Case Management Corner: Trauma-informed Approach Improves Care For Patients
By Kelly Bilodeau
A hospital visit can be a stressful experience for anyone, but it may be particularly overwhelming for the more than 50% of Americans with a history of trauma. For those who have endured physical or emotional abuse, medical encounters can trigger panic, complicating treatment and sometimes leading to emotionally volatile encounters that can put medical staff members at risk.
“As a trauma therapist and clinical social worker in the emergency department, I often witness how standard medical practices can inadvertently retraumatize patients. Trauma-informed care transforms these encounters, allowing us to offer not just treatment, but healing,” said Kalie Wolfinger, manager of clinical services for Phoenix Medical Management.
In the past, providers often dismissed trauma-induced outbursts as bad behavior or a character flaw. However, there’s a growing recognition that these responses are not only a predictable reaction to traumatic events but also preventable and manageable with the right approach.
Training staff members in Trauma-Informed Care (TIC), a patient-centered communication approach, can improve care, follow-up, and outcomes, and avoid exacerbating the problem, according to Wolfinger.
The impact of trauma
Many people think that trauma occurs in the wake of physical violence. However, a range of harmful experiences can traumatize patients, including accidents, natural disasters, serious or chronic illnesses, emotional abuse, neglect, racism or other forms of discrimination. Experts use the three E’s formula to understand how these experiences have affected patients, Wolfinger said. These are the Event, how the patient Experienced it, and its long-term Effect on them.
Research has shown that traumatic events can leave a lasting mark on people’s health. Adverse Childhood Experiences (ACES), for example, confer a higher risk of chronic illnesses, such as heart disease, depression, or substance use disorders. A hospital visit can exacerbate the problem, Wolfinger said, which is where TIC comes in. The model trains medical staff members to spot signs and symptoms of a trauma response and provide needed support without making the patient’s condition worse.
TIC is based on six guiding principles, according to the Substance Abuse and Mental Health Services Administration (SAMHSA):
Safety
Trustworthiness and transparency
Peer support
Collaboration and mutuality
Empowerment and choice
Cultural, historical, and gender sensitivity
Nowhere is this training more critical than in the ED, where emotions already run high. Many patients who come into the ED have experienced trauma in the past. Often those who’ve experienced childhood trauma avoid the doctor’s office and only seek care when it becomes an emergency.
Barriers to Implementation
While using TIC can be effective, many doctors aren’t familiar with the approach or even aware of how many of their patients have a trauma history. One survey found that only 16% of doctors believed that half of their patients had experienced trauma. Traditional constraints, such as a lack of time and resources, can also hinder TIC programs. Many hospitals are short-staffed, the workload is unrelenting, and burnout rates are high. Adding additional training and responsibilities is seen as an extra hurdle to overcome, Wolfinger said. However, organizations that invest the time can reap benefits, including improved safety for the care providers.
An effective TIC program starts with training on how to provide trauma-sensitive care and to de-escalate tense situations with stressed patients. It also implements screening procedures to flag patients in need of additional support and strives to improve the medical environment for patients. These include strategies such as increasing patient privacy, offering them more control over decision-making, and avoiding unnecessary physical contact.
“In my role as a trauma therapist in the emergency department, I’ve seen how medical exams can trigger severe trauma responses in patients. For example, I often write advocacy letters requesting modified physical exams for individuals with PTSD,” Wolfinger said. “These letters typically request accommodations such as allowing the patient to remain clothed, having a female provider present, and narrating care before physical contact. These small changes can dramatically reduce distress and prevent re-traumatization.”
Other procedural changes reduce the need for the patient to repeat upsetting details.
“Another example from the ED involves survivors of human trafficking. When multiple agencies are involved, we work to minimize how often the individual has to repeat their story,” Wolfinger said. “Coordinating between departments ensures that care is not only trauma-informed but also efficient and respectful, reducing both emotional and procedural harm.”
Case managers should also strive to match patients who will need additional support after discharge with community organizations and programs in addition to providing strong advocacy throughout the process.
“Whether I’m supporting a survivor of human trafficking or writing a letter to request a modified physical exam, my role is about advocacy. Trauma-informed care isn’t a luxury. It's a necessity for dignity and safety in medical care,” Wolfinger said.
Case Management Corner is your go-to source for insightful discussions on relevant topics in case management. Through an engaging interview-style format, our team members share their expertise, experiences, and best practices to keep you informed and empowered. Whether you're looking for industry updates, practical strategies, or real-world perspectives, we bring you valuable conversations designed to enhance your knowledge and support your professional growth. Stay tuned for expert insights straight from the field! Kelly Bilodeau has been a longtime writer for HCPro’s Case Management Monthly.