Healthcare Providers are Being Indoctrinated with ‘Trauma Informed’ Myths

Healthcare Providers are Being Indoctrinated with
‘Trauma Informed’ Myths

Colleen Farmer, BSN, RN

June 1, 2021

I have been a Registered Nurse for the past 32 years and I have worked in the emergency room for the last 25 years. I love my job and love taking care of my patients. I am concerned, however that my coworkers –nurses, doctors and physician assistants – who recently completed the “Trauma and Sexual Assault Survivor Support Training” course were immersed in biased theories that are not scientifically supported.1

What is a trauma-informed approach?

To be “trauma-informed” means you take a “victim-centered or a “Start by Believing” approach to the care you are providing.2 There are two parts to a trauma-informed approach.

The first step “recognizes the presence of trauma symptoms, acknowledges the role that trauma has played… and how trauma interferes with one’s ability to cope.”3 These trauma informed principles then allow healthcare providers to assess and modify care with an “understanding of how trauma affects the life of an individual…” so we can “avoid triggers and re-traumatization.”3

There is nothing new about healthcare providers recognizing the role of trauma in the care of our patients. We see trauma every day in an emergency room, and I would argue that our role on how to handle trauma has not changed. Our goals have always been to recognize where our patients are, be kind, caring, sensitive, supportive and empathetic while being a good active listener to all of our patients.

Nursing care has always looked to promote a safe environment, trustworthiness, and transparency while being respectful, using clear instructions, effective communication and always encouraging our patients to voice how they feel, empowering them with choices and being a part of their own care plan as we always have.

Trauma-informed theory is not scientifically proven

The second part of a trauma-informed approach is the ”science” of neurobiology. It is explained as a stressful or life-threatening event that causes a “flood of hormones… resulting in a complete shutdown of bodily function.” This state of mind is referred to as “paralysis, tonic immobility or freezing.” The “trauma physiologically impedes the victim’s ability to resist or coherently remember the assault resulting in an impaired memory or fragmented memory recall due to the disorganized encoding that occurred during the incident.”4,5 Various experts state, the “talk on fragmented memory and tonic immobility is unsupported by prevailing scientific research findings.”5

Many scientists, psychology professionals, and groups have published papers explaining how trauma-informed concepts are unsupported. The US Air Force Office of Special Investigations, for example, sounded the alarm calling for the end of “trauma-informed” training. Regarding the use of trauma-informed training methodology (FETI), the Air Force Office stated that it is “loosely constricted, is based on flawed science, makes unfounded claims about its effectiveness, and has never once been tested, studied, researched or validated.”6

“There is no scientific evidence to support the idea that a trauma-informed approach should be offered as a valid clinical method for working with victims of trauma.”6 Simply stated, the science of neurobiology is not empirically supported. 1,5,7,8

The flaws and failures of trauma-informed training

– In trauma-informed training, tonic immobility is not only applied in life threatening situations but also expanded to include low-level, non- contact incidents or stressful incidents.9,10

– Current trauma-informed training teaches that a patient who remembers every detail of an incident or a patient who remembers little to nothing of an incident both indicate a trauma has occurred.1,4

When we make the assumption that trauma is the only possible cause, this can lead to misdiagnoses, because providers are discouraged from looking at other possible causes of memory loss such as mental illness, drug/alcohol problems or other factors. In defining trauma the Journal of Adolescent Health states, “A trauma-informed approach does not necessarily seek disclosure…”11 however, as clinicians, we need to seek the truth in order to properly treat, diagnose and care for our patients.

– In cases of sexual assault, trauma-informed, victim-centered, or “Start By Believing” training teaches us to view the patients as a “victim” vs. an alleged victim. Not only is this presumptuous, it violates both our legal and sworn ethical codes to remain neutral and impartial in our collection of evidence in our role as a sexual assault nurse examiner (SANE) provider.12 Not only are nurses and doctors being trained in this debunked science, but also our law enforcement, court personnel, judges, attorneys, staff and students on college campuses and more. 13,14,15

– When trauma is used as a preconceived assumption to justify inconsistent behavior, our objectivity as a SANE nurse or provider becomes compromised, as relevant evidence might be excluded.9 Trauma-informed training often emphasizes that documentation should “corroborate the victim’s account.”5,16,17,18 Training that suggests SANE nurses or providers corroborate a patient’s account of events, leading us to discredit inconsistencies in a patient’s story places us in the role of judge and jury, which is not our job. This violates our legal and ethical duties requiring us to remain neutral. As clinicians, we should follow scientific and lawful procedures to collect all evidence, without bias, to ensure quality of care for those who allege they have been assaulted. Our charting and reporting of events in an accurate, fair and complete way, is essential to providing good quality care for our patients.

– Trauma-informed training, care, approach, or theory, has become so broadly used and poorly defined it has the unfortunate effect of turning almost anyone into a “victim” or “survivor.”⁷

– New York State trauma-informed programs have included trainings led by Dr. James Hopper. Dr. Hopper has stated, “Focusing on the brain…I’m able to… truly change lives, institutions, and ultimately cultures.”19 “Effective trauma-informed…methods are essential to treating victims justly…and holding perpetrators accountable.19 Hopper’s real intent appears to go well beyond what any science would support.

– A Washington Post and Kaiser Family Foundation Survey found 44% of women think when they give a guy a “nod in agreement,” that isn’t enough for consent. 24% of women surveyed agreed that “sexual activity when both people are under the influence of alcohol or drugs…” “Is sexual assault,” and 35% of women felt “sexual assault accusations are often used by women as a way of getting back at men.”20 This survey shows us there are real life consequences in being trained to “Believe the Victim.” When a nod of the head, having a drink or an angry partner is all that separates someone from a rape or sexual assault charge, we need to be very diligent in factually documenting all potential evidence. In these types of cases, the potential for harm in “corroborating a victim’s account” is very high.

The high stakes of trauma-informed policies

Currently, college and university lawsuits are the best place to see the failures of trauma-informed training. The training has been well established for the last decade. It is on our campuses, where the seed of “believe the victim” began and has grown to become the cultural movement of #MeToo. More and more due to the biases of trauma-informed training, courts are denouncing victim-centered philosophies. They are showing they support “clear standards for admissibility of scientific evidence in court.”^21,22

Trauma-Informed training does not meet this standard and has been questioned in many court cases.9,21 “Misuse of trauma-informed policies was clearly evident in Doe v. University of Mississippi. The court found trauma-informed training materials caused those trained to make “an assumption … that an assault occurred.” Even the Association for Title IX Administrators, a prominent agency that leads the way on campus policy and training, had this to say about trauma-informed training, “You will need to assess whether you can afford to have a non-empirical, biased training on your resume in this age of litigation.”23

Where do we go from here?

The “Trauma and Sexual Assault Survivor Support Training” that New York healthcare providers have attended was based on the flawed concepts of neurobiology outlined above. We need to question why medical professionals are being “trained” in unsupported scientific theory! The title of the training itself should make us question the goal of what is being taught and why we as medical professionals received training and instruction from college advocates, who work from a “survivor-centric” viewpoint that lacks transparency, accountability and is fraught with conflicts of interest.15

We need to end the unscientific “trauma-informed” training of all professions. It is extremely important that we, as nurses and providers conducting evaluations in cases of rape, sexual assault or sexual violence adhere to methods that have been scientifically validated.6 We would not want to see rape cases thrown out of court due to the use of this flawed training. We are capable of recognizing “real” trauma without the unethical use of trauma-informed training.

Citations:

Trauma Informed Junk Science: http://www.prosecutorintegrity.org/sa/ trauma-informed/
Center for Prosecutor Integrity Start by Believing: http://www.prosecutorintegrity.org/sa/start-by-believing/
What Does “Trauma Informed Care” really mean? J. Kellie Evans, LCSW, CSOTP May 1, 2013: https://www.csa.virginia.gov/content/doc/What_does_Trauma_Informed_Care_Really_Mean_2013.pdf

Trauma Informed Junk Science: http://www.prosecutorintegrity.org/sa/ trauma-informed/
Center for Prosecutor Integrity Start by Believing: http://www.prosecutorintegrity.org/sa/start-by-believing/
What Does “Trauma Informed Care” really mean? J. Kellie Evans, LCSW, CSOTP May 1, 2013: https://www.csa.virginia.gov/content/doc/What_does_Trauma_Informed_Care_Really_Mean_2013.pdf
Jim Hopper PhD: https://www.jimhopper.com/
The Bad Science Behind Campus Response to Sexual Assault by Emily Yoffe September 8th, 2017: https://www.theatlantic.com/education/archive/2017/09/the-bad-science-behind-campus-response-to-sexual-assault/539211/
Report on the use of the Forensic Experiential Trauma Interview (FETI) Technique within the Department of the Air Force October 2015: http://www.prosecutorintegrity.org/wp-content/uploads/2019/03/AIR-FORCE-FETI-STUDY.pdf
Trauma-Informed Approaches: The Good and the Bad by Michael S. Scheeringa, MD, Sept. 17, 2017: https://www.psychologytoday.com/us/blog/stress-relief/201709/trauma-informed-approaches-the-good-and-the-bad
Truthiness of the Trauma-Informed Science-Policy Gap by Michael S. Scheeringa, MD, Sept. 11, 2018: https://www.psychologytoday.com/us/blog/stress-relief/201809/truthiness-the-trauma-informed-science-policy-gap
FACE Families Advocating for Campus Equality, Trauma Informed Theories disguised as evidence: https://static1.squarespace.com/static/5941656f2e69cffcdb5210aa/t/5ccbd3c153450a492767c70d/1556861890771/Trauma-Informed+Theories+Disguised+as+Evidence+5-2.pdf
Stress Is Not Trauma by Michael S. Scheeringa, MD, June 6, 2017

https://www.psychologytoday.com/us/blog/stress-relief/201706/stress-is-not-trauma

College Sexual Assault: A Call for Trauma-Informed Prevention Heather L. McCauley, Sc.D. Adam W. Casler, M.Ed. https://www.jahonline.org/article/S1054-139X%2815%2900119-6/fulltext
Nursing Ethical Considerations Lisa M. Haddad; Robin A. Geiger. Last Update: September 1, 2020: https://www.ncbi.nlm.nih.gov/books/NBK526054/
Trauma-Informed Courts: The How and Why By Carl Donovan Trauma Training for Criminal Justice Professionals: https://www.samhsa.gov/gains-center/trauma-training-criminal-justice-professionals
ATIXIA Training Materials Paul Smith’s College Building Partnerships among Law Enforcement Agencies, Colleges and Universities: Developing a Memorandum of Understanding to Prevent and Respond Effectively to Sexual Assaults at Colleges and Universities https://www.paulsmiths.edu/title-ix/ training/
Paul Smith’s College Coordinated Community Response

https://www.paulsmiths.edu/care/

This Campaign Against Sexual Violence Strongly Favors Female Victims, Strips Men Of Due Process Wendy McElroy June 07, 2018: https://dailycaller.com/2018/06/07/start-by-believing-program/
Has EVAW Been Moderating or Covering its Tracks? By James Baresel February 16,2021: http://ifeminists.net/e107_plugins/content/content.php?content.1497
CPI ‘Believe the Victim:’ The Transformation of Justice: http://www.prosecutorintegrity.org/wp-content/uploads/2018/01/Believe-the-Victim-FINAL.pdf
The Brain Under (Sexual) Attack Why people don’t fight, why memories are fragmentary – and some big implications. Jim Hopper, PhD – December 14, 2017

https://www.jimhopper.com/pdf/hopper2017_brain_under_(sexual)_attack_blog_intro.pdf

20. Washington Post-Kaiser Family Foundation Survey of College Students on Sexual Assault: http://apps.washingtonpost.com/g/page/national/washington-post-kaiser-family-foundation-survey-of-college-students-on-sexual-assault/1726/