The immediate impact of traumatic experiences can be devastating. While “time heals” is a popular mantra, traumatic events stay with us and have a lasting effect on our well-being. It’s important for healthcare providers to recognize the presence of past traumatic events and how they may be impacting a patient's health and treatment in present day.
“A trauma-informed approach offers us a way to gain the knowledge and skills needed to promote healing, recovery, and wellness,” states Elizabeth Hillman, Director of Social Work and Care Coordination at Pullman Regional Hospital. “We frequently associate this with adverse childhood experiences, and how those experiences affect us into adulthood.”
Hillman explains the solution isn’t necessarily rooted in understanding or revisiting the past trauma; rather, it’s knowing the trauma existed and is having a negative impact. She provides the examples of patients practicing noncompliance with medications or not following health recommendations to effectively treat chronic illnesses.
“We need to take a step back and wonder what's driving those health behaviors. Not with a judgmental lens, but a lens of, ‘how do we view this whole person and what do we need to do to help them address those health issues?’ There's a reason they're not taking their medicine, that they're not cutting back on sugars, whatever it is that’s driving their illness,” she notes.
Impact of Adverse Childhood Experiences (ACEs)
Adverse childhood experiences, or ACEs, had not been studied until Dr. Vincent Felitti undertook research on the phenomenon between 1995 and 1997, studying 17,000 adults. Dr. Felitti, who was running a bariatric clinic for Kaiser Permanente, was inspired to understand why health behaviors were significantly interfering with patients’ success after bariatric surgery.
Results revealed that 15 percent of patients who were financially stable, well-educated individuals, had two or more ACEs and 10 percent had three or more ACEs. “What we learned is that adverse childhood experiences are common, and they're threatening to well-being. Unfortunately, in our society they're too often denied, which is one reason they have led to such chronic health issues, health risk, disease, and premature death,” explains Hillman.
Traumatic events in childhood are also a major factor underlying addiction. “It's a consequential study; it was done 20 years ago and we are still talking about it—but not acting on it quite in the way we should. We here at Pullman Regional Hospital are trying to change what we're doing with that information and trying to become more proactive,” assures Hillman.
Shocking Statistics Call for a Revolution in Care
In Washington State, the latest comprehensive statistics available (from 2016) reveal 93,000 referrals for child abuse and neglect and nearly 11,000 children in out-of-home placements. Twenty-six percent of adults in the state report having three or more ACEs, which is consistent for Whitman County as well.
“That's a lot of kids and that's a lot of adults. If you have six or more adverse childhood experiences, that makes you 4,000 times more likely to become an IV drug user, 3000 times more likely to attempt suicide, and it reduces life expectancy by up to 20 years,” warns Hillman.
Studies have also linked a greater number of ACEs to heart disease, cancer, chronic lung disease, liver disease, and diabetes. Those with an ACE score of four or more also tend to have higher rates of mental illness.
Community Efforts Driving Change
Traumatic events cannot be completely eliminated, so the strategy is to help mitigate the aftermath. The Whitman County Health Network, which is comprised of a group of agencies including Pullman Regional Hospital, secured grant funding to bring a prevention program to Sunnyside Elementary. This program was focused on training the staff to work with children with behavioral issues. In 2019, additional grant funding was awarded to bring the Strengthening Families Program to the entirety of Whitman County, which is an evidence-based program that improves family functioning and increases resilience within the family.
To help adults in the community better deal with trauma, Pullman is implementing a health coaching program within the hospital and clinic network.
“We believe in interdisciplinary care. We believe that you provide people better care when you have multiple professionals working together to provide that care,” shares Hillman. “We have a nurse and a social worker who are being trained as health coaches and in motivational interviewing to do health coaching with our patients in order to address health behaviors affecting their chronic illnesses. We're training our staff so that all staff can be working with our patients in a way that is proactive, respectful, and engaging them in their own healthcare.”