Study outlines principles for delivering trauma-informed virtual care

The COVID-19 pandemic has prompted a rapid expansion of telehealth use in the U.S. While articles have been published on telehealth and best practices for patient-centered communication during the crisis, none have focused on applying principles of trauma-informed care until now.

COVID-19 is traumatizing for many and has a disproportionate impact on those who have prior trauma exposure and mental health conditions. Catastrophic events, such as natural disasters and pandemics, may serve as both newly traumatic and as potential triggers for survivors who have endured prior trauma. Social distancing serves to protect communities, but may amplify isolation and danger in abusive relationships or exacerbate underlying mental illness.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed six principles of trauma-informed care: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice and choice, and sensitivity to cultural, historical and gender issues. Researchers from Boston University School of Medicine (BUSM) describe ways in which these concepts can be used during telehealth encounters in primary care and other specialties to help mitigate the isolating, traumatic effects of COVID-19.

The researchers, experienced primary care and mental health clinicians at the Veteran's Health Administration, share their experience with telehealth and discuss the case for applying the principles of trauma-informed care to all telehealth encounters. Their article takes a practical, skills-based approach including a case study.

Trauma-informed care is a global, "universal precautions" approach to providing quality care that can be applied to all aspects of healthcare and to all patients."

Megan R. Gerber, MD, MPH, corresponding author, medical director of women's health at VA Boston Healthcare System

According to the researchers, trauma-informed virtual care during the COVID-19 pandemic has the potential to ensure and even expand continuity of medical care, offer connection and support to trauma survivors, and enhance patient and clinician resilience in this time of need. "Clinicians have a unique opportunity during this pandemic to apply trauma-informed care principles early on and to envision how telehealth may contribute to a more meaningful care experience for all and a more equitable future for those we care for," said Gerber, associate professor of medicine at BUSM.

The researchers believe it is critical for clinicians to be mindful that the public health approach to the pandemic may actually result in trauma and retraumatization for patients, which in turn can impact both access and response to care. "Because trauma may be unseen, unmeasured and unnamed, it is important to deliver all medical care with sensitivity to its potential presence. All clinicians have a unique opportunity in the setting of COVID-19 to apply a trauma-informed lens to our telehealth encounters which may promote connection, equity and healing-centered engagement in care."