Trauma-Informed Systems of Care: The Role of the Behavioral Health Clinician

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Trauma-Informed Systems of Care: The Role of the Behavioral Health Clinician

Kimberly Burkhart, PhD

Individuals can overcome traumatic experiences with the right services and supports in place. Research shows that without these appropriate supports, there can be long-lasting effects of trauma such as impaired neurodevelopment, dysfunction of the immune system response, and chronic physical and/or behavioral health disorders. Within the context of the medical system, recalling traumatic events and invasive medical procedures can be re-traumatizing.  

Behavioral health clinicians can assist with creating trauma-informed systems of care in several ways such as providing education to all staff on the various types of trauma, the effects of trauma, and how trauma might manifest within the medical system.  For example, when taking a trauma-informed approach, patients’ behavior is considered through the lens that maladaptive coping strategies have been adopted to survive adversity and self-preserve.  The family who presents to the clinic late for their child’s well child check and yells at front desk staff for not being able to be seen or the child who screams and elopes when told he needs a blood draw would benefit from a trauma-informed approach.  In these two examples, within a trauma-informed system of care, patient history (i.e. previous completion of trauma screening) would inform the approach taken. Interacting with the patient calmly, using active listening, validating feelings, and engaging in problem solving can often de-escalate such stressful situations.

There are six key principles of a trauma-informed approach: 1) Safety, 2) Trustworthiness and Transparency, 3) Peer Support, 4) Collaboration and Mutuality, 5) Empowerment, Voice, and Choice, and consideration of 6) Cultural, Historical, and Gender Issues.  The settings in which staff work and patients are seen should be physically and psychological safe. To build trust, there should be transparency with what is going to occur within the medical visit. Results should be communicated with compassion and at the appropriate developmental level with shared medical decision-making.  Self-advocacy is fostered and processes are in place that are responsive to the racial, ethnic, and cultural needs of the population being served.

Behavioral health clinicians can assist with the identification of trauma-informed screening and assessment, participate in peer supports integrated into service delivery to address secondary traumatic stress, provide patients connection to social needs and community resources, and assist in systems evaluation in determining whether patient needs are being addressed.  Several benefits to trauma-informed care have been documented.  Some of these benefits include enhancing patient access to services, improving quality of care, lower overall health costs, and improved social, emotional, and behavioral functioning. The following are possible ways that behavioral health clinicians can be involved in providing trauma-informed care within medical settings.  

Screening instruments: Trauma screening is intended to identify ongoing risks for harm, assess risk for suicidality and potential for developing posttraumatic stress disorder, and to assess the need for evidence-based trauma treatments.  Examples include:

  • PsySTART: An assessment and triage tool used in Emergency Departments as a link to mental health services within disaster systems of care
  • Screening Tool for Early Predictors of PTSD (STEPP): A screening tool used in Emergency Departments to identify those significantly at risk for developing PTSD symptomatology
  • Child Stress Disorders Checklist (CSDC) Screening Form: Brief screen used to assess for acute stress disorder or posttraumatic stress disorder, which can serve as evidence for prediction of later PTSD in hospitalized children
  • UCLA Child/Adolescent PTSD Reaction Index DSM-5: Semi-structured interview that assesses for exposure to various trauma types and current level of distress and impairment
  • Ask Suicide-Screening Questions (ASQ): A set of four screening questions that takes 20 seconds to administer. This is used to screen youth ages 10-24 to identify youth at risk for suicide
  • Columbia-Suicide Severity Rating Scale (C-SSR): A scale used to quantify the severity of suicidal ideation and behavior
  • Adverse Childhood Experiences (ACEs): A checklist of potentially traumatic events that occurs prior to a child turns 18-years-old
  • Safe Environment for Every Kid (SEEK): A checklist used to identify patient and family needs. The questionnaire aims to strengthen families, support parents and parenting, and to promote children’s health, development, and safety