The COVID-19 pandemic has affected the medical system in ways few individuals could have predicted. This healthcare crisis has tremendously impacted the ways upon which patients and providers interact with each other. In the context of trauma-informed care (TIC) health practices, these challenges are especially pressing. TIC practices are particularly necessary for patients of color, and some providers of color often seek to implement these services with their patients, especially those from marginalized populations.
TIC is an approach that takes into account any possible trauma a patient may have faced in order to provide them with affirmative care that puts them in charge of their health care. According to Dr. James Rodriguez Ph.D, at New York University’s McSilver Institute for Poverty Policy and Research, it is important to distinguish between trauma treatment and TIC. Trauma treatment directly deals with the trauma that individuals have faced. TIC is a more comprehensive approach. Dr. Divya Chhabra, a psychiatrist in New York, describes TIC as based in compassion, kindness, and thinking of individuals as humans when providing treatment. According to Chhabra, examples of TIC practices include physicians asking patients for permission to talk about topics, offering a sense of control to patients in the clinical environment, and being mindful of systemic factors they may have experienced that could affect how they respond to and perceive health care. Historically and presently, the medical community has been exploitative and condescending to people of color. People of color often speak of negative experiences with the medical system, so providers of color who practice TIC seek to mitigate those fears and avoid re-traumatizing patients.
The COVID-19 pandemic has given rise to factors that have increased the trauma faced by marginalized populations. Factors such as disproportionately higher rates of COVID-19-related unemployment and death have particularly affected individuals of marginalized backgrounds. According to Rodriguez, everyone is exposed to this disaster in some way, but vulnerable groups are likely to feel the impacts of the pandemic more deeply than others. People from disempowered racial groups, particularly those who are low income, have historically borne the brunt of most systemic stressors, and COVID-19 is just intensifying that.
There has been an uptick in forms of physical trauma perpetuated against individuals since the pandemic started. One particular example is the increase of women experiencing trauma from domestic violence. Domestic violence against women of color is already particularly high, and COVID-19 has made it even worse. Maria Cardenas, a nurse practitioner based in New Mexico, works at the only Level 1 trauma center in her state. A level 1 trauma center is dedicated to caring for victims who have experienced the most debilitating kinds of traumatic events. Since the beginning of COVID-19, her center has seen a massive increase in women from all over her state presenting as victims of serious forms of domestic assault.
With the advent of COVID-19, TIC practices have been harder to implement in certain healthcare scenarios. Cardenas believes that the COVID-19 pandemic has created “a bigger barrier between providers and patients” than was seen in healthcare settings before the pandemic, primarily due to physical limitations in patient to provider interactions that have been put into place. Because providers are advised not to get too physically close to patients and to spend less time than normal with them, many of the TIC practices have had to be adjusted. According to Cardenas, TIC practices are much harder to enact when you cannot sit next to a patient, or face them at an eye-to-eye level, or even hold their hand if they want. Patients are often no longer allowed to bring family members to their rooms as well.
While COVID-19 has created challenging barriers, many practitioners have found ways to still implement and integrate TIC into their limited options, finding ways to still transmit affirming and empathetic care, even during this incredibly distant time in medicine. Telehealth, which has surged during the pandemic, is a great conduit for providers to practice TIC with patients.
While telehealth does have its drawbacks, providers have shown that TIC can still be offered through phone calls and video screens. During the pandemic, many non-emergency physicians have turned to telehealth to avoid forcing patients to come into clinical spaces where they may be vulnerable to infection. While this has affected some of the TIC strategies that rely on person-to-person interaction, it has not completely negated the process. A considerable part of TIC is figuring out what kind of medical practices are most comfortable and affirmative for the patients. Chhabra has found that in her practice, certain patients actually feel more comfortable with telehealth services and feel less vulnerable when speaking over the phone or video chat.
Rodriguez agrees that certain patients may feel more comfortable in telehealth settings and that a major concern now is how to mitigate other challenges in providing TIC as a telehealth service. Providers are figuring out how to establish privacy and confidentiality for patients who may be speaking in tense situations, like domestic violence patients. Providers are also exploring how to be able to quickly respond from a physically distant location to patients who speak of suicidal ideation or harming themselves.
There are still obstacles in providing in-person TIC, but providers are still finding ways to navigate them as well. One example of this are clinics extending hours and options to patients in light of systemic COVID-19 restrictions placed on individuals. Cardenas also works part-time at an abortion clinic in New Mexico. Due to repressions of states like Texas regarding abortion services during COVID-19, the clinic she works at increased their capacity to accommodate women driving from out of town states to receive abortion services.
Despite the new challenges presented by COVID-19, TIC practitioners are responding by fine-tuning and integrating these practices to adapt to the newly placed medical restrictions. The mass exposure and increase in trauma individuals are experiencing during the pandemic has in fact made TIC even more necessary for the future of medicine.
Tiffany Onyejiaka is a writer and health worker based in the Washington, D.C., area. She is a 2017 graduate of Johns Hopkins University where she majored in public health, Africana studies, and natural sciences. Onyejiaka is interested in exploring the way health and society connect, particularly how health affects this country’s most disempowered demographics. She is also passionate about helping to craft dynamic social justice and change in her local community.