Closing the Gap Healthcare Project Research Study Article

[Kizzie]

For those who are interested, the article from the research study that was part of the healthcare project I co-led was just published here.

The abstract (intro and conclusion) for those who want a short version reads as follows:

Complex relational trauma (CRT) occurs in close relationships where adversity is prolonged, repeated and inescapable. Despite the known connections between CRT and adverse health outcomes, anecdotal reports from survivors indicate that education on CRT is not translating into more effective clinical practice, resulting in substandard and even harmful experiences of healthcare.

The current study demonstrates that CRT survivors experience difficulty accessing TIC within both medical and mental health settings, and that a lack of access to appropriate care may have significant negative effects both on overall health as well as creating experiences of re-traumatization. While there is growing awareness of TIC, greater efforts need to be pursued to increase the safety and inclusivity of healthcare for trauma survivors – something that could prove to be more cost-efficient for the healthcare system once broadly implemented. 

[zen_racer]

I haven't finished reading the article yet.  I'm about halfway through.  But in the beginning of it, the article brought to light that even beyond the childhood trauma, I have so much other trauma on top of it.  Intimate partner coercion and abuse, chronic illness (which also brought more abuse from FOO), police misconduct, justice system failures, religious based abuse (being an atheist while installing church organs for 14 years and being abused by the company and forced to do things which resulted in major injuries and then denied proper worker's compensation for those injuries).

Okay, stopping there and taking a breather...

That was a very well written article.  I've finished it during the breather.  And I relate to a lot of it.  I've had traumatizing experiences in seeing doctors, in getting adequate care, in being dismissed by doctors, in dealing with dentists that were not qualified and caused so much damage and pain that I was in shock for over 24 hours (would've been traumatizing to anyone, survivor or not).  I had known for so long that I needed to see a therapist but couldn't afford it.  Then when I started being able to afford it, not being able to find one that would see me, then not being able to afford it, rinse and repeat.

Thank you once again for pushing try to change things for the better for us survivors.  It is very much appreciated!

[NarcKiddo]

Thank you for the link.

One of the things I worry about in connection with the growing awareness of TIC is the possibility of it turning into a tick-box exercise. One of the study participants commented that they had checked a box asking whether they had PTSD, but nothing was ever said. I have the same experience, and it took me quite a while to summon up the courage to tick that box. And then of course the stressing over whether they would ask about it, and what I would say, until I eventually had the surgery and realised nothing ever would be said. I had no issues with anything connected to that surgery, and maybe (I doubt it, but you never know) they did inform my care team. Even something as simple as saying on a form "If you check this box we may not ask you about your trauma history but please know that the team has been informed and if you feel something is not working well for you please tell the team." Possibly followed by another check box if you actively want to discuss certain aspects of your care - so that if you are scared of lying fully flat at the dentist they will give you an opportunity to say so.

I have a chronic lung condition that requires review every year. It used to be in person but since Covid it is simply a tick box exercise over the phone. Very unsatisfactory, but that seems to be the way our NHS deals with targets these days. Requiring more awareness and training of medics can only be good, but I fear it is all too easy to find ways of saying they have fulfilled their obligations by boxes getting ticked. Another patient in the study commented on the 10 minute appointment slots (and in the UK we are only allowed to ask about one condition per appointment so you have to be quite creative about picking the thing that might get you the best result). I do think a lot could be done 'behind the scenes' with questionnaires and pre-screening, but if all of that just ends up in a file never to be looked at there is hardly any point in a patient expending the mental energy on going along with that.

My comments sound rather sour and negative and I'm sorry about that because I really do appreciate all the work you and others are putting into this. We do have to start somewhere after all! Thank you.

[Kizzie]

Thanks Zen Racer and Narc Kiddo, feedback is always good.     

I agree NK that it's possible at least for a while that we will end up in a checkbox situation. At the same time I think if we call attention to the gap in healthcare and the serious mental and physical impacts survivor patients deal with, educational institutions and professionals organizations will come to understand we cannot they cannot treat us as just a check in the box.

The medical educators conference I attended recently (international) did not have any complex trauma content but I did see a lot of presentations and posters about marginalized communities, social accountability, topics that were about the caring part of medical care. I think (hope) as more survivors and trauma researchers/ academics/ clinicians work to raise awareness about CPTSD, at some point more education will be offered in programs - currently, there are very few universities that offer more than a few hours about trauma. 

Those of us involved in one way or another around complex trauma may have to push and prod, squawk, provide relevant research, write books and guides, and offer training to get those in medicine to pay real attention to us but so be it.

For example, the book we've written here at OOTS about complex relational trauma and complex PTSD has been picked up by a very reputable publisher known for their healthcare/academic publications. A significant part of their marketing plan will focus on medical and mental health professionals and organizations.       

Also, the professor from UVic who was my co-lead has been doing lots of presentations to healthcare professionals about the study and project and has received very positive feedback. As such, the team will be working together again to develop an online course for healthcare professionals about complex trauma, CPTSD and TIC.

Every little bit moves us forward 

[TheBigBlue]

    
Congratulations!
 

[Armee]

 

Great work, Kizzie!!!!

[SenseOrgan]

Congratulations Kizzie! And thank you very much for helping to put this on the map. Not even having read the article itself yet, and living on a different continent, I feel incredibly validated in my experience navigating health care over here. I've experienced a top clinical facility, which offered a client centered approach, as the antithesis of TIC. In my experience it's often not so much the intention or an insufficient skill set of the therapists that cause harm, rather than the paradigm they're in. Part of it is not being aware of something like CRT, or CPTSD, or taking it seriously. It's a clients problem until something changes in the therapist's understanding about the manifestations of trauma. In general, it won't be recognized, acknowledged, nor (cost-)efficiently addressed before that update happens. There's something deeply disturbing about having to become an expert yourself in order to be able to seek out the right kind of help. On top of dealing with the storm itself on a daily basis. And that only applies to an unknown percentage that is able to find their way to a good enough understanding of what they're actually struggling with. 

[Kizzie]

I feel incredibly validated in my experience navigating health care over here. I've experienced a top clinical facility, which offered a client centered approach,

Now that is so good to hear!

It's a clients problem until something changes in the therapist's understanding about the manifestations of trauma. In general, it won't be recognized, acknowledged, nor (cost-)efficiently addressed before that update happens.

That is absolutely the issue here in North American at least and has a lot to do with the APA and its resistance  first to adding PTSD into the DSM, and now the same thing with Complex PTSD. Re PTSD, the veterans had to join together and fight alongside a determined group of professionals to get PTSD into the DSM but they did eventually made it happen. The vets were able to push effectively because they had chapters in every state and as such, had a large nationwide voice with which to pressure the APA. We don't have that but we do have a similar determined group of professionals fighting for us and the more we as survivors speak up the harder we all are to dismiss/ invalidate/ignore.