The social model of health and client centred approach coupled with a trauma and gender informed practice
Miriam Brooks, Lesley Barclay and Claire Hooker of Women’s Health NSW undertook research at the Blue Mountains Women’s Health and Resource Centre Young Women’s Clinic. The research has been published in the Australian Journal of General Practice and is a good articulation of the 9social model of health and client centred approach coupled with a trauma and gender informed practice.
Like otherwomen’s health centres across Australia, Blue Mountains Women’s Health & Resource Centre’s(BMWHRC) vision and statement of purpose reflect a social view of health that recognises the role of adversity and trauma in creating illness.
In 2004, BMWHRC established a weekly after-school clinic for girls and women aged 12–25 years. The Young women’s Clinic (YWC) provides drop-in appointments with a nurse, counsellor or general practitioner (GP). These services are offered alongside an art group for young women. At ‘Artspace’, clients can draw, paint or collage, building social connectedness with other young women in the community. Artspace is facilitated by a youth worker or art therapist, who, when needed, refers clients to a YWC GP or counsellor.
The initial intention of YWC was to offer sexual and reproductive healthcare. Over time, however, increasing proportions of young women presented with mental health distress, and the service adapted to meet their needs. Clients presented to YWC for assistance with contraception, sexually transmissible infection (STI) screening and treatment, polycystic ovarian syndrome, Pap smears, unplanned pregnancy, period problems, vaginal conditions, antenatal care, breastfeeding issues, stress at school or at home, self-harm and suicidal thoughts, relationship violence and sexual assault.
This study sought to explore how trauma-informed care can support recovery from adversity and illness. Awareness of issues pertaining to gender, income, culture, sexuality and disability were identified as a core value of trauma informed care. Principles of trauma-informed care identified in the data include:
- ‘Holding’: creating a safe space through having empathic and skilled staff
- Understanding the health consequences of trauma
- Recognising the impact of trauma on consultations
- Tailoring consultation length to client needs
- Providing trauma therapy as well as physical healthcare
- Providing trauma-sensitive gynaecological care, including empathetic, clear explanations; allowing extra time; ensuring client consent and safety throughout the procedure
- Recognising the importance of self-care for health practitioners.
YWC staff saw advocacy as another crucial aspect of trauma-informed care. GPs often wrote letters or made phone calls on behalf of clients, pressing for affordable housing, affordable care with medical specialists, as well as advocacy with Centrelink, employment agencies, schools, university and TAFE.
YWC staff considered trauma-sensitive care for a younger adolescent to be more about harm reduction, managing symptoms and increasing safety, whereas a young adult is more likely to be ready to address underlying psychosocial impacts through talking therapies. Practitioners and community organisation staff in this study noted the importance of ‘holding’ for social inclusion of young people experiencing adversity, enabling a sense of safety so that anxiety is less of a barrier to accessing care, and dealing with issues in an age-appropriate manner.
The findings of the research demonstrate the importance of holistic general practice services in preventing and managing the long-term health consequences of adversity and trauma. The researchers argue that by being trauma informed, GPs can be advocates for patients' trauma recovery. This includes providing emotional and physical safety, by addressing both the physical and mental health impact of trauma, creating long-term trusting relationships, practising shared decision making with patients, facilitating informed choices, ensuring consent and patient control within gynaecological consultations, and adopting a strengths based approach in which the impact of the trauma is addressed while personal resources and the potential for recovery are emphasised.