Megan R. Gerber - Trauma-Informed Healthcare Approaches: A Guide for Primary Care

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In recent years, trauma-informed care (TIC) has gained traction as an important set of principles that should guide optimal healthcare delivery. Our understanding of the profound impact traumatic exposure has on health is not new, but the recent #METOO movement has resulted in expanding interest in optimizing the healthcare response to interpersonal trauma. The literature contains many offerings on TIC in mental health, substance abuse, and pediatric care settings, but there has been comparably less published on TIC principles in general adult medical settings. There is a continuum from being trauma-aware to trauma-informed. Organizations may be trauma-aware and have outstanding trauma-focused care, but being trauma-informed is a process of infusing an entire organization or system with a guiding set of principles that reorders the environment to promote safety, empowerment, and healing for both patients and staff. A truly trauma-informed health system understands its community and collaborates with stakeholders, service providers, and relevant social services.

This book is geared toward general medical practitioners, healthcare administrators and leaders. While trauma has a profound impact on global health, this volume restricts its focus to the United States and similar countries. It begins with a broad overview of trauma and the suspected mechanisms by which it creates poor health. A discussion of practical applications of TIC principles is followed by an introduction to the concept of TIC as an important promoter of health equity through acknowledging and addressing trauma in individuals and communities. The World Health Organization (WHO) Commission on Social Determinants of Health (SDoH) ( http://www.who.int/social_determinants/thecommission/finalreport/en/ ) described health systems as intermediary determinants of SDoH. Trauma is inextricably linked to many SDoH, so conceptualizing healthcare as having a role in mitigating SDoH is another way of understanding its role in achieving health equity and reducing disparities that often result from trauma.

The concept of cultural humility and its critical role in TIC is followed by a series of chapters (Part II) on selected special populations including men of color, gender nonconforming persons, and US military Veterans. While not all groups who are susceptible to trauma are covered, these chapters provide useful paradigms to apply/customize TIC principles to vulnerable populations.

Part III of the book is geared toward both clinicians and healthcare administrators. It covers practical clinical strategies for primary care (adult, adolescent and pediatric) and maternity care settings. Chapter discusses adolescent and pediatric trauma-informed care through the lens of developing and extending trauma-informed systems. This chapter is relevant to all healthcare settings. Finally, a chapter on trauma-informed holistic nursing provides an overview on transforming nursing care across the health system. The book concludes with a chapter on fostering resilience and self-care for staff; an organization cannot transform into a truly trauma-informed system without understanding the needs of staff who treat survivors.

We are grateful to the Society of General Internal Medicine (SGIM) for providing a professional home to many of us and a platform over the years for discussing and advancing the needs of trauma survivors in general medical settings. We wish to especially acknowledge our colleagues in the Physicians Against Violence Interest Group for supporting us and shaping our collective voice. William R. Bachman, MD; Christine J. Kolehmainen, MD, MS; and Aasia S. Romano, MD, provided invaluable assistance in content review and preparation of this book.