Many patients have experienced some form of trauma, which can have lasting adverse effects on physical and mental health. Adopting a trauma-informed care (TIC) approach is integral to improving health outcomes and creating better patient-provider relationships. 

“Trauma-informed care is really about creating a space where every person, including people who have experienced trauma, feel safe, feel included, and feel understood as a whole person,” says Stephanie Hargrove, PhD, clinical psychologist and assistant professor at Duke. A comprehensive approach must include making changes at all levels within a health care practice, including nonclinical staff, who have significant interactions with patients and are critical to ensuring patients feel safe. 

Below, Hargrove shares tips, based on six core principles of TIC developed by the Substance Abuse and Mental Health Services Administration, for how providers can incorporate TIC into their organization’s clinical practices and policies. 

1. Safety
Creating a safe environment begins in the waiting area. A respectful and welcoming environment might feature a rainbow flag denoting the clinic is proud to serve the LGBTQ+ community, with literature and signage available in multiple languages, as well as accessibility options for patients with disabilities. 

2. Trustworthiness and transparency
“Give clear directions of where people should go and who they should talk to,” Hargrove says. “Make it so that patients know what’s happening and feel they have a choice in what’s going on.” Explain to patients what to expect before, during, and after the exam. 

3. Collaboration and mutuality
Ensure patients feel they are part of the decision-making process. “Inviting patients to ask questions, and asking questions to learn about what they’ve already tried to do to address their health issues balances out the power dynamic between providers and patient,” Hargrove says.

4. Empowerment and choice
Inform patients that everything that happens during an exam is within their control, and they can consent and opt out at any time. Offer alternatives if they feel uncomfortable with some treatment options, and allow patients to tell you what makes them comfortable. 

5. Cultural, historical, and gender issues
“People coming from diverse backgrounds might have had traumatic experiences in hospital systems,” Hargrove says. Patients may need more support when interacting with health care systems that have historically harmed people from similar backgrounds. Including a family member in the visit might help patients feel more comfortable.