Feature

Offering trauma-informed care in general practice


Morgan Liotta


6/06/2018 2:23:45 PM

Establishing trust and offering a collaborative, welcoming service can assist GPs in identifying patients who have experienced trauma, new research has found.

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Dr Mary Belfrage believes a commitment to building trust with patients who have experienced trauma, as well as a multidisciplinary team approach to care, can benefit all.

A patient presents to their GP with a number of health issues – both discernible and understated. The GP says, ‘I get a sense that you’ve got a really deep sadness or trauma. In my experience, often people who describe what you are describing have gone through something really terrible’.
 
Dr Mary Belfrage uses this example of how to broach the subject of trauma with a patient.
 
Dr Belfrage is a GP, project advisor for RACGP Aboriginal and Torres Strait Islander Health, and author of the chapter ‘Preventing child maltreatment: Supporting families to optimise child safety and wellbeing’ in National Aboriginal Community Controlled Health Organisation (NACCHO) and the RACGP’s National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (National Guide).
 
The majority of Dr Belfrage’s work has been in Aboriginal community health settings and lower socioeconomic groups, which are, she said, often associated with trauma. Through her encounters, she has learnt to recognise the markers of people who are carrying experiences of trauma.
 
‘When you have an awareness of trauma, you recognise the red flags,’ Dr Belfrage told newsGP.
 
‘It’s around people’s sense of agency and level of self-care.
 
‘I ask [a patient] about their mood, substance use, general wellbeing. If there is a pattern of depression, low self-esteem, substance use, those things might be associated with trauma.’
 
But raising the topic of trauma is a sensitive issue – for anyone.
 
Dr Belfrage believes a gentle approach from the outset is essential in building a relationship of trust between a GP and their patient, one in which the patient feels safe to disclose their experiences and work towards a possible resolution.
 
‘When you spend time establishing trust you have to negotiate the therapeutic goal in quite a gentle way,’ Dr Belfrage said.
 
‘People aren’t necessarily always quick to adhere to medical advice, so you often need to have flexibility, as well as patience and kindness.’
 
Dr Belfrage also sees the role of the GP as lending itself to being part of a multidisciplinary team and adopting collaborative approaches between providers and patients.
 
‘Trauma-informed care at a practice level includes a fence of welcome and kindness when people arrive,’ she said.
 
‘It’s at reception, how people make appointments. It’s right from the beginning [of their time in a practice].’
 
Another reason to have integrated models of care for people dealing with trauma, according to Dr Belfrage, is the ripple effect of trauma.
 
People who have complex health needs often have an associated history of trauma. Evidence of low self-esteem, a sense of agency, confidence navigating the world, or not feeling worthy can all be hallmarks of trauma. Dr Belfrage classifies trauma as ‘an experience that overwhelms a person’s capacity to process, that impacts on health in all sorts of ways, including choices they make’.
 
‘These patients are utilising [or need to] a whole range of health and social services,’ she said.
 
‘And for that to actually be effective in improving health outcomes, there needs to be consideration of how things are linked.’
 
Dr Belfrage believes an approach to effective trauma-informed care can be in a way that most GPs hold as their belief and use in their daily practise – one of equity and empathy.
 
‘Trauma-informed care requires a commitment to building trust – that is significant – as well as a valuing of equity and kindness, [doctor–patient] collaboration, and integrated services,’ she said.
 
‘I think that makes a difference and is how you [as a GP] want to practise.’
 
In the June issue the Australian Journal of General Practice (AJGP), Dr Miriam Brooks, a GP at Blue Mountains Women’s Health and Resource Centre and senior lecturer at Western Sydney University, with co-researchers Emeritus Professor Lesley Barclay and Dr Claire Hooker, conducted research and wrote of the findings about trauma-informed care in general practice.
 
They found that trauma-informed care has a positive influence on patient care and increased awareness of traumatic experiences in patients’ lives can significantly improve GPs’ ability to provide appropriate and effective healthcare.
 
According to Dr Brooks, trauma can be classified as experiences of physical or sexual violence, childhood abuse or neglect, the death of a loved one, serious accidents, natural disasters, terrorism, war-related trauma or medical trauma.
 
‘These health consequences could be significantly lessened if people access appropriate care when needed,’ she said.
 
‘Awareness of issues pertaining to gender, income, culture, sexuality and disability is a core value of trauma informed care.’
 
Dr Brooks and her AJGP co-authors are of the same mind as Dr Belfrage, that establishing trust and offering services in a safe and accommodating way can help in caring for people experiencing the health impacts of trauma.
 
They also cite the importance of GPs and relevant healthcare professionals to recognise the role of trauma in different patient presentations and provide access to support patient needs to enhance their health and wellbeing.
 
‘Part of the aim is that you create that holistic net, and it holds patients [experiencing trauma], emotionally, physically and in all kinds of other ways,’ Dr Brooks said.
 
GP resources



abuse-and-violence AJGP National-Guide trauma-informed-care White-Book



Michael Fasher   8/06/2018 11:12:56 AM

It is exciting to see trauma informed care emerge into mainstream general practice conversation. At GP16 the topic seemed novel. The prolific American writer/researcher, Christina Bethell, points to the therapeutic value of Safe, Sustained, Nurturing Relationships (SSNRs)


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