Learning Objectives
By the end of this topic, the student should be able to:
- Describe the relationship between trauma-informed practice and access to care.
- Discuss strategies for creating low or no-barrier healthcare spaces.
Key Concepts
- Barriers to care can result from more than just physical, built environments.
- Physical, emotional, cultural, and spiritual safety and trustworthiness are imperative to creating open, welcoming and accessible spaces for persons using opioids and persons with opioid use disorders.
- A trauma-informed approach to care is required
Before you begin…
What are some barriers and facilitators to accessing health care? Reflect on these as you read the module.
Barriers to Healthcare Access
Barriers to healthcare access can be related to the built environment; stairs, doorways, room layout etc. Factors such as physical locations create barriers as well: consider urban versus rural living persons, those dependent upon public transportation for example.
Read about physical Barrier-Free Design from the Canadian Abilities Foundation.
Other barriers that must be considered (Moroz et al., 2020) relate to those produced by:
- socioeconomic factors
- knowledge of available services
- stigma
- structural racism
- language and lack of translation facilities
- previous trauma and experiences with the healthcare system
Adopting a trauma-informed approach to practice, advocating for public policy to create low or no-barriers in the built environment and promoting an open and positive space for persons using opioids and persons with an opioid use disorder can contribute to the accessibility of appropriate screening, assessment and overall care.
Trauma-Informed Practice
Adopting a Trauma-informed approach to care is essential to care – particularly in the context of opioid use and opioid use disorders. A trauma-informed approach Realizes the impact of trauma, Recognizes the signs and symptoms of trauma, Responds on a multi-system level and Resists re-traumatization (SAMSHA, 2014).
Trauma-informed practice can address harmful opioid use by
- improving access to and engagement with health care and social services
- creating opportunities for individuals to heal from trauma
- supporting the development of wellness skills and pain management skills to help prevent opioid misuse and dependence, and
- improving the safety of service providers to prevent compassion fatigue and burnout.
For more on trauma-informed practice, please see Module 3, Topic D
Strategies to create low and no-barrier services
fizkes/iStock
- Create welcoming intake procedures:
- Greet persons as they enter
- Provide an orientation to the space (seating, washrooms, other amenities)
- Identify someone to answer questions
- Provide clear information about care processes and obtain informed consent
- Explain the roles of relevant care providers
- Introduce team members as early as possible
- Provide clear rationale for screening, assessments and any care activities using accessible language
- Explain and ensure confidentiality
- Communicate and negotiate reasonable expectations for interactions between persons and team members
- Schedule appointments in a consistent manner
- Maintain a trauma-informed approach
- Explain the roles of relevant care providers
- Adapt the physical space to be more inviting:
- Furniture can be arranged in “living room” style
- Consider mobile furniture that can be rearranged to suit specific needs
- Include single chairs and screens to allow for privacy, couches for those who want to connect with others
- Consider community art as wallcovering
Pacificenterprise/iStock
Where possible, organizations can consider these additional solutions to increase access:
- Advocate for primary and community-based care delivery
- Use internet-delivered services where possible/appropriate
- Use telehealth/mobile services where possible
Stop and Think
Now that you have reviewed this content, try this:
List as many additional ways to reduce barriers to accessing care as you can think of. Share your ideas with your peers and mentors.
References
ACOG Committee on Health Care for Underserved Women, & American Society of Addiction Medicine (2012). Opioid abuse, dependence, and addiction in pregnancy (Committee Opinion No. 524). Obstetrics and Gynecology, 119(5), 1070–1076. http://m.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy.
Center for Adolescent Substance Abuse Research, Children’s Hospital Boston. (2009). The CRAFFT screening interview. http://www.ceasar.org/CRAFFT/pdf/CRAFFT_English.pdf
Center for Preparedness and Response. (2020). 6 guiding principles to a trauma-informed approach. https://www.cdc.gov/cpr/infographics/00_docs/TRAINING_EMERGENCY_RESPONDERS_FINAL.pdf
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Institute for Safe Medication Practices Canada. (2011). Optimizing medication safety at care transitions: Creating a national challenge. https://www.ismp-canada.org/download/MedRec/MedRec_National_summitreport_Feb_2011_EN.pdf
Kahan, M., Mailis-Gagnon, A., Wilson, L., & Srivastava, A., & National Opioid Use Guideline Group. (2011). Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 1: General population. Canadian Family Physician, 57(11), 1257–1266.
Moroz, N., Moroz, I., D’Angelo, M.S., 2020. Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthcare Management Forum 33, 282–287.
Nathoo, T., Poole, N., & Schmidt, R. (2018). Trauma-informed practice and the opioid crisis: A discussion guide for health care and social service providers. Centre of Excellence for Women’s Health.
National Opioid Use Guideline Group. (2010). Canadian guideline for safe and effective use of opioids for chronic non-cancer pain. Part B: Recommendations for practice. http://nationalpaincentre.mcmaster.ca/documents/opioid_guideline_part_b_v5_6.pdf
Reisfield, G. M., Salazar, E., & Bertholf, R. L. (2007). Rational use and interpretation of urine drug testing in chronic opioid therapy. Annals of Clinical & Laboratory Science, 37(4), 301–314.
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Washington State Department of Health. (2012). Substance abuse during pregnancy: Guidelines for screening. http://aia.berkeley.edu/media/pdf/WA_15_PregSubs_E12L.pdf
Webster, L. R., & Webster, R. M. (2005). Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the Opioid Risk Tool. Pain Medicine, 6(6), 432–442.
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