The state of the science on trauma inquiry.

Within the context of longitudinal medical care for adults, health care providers have a unique opportunity to inquire and respond to the traumatic life experiences affecting the health of their patients, as well as a responsibility to minimize retraumatizing these patients during medical encounters. While there is literature on screening women for intimate partner violence, and there is emerging data on pediatric screening for adverse life experiences, there is sparse literature on inquiry of broader trauma histories in adult medical settings. This lack of research on trauma inquiry results in an absence of guidelines for best practices, in turn making it challenging for policy makers, health care providers, and researchers to mitigate the adverse health outcomes caused by traumatic experiences and to provide equitable care to populations that experience a disproportionate burden of trauma. This state of the science summarizes current inquiry practices for patients who have experienced trauma, violence, and abuse. It places trauma inquiry within an anchoring framework of trauma-informed care principles, and emphasizes a focus on resilience. It then proposes best practices for trauma inquiry, which include tiered screening starting with broad trauma inquiry, proceeding to risk and safety assessment as indicated, and ending with connection to interventions.

Engaging the Voice of Patients Affected by Gender-Based Violence: Informing Practice and Policy.

INTRODUCTION: Evidence regarding the benefits, opportunities, and risks associated with providing health care to patients experiencing gender-based violence (GBV) and, moreover, their satisfaction with health care services is sparse. METHOD: Using a patient- and trauma-informed relationship-based framework, survivors of GBV who were referred for follow-up care were asked to participate in a quality improvement (QI) initiative in an effort to understand their perspectives of receiving healthcare services. Patients were asked to answer three open-ended questions in regard to their healthcare experience. Individuals who were eligible for evidence collection after sexual assault (<5 days) were asked two additional questions. RESULTS: Of the 353 women and six men (359) referred to the C.A.R.E. (Coordinated Approach to Recovery and Empowerment) Clinic, 327 patients were contacted. Of the participants, 24% (86) had a mental health diagnosis; 41% (145) reported their incident to the police; 8% (28) had comorbidities of substance abuse, mental health, and/or homelessness; and 33% (118) of the incidents involved alcohol or drugs. Most of the patients stated that they were well cared for and felt safe during their visit. However, many reported "long waits," "disjointed," "chaotic," "too many" providers, "conflicting" and "miss-information," and "confusion" about what to do after their acute care visit. Over half (59%) did not report incident to the police. Some reported regrets with reporting to the police (16%) and regrets in having evidence collection (15%). Of the patients who did not have evidence collected (47), none expressed regret over choosing not to have evidence collected. Five patients with mental health problems were hospitalized within 5 days of their emergency department visit for suicidal thoughts. CONCLUSIONS: A number of opportunities to improve the healthcare response were identified. Patients affected by GBV require an improved coordinated and trauma-informed approach. Explicit consent related to evidence collection is needed. Not all patients who have been sexually assaulted should have evidence collected. More extensive research and program evaluation including outcomes research are warranted.