Trauma-Informed Health Care Practice in the Adolescent Well Visit

Primary care is well positioned to address trauma within the adolescent visit given the impact on health that trauma presents. Trauma not only predisposes adolescents to health consequences in adulthood but mitigates neurobiological functioning which impacts emotional and behavioral functioning.(37) Trauma is likely to occur amongst children who experience adverse social determinants of health such as housing instability, less food access, and racism and discrimination. Trauma-informed practices are an optimal way to engage with adolescents and their families to address these needs. However, barriers to utilization of TIC may include a lack of awareness of the tools needed to implement this approach and concerns regarding the possibility of retraumatization. Tools can include strategies for integrating a trauma-informed approach to the physical examination, mental health screening tools that address trauma, and ways to integrate trauma-informed systems by addressing staff well-being. Approaching TIC from the framework of universal precautions is an effective tool in which trauma-informed systems can approach all patients. In this way, policies and practices within a clinic are designed with an eye toward trauma. For example, screening for trauma may not occur at the initial visit but may occur as rapport is built and is couched in terms of understanding the needs that the family may have. Addressing trauma throughout the course of clinical care will, in the long run, save time within the patient's course of treatment. Universal precautions can also be a meaningful approach because the ubiquity of trauma makes it such that we cannot make assumptions about a person's likelihood of exposure based on gender, socioeconomic status, or other dimension of identity. We recognize that historically minoritized and marginalized individuals experience racial traumatization at other intersectionalities. Because of this reality, TIC supports equitable treatment in an inequitable health care landscape. Racism impacts the health of adolescents and staff members. Attention to the role of racial equity is a key component to TIC. Trauma-informed care practices not only serve to promote person-centered care, but they serve to avoid retraumatizing adolescents in the health care setting by promoting cultural humility and patient-centered care. Trauma- informed systems recognize the importance of attending to the health care environment which is critical for clinician and staff well-being. Trauma-informed systems benefit patients, physicians, APPs, and all those individuals who interact with patients. Medicine has embarked on a new era of understanding the role of structural determinants on health outcomes and is no longer only focusing on individuals and individual behavior when understanding health outcomes. TIC practices promote that notion by understanding that an individual's experience is an important determinant in their health outcomes and providers support this by utilizing trauma-informed care.