Primary care providers are on the front lines for treating effects of trauma

By Dennis Archambault

Whether incidents of trauma are increasing, or whether our awareness of trauma is increasing – or both – is a matter of professional discussion. What is clear is that people living in poverty are likely to incur trauma – from adverse childhood experiences to generational trauma. This impact results directly and indirectly in medical problems, which are first treated by primary care providers.

The American Psychological Association defines trauma as “any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning.” Adverse childhood experiences, for example, have been correlated with serious medical conditions in adulthood such as hypertension, obesity, cancer, stroke, diabetes, and depression. Recent research has also linked the effects of trauma to several types of brain disfunction.

Traumatic events include those caused by human behavior – interpersonal and sexual violence, war, workplace injuries, as well as by natural disasters, are often treated as medical emergencies, but have lingering effects that show up in the primary care setting. Psychological fallout from these events can lead to depression and misuse of alcohol and other drugs.

Research in the last decade has advanced the knowledge of how primary care providers need to understand how the effects of trauma may be affecting their patients – and how integrated mental and psychological care will best improve the patient’s health and recovery. Many physicians are uncomfortable addressing psychological trauma in their discussions with patients. Authority Health has been an early proponent of medical training in this area and still offers one of the few training opportunities for primary care physicians to learn about the relationship between trauma and health.

Realizing that physicians treating people living in poverty, whether in urban or rural areas, need to be sensitive to the cumulative impact of trauma, Authority Health developed a curriculum on understanding adverse childhood experiences and their potential long-term effects, as well as the broad range of trauma-informed care. Residents complete directed readings and video assignments and meet with Mark Sloane, D.O., a national expert in this area.

Focused training in trauma informed care has been validated through research such as a 2019 study published by the National Institutes of Health on “Trauma-Informed Primary Care for Medical Residents.”  The study concluded that “training residents in trauma-informed care results in improved knowledge, attitudes and practices in caring for patients with psychological trauma.”

Other literature has documented that learning to manage medical and psychological triggers and develop coping mechanisms can help the body and mind recover from traumatic stress. Patients that are properly treated for their psychological and physical symptoms can heal and actually experience what is known as “post-traumatic growth,” which can include a renewed appreciation for life, a stronger sense of personal strength, and increased connection to others. Psychotherapy offered through behavioral health professionals within Authority Health Centers and psychiatrists in the Mel Bornstein Psychotherapy Center offer access to low-income patients on a sliding fee scale.

Dennis Archambault is vice president of Public Affairs for Authority Health.