Primary care experiences of women with a history of childhood trauma and chronic disease: Trauma-informed care approach

Article Figures & Data

Table 1.

Participant characteristics: N = 26.

CHARACTERISTICS	VALUE^*
Place of birth, %
• Canada	84.6
• Other or no response	15.4
Religion, %
• None identified or agnostic	42.3
• Christian or Catholic	42.3
• Other	15.4
Marital status, %
• Single	11.5
• Common law or married	46.2
• Divorced or separated	42.3
No. of children, %
• 0	19.2
• 1–3	69.2
• > 3	11.5
Education level, %
• Some high school	7.7
• High school diploma	23.1
• Trade or diploma program	15.4
• College degree	30.8
• Undergraduate university degree	15.4
• Graduate university degree	7.7
Employment, %
• Full time	19.2
• Part time	19.2
• Unemployed	15.4
• On ODSP or other disability	38.5
• Retired	19.2
Annual income, %
• < $20 000	46.2
• $20 000–$40 000	15.4
• $40 000–$60 000	3.8
• $60 000–$80 000	11.5
• ≥ $80 000	15.4
• Do not know or do not wish to answer	7.7
Health insurance, %
• No	19.2
• Yes, ODB	34.6
• Yes, private	42.3
• No response	3.8
Living situation, %
• Alone	38.5
• With others	61.5
• Housing adequate for my needs	84.6
• Housing not adequate for my needs	15.4
Mean (range) no. of chronic medical conditions excluding mental health	4.9 (2–19)
ACE score, n
• 5	4
• 6	4
• 7	6
• 8	8
• 9	3
• 10	1

ACE—adverse childhood experience, ODB—Ontario Drug Benefit, ODSP—Ontario Disability Support Program.
↵* Percentages might not add to 100 owing to rounding or because participants were allowed to select more than 1 answer.

Table 2.

Principles of trauma-informed care

PRINCIPLE	APPLYING THE PRINCIPLE
Trauma awareness and acknowledgment	Be aware of the prevalence and effect of trauma on substance use, and physical and mental health, and ensure that all staff members understand how trauma affects life’s experiences Recognize the effect of violence and abuse on a patient’s development and coping strategies Recognize the pervasiveness and long-term effects of violence and abuse
Safety and trustworthiness	Help patients feel they are in a safe place Recognize the need for physical and emotional safety Avoid interventions that might trigger or retraumatize a patient Design services that maximize access and participation by trauma survivors (including flexibility in scheduling) Consider cultural competence with respect to a person’s context (eg, financial instability) and life experiences
Choice, control, and collaboration	Include patients in decisions affecting treatment Develop a collaborative relationship Involve service users when designing and evaluating services
Strengths-based and skills-building care	Support a patient’s empowerment Highlight a patient’s strengths and resilience rather than focusing on symptoms and pathology
Cultural, historical, and gender issues	Incorporate processes that are sensitive to a patient’s culture, ethnicity, and personal and social identity, as well as to his or her experience with trauma associated with group marginalization