Delivering Trauma-informed Care in the Military Health System

REALIZE the prevalence - RECOGNIZE the impact - 4 Rs of Trauma-informed Care - RESPOND appropriately - RESILIENCE through skill-building
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By Laura Faulconer, MSW, MPA
April 30, 2018

Unless you’ve been deployed or too busy with patients to read the latest literature, you’ve likely noticed increased use of the terms “trauma-informed” and “trauma-sensitive” in psychological health articles, training seminars, and clinical practice guidelines. I recently even read about trauma-informed yoga and trauma-informed parenting. So what does it mean to be trauma-informed and why is it important to how we deliver care to service members?

Trauma-informed care focuses on how traumatic experiences may impact all areas of a patient’s health and life (neurological, biological, psychological and social) as well as his or her response to mental health or substance use disorder treatment. Being a trauma-informed provider doesn’t mean that you assume everyone has a history of traumatic experience(s); rather you anticipate the possibility while providing care and practice accordingly – from your initial contact, intake processes, and screening and assessment procedures.

According to the Substance Abuse and Mental Health Services manual Trauma-Informed Care in Behavioral Health Services, trauma-informed services are delivered when:

  • There’s an awareness of the prevalence of trauma
  • There’s a recognition of how traumatic event(s) affect all individuals including its own work force
  • Treatment is person-centered and recognizes that symptoms originate from adaptations to the traumatic event(s)
  • Treatment is focused on improving patients’ wellness and resilience rather than only treating symptoms
  • The service delivery system puts this knowledge into practice and avoids institutional processes and individual practices that may re-traumatize patients and/or providers who already have histories of trauma

If a service member wishes to engage in psychotherapy for acute stress disorder (ASD) or posttraumatic stress disorder (PTSD), the 2017 VA/DoD clinical practice guideline for ASD and PTSD recommends providing trauma-focused psychotherapy. This assumes that the post-traumatic response is the focus of psychotherapy and requires a specific set of provider skills (cognitive, emotional or behavioral techniques) to reduce the symptoms that develop following the traumatic experience. The trauma-focused psychotherapies with the strongest evidence for obtaining change in core PTSD symptoms are: prolonged exposure (PE)cognitive processing therapy (CPT) and eye movement desensitization and reprocessing (EMDR). Other psychotherapies with sufficient evidence to recommend for trauma include specific cognitive behavioral therapies for PTSD, brief eclectic psychotherapy (BEP), narrative exposure therapy (NET), and written narrative exposure therapy.

To learn more about what you can do to implement trauma-informed care practices, read or download the new Health Care Provider’s Guide to Trauma-informed Care created by PHCoE in collaboration with the Department of Defense and Department of Veteran Affairs Evidence Based Practice Work Group. Hard copies of the guide will be available to order soon on the Army Medical Command clinical practice guidelines tool kit shopping cart website.

Faulconer is a contracted social worker subject matter expert on the evidence-based practice team at the Psychological Health Center of Excellence. She has a master of social work and a master of public administration.

The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.

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