individualized interactions,” Simpson said. “Everybody’s needs aren’t equal. When you think about equality versus equity, that’s the point that we’re getting to. We’ll meet the people at their need.”
Part of that distinction involves understanding that many of the health risks and behaviors that certain demographics, especially racial demographics, may be predisposed to are not the result of individual failures or choices, but social determinants of health and systemic discrimination. Patricia Davis, program manager of trauma-informed care at Children’s Mercy Kansas City, shared research from the Institute of Medicine: “The vast majority of published research indicates that minorities are less likely than whites to receive needed services, including clinically-necessary procedures, even after correcting for access-related factors such as insurance status.”
Despite this research being more than 20 years old, its findings remain true today. “You may be a wonderful person and a God-fearing person, whatever you believe helps you to be the best person possible, but you’re part of a system that isn’t treating everybody equally. We have to remember that, or we won’t be able to change that,” Davis said. “We have bias as human beings, and when it’s unconscious and we’re not paying attention, we are potentially causing health inequities.”
The guidance of patients and front-line workers is the crux of the model, rather than allowing teams in the health care administration system to decide policy and direction for the people that policy actually affects. This measure in concert with a practice of rigorous self-assessment and evaluation ensures that any policy or direction adjustments being made stand a real chance of generating lasting positive change for patients.
“I think too often we think about this as, ‘Hey, I’m the provider, you’re the patient. You have to listen to me. I’m in charge,’ when really, we can’t even serve them without them. Anybody who comes through our system, it requires them to tell us their story. So how do we spend more time investing in their story and their testimony, and then being their advocate of their life experience? Because they are the experts of their own health, and we’re just the guide to say, ‘Hey, here are my recommendations on how you can improve your health and continue to maintain that health,’ and not, ‘I am the powerful force that tells you what you need to do.’ But how do I partner with you to help you see the ways that you can maintain your health?” Simpson said.
Patients, of course, are not the only party in the health care system impacted by trauma. Physicians and health care workers are catastrophically under-supported for handling the deluge of traumas they are tasked with witnessing and treating in their day-to-day work, not to mention their own individual systemic oppression.
“As a clinician myself, if I am not well, I am less likely to give and provide excellent care to those that I’m serving. I am also more likely to not have good interactions with those that I work with,” Simpson said. “We onboard a lot of vicarious trauma. If you don’t think that you’ve ever been traumatized, at some point, I’d love to have that conversation with each of you so that you can learn the different types of traumas that do impact us. As a health care professional, or even just as a member of the community, the stories that we hear that cause us to react emotionally are labeled as vicarious trauma.”
Ensuring that medical professionals have the ability to take the time for mental health days and processing, to recover and rebound from the intense emotional exhaustion that can accompany their work, is critical to provider well-being — which is, in turn, necessary for excellent patient care. Without the space to recover and heal, clinicians carry those burdens, often unseen or completely unacknowledged, indefinitely.
When clinicians are at their best, so too is the care they provide and their ability to listen to patients, facilitating positive patient interactions and encouraging patients to feel comfortable returning to their providers to receive care. With increased trust in health care providers comes increased participation in preventative care, which improves the health outcomes of the population as a whole and leads to cost reductions as preventative care reduces the need for more expensive treatments of problems left to fester. “It really is a domino effect,” Simpson said.
To hear more about the connections between EC-TIC and patient and provider wellness, watch the webinar here.