Key messages:
- Recognizing potential barriers and enablers to implementing trauma-informed care in oral healthcare is essential for providing high-quality, person-centred care and improving client outcomes.
- Oral healthcare providers must respond effectively and compassionately to individuals with a history of psychological trauma while minimizing the risk of retraumatization.
- Future research is needed to further understand client perspectives and how trauma-informed care is best delivered, implemented, and evaluated in oral healthcare settings.
Introduction
Psychological trauma is an emotional response to an event that a person finds extremely stressful and threatening to their safety. This can involve single incidents, such as a car accident, or repeated situations, including domestic violence.
Life events that lead to psychological trauma are common and affect a substantial portion of the global population. By examining the root causes of these adverse experiences, perspectives can shift from viewing trauma as an individual issue to recognizing the need to address the structural barriers that can create or perpetuate trauma.
Psychological trauma can make interactions with others feel threatening, making it difficult for a person to cope in everyday life. This is particularly relevant in oral healthcare settings, where individuals may find themselves in an unfamiliar environment, surrounded by strangers, having their face and mouth touched, and being leaned over in a supine position. These factors can trigger memories of past traumatic experiences, making clients feel unsafe. This discomfort may lead to the re-enactment of prior traumatic events and contribute to the avoidance of oral health appointments, ultimately resulting in poor oral health outcomes.
Objectives
This article examines the barriers and enablers of implementing trauma-informed care in oral healthcare settings and discusses the benefits of adopting this approach.
Staff training
A trauma-informed approach is essential for ensuring that oral healthcare providers possess the necessary skills to support clients with a history of psychological trauma. This requires educating staff about the effects of trauma and implementing organizational changes to reduce the risk of retraumatization. However, a significant challenge in this implementation is staff uncertainty about how to adopt a trauma-informed approach and what it involves. Education on trauma-informed care is often inadequate, highlighting the need to prioritize this training in oral healthcare settings and educational programs.
Training staff is an effective way to create a shared understanding of trauma and support individuals with a history of psychological trauma. This training includes teaching providers how to screen for a history of psychological trauma and promoting awareness of the effects of trauma, such as an increased fear of attending appointments.
Training can help staff identify risks related to vicarious traumatization, which refers to the psychological effects of being exposed to others’ firsthand experiences of trauma. Oral health professionals treat clients from various backgrounds and often with complex needs. Subsequently, they may encounter clients experiencing physical and emotional distress, which can significantly affect their treatment. By receiving training in trauma-informed care, oral health practitioners can better manage these encounters, ensuring they provide compassionate and effective care while also safeguarding their own mental health and well-being.
Structural factors
Numerous trauma-informed care frameworks have been developed to address specific needs and facilitate change in healthcare environments. These approaches can effectively guide staff toward more client-centred responses to distress.
Frameworks such as the Attachment, Self-Regulation, and Competency (ARC) have the potential for implementation in oral healthcare settings. They can assist staff in recognizing and responding to signs of trauma, creating safe environments for appointments, and building trust through collaborative conversations with clients. Implementing such frameworks alongside staff training is essential for fostering a trauma-informed workforce. These measures can ensure high-quality, person-centred care, improve treatment adherence, and help prevent staff burnout. However, there is a need to adapt these frameworks specifically for oral healthcare settings and consider the best strategies for their successful implementation.
One of the challenges in applying a trauma-informed approach is securing sufficient resources for change and allowing adequate time for implementation. It is important to recognize the time constraints during appointments. Therefore, minor adjustments, such as offering choices and asking clients if any modifications are needed to make them feel more comfortable, can enhance trauma-sensitive care.
Leadership
When healthcare professionals work with clients who have a history of trauma, they might be unsure about how to start a conversation about psychological trauma and how to handle the responses that may follow. This uncertainty can also stem from health professionals feeling limited in their ability to provide adequate care due to time constraints. There may also be concerns about unintentionally harming clients during such conversations.
Leaders in organizations who are committed to the change process, set achievable goals, and clearly communicate that trauma-informed care initiatives are a priority are more likely to successfully implement a trauma-informed approach. Effective implementation also requires policy support, adequate resources, training, and continuous ability to evaluate the initiatives in place.
A lack of policy endorsement and transparent leadership can hinder the implementation of trauma-informed services. It is important to provide opportunities for reflecting on practice, incorporate feedback from service users, and ensure access to training to facilitate trauma-informed care. This is crucial in oral healthcare, as investing resources in promoting trauma-informed care encourages individualized care and empowers clients to have control and make informed choices during their treatment.
Summary
As the rates of psychological trauma continue to rise, oral healthcare services must respond effectively and compassionately to individuals with a history of trauma, while minimizing the risk of retraumatization. To achieve high-quality, person-centred oral healthcare, it is essential to understand the barriers and enablers to implementing trauma-informed care and to increase knowledge within the workforce.
Training staff on the impact of psychological trauma and vicarious traumatization can enhance client care and improve the well-being of staff members. However, this improvement requires effective leadership, policy support, resources to facilitate change, and time for implementation. Future research is needed to gain a deeper understanding of client perspectives and to determine effective ways to deliver, implement, and evaluate trauma-informed care in oral healthcare settings.
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