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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Healing Health Care: Addressing Trauma in Primary Care

August 15, 2018 | Healthcare | Comments
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The human spirit is indomitable, but there are times when trauma overwhelms a person’s ability to cope. Addressing trauma in an individual’s life isn’t a matter of the latest treatment fad – it can be a matter of life and death.

It could have been for Jess, who was sneaking sips out of her parents’ liquor bottles by age nine or 10. By the time she was 12, Jess had moved on to marijuana and, by the age of 16, she was using heroin.

Jess was lucky. Her family found a facility that gave Jess the care she needed for both her substance use disorder and the depression and anxiety that fueled it. She had never told anyone that she had been molested by a trusted father figure. With the help of a team of counselors, doctors and peer support, she came to terms with her trauma. Today, she’s looking forward to culinary school and a new life as a chef.

We can’t begin to help the Jesses we encounter unless we identify and address their trauma. After more than a decade of implementing trauma-informed approaches in behavioral health organizations, we are transitioning that work to the place where most people first present for help – primary care.

Addressing Trauma in Primary Care

The need for primary care to identify and address trauma is clear. First, many individuals with histories of trauma will present in primary care.

Second, individuals who have experienced trauma can find medical settings stressful, answering personal questions or submitting to physical exams that may bring up painful memories.

Third, primary care providers in high-volume, high-demand practices

can struggle to understand and meet the needs of patients affected by individual and community trauma.

The landmark Adverse Childhood Experiences (ACE) study makes clear the prevalence of trauma and the link to physical and behavioral health conditions. Fifty-nine percent of people have experienced at least one adverse childhood experience before the age of 18, and the greater the number of adverse experiences, the greater the risk for negative health outcomes.

Fostering Resilience and Recovery

The National Council’s Trauma-Informed Primary Care: Fostering Resilience and Recovery project, supported by Kaiser Permanente, is developing and piloting a change package offering primary care practices field-informed methods, tools and resources to advance understanding and address the impact of trauma.

A multidisciplinary group of health care experts has developed a model to support patients who have experienced trauma, including recommendations for standardized screening and assessment tools, evidence-based clinical interventions, outcome measures and potential policy changes.

The following organizations will participate:

  • Malama I Ke Ola – Wailuku, Hawaii
  • Colorado Coalition for the Homeless – Denver, Colo.
  • Richmond Behavioral Health Authority – Richmond, Va.
  • Zufall Health Center – Dover, N.J.
  • Peninsula Community Health Services – Bremerton, Wash.
  • Oregon Health & Science University, Family Medicine at Richmond Clinic – Portland, Ore.
  • Willamette Family, Inc. – Eugene, Ore.

Individually and together, these organizations are determined to improve care, health, costs and patient and provider satisfaction – the quadruple aim of health care. We are grateful for their participation and their patients will be, as well.

How are you identifying and addressing trauma? I’d love to learn from your experiences. Please email me at