Recognizing Trauma in Your Clients

How do I recognize if trauma is playing a part in the behavioral health concerns my patients are experiencing?

First, it is essential to understand the degree to which trauma has permeated our culture.

Consider the following statistics from the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA):

• Experts estimate that about 60% of men and 50% of women will experience at least one traumatic event in their lives.
• The lifetime prevalence for sexual violence is about 50% for women and 20% for men.
• About 25% of women and 14% of men will endure severe physical violence by an intimate partner at least once in their lives.
• About 19% of men and 15% of women will survive at least one natural disaster.

Among certain populations, especially those who may need treatment for mental and/or behavioral health issues, the prevalence of trauma is much more common. The National Association of State Mental Health Program Directors has reported the following:

• More than 90% of men and women who received publicly funded behavioral healthcare have a history of trauma. Most of these individuals have endured multiple traumatic events.
• About 75% of adults who receive treatment for substance abuse and addiction have a history of trauma.
• Virtually every homeless woman who struggles with mental illness has experienced physical and/or sexual abuse. About 87% of these women report having experienced this type of trauma both during childhood and as adults.

Statistics of trauma

Of course, trauma is hardly limited to individuals who live in the United States. Data collected by the World Health Consortium, which included information on 68,000 adults from 24 countries, revealed that more than 70% of individuals who were studied had experienced at least one type of trauma.

In addition to appreciating the likelihood that your client or patient has experienced trauma, it is also important to understand their risk for suffering long-term negative effects. Most people who experience trauma will not struggle with ongoing impairment as a result. However, for some trauma survivors, the experience can have a catastrophic ongoing impact on their health and well-being.

Possible causes of trauma

The CDC reports that the following factors can significantly influence a person’s risk for trauma-related problems:

• Being in close proximity to the traumatic event. Closer exposure correlates to a greater likelihood of negative effects.
• Experiencing multiple stressors, or an accumulation of stressors over time.
• Having prior exposure to trauma.
• Living with chronic physical illness and/or psychological disorders.

Screening for trauma in clients

Finally, identifying the role that trauma may be playing is a matter of effective universal screening. SAMHSA recommends the following:

• Ask all patients about personal history of trauma.
• Use a valid instrument, such as the Adverse Childhood Experiences (ACEs) questionnaire.
• Screen all patients with a history of trauma for suicidal thoughts and behaviors.
• Do not require patients to provide detailed descriptions of past traumatic experiences during the screening process.
• Address the connection between past trauma and current behavioral/psychological struggles.
• Discuss with the patient how these trauma-related findings will be incorporated into their treatment.
• Ensure that the patient is safe, and has necessary social and emotional support, prior to the end of the screening session.

How do I decide the best program to refer my patients to if what they need is outside of my scope?

Treating patients whose behavioral healthcare needs are influenced by a history of trauma can be a complex endeavor. SAMHSA advises that a trauma-informed treatment environment should accomplish the following objectives:

• Meeting the patient’s needs in a safe, collaborative, and compassionate manner
• Ensuring that no treatment practices will re-traumatize the patient
• Building on the strengths and resilience of the patient in the context of their environments and communities
• Endorsing trauma-informed principles through support, consultation, and supervision

Depending upon the nature of your practice and the scope of your services, you may determine that a referral is in the best interest of your patient. Once you have made such a decision, the Treatment Placement Specialists (TPS) team can help.

When you contact TPS, we will make sure to ask all the necessary questions to we gain a thorough understanding of your patient’s needs and preferences. Our team will then conduct all necessary research, and will provide you with carefully vetted placement options for your patient.

Throughout this entire process, our goals will be to identify optimal placement recommendations for your patient, and to ensure that you are free to focus on your practice. We will provide you with the answers you are seeking, and you and your patient will decide which actions to take based upon the information we provide.