Trauma-informed

Providers should recognize the high prevalence of trauma, including sexual violence, and its many documented effects on SRH and health in general.49 

As service sites work toward becoming trauma informed, there are many resources available, including universal trauma precautions or trauma-informed screening protocols. Trauma screening is an approach that refers to a brief, focused tool used to determine whether an individual has experienced or had reactions to traumatic events. Patients should be reassured that they are in control of any details they share.8

Providers should practice universal trauma precautions and trauma-informed care with all patients (Exhibit 5).50, 51 This kind of care involves a strengths-based approach emphasizing autonomy, safety, trust, and empowerment. The goal of universal trauma precautions is not disclosure but rather to acknowledge the presence and impact of trauma. It assumes that all patients have been exposed to negative conditions or traumatic events.

The Substance Abuse and Mental Health Services Administration (SAMHSA) established a framework to support implementation of trauma-informed approaches grounded in a set of four assumptions:52 (1) realize the widespread effects of trauma; (2) recognize the signs of trauma in patients, families, staff, and others involved with the system; (3) respond by fully integrating knowledge about trauma into policies, procedures, and practices; and (4) resist retraumatization of patients and staff. 

SAHMSA also recommends adherence to six principles of a trauma-informed approach:53 (1) safety; (2) trustworthiness and transparency; (3) peer support; (4) collaboration and mutuality; (5) empowerment, voice, and choice; and (6) cultural, historical, and gender issues. To support full implementation of trauma-informed approaches to care, changes should involve both organizational and clinical practices.

Exhibit 5. Key Considerations and Actions to Implement Trauma-Informed Care

Before Exam

• Consider the physical environment
• Offer a support person
• Establish rapport
• Discuss goals and involve patients in the treatment process
• Ask how you can support the patient throughout visit
• Discuss the exam process
• Repeatedly assure patients that they are in control
• Observe for signs of distress

During Exam

• Explain the steps of the exam
• Describe what you are going to do, and why
• Ask questions to gain permission at every step of the examination or procedure
• Allow the patient to be in control
• Practice preventive strategies to avoid retraumatization
• Watch for discomfort or distress
• Stop exam immediately if the patient is distressed

After Exam

• Allow the patient to get dressed prior to finishing the visit
• Discuss and summarize the visit
• Make an action plan with the patient for follow-up
• Share the timeline for any follow-up needs
• Share contact information for further discussion
• Provide referrals and resources
• Confirm documentation preferences

Source: Clinical Training Center for Sexual and Reproductive Health (CTC-SRH).