keyword: ptsd

Tips for Discussing Trauma During an Initial Assessment

Introduction

Trauma can increase the risk of health, social, and emotional problems. Despite the high prevalence of patients with a past history of trauma, few clinics or Collaborative Care teams have a protocol for addressing it. These three tips can help clinicians safely and effectively discuss the trauma history of their patients during their initial assessment.

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Discussing Past Trauma with Patients During an Initial Assessment

Many patients with depression have experienced trauma in their lives. Discussing the past traumas in a patient’s life can be tricky due to the risk of re-traumatization or re-triggering the symptoms related to Post-Traumatic Stress Disorder (PTSD). It is also common for the patient to dissociate as a defense mechanism to avoid their past trauma. We have compiled a few tips to help clinicians talk with their patients about past trauma and safely learn their stories during an Initial Assessment.

This is only the beginning of a very complex subject. For more information about caring for patients with trauma history, please read “TIP 57: Trauma-Informed Care in Behavioral Health Services” by SAMHSA.

Tip 1

To prevent re-traumatizing or re-triggering PTSD symptoms, encourage the patient to respond with short, concise descriptions of the trauma.

  • Ask for a 2-3 sentence or <25 word description to get a general sense of the trauma.
  • Be directive and feel free to stop the discussion if you see the patient is having trouble containing their emotions.
  • Normalize the extreme difficulty patients often have when re-telling their stories.

Tip 2

Don’t start with a checklist! Patients often have post-injury concerns and interpret trauma uniquely.

  • Encourage the patient to tell their story in their own words.
  • Ask open-ended questions.
  • Remember, you don’t need all the details to make the diagnosis or treat depression!

Tip 3

If you notice the patient dissociate, work with them to help them get grounded and then educate them on dissociation.

  • A way to help ground the patient is to direct them to engage in their immediate environment.
  • Once they are grounded, educate them on dissociation.

Tips adapted from: Stephens, K., & Bentham, W. (2010, June 17). PTSD in Primary Care. Mental Health Integration Program (MHIP) Webinar.

PCL-5

The PTSD Checklist for DSM-5 (PCL-5) is a 20-item self-report measure that assesses DSM-5 symptoms of PTSD. This measure was developed by staff at the Veterans Affairs (VA) National Center for PTSD. It is free for qualified health professionals and researchers to use.

Post Traumatic Stress Disorder (PTSD) Handout

This tool provides an overview of Post Traumatic Stress Disorder (PTSD), including symptoms, risk factors and treatment options. A Behavioral Health Care Manager can use this handout to supplement a patient’s education about PTSD.