The phones at U.S. sexual assault hotlines have been ringing in record numbers as the #MeToo social movement spurs victims to reach out for help. The number of calls to the hotline operated by the Rape, Abuse & Incest National Network (RAINN) surged 25 percent in November from a year earlier, and another 30 percent in December, according to RAINN (Reuters, January 17, 2018). Some sexual assault victims kept silent for decades, some were more recently traumatized. No matter the timeline, it is an important reminder that health care providers should approach patients with the mindset that there may be traumatic events impacting a person’s health - both physical and mental.
“Most people think of hurricanes, war or mass shootings when they hear the word trauma. Trauma can be a single incident or an accumulation of stressors,” says Kim Kehl, the Trauma-Informed Care (TIC) Project Coordinator for the Ohio Department of Mental Health and Addiction Services (OhioMHAS). “Trauma is different for everyone, but it always has lasting effects which are seen in reactions, responses and choices. Experiencing trauma has a direct correlation to unhealthy choices and increased chronic disease, and research verifies this.”
With a Master’s degree in education, 19 years of experience with the Ohio Department of Developmental Disabilities, and other leadership roles, Kehl brings a wealth of knowledge and experience to OhioMHAS. In his role, Kehl works under the leadership of the medical director to establish training, protocols and develop resources related to TIC.
“The goal is to help others understand the impact of trauma and how incorporating that into their delivery of services can result in better health outcomes,” says Kehl.
Medical settings have started to incorporate trauma-informed care into their practices as well. Kehl says it is not only important to be informed about patients’ backgrounds, but to be informed on the most effective way to collect information on their backgrounds. One modification is the development of shorter screening tools.
“If we are hitting patients with question after question when they arrive, it can do more damage. We would like to get to a single point of entry, which means the patient tells their story only once, to minimize the risk of retraumatization. If a patient is vulnerable and scared, all barriers go up,” says Kehl.
How can you tell if someone has been negatively affected by something in their lives, which causes them to react in an unexpected way? For some, trauma is chronic and becomes the norm; resiliency develops and can minimize the effect of the trauma. For others, trauma results in adaptive behavior, which may be interpreted as agitation, paranoia, distrust or anger.
“It is important to establish a therapeutic relationship and an environment of safety,” says Kehl.
“Using a trauma-informed care approach may also result in less use of restraints and less misdiagnosis.” - Kim Kehl
To create an environment that supports trauma-informed care, Kehl urges providers to keep in mind the basic principles of TIC:
- Safety
- Trustworthiness and transparency
- Peer support and mutual self-help
- Collaboration and mutuality
- Empowerment, voice and choice
- Cultural, historical and gender issues
As health care providers are asked to do more holistic care, addressing patients’ physical and mental health, it is important to point out that the providers themselves can also fall victim.
“An emerging area is a secondary or vicarious trauma,” says Kehl. Secondary traumatic stress is the emotional duress that results when an individual hears about the firsthand trauma experiences of another.
“Caregivers experience trauma over time due to the toll their responsibilities take on them. This is referred to as compassion fatigue. Also, first responders are often overlooked as being traumatized by some of their experiences.” - Kim Kehl
TIC means that every part of an organization or program understands the impact of trauma on the individuals they serve, as well as on those whom they employ, and adopts a culture that considers and addresses this impact.
As part of the Creating Environments of Resiliency and Hope in Ohio Trauma-Informed Care (TIC) Statewide Initiative, Kehl and his team support the implementation of trauma-informed care systems and trauma-specific services across Ohio’s social services systems.
“This is really a workforce development issue. Having more empathy can change the organization's environment,” says Kehl. “We all have an innate sense of looking out for each other, but sometimes professional field constraints do not allow us to do that. It is about empathy, not sympathy.”
For additional information on bringing TIC training to your workplace, resources throughout Ohio and continuing education videos, visit http://mha.ohio.gov/Initiatives/Trauma-Informed-Care.
Tessie Pollock is director of communications at the State Medical Board of Ohio. Feedback welcome at feedback@cityscenemediagroup.com.
