Health Access Equity Unit, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.
Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.
J Gen Intern Med. 2019 Jun;34(6):1048-1052. doi: 10.1007/s11606-018-4783-1. Epub 2019 Mar 25.
Trauma is pervasive in the USA, but disproportionately present in individuals and communities burdened by poverty, violence, and exposure to the criminal justice system. Engagement in clinical care, especially community-based primary care, is particularly important in the immediate period following community reentry from incarceration, where opportunities to engage clients in services are essential for improved health and reduced recidivism. Trauma-informed care offers an important and innovative opportunity for healthcare systems and primary care providers to improve quality of care and the patient experience, thereby increasing longitudinal engagement of marginalized and hard-to-reach patient populations like persons with criminal justice system exposure. Trauma-informed care implementation includes educating providers and transforming practices to incorporate safety, trust, peer support, collaboration, empowerment, and cultural perspectives into everyday operations and care delivery. While comprehensive trauma-informed care involves transformation on a system level, trauma-informed approaches can also be adopted by the individual provider to improve the clinical consultation. By recognizing the role of trauma and its impact on an individual's physical, emotional, and behavioral health, providers and clients can build mutual trust, focus on individual growth, and begin to foster healing.
在美国,创伤普遍存在,但在贫困、暴力和接触刑事司法系统的个人和社区中尤为突出。参与临床护理,特别是社区基层医疗保健,在社区重新融入监禁后立即接触客户的机会至关重要,这对于改善健康状况和减少累犯至关重要。创伤知情护理为医疗保健系统和基层医疗保健提供者提供了一个重要的创新机会,可以提高护理质量和患者体验,从而增加边缘化和难以接触的患者群体(如接触过刑事司法系统的人)的长期参与度。创伤知情护理的实施包括教育提供者并改变实践,将安全、信任、同伴支持、协作、赋权和文化视角纳入日常运营和护理服务中。虽然全面的创伤知情护理涉及系统层面的变革,但个人提供者也可以采用创伤知情方法来改善临床咨询。通过认识到创伤的作用及其对个人身体、情感和行为健康的影响,提供者和客户可以建立相互信任、关注个人成长,并开始促进康复。