Penn Medicine Lancaster General Health is Addressing Childhood Trauma's Long-Lasting Health Impacts

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ADDRESSING CHILDHOOD TRAUMA’S LONG-LASTING HEALTH IMPACTS

Penn Medicine Lancaster General Health works with community partners to provide awareness and resources.

The patient’s troubled medical history finally began to make sense once he revealed a painful childhood secret.

His health challenges, including hospitalization and surgery, began in his teens. As an adult, he experienced a string of failed relationships, struggles with substance abuse, and poorly controlled diabetes.

At times he was so paralyzed by anxiety and depression that he was afraid to leave his house, resulting in many missed medical appointments. He eventually sought care at Penn Medicine Lancaster General Health Physicians Care Connections, a clinic for people who’ve had multiple hospitalizations over a short period of time.

When asked about any possible traumatic events in his past, the patient at first was reluctant to respond. After some gentle prompting, he described attending a family event as a young boy. An older relative took the boy to a location away from the others and sexually abused him.

“My patient, who was now middle-aged, had never disclosed what happened to him,” his physician, Jeffrey R. Martin, MD, said. “As we talked about the secret he had kept since he was a young boy, a picture of the consequences of childhood trauma began to emerge.”

Unfortunately, similar stories are all too common. Childhood trauma — or “adverse childhood experiences” (ACEs) — can cause significant, long-lasting impacts on mental, physical, social, emotional or spiritual well-being. These traumatic events may include abuse or neglect; violence, mental health problems or substance abuse in the home; or instability due to parental separation or incarceration.

LG Health convenes community partners working to prevent and reduce the impact of trauma by increasing awareness and creating more places in the community where trauma survivors can feel safe, valued, and empowered. The health system’s efforts include offering training for medical providers and other community members.

Recognizing and supporting survivors is an issue of growing concern for many communities across the United States. In a recent Centers for Disease Control-Kaiser Permanente study, nearly two-thirds of respondents reported at least one adverse childhood experience, while more than 20 percent reported three or more.

Martin, Chair of the Department of Family & Community Medicine at Lancaster General Hospital, said medical experts recognize the well-established connection between childhood trauma and both risky health behaviors and chronic health conditions in adulthood.

“Individuals who have experienced more than four ACEs are at a significantly higher risk for seven of the top 10 leading causes of death, including heart disease, diabetes, emphysema, and suicide,” he said. “Those with six or more ACEs have a life expectancy on average nearly 20 years less than those without ACEs.”

RECOGNIZING AND RESPONDING TO THE LASTING IMPACTS OF TRAUMA

Trauma can affect survivors in many different ways, with lasting adverse impacts that range from difficulty trusting others to irritability, anxiety, depression, and substance abuse. These effects may not surface until well into adulthood, and many survivors carry the burden alone in silence for years.

To offer survivors more supportive services both in health care and across a variety of community settings, LG Health collaborates with many community partners to raise awareness of the pervasiveness of trauma and its impact on those who have experienced it. LG Health and its partners work together to provide education and training, as well as implement sustainable changes to policies and systems in order to support trauma-informed care.

Mary Dorman, a health promotion specialist at LG Health, said completing a training can help individuals and organizations to better understand trauma, how it affects survivors, and how to best respond. In particular, understanding the impacts of trauma can help medical providers gain greater insight into their patients’ experiences and needs, while building a stronger therapeutic rapport and connection.

Many survivors of trauma may be less likely to seek care due to fear and anxiety, she said. An invasive medical procedure could be especially traumatizing for those patients.

“A provider may have a patient who doesn’t show up for appointments,” she said. “By learning more about a trauma-informed approach to care, you learn to shift your perspective from ‘What’s wrong with them?’ to ‘What happened to them?’’’

Since one in eight Pennsylvanians has experienced four or more ACEs, it makes sense to take a “universal precautions” approach when caring for patients, Dorman said. In addition, it’s important to note that ACEs do not paint the full picture. Research shows that positive childhood experiences (PCEs) can provide protection against adversity.

LG Health encourages medical providers, as well as anyone in the community who interacts with individuals and families who may have experienced trauma, to take the free virtual training course, “Understanding Trauma, Resilience and Trauma Informed Care.” The self-paced course includes four one-hour modules that can be accessed anytime, from any location.

To date, more than 7,000 health care and behavioral health providers, first responders, law enforcement and criminal justice professionals, educators, community volunteers, and others have completed the training, Dorman said. Community members can access the training at pacesconnection.com/g/lancaster-county-pa-aces-and-resilience-connection; medical professionals can find specific instructions on the page.

In addition to completing a training, medical professionals can provide more trauma-informed care by assessing their practice environment and making fairly simple modifications to ensure that patients and staff feel both physically and psychologically safe, she said. For example, people who have survived trauma will likely feel more comfortable in an environment that is serene and calming, instead of a cluttered and chaotic waiting room.

LG Health also has specially trained staff members in place in a variety of settings to care for patients who have experienced trauma, including the Emergency Department and Seraph-McSparren Pediatric Inpatient Center at Lancaster General Hospital, as well as Labor & Delivery at Women & Babies Hospital.

“With awareness, knowledge and the right tools, we can create a supportive and safe community for everyone,” Dorman said. “This is a sensitive and challenging issue, but our shared success is necessary to ensure the health, well-being, and resilience of our community now and for future generations.”