10 Easy Ways You Can Make Your Pediatric Practice More Trauma-Informed

Relatively minor alterations in your practice can help you facilitate a trauma-informed approach. Small adjustments may have a major impact on the health care experience of patients with a history of trafficking and exploitation and those at risk.

1. Ensure that intake and other patient forms are gender-neutral and translated into languages commonly used by your patients.
2. Create signage to welcome LGBTQ+1 patients, children with disabilities and those from minority cultures or groups.  An example of this includes creating a sign indicating that the bathroom is gender-neutral or including magazines written in non-English languages.
3. Ensure that conversations in which staff obtain sensitive information from the patient or caregiver are conducted in quiet, private places, where there is limited opportunity for disruption.
4. Establish a clinical practice for separating an older pediatric patient from the caregiver, enabling a private conversation with the youth.  An established procedure makes the process much easier to use, and clearly indicates to families that they are not being singled out for special treatment.
5. To ensure transparency and encourage shared decision-making, remind all staff interacting with patients and caregivers to explain the reasons behind each step of the medical visit (e.g. asking sensitive questions, taking vital signs, ordering urine or blood testing).  Ask if the patient/caregiver have questions; and seek assent/consent whenever possible.  Exceptions to this include providing confidential reproductive services to an adolescent without parental consent, or forgoing consent in a medical emergency.   The process should be repeated for each step of the medical visit.  This ensures truly informed consent and empowers traumatized patients to take some control over their experience.
6. Offer the traumatized patient as much choice and control as possible during the visit.  For example, you may want to ask if the patient wants to sit on the bed or the chair while you take your history; if they want to hold the stethoscope while you listen; if they want an extra blanket.  You cannot offer choices when you are mandated to take a certain action (e.g. report suspected child trafficking to authorities), but whenever possible seek and respect the patient’s opinion and obtain permission; encourage patient involvement in decisions.
7. Always use a professional, qualified interpreter; do not use family members or companions to help translate during the visit.  If a child or youth is being exploited by the person accompanying them to the visit, it may be dangerous to include that person when you attempt to obtain information from your patient.
8. When discussing referrals for additional services (e.g. peer support groups, anti-trafficking victim services), begin by asking the patient what they think would work best for them.  Listen to their ideas and ask about their concerns.  Then you can offer to give some suggestions if the child/youth is interested.  Discuss the pro’s and con’s of each idea.  Encourage the patient to play an active role in the safety planning and referral process. 
9. When you are mandated to make a report of suspected abuse/exploitation/trafficking to authorities, explain this carefully to the patient, including why you need to make the report and emphasize your desire to help and support the patient through the process.  Offer choices as you are able.  For example, you may want to say, 
   
   “The things happening in your life have made me very concerned about you and your safety.  I’m worried that others may be taking advantage and harming you, or may harm you in the future.  Because I’m worried about your health and well-being, I will need to call authorities so that they can provide some help.  This means, I’ll need to call the local police, and also child protective services.  Neither you nor I have a choice in this part of the process, because there is a law mandating that I do this.  But we can control other parts of the process.  Let’s talk about how we are going to make the report.  Would you like me to go to another room and call authorities while you use the i-pad in here?  Or would you like me to make the call in here?  Would you like me to use the speaker phone so you can talk with them, as well?  That way you can make sure they understand.”

10. Use the information you’ve gleaned from your patient history and other sources to determine possible resources and referrals for the child/youth and family.  These may include local or national support organizations for LGBTQ+ youth, refugee organizations, food banks, homeless and intimate partner shelters, or anticipatory guidance regarding reproductive health and maintaining healthy relationships.  Have a ready list of community and national resources that address common vulnerabilities in your patient population, especially those experiencing violence or other trauma.  The National Human Trafficking Resource Center (1-888-373-7888); text: BeFree) provides 24/7 services and resources to providers, victims and the public.