From Trauma to Resilience: One Doctor’s Journey to Transform Trauma-Informed Care
Trauma – an event, series of events or set of circumstances, such as neglect and abuse, that is experienced by an individual as harmful or life-threatening – is a nearly universal experience. The landmark Adverse Childhood Experiences (ACE) Study, conducted by the Centers for Disease Control and Prevention and Kaiser Permanente, revealed that experiences of trauma can impact every area of a person’s functioning.
When Brigid McCaw, M.D., first started practicing medicine, research around the long-term health impact of trauma was just emerging. When she was in medical school, she learned that her sister was in a physically and emotionally abusive relationship and found that resources available for individuals who experience trauma were limited. While her sister had to reach out for help on her own, Dr. McCaw wanted health care to provide a place where patients could get resources and support.
With the success of programs addressing family violence and advances in the science exploring the impact of both childhood and adult trauma, Dr. McCaw realized that it was time to expand beyond family violence and begin to incorporate a trauma-informed approach into the health care setting more broadly.
With this goal in mind, Dr. McCaw focused on using an innovative systems model approach that includes creating a supportive and empowering environment for all individuals impacted by family violence to create the Family Violence Prevention Program at Kaiser Permanente and assumed the position of medical director.
A Trauma-Informed Approach
“I think if we incorporated a trauma-informed approach industry wide, we would have many people in health care – nurses, doctors, etc. – who would be far more satisfied with their work and patients would be more empowered in how they can move forward in their own recovery,” said Dr. McCaw.
One way to do this is to ensure privacy and safety. Dr. McCaw has worked to make “private time” for patients and clinicians an integral part of their clinic visit.
“It can sometimes be difficult for clinicians to explain why this one-on-one time is so important to their patients. It gives them the time and space to discuss potentially sensitive topics, such as experiences of trauma or mental health concerns,” said Dr. McCaw. “We now provide training to help doctors become more comfortable and pro-active in these conversations.”
To help build a foundation of trust, Dr. McCaw found when she met with a patient, asking simple questions like, “How are things at home?” can help open the door to further conversation and opportunities to offer information and resources. She says when a clinician shows compassion and that they care, they can significantly impact a patient’s health and well-being.
In working with individuals who have experienced trauma, Dr. McCaw learned how to speak with patients in a way that helped identify their resilience and strength and how they could act on it.
Fostering Resilience and Recovery
Resilience is a critical component of the National Council’s Trauma-Informed Primary Care: Fostering Resilience and Recovery initiative, supported by Kaiser Permanente and informed by a multidisciplinary group of health care experts that includes Dr. McCaw.
One of 11 Practice Transformation Team members, Dr. McCaw contributed to the development of a change package for primary care and behavioral health providers – a resource that demonstrates how to help health care organizations become trauma informed and support patients impacted by trauma. Seven primary care organizations are currently piloting the model. The final change package will be released later this year.
“One of the beauties of this initiative,” Dr. McCaw said, “[is learning how] to include a patient’s underlying recovery and resilience.”
By using the same trauma-informed approach Dr. McCaw has used throughout her career, providers can work with patients to shift the conversation from focusing solely on what has happened to a person to how they can foster resilience and recovery and achieve their hopes and dreams.
Dr. Brigid McCaw recently retired from her position at Kaiser Permanente. Her contributions to understanding the importance of trauma-informed care and integrating it into practice will be far-reaching in their impact on patients and clinicians alike.