Samara Grossman

This is a cross-sectional study investigating the prevalence and nature of trauma-informed care (TIC) training in obstetrics and gynecology residency programs. In our sample, 20% of programs had annual TIC training, 53% had less than annual training, and 27% had no training at all. Only 25.3% of respondents were satisfied with their current training in interpersonal trauma and TIC. A lack of facilitators to conduct such training was the primary barrier to implementing TIC. Significant… Show more

This is a cross-sectional study investigating the prevalence and nature of trauma-informed care (TIC) training in obstetrics and gynecology residency programs. In our sample, 20% of programs had annual TIC training, 53% had less than annual training, and 27% had no training at all. Only 25.3% of respondents were satisfied with their current training in interpersonal trauma and TIC. A lack of facilitators to conduct such training was the primary barrier to implementing TIC. Significant opportunity exists to improve TIC education for Ob/Gyn trainees. Show less

To describe factors that influence interprofessional staff decisions and ability to implement trauma-informed care (TIC) in a level-one emergency department (ED) trauma center. This qualitative research study consisted of semi-structured interviews and quantitative surveys that were conducted between March and December 2020 at an urban trauma center. Eligible participants were staff working in the ED. Interview questions were developed using the Theoretical Domains Framework (TDF), which is… Show more

To describe factors that influence interprofessional staff decisions and ability to implement trauma-informed care (TIC) in a level-one emergency department (ED) trauma center. This qualitative research study consisted of semi-structured interviews and quantitative surveys that were conducted between March and December 2020 at an urban trauma center. Eligible participants were staff working in the ED. Interview questions were developed using the Theoretical Domains Framework (TDF), which is designed to identify influences on health professional behavior related to implementation of evidence-based recommendations. Interview responses were transcribed, coded using Atlas software, and analyzed using thematic analysis. Key themes identified included awareness of TIC principles, impact of TIC on staff and patients, and experiences of bias. Participants identified opportunities to improve care for patients with a trauma history, including staff training, more time with patients, and efforts to decrease bias toward patients. Most participants (85.7%) felt that a TIC plan, tiered trauma inquiry, and warm handovers would be easy or very easy to implement. We identified key interprofessional staff beliefs and attitudes that influence implementation of TIC in the ED. These factors represent potential individual, team-based, and organizational targets for behavior change interventions to improve staff response to patient trauma and to address secondary trauma experienced by ED staff. Show less

A patient’s current or previous experience of trauma may have an impact on their health and affect their ability to engage in health care. Every year, millions of patients who have experienced physically or emotionally traumatic experiences present to emergency departments (ED) for care. Often, the experience of being in the ED itself can exacerbate patient distress and invoke physiological dysregulation. The physiological reactions that lead to fight, flight, or freeze responses can make… Show more

A patient’s current or previous experience of trauma may have an impact on their health and affect their ability to engage in health care. Every year, millions of patients who have experienced physically or emotionally traumatic experiences present to emergency departments (ED) for care. Often, the experience of being in the ED itself can exacerbate patient distress and invoke physiological dysregulation. The physiological reactions that lead to fight, flight, or freeze responses can make providing care to these patients complex and can even lead to harmful encounters for providers. There is a need to improve the care provided to the vast number of patients in the ED and create a safer environment for patients and healthcare workers. One solution to this complex challenge is understanding and integrating trauma-informed care (TIC) into emergency services. The federal Substance Abuse and Mental Health Service Administration’s (SAMHSA) six guiding principles of TIC offer a universal precaution framework that ensures quality care for all patients, providers, and staff in EDs. While there is growing evidence that TIC quantitatively and qualitatively improves ED care, there is a lack of practical, emergency medicine-specific guidance on how to best operationalize TIC. In this article, using a case example, we outline how emergency medicine providers can integrate TIC into their practice. Show less

In health care settings across the nation, patients bring their experiences of trauma — either past or present — into their health care encounters. Researchers from across national health care institutions published an article demonstrating how health care providers and larger organizations can practice patient-centered, trauma-informed care. Samara Grossman, MSW, LICSW, is a clinical social worker at the Brigham and the study’s lead author. She told us more about the team’s publication in this… Show more

In health care settings across the nation, patients bring their experiences of trauma — either past or present — into their health care encounters. Researchers from across national health care institutions published an article demonstrating how health care providers and larger organizations can practice patient-centered, trauma-informed care. Samara Grossman, MSW, LICSW, is a clinical social worker at the Brigham and the study’s lead author. She told us more about the team’s publication in this Q&A. Show less

Trauma exposure is a highly prevalent experience for patients and clinicians in emergency medicine (EM). Trauma-informed care (TIC) is an effective framework to mitigate the negative health impacts of trauma. This systematic review synthesizes the range of TIC interventions in EM, with a focus on patient and clinician outcomes, and identifies gaps in the current research on implementing TIC.

This chapter begins reviewing the high prevalence of trauma and adversity among transgender and gender diverse (TGD) people and explaining the potential effects of trauma on their overall health and well-being. The chapter then describes how clinicians can support the healing and recovery of their TGD patients by incorporating principles of trauma-informed care during health care encounters and by advocating for trauma-informed changes at both institutional and systems levels.

Trauma in Adult and Higher Education: Conversations and Critical Reflections invites readers to think deeply about the experiences of trauma they witness in and outside of the classroom, because trauma alters adult learners' experience by disrupting identity, and interfering with memory, relationships and creativity. Through essays, narratives, and cultural critiques, the reader is invited to rethink education as more than upskilling and content mastery; education is a space where dialogue has… Show more

Trauma in Adult and Higher Education: Conversations and Critical Reflections invites readers to think deeply about the experiences of trauma they witness in and outside of the classroom, because trauma alters adult learners' experience by disrupting identity, and interfering with memory, relationships and creativity. Through essays, narratives, and cultural critiques, the reader is invited to rethink education as more than upskilling and content mastery; education is a space where dialogue has the potential to unlock an individual’s sense of power and self-mastery that enables them to make sense of violence, tragedy and trauma.

Trauma in Adult and Higher Education: Conversations and Critical Reflections reveals the lived experiences of educators struggling to integrate those who have experienced trauma into their classrooms - whether this is in prison, a yoga class, or higher education. As discourses and programming to support diversity intensifies, it is central that educators acknowledge and respond to the realities of the students before them. Advocates of traumasensitive curriculum acknowledge that trauma shows up as a result of the disproportionate amount of violence and persistent insecurity that specific groups face. Race, gender, sexual orientation, ability, and immigration are all factors that expose individuals to higher levels of potential trauma.

Trauma has changed the conversations about what education is, and how it should happen. These conversations are resulting in new approaches to teaching and learning that address the lived experiences of pain and trauma that our adult learners bring into the classroom, and the workforce. This collection includes a discussion of salient implications and practices for adult and higher education administrators and faculty who desire to create an environment that includes individuals who have experienced trauma, and perhaps prevents the cycle of violence. Show less

Trauma is often viewed as an individual or interpersonal issue. This paper expands the definition of trauma to include the impact collective and structural elements on health and well-being. The need for a trauma-informed response is demonstrated, with instruction as to how to implement this type of care in order to resist re-traumatization. Three examples from healthcare settings across the nation are provided, to demonstrate the ways in which organizations are bringing forward this… Show more

Trauma is often viewed as an individual or interpersonal issue. This paper expands the definition of trauma to include the impact collective and structural elements on health and well-being. The need for a trauma-informed response is demonstrated, with instruction as to how to implement this type of care in order to resist re-traumatization. Three examples from healthcare settings across the nation are provided, to demonstrate the ways in which organizations are bringing forward this patient-centered, trauma-informed approach to care. Show less

Diversity, equity, and inclusion (DEI) have become increasingly recognized as essential to the practice of high-quality patient care delivery and the support of members of the clinical environment. A solid understanding of DEI contributes to a better grasp of what drives health care disparities and yields improved clinical outcomes for minority populations. This column discusses how individuals can practically promote DEI by describing the design and implementation of DEI in an academic… Show more

Diversity, equity, and inclusion (DEI) have become increasingly recognized as essential to the practice of high-quality patient care delivery and the support of members of the clinical environment. A solid understanding of DEI contributes to a better grasp of what drives health care disparities and yields improved clinical outcomes for minority populations. This column discusses how individuals can practically promote DEI by describing the design and implementation of DEI in an academic psychiatry department. The authors highlight the powerful role of departmental initiatives in establishing best practices for DEI and lessons learned through the work of the psychiatry department's DEI committee. Show less

Trauma is ubiquitous and associated with negative effects on physical and mental health. Trauma-informed care (TIC) is a framework for mitigating these health effects and improving patients' engagement with medical care. Despite these clinical benefits, TIC is not routinely taught in undergraduate medical education.

Methods: We designed a session for first-year medical and dental students to introduce TIC principles and their application in patient care. The session focused on screening… Show more

Trauma is ubiquitous and associated with negative effects on physical and mental health. Trauma-informed care (TIC) is a framework for mitigating these health effects and improving patients' engagement with medical care. Despite these clinical benefits, TIC is not routinely taught in undergraduate medical education.

Methods: We designed a session for first-year medical and dental students to introduce TIC principles and their application in patient care. The session focused on screening for and inquiring about trauma and responding to disclosures of trauma. Using live patient interviews, small-group discussions, and case-based role-plays, the session offered expert instruction and hands-on practice. Students completed pre- and postsession surveys and a 5-month follow-up survey. Students reported their comfort with screening for trauma and responding to disclosures of trauma before and after the session and at 5 months following the session. Show less

Within the context of longitudinal medical care for adults, health care providers have a unique opportunity to inquire and respond to the traumatic life experiences affecting the health of their patients, as well as a responsibility to minimize retraumatizing these patients during medical encounters. While there is literature on screening women for intimate partner violence, and there is emerging data on pediatric screening for adverse life experiences, there is sparse literature
on inquiry… Show more

Within the context of longitudinal medical care for adults, health care providers have a unique opportunity to inquire and respond to the traumatic life experiences affecting the health of their patients, as well as a responsibility to minimize retraumatizing these patients during medical encounters. While there is literature on screening women for intimate partner violence, and there is emerging data on pediatric screening for adverse life experiences, there is sparse literature
on inquiry of broader trauma histories in adult medical settings. This lack of research on trauma inquiry results in an absence of guidelines for best practices, in turn making it challenging for policy makers, health care providers, and researchers to mitigate the adverse health outcomes caused by traumatic experiences and to provide equitable care to populations that experience a disproportionate burden of trauma. This state of the science summarizes current inquiry practices for patients who have experienced trauma, violence, and abuse. It places trauma inquiry within an anchoring
framework of trauma-informed care principles, and emphasizes a focus on resilience. It then proposes best practices for trauma inquiry, which include tiered screening starting with broad trauma inquiry, proceeding to risk and safety assessment as indicated, and ending with connection to intervention. Show less