Supporting Resilience through Trauma-informed Care
Dr Nomi Levy-Carrick, Psychiatrist, Division of Medical Psychiatry, Brigham and Women’s Hospital
Dr Levy-Carrick opens with some definitions of psychiatric trauma, providing categories/examples. The macro statistic (from one very large mental health study) is that 63% of people have experienced trauma of some sort. There is a discussion of affluence/resource, and the relationship between early trauma and later negative life events or conditions. Those who have experienced trauma have much higher incidence of behavioral health issues later in life – smoking, diabetes, depression etc.
Allostasis – the body’s ability to return to a neutral state (after stress). Citation: McEwen, 2017. Trauma negatively affects allostasis.
Dr Levy-Carrick suggests that we’re talking about a paradigm shift from ‘what’s wrong with you?’ to ‘what happened to you?’. This frames Trauma Informed Care (TIC) as a principle of justice and health equity. http://www.traumainformedcareproject.org/
The guiding principles of TIC:
- Safety: Physical and psychological
- Peer Support
- Empowerment, Voice, Choice
- Trustworthiness and transparency
- Collaboration & mutuality
- Cultural, historical and gender knowledge
We look at three Universal Trauma Precautions – to avoid retraumatising those to seek/provide assistance, to proactively engage survivors in treatment planning, and to attend to impact on providers and organizations.
The current thinking, we hear, is that detailed disclosure is not the goal. The approach is to begging with broad enquirer, assess the risk, and then intervene appropriately. A trauma informed approach asks (and discusses with the patient) what can be done, how it’s going to be done, and why it’s necessary.
The provider (of trauma care) also has a perspective. Providers can fear making bad decisions or being overwhelmed, can feel helpless, can be frustrated with the survivor for not aligning their behaviors to the provider’s motivation, and the risk of providing interventions that may increase vulnerability (retriggering, vicarious trauma, burnout). If these things are not considered, the risk is that the survivor will simply walk away.
Resilience is not how you endure, it’s how you recover. Music has a role to play – individually, interpersonally, and collectively.