I’m preparing to begin a day of VA exams. I’m just going to work again. Firing up the laptop, logging in, reviewing files, getting a cuppa. I look ahead for the day. I don’t wonder how they’re doing because I know. They’ve told me. They’re gearing up or crashing down for their VA psych exam. I absorb that awareness, which is the beginning of me being trauma informed care. In this context, applying trauma informed care principles is essential for understanding their experiences. By incorporating trauma informed care into my approach, I aim to create a supportive environment for each individual.
They’ve been anxious for days or months about this exam.
Understanding the complexities of their situation allows me to ensure that trauma informed care is at the forefront of my evaluations.
This approach ensures that I respect their experiences and integrate trauma informed care into my evaluation process.
They didn’t sleep much last night. Each one is special and unique. I prepare to listen to each one from the frame that I am briefly part of their village. I’m a doctor, about to evaluate a person who is reporting mental distress.
My goal is to provide trauma informed care during every interaction, ensuring that they feel safe and understood.
It’s my job. It’s their life. It’s fair to have experts do medical-legal exams when access to healthcare is on the line.
In this role, maintaining a commitment to trauma informed care is crucial for establishing trust.
- A forensic mental health examination is a deep dive. It’s best to start by orienting them to what they can expect in the next 45-60 minutes. Yes, an hour or slightly less. A trauma survivor will not be open if they are rushed and yet the process shouldn’t be dragged out. The hour has barely started. Take the time to describe what they can expect.
- I’m going to find out what your sleep pattern is like and how long that’s been going on. Then, I’ll ask you about your mood during the day. I’m going to ask you to give me some examples about how symptoms are affecting you at work, at home, so I’m going to find out about your context. I’ll ask you about things you might not think to bring up, and I’ll make sure the details are here that the VA requires. But first, I’m going to let you know what I’ve been reviewing to prepare for our conversation, and then I’m going to give you the floor to tell me what’s going on that made this the time that you filed the claim.
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- The post traumatic stress pattern of symptoms is a shared human experience. Confronted by violence, our survival brain kicks into gear. The #1 goal is survival, whether that be by fight, flight, freeze, or faun. The fact that this person is sitting in front of me is evidence that they survived. One of my jobs is to find out what happened and what happened next. To be trauma informed is to find out how they got out of there.
Being trauma informed means recognizing the importance of context and creating a space where trauma informed care can thrive.
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- Trauma memory is the single thing that distinguishes trauma-related psychological injury from any other stressor-related injury. Trauma memory – that moment in time, frozen in time. IYKYK. If you don’t, you just don’t. “Was there a day or event that happened that continues to trouble you?” Then wait. It’s hard on them to say it out loud.
It’s vital that I approach these memories with a trauma informed care perspective to support their healing process.
- Forensic/Disability examinations identify whether there are clinically significant psychosocial symptoms and, if so, what caused it. Forensic examiners view mental health conditions for their potential to have been an injury sustained in a certain context. The responsible party for that context becomes the responsible party for healthcare, so it’s a big deal. I take that seriously.
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- For this purpose, it’s necessary for me to hear about what happened. As much or as little as they can say, and that part is up to them. It’s necessary that the space is safe. Sort of ironic for forensics but trauma-informed, none the less. I’m not there to take sides or determine facts, I’m there to document what happened as told to me. I’m not a lie detector. I’m not an investigator. I’m a doctor. What happened? What happened next?
Understanding their experiences through a lens of trauma informed care ensures that I am fully present and responsive to their needs.