International Society for Traumatic Stress Studies

Integrating Cultural Humility Into Trauma-Informed Pediatric Health Care

09/11/2019
by Patty Davis, LSCSW, LCSW, IMH-III; Briana Woods-Jaeger, PhD; and Amy R. Beck, PhD
In 2010, our children’s hospital formed the Council on Violence Prevention (COVP) with a mission to reduce the impact of violence on patients and their families through coordination and support of existing and future hospital efforts. Recognizing the importance of, and supporting, direct trauma treatment services in pediatric health care was an early success of the Council.  However, health care team members, not wanting to cause unintentional harm to patients and families, recognized how easily this can happen when intervention occurs without knowing patient history. Thus, the concepts of trauma-informed care also became a natural fit for this work.  In 2014, a Trauma-Informed Care workgroup under the COVP was formed, with an understanding that all health care team members, given education and supports, could provide universal trauma-sensitive practices independent of patient and family history.  The hospital model of trauma-informed care includes hospital-wide awareness of the prevalence and effects of traumatic stress, promotion of universal trauma-sensitive practices, and staff awareness of the impact of trauma in their own lives and work accompanied by interventions designed to care for them while they care for others (www.integration.samhsa.gov).​ Our mission is to universally promote trauma-informed care to patients, families and staff by creating a culture of trauma awareness that embeds trauma-informed key principles—safety, trust, choice, collaboration and empowerment, all with a foundation of cultural humility—into policies, procedures and practice.
 
In their seminal paper describing cultural humility, Melanie Tervalon and Jann Murray-García define it as: “a lifelong commitment to self-evaluation and critique, to redressing the power imbalances in the physician-patient dynamic, and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations” (1998, p. 123). We have included a foundation of cultural humility in our trauma-informed care work due to our recognition that we need an intentional and robust framework to ensure we are incorporating diversity, equity and inclusion. Cultural humility as an organizing framework supports specific strategies and tools that pediatric providers can use to address health inequities through clinical practice, research and advocacy. We operationalized cultural humility in our trauma-informed care initiatives through enhancing education about the prevalence and impact of trauma among diverse families, introducing tools that support enhanced communication about diversity in trauma-informed care, and developing opportunities for partnership in institutional advocacy with diverse families.
 
First, we began integrating racial trauma education into our trauma-informed care education offerings. We also began including an experiential tool, the cultural identity inventory (Hyde, 2012), to promote critical self-reflection among hospital employees regarding cultural identity, privilege and bias. Feedback regarding this tool suggests that it has provided an opportunity for thoughtful self-reflection as well as stimulating dialogue among colleagues regarding how cultural identity and bias influences providing health care. Second, we utilized film and storytelling to raise awareness about the value of addressing racial inequities as part of trauma-informed care. In particular, we have facilitated several film screenings of Cracking the Codes: The System of Racial Inequity (Butler, 2012) that included facilitated discussion of how to promote health equity among trauma-exposed children and families served by our institution. Audiences for these screenings have included staff from all areas of the hospital as well as administration, and consistently feedback from these screenings include requests for continued education and dialogue. Third, we have partnered with diverse families to engage in advocacy focused on institutional change to better support diverse trauma-exposed families. This has included inclusion of diverse families on hospital committees focused on hospital data review and systems change and co-presenting with parent advocates during medical education opportunities and events. These presentations have focused on parents sharing their experiences as families of color in our system and providing education on how to apply cultural humility in responding to diverse patient concerns.
 
As we continue to integrate cultural humility into our trauma-informed care work we will focus on education, communication and advocacy in all systems of direct patient care as well as hospital operations. To accomplish this we will work with diverse partners ranging from human resources, administration, providers and diverse patient and families. Our current priority is to continue to build infrastructure and opportunities to gain expert knowledge from diverse patients and families who carry lived experience of traumatic stress related to health care as well as other adverse life experiences. As we provide more opportunities for those with lived experience to inform health care expertise and practice, we hope to witness an increased sense of safety, trust and mutual respect of all who encounter our systems of care.
 

About the Authors:

 
Patty Davis, LSCSW, LCSW, IMH-III, is a licensed clinical social worker and program manager for Trauma Informed Care at Children's Mercy, Kansas City. In this role she is strategically moving the Children’s Mercy healthcare system toward a trauma-informed organization. She has a long history of serving children and families through individual and family therapies focused on preventing and healing traumatic stress. Patty’s interests include serving community-wide efforts focused on reducing the impact of toxic stress and trauma on health and wellbeing.  
Briana Woods-Jaeger, PhD, is an assistant professor in the Behavioral Sciences and Health Education Department at the Emory University Rollins School of Public Health and a licensed clinical psychologist. Her research focuses on partnering with communities to reduce and eliminate health disparities associated with stress and trauma through the development and implementation of trauma-informed, strengths-based interventions.
Amy Beck, Ph.D., is an associate professor and psychologist in the Weight Management Program in the Center for Children’s Healthy Lifestyles & Nutrition at Children’s Mercy Kansas City (CM).  Her professional interests include weight bias/stigma and the clinical implementation of yoga. At CM, Dr. Beck is involved in the Trauma-Informed Care and Youth Peer Violence workgroups under the Council on Violence Prevention, as well as related initiatives under the Equity and Diversity Council, where she is a former chair. 
 

References

 
Butler, S. (2012). Cracking the codes: The system of racial inequity. United States: World Trust Educational Services, Inc.
 
Hyde, C.A. (2012). Challenging ourselves: Critical self-reflection on power and privilege. Community organizing and community building for health and welfare (3rd ed., pp. 428-436). New Brunswick, N.J.: Rutgers University Press.
 
Substance Abuse and Mental Health Services Administration (SAMHSA)--Health Resources and Services Administration (HRSA) Center for Integrated Health Solutions. Trauma-Informed. Retrieved June 26, 2019, from https://www.integration.samhsa.gov/clinical-practice/trauma-informed.
 
Tervalon, M. & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved (9), 2, 117-125.
 

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