Trauma informed care in dental practice Lecture 3 Flashcards
What is trauma based on DSM V definition?
Person has been exposed to traumatic event where they confront death or threatened by death or injury or physical integrity.
What are some forms of trauma?
-Accidents, war, sexual absue, elders abuse, community violence, natural disasters, childhood sexual abuse… etc.
What is toxic stress?
Strong frequent and prolonged adversity particualry as a child.
- absence of support
- neglect , abuse, homelessness discrimination and care giver mental illness.
What is PTSD?
- Reliving the event
- Avoiding situational reminders
- increase in negative beliefs in yourself and the world
- Feeling hyperaroused
Can trauma be consensual?
no usually victim is discomfort fear, feels intimidated and bodily integrity
What are the stats of sexual abuse?
18% of women and 1.5% of men but its vastly underreported.
What is child abuse?
What are the stats of death due to child abuse?
What are the implications on childs future?
-Failure of parent or care taker which results in death, harm or abuse or exploitation.
- More than 5 kids a day die of abuse
- 80% of children experiencing abuse are under the age of 4
- Make people more vulnerable for future abuse
- 1/4 girls and 1/6 boys
What is intimate partner violence? what are the implications for men? for women?
- Violent confrontation between family or household members results in sexual or physical violence or just the fear of being violated.
- Spouses, former spouses, blood related
- Men who witness their parent being abuse are 2x as likely to be abusive
- more than 3 women a day are muredered by husband or boyfriend.
- Girls who have witnessed abusive violence are more likely to stay in abusive relationships
more than 50% of batters abuse their children too.
What is elder abuse?
-Intentional act to harm or failure to act by care giver to protect the elder.
Can be: -physical -Sexual -emotional -financial or material -neglect 1/10 report elder abuse
-under reported only about 1/14 is reported.
Adults in elders homes with dementia are most vulnerable.
What is combat trauma? what are the stats>
violence due to war
about 7% of US population are victims.
-Military sexual harassment among female vets.
What are the stats behind community and firearm violence?
about 12K firearms homicides/ year.
-US is 5% of worlds population but 30% of worlds mass shootings.
-CDC reports death due to fire arms is now equal to leading cause of none medical deaths.
Toxic stress as an issue in public health. What are the implications of trauma and toxic stress?
o Toxic stress in community (violence, substance abuse, incarceration, homelessness)–> childhood traumatic stress (poverty, abuse, neglect) –>adult traumatic stress (assault, domestic violence)
What is the immediate aftermath of trauma?
- Psychological: disblief, shame, guilt, anger and confusion
- Physical–> apetite sleep changes and body aches
-Behavioral: difficulty trusting, can lead to substance abuse.
What are the prevelance stats of PTSD?
60% of women experience it and 50% of men.
about 7-8 % of population will experience PTSD.
Most people who experience trauma will not experience PTSD.
More women than men experience PTSD
What are the biological aspects of PTSD?
- Amygdala responds to fear
- Hypothalmus is activated.
- SNS stimulates fight or flight
AS a result sharper vision, more oxygen and more energy to body.
Amygdala (senses threat)-> hypothalamus (releases corticotropin releasing hormone) ->pituitary (releases adrenocorticotropic releasing hormone)-> adrenal cortex (releases glucocorticoids including cortisol)
What is the neurpphysiology of stress?
- Our body usually responds to stress in short term discrete threats/
- PTSD individuals will tend to generalize this fear.
- Amygdala fails to discern safe from dangerous.
- Chronic Hypertension leads to cardiovascular issues.
- Chronic increase of glucose levels will lead to insulin resistance and insulin overproduction.
In terms of physical health aspects to trauma, how do people cope?
- Over eat, abuse alcohol, drug use, High risk sex.
- Develop chronic pains, GI disorders,
- Multiple trauma associated with high disease burden
What is an ACE?
Adverse childhood experience.
- Growing up with these conditions prior to 18.
- Recurrent physical abuse
- alcohol abuser
- Incarcerated household member
- Emotional or physical neglect
ACE leads to early death
What is the summary traumatic event?
Trauma leads to behavioral and neurpsychological changes that will result in adverse health outcomes.
PTSD survivors are more likely to utulize medical service. it actually a predictor of medical service utulizatatuin.
LESS LIKELY THO to go for prevenative care such as hygiene appointments, or mammograms or screenings.
Why do trauma survivers have dental anxiety?
- Have to lie down
- Objects in the mouth
- Dentists hands on face
- Fear of not being able to breath or swallow
- Fear of gagging or feeling sick
- Worry of dentist getting angry
What is trauma informed care pyramid?
- Base has patient centered communication
- Understanding trauma effects on health
- Collaboration and understanding professional roles
- Understanding your own history
- Screening at the apex
What does it mean to have patient centered communication skills?
-Ask if they seem anxious, or how to make them more comfortable, model procedures and dont just rely on distraction techniques.
What does it mean to understand the health effects of trauma/
- Does not involve dentist asking too much about trauma history.
- understanding negative health related effects.
What does it mean to collaborate and understand professional roles?
- Respect wishes of survivor
- Maintain list of refereals and sources for patients with trauma history
- Keep information available
- Understand youre mandated reporter in certain aspects and have to breach confidentiality.
What does it mean to understand your own history?
Providers are human beings too.
-Your own history should not interfere.
-Learn not to delve into shit youre not meant to fix.
Youre a mandated reporter of child abuse, how do you make sure its abuse before reporting it?
- Open ended questions and avoid accusation
- Suspicious injuries on patients charts
- Consult physician, social worker or authorities.
What are the stats on IVP or interpersonal violence?
88% were not asked about their injuires, 69% would like to have been asked.
87% if dentists never screen for domestic violence
18% never screen even if its obvious.
The barriers are usually presence of abusing party, lack of training and concern about offending the patient.
What are some suggestions for IVP? hint; AVDR
A; Ask
V: validate
D: document
R: Refer
