What nurses need to know about Trauma-Informed Care

What nurses need to know about Trauma-Informed Care

Define trauma-informed care Identify how to assess for trauma Tap in to resources for these patients and their families

Kaiser Permanente,1995-1997 Over 17,000 adults Exposure to ACEs Physical, emotional, sexual abuse Felt unloved Not enough to eat, dirty clothes, felt unprotected/unsafe Exposure to mental illness/suicide Incarcerated household member Witness to domestic violence Lived with alcohol or drug use Lost a parent through divorce, abandonment, other CDC, 2018; Robert Wood Johnson Foundation, 2013

63.5% reported at least 1 ACE 12% reported 4 or more Used to assess cumulative childhood stress 76 studies (CINAHL Plus) Findings consistently reveal a doseresponse relationship between ACEs and negative health and well-being outcomes across the life course CDC, 2018

Ischemic heart disease Cancer Stroke Chronic bronchitis or emphysema Diabetes Smoking Obesity Depression Suicide attempts Illicit drug use STDs Alcoholism and abuse COPD Liver disease Poor work performance Health-related quality of life Risk for Intimate Partner Violence Multiple sexual partners Unintended pregnancies Early initiation of smoking Early initiation of sexual activity Adolescent pregnancy Risk for sexual violence Poor academic achievement Fetal death Intergenerational risk for physical & emotional health problems Felitti, 1998; CDC, 2018

Infant Mental Health began in 1970s More recent 2018 study from Canada N = 1994 Mother-infant dyads Found association between maternal ACE scores and infant developmental outcomes at 12 months Mothers with higher ACEs infants born with more health risks and poorer developmental outcomes Prenatal stress infant development Racine et al, 2018

Mother-infant dyads N = 501 Biomedical risk factors Maternal diabetes, hypertension, thyroid, loss of fetal movement, injury to abdomen Infant NICU stay, oxygen/ventilation, transfer to specialized hospital, low birth weight (<2500), short gestation (<37 weeks) Psychosocial risk factors Single or teen parent, low family income, low maternal education, maternal depression, marital conflict At 18 months, child s emotional and physical health problems assessed Findings ~ Dose response - more maternal ACEs were indirectly associated with: Increased risk of infant physical health problems Increased risk of infant emotional problems Madigan et al, 2018

Nadine Burke Harris, MD, MPH Center for Youth Wellness (CYW) National representative samples showing at least one ACE in children One-third to one-half of the pediatric population Children at high-risk for maltreatment - rate as high as 91% In children, morbidity correlations continue: Fair or poor general health Illness requiring a doctor Fair or poor dental health Asthma ADHD Autism Overweight or obese Learning difficulties Violent behavior in adolescence (delinquent behavior, bullying, physical fighting, dating violence, weapons) Harris & Renschler, 2015

Toxic stress disrupts developing architecture Leads to functional differences in learning, memory, and aspects of executive functioning Associated with hypertrophy and overactivity in amygdala and orbitofrontal cortex Loss of neurons and neural connections in hippocampus and medial prefrontal cortex Increased cortisol levels De Bellis, 2005 & 2013

1. Realizes the widespread impact of trauma 2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others; 3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and 4. Seeks to actively resist re-traumatization Trauma-informed care embraces a perspective that highlights adaptation over symptoms and resilience over pathology. (Elliot, Bjelejac, Fallott, Markoff, & Reed, 2005) SAMHSA, 2018

1. Safety 2. Trustworthiness and Transparency 3. Peer support 4. Collaboration and mutuality 5. Empowerment, voice and choice 6. Cultural, Historical, and Gender Issues Ask What happened to you? instead of What s wrong with you? SAMHSA, 2018

Continued

Understand the prevalence and impact of trauma Pursue the person s strength, choice and autonomy Providers must earn trust Healing happens in relationships Provide holistic care Share power Communicate with compassion Promote safety Embrace diversity Respect human rights

Routine Screening Relevant Symptomatology CYW ACE-Q Score 0-3 without symptomatology Anticipatory guidance CYW ACE-Q Score 1-3 with symptomatology or 4 ACE score Refer to treatment Sleep disturbance Failure to thrive Constipation Poor control of chronic disease Aggression Frequent crying High risk behavior in adolescents Depression Interpersonal conflict Weight gain or loss Enuresis/encopresis Hair loss Developmental regression Poor impulse control Restricted affect or numbing Unexplained somatic complaints Anxiety Harris & Renschler, 2015

Integrates: Primary health care Mental health and wellness Research Policy Education Community and family support services Promising Interventions Regular exercise Good nutrition Sleep Mental health Mindfulness practice Supportive relationships Harris & Renschler, 2015

A possible end