Taking a Trauma-Informed History

Since everyone is a trauma survivor, it behooves professionals who work with the public to change their approach when it comes to gathering information about their clients. "Trauma-informed" means using a compassionate approach that recognizes trauma is widespread and can look or feel different for different people. A trauma-informed approach can be used for systems, program, or within organizations. They should be the expectation, not the exception to the rule. But where do you start?

A good place to begin is the client intake which usually involves forms and an in-person conversation. Past trauma often includes abuse and abuse is about power and control. So as someone more powerful than your client or patient, do whatever you can to offer power back to the client or patient. Before a new client even arrives at your office, make sure she knows that your intake forms are available on your website. This helps clients mentally prepare for the questions they will be asked and allows them to take their time to write in answers that may feel triggering. 

When you meet in person, start by asking ask what they prefer to be called, including the pronoun they use. Don't make assumptions, even if it feels safe or obvious. Is it Ms. Johnson or Elizabeth? Conversations about past abuse or other important medical history can go more smoothly if you establish trust early on. Using the preferred name and pronoun helps establish that trust. 

Next, acknowledge the difficult content early on in your meeting. Here is some sample language: 

“Some of this conversation may seem a bit personal. Because violence is so common, I want to make sure that I do everything I can to help patients who have experienced violence or are experiencing violence. So I’ve started to ask everyone the same things."

At this point, pause and look for acknowledgment from the client before proceeding. If they seem uncertain, ask if they want to ask a question or share a concern. Allow more time than you are comfortable with for their response. When this disclaimer is out of the way, allow the patient to lead the conversation about past medical history (or whatever is relevant for your field), whenever possible. Make sure you always tell clients upfront, “we can stop at any time," (a question, procedure or conversation) and "you never have to answer anything I'm asking,".

All of this is trauma-informed. You are showing that you recognize the person in front of you could be a past trauma survivor and are taking care to avoid re-traumatizing her as well as allowing her to guide her own health care choices. This kind of care is not only the "right" thing to do but as I've mentioned above, goes a long way to developing trust. A trauma-informed approach will also help ensure that the person in front of you won't become another disappearing or consistent no-show client, thus saving your office both time and money.  Remember that literacy level, cultural background and primary language will all impact your trauma-informed conversation and the level of understanding at which your client understands you and you, them.

What are your challenges in establishing a trauma-informed approach in your work? Leave me a comment below. Thanks for reading. And if you liked this piece, tap the heart below.