Laneita Williamson, RN, BSN – Trauma-Informed Care

Today we talk with Laneita Williamson the trauma informed care manager at CareNet, who shares with us the effect of trauma on a patient, and also ways it can impact their care, and techniques for managing this potential barrier to positive outcomes. Laneita Williamson welcome to the move to value podcast.

Thank you so much I am so glad to be with you today and to talk with you.

Well we certainly are glad that you could join us. So my first question for you Laneita is what is trauma?

Sure, so if we’re thinking about trauma we want to think about it as an event a series of events or a set of circumstances experienced as physically or emotionally harmful or life threatening and then has a lasting adverse effect on you, as the individual, or an organization, or communities, functioning. And this could be your functioning mentally, physically, socially, emotionally, and even your spiritual well-being.

So now I want to ask you – what is trauma informed care and what are the benefits?

When we are thinking about trauma informed care we want to recognize that it is an approach. It’s an approach that a program organization or system takes when they become informed about trauma and the impacts from trauma. It is the approaches taken by those that realize the widespread impact of trauma and then understands the potential paths for recovery. And then also recognize the signs and symptoms of trauma in your clients, families, staff and the others. They would integrate knowledge about trauma into the policies procedures and practices. And then of course we want to seek to actively resist retraumatization in those clients, family, staff, or each other. And in regards to the benefits of a trauma informed care approach, what it ends up doing is it allows us to listen to our patients more. We begin to practice more patience and then that creates more empathy. We learn to get along better as a team. When a patient or a client or someone does something harmful, we actually began to look at the reason why or understand what is the cause of that action instead of judging that person. We also talk about how our work actually impacts us or affects us and then when we’re having that connection and that peer connection with each other, we began to develop tools that help us understand what we need in our work day in order to continue forward. We begin to have new ideas, new creations of treatment plans, you know, recognize how we’re to work together as a team or you know to address system issues and just create that connectedness to each other. This all of this allows us to feel more valued and be human and to recognize it’s OK to have our human feelings to take care of ourselves and then to come back reenergized and hopeful so that our resilience is increased. The trauma informed care really does have a lot of benefits.

Well can you share an example or two from your own experience of how trauma informed care has been used to improve a patient outcome?

So there’s so many examples we can use when working with patients in a hospital system where trauma informed care actually impacts that patient in such a way that it creates a better outcome. And I have so many stories, but it can be something as simple as you as a clinician or provider identify that it’s not necessary to get a lab draw in the middle of the night. And the reason for that is that when we are going into a person’s private space which is there you know hospital bed, their hospital room, to wake them up, then that can actually trigger them and they will want to leave the hospital. They may go back into a time where that being awakened during the middle of the night was something that was a trauma. So as we begin to think through how we work with our patients we’ve recognized something as simple as lab draws, we do it at a later time in the morning when they’re awake. Or if we have someone who is struggling with addiction and they’re in our suboxone clinic, we recognize that getting a lab stick may be a trigger and can actually send them back into injecting again. So we try to minimize those lab visits or have peer support with them so that they’ve got somebody there to actually help them through the process. So, again, there’s so many benefits to trauma informed care but that is one simple you know example that we can use in our everyday practice. Of course there are many more stories that I could share that revolve around things like workplace violence and patients that have shared their stories that wanted to leave the hospital because they were being triggered by maybe a bath and maybe their trauma in childhood was around a bath and we found ways to work with that patient to create a new treatment plan so that they felt safe they had a choice and they were able to stay in the hospital setting.

Laneita, how do we go about discovering what past traumas may be present for our patients?

When we’re thinking about our patients coming into any setting, no matter where you may work, we begin with a universal precaution. And that means that we assume all patients have had trauma and then we approach that patient just like we know they’re coming in for an acute traumatic violent event. We use some of the same strategies and tools and we may not identify if this patient has had physical abuse, sexual abuse, emotional abuse, or neglect, but we’re using the same approaches to that patient so that they already feel safe. They already know that there’s someone that is allowing them to be in a space where they have a voice and they can actually feel safe and be a part of the treatment plan. We don’t have to necessarily get into specifics of a trauma or ask specific information, like were you physically abused or sexually abused because we’re going to be using the same approach no matter what.

It’s funny that you mentioned the approach because that leads into my next question. Will you explain to us the six guiding principles of trauma informed care?

When we are approaching our patients through a trauma informed care lens, we do want to use the six guiding principles and the very first one of those is safety.

And of course you know most people in medicine is going to say well we already provide safety. And yes we do have a framework for safety – are they not falling, you know, are they getting the right medicines, the right treatment plans. But what I mean by this is does that person feel psychologically emotionally safe not retraumatized, not triggered. And one of the ways that we can do that is by asking questions. By asking that patient, What makes you feel safe today? How can I help you feel safe? Would you like the door open? The door closed? How would you like me to address you? What are the best ways that you can have this procedure? Is it with a friend? Is it someone there for you? Is there anything you need us to know before we begin this treatment plan? So just identifying safety is the first principle.

The second principle kind of has two components. It is trustworthiness and transparency. Trustworthiness means that we are utilizing concrete information, we are not making promises that we cannot meet, we are being open, we are talking with that patient, we are keeping things factual so that everybody is on the same page hearing the same information and again that transparency, if something has occurred then we talked to that patient. Or if we think there is something that’s going to be happening in the near future maybe we want to get an X-ray or we want to do certain treatments or labs, we go in and we say these are the things that we are thinking about, we wanted to share this with you and see what your thoughts are to these treatment plans.

The other thing or the third principle is peer support. Who do you want with you? If they don’t have a family member, which they often may not, that they feel is trustworthy, can we offer chaplains. Is there someone that can come visit you? Is there a friend in the community? And if this is a person that has had an injury that’s going to be a life changing event, such as an amputation, there are peer support groups for those. Would you like a peer support advocate to come in and be with you.

The fourth is collaboration and mutuality, we’re always wanting to collaborate with the patient. Have that mutual decision-making process. Yes we are looking at all of the symptoms and then we are coming up with our differential diagnosis. However, all of that information needs to be shared with that patient and that patient needs to be part of that decision making process of how their health is going to be managed.

We want to empower them so no matter what it may be, if they’re coming in and they are just really at a place that they can’t cope but we can find one thing that they are doing well, empower that empower that moment with them so that they know that they’ve got that skill set and then help build them to the next skill set to make it through that journey of their health. Because healthcare journeys can be short or can go on for years. So we want to empower everything that they do that is helping them move forward for themselves at the rate that they can move forward.

We want to give them a voice and a choice. You know, what are their thoughts about their health? Maybe our goals are not their goals so we need to hear what their voice is and we want to give them the choice. You’re maybe is something as simple as your A1C is too high we would like to change, which is your blood sugar, we would like to change your meal plans and your diet and your exercise so that we can lower that and actually help you stay healthy for longer. But that may be their meals may be the best that they can do or coping mechanism, so it may not be something that they’re ready to do. So we have to give them that choice. We have to think about their culture where are they coming from you know which area or region.

There are historical trauma into any gender challenges that may be coming up while they’re in a healthcare setting, which oftentimes may feel like a very unsafe space for LGBTQ community. So we want to actually support them any way that we can. So just to recap the six principles are safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment voice and choice, and then cultural historical and gender issues.

That was a very comprehensive answer. Can you take it a step further and share what a trauma informed care approach would look like in a clinical setting?

Trauma informed care in a clinical setting is going to be literally embedded in everything from governance and leadership to finances. There are 10 organizational domains that is applicable for trauma informed care. And the first is governance and leadership. You have those leaders that understand what trauma informed care means and they are backing it they are finding ways to make trauma informed care education, knowledge, cultural changes take place and they help you lead that mission throughout the entire enterprise.

You’re looking at policies. Are your policies trauma informed? Maybe they are maybe they are already as good as they can be or maybe they’re missing a component to where we’re not helping the employees or the staff feel safe in certain situations. Maybe when it’s their annual review or when there is a challenge that comes up. So we’re looking at those policies from the same guiding principles that we use with patients.

We look at our physical environment. Is it welcoming? Is it using the correct colors to help calm people? Are there the correct smells? Lighting? Is there lighting in the parking lot? Is there security that’s available for urgent needs? You know that physical environment is extremely important. For example when we walk into a spa it’s all quiet it smells good and we immediately relax. But when we walk into a clinical setting that is chaos and we don’t have an environment set up for either the number of people or the sound and the noise or what we see or what we hear, that actually triggers people in trauma. So we would want to look at those physical environments and actually make it a place that would down regulate those emotional stressors for those sick patients that are coming in with a history of trauma.

We want to have engagement and involvement, not only with each other, but with our community. What is our community saying that they need from our organization. Do they need something that we’ve never thought about?

We want to look at cross sector collaboration. How do our departments work together utilizing the six guiding principles with each other and thinking about how we can come together and be a team that helps the patient, helps the system and the organization move forward with the safety lens of trauma informed care. When indicated in certain environments in clinic settings or in the hospital and when the organization has reached the point that they are trauma informed.

We can think about screening, assessment, and then referrals or treatment if needed for those trauma survivors.

There is ongoing training and workforce development it can be around safety it can be through workplace violence incidents it can be through annual training modules but we want to make sure that that training of trauma informed care and just continues to help the workforce, especially in hospital settings because there’s so much turnover in staff, that trauma informed care is not a one and done is a continual journey. It’s not an end goal.

We want to look at progress and monitor what we’ve been doing. Look at some data see how it’s working.

You know think about that quality assurance making sure that we are reflecting upon all of the process changes that we’ve implemented through a trauma informed care lens and continue to improve upon that or maintain it if we’ve reached the goal that we want.

We want to think about financing. How does this work? How do we have enough people on board that can help teach others that can provide material and how do we allow enough financing that we can have our clinicians come out of their space for just enough time to get their training and to do some of their research and then practice it and then go back into their specific specialty in space and continue forward with trauma informed care?

And of course, then evaluate all of that. So those ten organizational domains again just to recap those this governance and leadership policy physical environment engagement and involvement cross sector collaboration screening assessment and treatment when indicated training and workforce development progress monitoring and quality assurance financing and evaluation.

Outstanding! Laneita Williamson thank you for joining us today on the Move to Value Podcast.

Thank you so much! I have really enjoyed being with you today and just going through these questions, thank you.