Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

ABSTRACT

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.

KEYWORDS:

• Communication
• continuing medical education
• patient- centeredness
• primary care
• trauma

Acknowledgments

The authors wish to acknowledge the following study personnel and individuals: Interviewers Adriana Serrano, MA, Janice Yuan, and Cristina Parodi, PhD. Sites of the study were Family Medicine residencies: Georgetown University, Pat Evans, MD, Residency Training Director; Howard University, Ruth Elaine Graves, PhD, Dir. Behavioral Medicine, Residency Program; Spanish Catholic Center, Marguerite Duane, MD, Medical Director; Johns Hopkins Community Physicians, Gary J. Noronha MD, FACP, Director of Research; and RA Nicholas Talisman.

Additional information

Notes on contributors

Bonnie L. Green

Bonnie L. Green is a professor of psychiatry and director of the Center for Trauma and the Community at Georgetown University Medical School. Her current research focuses on the mental health needs and treatment of uninsured, mostly minority populations with trauma in safety-net primary care settings.

Pamela A. Saunders

Pamela A. Saunders is an associate professor in the Departments of Neurology and Psychiatry at Georgetown University Medical School. Her research, teaching, and writing focus on doctor–patient communication, language and dementia, and reflective writing in medical education.

Elizabeth Power

Elizabeth Power is principal of EPower & Associates, Inc., of Nashville, Tennessee. Her current work helps organizations in the public, private, and nonprofit setting become trauma-responsive.

Priscilla Dass-Brailsford

Priscilla Dass-Brailsford is an associate professor in the Department of Psychiatry at Georgetown University Medical School. She studies the effects of trauma and violence and other stressful events, especially whether individuals from historically oppressed or stigmatized groups experience unique stressors or exhibit culturally specific coping processes.

Kavitha Bhat Schelbert

Kavitha Bhat Schelbert is a family physician at the University of Pittsburgh Medical Center. Her research interests include health behavior change and motivational interviewing, primary care and adolescent health, and obesity and stress/trauma.

Esther Giller

Esther Giller is founder and CEO of Sidran Institute, a nonprofit organization of international scope, which fosters multidisciplinary support for traumatized individuals, families, and communities. Sidran developed and disseminates the Risking Connection family of training products.

Larry Wissow

Larry Wissow is a professor of health, behavior, and society at the Johns Hopkins School of Public Health, where he also directs the Center for Mental Health in Pediatric Primary Care. His research focuses on the redesign of mental health interventions for use in collaborative care between medical, mental health, and community services.

Alejandra Hurtado de Mendoza

Alejandra Hurtado de Mendoza is a research instructor in the Department of Oncology at Georgetown University Medical School. Her research focuses on mental health disparities and cancer-related disparities among ethnic minorities and underserved populations.

Mihriye Mete

Mihriye Mete is an associate professor in the Department of Psychiatry at Georgetown University Medical School, and Biostatistics Manager at MedStar Health Research Institute. She is a co-investigator and primary statistician in multiple clinical trials in different fields of medicine. Her research focuses on diabetes, obesity, nutrition, and mental health.