Practicum Highlight: Laura Ward, MPH’18

Community: Hill Center for Women, a program offering psychiatric and psychological services for women with histories of trauma and related disorders (McLean Hospital, Belmont, MA)

Opportunity: Approximately 20-50% of adults in the primary care settings in the United States report experiencing physical or sexual abuse during childhood, while reports of abuse may run as high as 70% in patients with substance abuse, depression, irritable bowel or chronic pain. Yet, patients with a history of childhood trauma may receive inadequate or incomplete care when trauma history is overlooked or not discussed in a medical setting. A clear understanding of the patient’s perspective and preferences regarding disclosure of childhood trauma is not well studied. Research in this area could lead to more effective screening protocols, treatment plans, and, ultimately, better health outcomes.

“I saw many women come in for treatment without awareness of any connection between their trauma and their physical symptoms,” Ward says. “At the same time, we found the women were infrequently screened for a history of trauma, and past trauma or abuse was rarely talked about in many health care settings.”

However, the women who were able to make a connection not only between their physical symptoms but also their (behaviors related to health conditions) were able to better understand their actions and, ultimately, to make positive changes.

Working with the team from the Dissociative Disorders and Trauma Research Program at McLean, Ward designed a 15-item questionnaire to assess perceived connections between physical health and trauma exposure, experiences of disclosure, and beliefs around stigma reduction and trauma disclosure. 

Among the surprising findings: Survey participants—women with histories of childhood trauma currently in a hospital level of treatment—preferred to be screened and believed screening for a history of trauma was an important part of their medical care. Despite their desire to include trauma as part of their medical exam or history, participants expected the provider to initiate the screen, as they were not likely to self-disclose. They were most comfortable disclosing with physicians, and in the primary care setting, and felt less comfortable disclosing in urgent care or ER settings. Participants pointed to connections between physical symptoms and behaviors, such as, headaches, gastrointestinal issues and substance abuse, they believed were related to past trauma.

Health Impact and Next Steps: 
Ward is working with a primary care physician group at Brigham and Women’s Hospital in Boston and will be making a final report to them in a combined presentation/feedback session later this winter. She hopes to obtain their feedback to help create a more detailed survey that addresses questions of interest to PCPs.

“If we can gain a deeper understanding of what the patient is looking for, we can utilize this information to help inform both the medical and research communities to design even more effective treatments, interventions, and all-around care that aligns with the critically important needs of this patient population,” Ward says.

 

POSTED 1/2/2018 AT 02:37 PM IN #practicum