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Foundations

Trauma-Informed Care Facts

Many patients have experienced violence, and many never tell their clinicians. That's why trauma-informed care is used with every patient, as a universal precaution, not only with those who disclose.

The Four Rs

The core principles of a trauma-informed approach.

  1. R

    Realize

    how widespread trauma is and how it affects health.

  2. R

    Recognize

    the signs and symptoms of trauma in patients, families, and staff.

  3. R

    Respond

    by building trauma knowledge into policies, procedures, and practice.

  4. R

    Resist re-traumatization

    by actively avoiding practices that repeat harm.

Actions for clinicians, visit by visit

Before the visit

  • Review the chart for documented trauma history so the patient doesn’t have to repeat it.
  • Use what you learn to prepare the room, staff, and plan ahead of time.

During the conversation

  • Sit down, and ask trainees and staff to sit too. It lowers the power imbalance in the room.
  • Offer time alone with you, for example by having staff care for children who came along.
  • Talk about confidentiality at the start.
  • Explain what to expect from the history, the exam, and any procedures.
  • Let the patient know if you’ll be taking notes, and why.
  • Explain why you’re asking sensitive questions, such as about substance use or sexual history.
  • When using an interpreter, ask whether the patient has a gender or cultural preference.

Physical exam

  • Ask whether any part of the exam worries them and what would make it easier.
  • Ask the patient to move their own clothing rather than moving it for them.
  • Ask permission before each part of the exam, for example before moving from heart to lungs.

Sensitive exams & procedures

  • Consider alternatives, such as self-collected swabs instead of a speculum exam.
  • Ask whether they would like a support person in the room.
  • Explain the whole procedure, get consent, and set up all supplies before the patient undresses.
  • Describe what they may hear or feel, like the click of the speculum or cool lubricant.
  • Agree that the patient sets the pace and can signal, in words or gestures, to pause.
  • Offer speculum self-insertion.
  • Suggest instead of instruct: "Some people find a slow breath helpful here" rather than "Relax."
  • Have tissues or wipes ready for afterward.

Imaging & referrals

  • Warn patients ahead of time about imaging that is internal (transvaginal ultrasound), enclosed (MRI), or weighted (lead aprons).
  • With the patient’s permission, share relevant trauma history with referral colleagues so they can prepare.

After the visit

  • Give written after-care instructions and follow-up plans, in case anxiety or dissociation made it hard to take in information.
  • Choose sensitive wording for diagnoses in patient summaries and documentation.

Adapted from Ravi A, Little V. Providing trauma-informed care. Am Fam Physician. 2017;95(10):655–657, and SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach (2014).