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3 Essential Elements of Trauma-Informed Care

January 14, 2020
Rachel B. Nowlin, MS

,
Sarah K. Brown, DrPH

Patients with serious mental illness such as schizophrenia are more likely to report greater impairment in general functioning as a result of trauma, which is why trauma-informed care is so important.

Patients with serious mental illness such as schizophrenia are more likely to report greater impairment in general functioning as a result of trauma. However, trauma-informed care does not mean only focusing on a specific incident. Successful, trauma-informed care requires clinicians to consider the steps outlined in this report.

Recognition of a patient’s trauma can be achieved during the admission process via trauma screening. In fact, the current standards for accreditation by The Joint Commission (TJC) in behavioral health already require the use of such screeners. Current TJC estimates show roughly 95% of patients in accredited inpatient psychiatric programs are screened for trauma. Thus, many programs already collect these data, which should be made accessible and incorporated into treatment planning. In addition to admission screening, assessment of trauma and PTSD can easily be performed with the addition of a quick trauma screener, such as the PCL-C-6.

Once assessed, trauma can be addressed with patient psychoeducation and by entering diagnoses or progress notes into the medical record. If PTSD is present in a reduced form, a remission specifier or “not otherwise specified” may also be considered. Inclusion in the medical record provides a history of the patient’s experiences and encourages a clinical focus on all relevant issues. Moreover, noting PTSD in a chart allows the patient a record of his or her history, which encourages the continuation of trauma-informed care at follow-up once the patient leaves the current facility.

While PTSD can be a recurrent disorder that may not be fully treated in one inpatient stay, co-occurring PTSD and serious mental illness are best treated in conjunction. Recent evidence suggests popular treatments for PTSD can be used with patients with co-occurring serious mental illness, including psychosis. Unfortunately, many clinicians report not feeling equipped with the training they need to engage in trauma-specific treatment. Given the high incidence of trauma exposure and PTSD symptoms in the population of patients with serious mental illness, continuing education and training in this area should be a core component of behavioral health care practice.

For more on this topic, see Recognizing and Treating Trauma in the Inpatient Psychiatric Setting, on which this slideshow is based.

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