Meeting Survivors Where They Are: The Vital Role of Trauma-Informed and Competent Clinicians in Primary Care

For adult survivors of adverse childhood experiences, primary care is the entryway to treatment of post-traumatic stress disorder (PTSD). It is estimated 25% of adult primary care patients have PTSD, and they present to their provider more often with pain and non-specific physical symptoms rather than mental health issues. Physicians, even those somewhat knowledgeable about trauma and PTSD, are unlikely to assess for it in order to avoid issues they may not have the time and/or skills to sufficiently address. This is due to PTSD treatment not being a core training competency in graduate-level education and professional training being timely and expensive. Usual care for PTSD consists of medication to manage symptoms and a referral to a mental health clinician. However, substantial disparities and patient, provider, and delivery system-level barriers means survivors are unlikely to follow-through with referrals nor receive adequate treatment when they do. In this theoretical article, we review the trials and tribulations experienced by research teams and argue what is lacking is trauma-informed care. None of the trials reviewed mentioned trauma-informed care as a component of their intervention nor as a recommendation for future studies. We also outline a host of recommendations for best practice protocols that benefit patients and the collaborative care teams meeting them where they are. Trauma-informed care deepens the focus on relational, physiological, and physical safety. Attention to soothing physiological arousal through the physician-patient-clinician triad creates more positive associations toward moving forward in treatment for survivors and providers.