Implementing Trauma-Informed Care in Primary Medical Settings: Evidence-Based Rationale and Approaches

ABSTRACT

Chronic stress stemming from trauma exposure and posttraumatic stress disorder (PTSD) leads to many health problems that are typically seen by primary care providers. Unfortunately, providers rarely identify trauma as the root cause of patient difficulties. The present paper provides an evidence-based rationale for implementing trauma-informed care principles and processes into medical primary care systems. Beginning with a review of prevalence of trauma exposure and PTSD in primary care clinics, this article elucidates relationships between trauma exposure and behavioral and medical health problems, as well as clinical and physiological pathways that lead from trauma exposure to illness. The article concludes with exposition of trauma-informed interventions that can be implemented in primary care clinics, and discussion of future directions.     

Maternal reports of adaptive behaviours in young children: urban–rural and gender comparisons in Italy and United States

We compared how 182 Italian and US American urban and rural firstborn 20‐month‐old girls and boys cope with the demands of their environment through their adaptive behaviours in everyday activities. Using the Vineland Adaptive Behaviour Scales, we collected maternal reports of children's communication, daily living, socialization, and motor skills. Three sets of main effects (and no interactions) emerged. With respect to country, Italian children scored higher than US American children in adaptive communication and motor skills. With respect to region, urban children showed higher adaptive motor skills than rural children, and rural children showed higher adaptive daily living skills than urban children. Finally, with respect to gender, girls scored higher on an adaptive behaviour composite as well as adaptive communication skills, but boys higher in adaptive motor skills. We set these country, region, and gender main effects in the context of a discussion of developing adaptive behaviours in young children. Copyright © 2005 John Wiley & Sons, Ltd.