Susan’s nurse then relayed the following information to the healthcare team. Susan originally came to New Orleans with a boyfriend who got her a job dancing in a men’s club. She worked more and more hours until her boyfriend introduced her to some of his friends who would pay her for lap dances and give her cocaine to help her “get in the party mood.” At times, the guys would get rough with her and her boyfriend would “slap her around some to show her who’s boss.” There are yellow and brown bruises on the left side of her face, and she has a swollen area and laceration on her upper lip. Susan tells the nurse that she has been drinking heavily and using some drugs that she did not know the name of for about a year, although her story of the events was sketchy. She does not appear intoxicated at this time, but agitated and shaky. Whenever she is asked a question, she looks at her boyfriend before answering. Her reported address is generally described as “staying with a friend who moves a lot.” She has come to the ED with the boyfriend who stands across the room glaring at her. Despite the cold weather, Susan is wearing a lightweight shirt and jeans that seem too large for her, with the belt loops tied up in the back to make the waist smaller. Her clothes seem clean, but the shirt has some old brown stains at the shoulder that may have been blood. She is wearing flip-flops. Susan complains of vaginal bleeding that has not stopped for three weeks and very painful intercourse. Her boyfriend says that she needs a birth control shot to stop the bleeding and some pain pills. She is pale, has a B/P of 130/78, pulse of 100, respirations of 22, and a temperature of 100.8˚F. She has agreed to a gynecological exam.
has left them without control of their lives or bodies and without a sense of safety (Dignity Health, 2019). Healthcare professionals should be aware of the safety protocols specific for their facility, such as which phone numbers to call in case of threats of physical violence. Physical safety is a primary concern for both healthcare providers and patients. More details on creating a safety plan for staff members and patients is provided in the security section of this course. People who are being trafficked often have the best insight into safety threats and risk in their life with the trafficker. While it is important to advocate for their immediate safety and well-being, it is vital to build trust with the patient and integrate their intimate knowledge of the trafficking situation into their safety plan. Healthcare Consideration Professional Consideration: How healthcare providers conduct themselves is also important, especially in the early stages of obtaining information from a potentially trafficked individual. All providers should be nonjudgmental and allow the patient to process and convey his or her history in a safe and contained way (ICMEC, 2019). It may be the first time that the patient explores the fact that he or she has been trafficked, and this acknowledgment has the potential to cause emotional distress and affect the person’s psychological safety. CASE STUDY 3 Susan, a 19-year-old girl, has been living on the street for that past three years since she ran away from her Michigan farm. Her history is reported in fragments, with most of the information told to a nurse who took her to the bathroom.
TRAUMA-INFORMED CARE
understanding of how trauma differs among individuals (see Table 2). Healthcare professionals may frequently feel overextended. It is easy to fall into the trap of making a quick value judgment about patients. Bias may prevent the staff from making a thorough assessment or quickly dismiss any subtle signs. Some providers have only a few seconds to shake hands with a patient and persons accompanying him, make eye contact, and introduce themselves. These few seconds can allow the provider time to recognize not only the physical signs of tremors, sweating, or cold clammy skin but also the emotional effect of fear or anxiety in either the patient or attending person. Rushing to treatment and discharge can have deadly consequences for the patient who faces continued abuse.
Trauma-informed care is a broad approach to treating all patients, many of whom have experienced trauma and its physical, emotional, and social repercussions. This understanding the prevalence of and response to trauma is not a concept unique to caring for people who have been trafficked. Rather, it is a lens to view all people, patients and healthcare professionals, in the healthcare setting. Any individual may have experienced a trauma that is affecting their actions and decisions (National Technical Assistance Center for Children’s Mental Health, 2014). Trauma-informed care emphasizes the wide impact that trauma has on individual’s well-being and empowers survivors of trauma (Dignity Health, 2019; Hemmings et al., 2016) SAMHSA (2014) dissects trauma into the three E’s: event, experience of the event, and effect. Identifying these elements of trauma helps deepen the healthcare provider’s Table 2: Definition and Example of the Three E’s Definition
Example
Event
Either single or recurring circumstances of actual or extreme threat of physical or psychological harm or neglect.
Witnessing violence against others, being sexually violated, verbal abuse and/or threats, etc. For two siblings living in a toxic and abusive environment, one may view the experience as negative, and the other may not. Decreased ability to cope with normal stresses, developing a stress disorder such as PTSD, etc.
Experience The individual's perceptions of the event(s); how he or she labels it, assigns meaning to it, and is affected physically and psychologically by it.
Effect
The results and repercussions of the events, most frequently described as adverse effects, which negatively affect the individual who experienced the traumatic event.
Note : Adapted from Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach. (HHS Publication No. [SMA] 14-4884). Rockville, MD: Substance Abuse and Mental Health Services Administration.
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Book Code: MFL1227
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