Multicultural And Post-traumatic Approach

Question 1

What was the 6 point plan in the Amish example?

Answer 1

1. Hired language speakers
2. Hired a pt advocate
3. Got to know the pts
4. Made connections to the community
5. Became flexible to provide standard of care with traditional care
6. Didn’t assume

Question 2

How should you structure a pt visit?

Answer 2

Create a welcoming environment 
Speak the language 
Communicate 
Understand your goals 
Examine respectfully 
Make plans together 
Allow pt to teach about culture

Question 3

How can you create a welcoming environment during a pt visit?

Answer 3

Exhibit racially and ethnically diverse posters
Display media which is culturally relevant
Disseminate or visibly post a non-discrimination statement
Alter intake forms to be inclusive (relationship vs marital status, partnered as status, add transgender to female/male)

Question 4

How can you make sure to “speak the language”?

Answer 4

Arrange for translators
Use language that pts understand
Use the same language as the pt
Train front office staff to use non-discriminatory verbal and body language

Question 5

How should you communicate with your pt?

Answer 5

Develop a specific plan for each pt

Understand the patients goals of the visit

Question 6

How should you understand your own goals?

Answer 6

Be willing to negotiate non-important items or evaluate the unknown
Be willing to educate the pt while you are also being educated

Question 7

How can you examine respectfully?

Answer 7

Make yourself aware of the pt’s history (abuse, surgeries, piercings, tattoos)
Put on your doctor face (show empathy, not shock, horror or disgust)
Ask permission

Question 8

Describe violence screening

Answer 8

Attempt screening in a 1:1 setting
Ask all pts (men and women) violence screening questions in a gender neutral way
Do not accept the answer as unalterable truth (pts may lie to protect themselves and others)

Question 9

What are some violence screening questions?

Answer 9

Have you ever been hurt (physically or sexually) by someone you are close to or involved with or by a stranger?
Are you current being hurt by someone you are close to or involved with?
Have you ever experienced violence or abuse?
Have you ever been sexually assaulted/raped?

Question 10

What do you need to make sure when making a plan with your pt?

Answer 10

That the pt understands the need for the plan, is on board with the plan and needs a plan

Question 11

How to approach the exam room with LGTBQIA+?

Answer 11

Consider introducing yourself with your preferred pronouns
Ask relevant questions but not overly probing questions
Ask questions by phrasing it to help them understand the reason for the question
LGBTQIA people may have had a previous bad experience with a health care provider so it may be more difficult to establish rapport

Question 12

Describe decision making when considering LGBTQIA pts

Answer 12

Assess risk for STIs
Don’t assume
Vulnerability to social stresses (may have increased use of tobacco, drug or alcohol self tx for social stress)

Question 13

What does individual trauma result from?

Answer 13

An event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with last adverse effects on the individuals functioning and mental, physical, social, emotional or spiritual well being

Question 14

What is trauma informed care (TIC)?

Answer 14

Adoption of principles and practices that promote a culture of safety, empowerment and healing

Question 15

What are the 10 types of childhood trauma?

Answer 15

Five are personal including physical abuse, verbal abuse, sexual abuse, physical neglect and emotional neglect
Remaining five are related to other family members

Question 16

What are the childhood traumas related to other family members?

Answer 16

A parent who’s an alcoholic, a mother who’s a victim of domestic violence, family member in jail, a family member diagnosed with a mental illness and the disappearance of a parent through divorce, death or abandonment

Question 17

Survivors of childhood traumas are more likely to do what?

Answer 17

Attempt suicide, have eating disorders or become IV drug users

Question 18

What approach should be taken towards trauma pts?

Answer 18

1. Safety
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice and choice
6. Cultural, historical and gender issues

Question 19

How should you evaluate safety?

Answer 19

Make sure the pt is physically and psychologically safe
Setting is safe
Interpersonal interactions promote a sense of safety

Question 20

What should peer support provide?

Answer 20

Mutual self help

Safety, hope, build trust, enhance collaboration and promote recovery and healing

Question 21

Describe collaboration and mutuality

Answer 21

Partnering with your pt
Leveling power differences (sharing power and decision making)
Everyone has role to play

Question 22

Describe empowerment, voice and choice

Answer 22

Individuals strengths are recognized and built upon
Foster resilience
Ability of individuals, organizations and communities to heal and promote recovery
Empowerment for staff and clients
Cultivate self advocacy
Facilitate recovery rather than control recovery

Question 23

Describe cultural, historical and gender issues

Answer 23

Move past cultural stereotypes and biases
Leverages the healing value of traditional cultural connections
Responsive to racial, ethnic and cultural needs
Recognizes and addresses historical trauma

Question 24

For post trauma patients it is important to establish who has what?

Answer 24

Permission to touch 
Control over the situation 
The right to set limits 
The right to tell the story 
The right to hear the story