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BC Guidelines

Extended Learning Document: Primary Care Approaches to Addressing the Impacts of Trauma and Adverse Childhood Experiences (ACEs)

All individuals experience trauma throughout their lives. These traumatic experiences may be previous events, or they may be current. The health care community’s understanding of trauma’s impacts on our health continues to evolve, particularly in the context of the In Plain Sight Report  highlighting the experiences of Indigenous peoples in Canada, the ongoing toxic drug crisis, and mass traumatic events, such as natural disasters, warfare and genocide. Primary care providers are encouraged to learn how trauma affects an individual's and community’s health, as well as their utilization of the health care services, and health care experiences.

This extended learning document seeks to introduce primary care providers to the concept of trauma-informed practice (TIP). It provides information about tools including, but not limited to, the Adverse Childhood Experiences (ACEs) questionnaire. This document also provides additional resources for ongoing learning and professional/ personal development. 

This is not a clinical practice guideline as research in this area is still evolving, especially the evidence for the use of the ACEs questionnaire in clinical practice. The focus of the document is on adults. While some resources are referenced for the pediatric population, history taking and management of adverse childhood experiences in children and adolescents are outside the scope of this guideline.

Key Learnings

  • Build a strong, ongoing, consistent, and trusting relationship with patients. This is important to successfully address difficult topics in a culturally safe way and to support an individual’s ability to make positive changes over time. This enables primary care practitioners providing longitudinal care to better support their patients to improve their well-being, address past experiences, and give hope. While an ongoing relationship is important, there will be episodic encounters where practicing in a trauma-informed way will be imperative, to ensure patients return to seek care (e.g., walk-in or emergency department setting).

  • Recognize and respect the prevalence of historical, intergenerational and current trauma, as well as the many ways that trauma can be experienced. See Indian Hospitals in Canada to learn more.

  • Be sensitive to trauma-informed principles in patient interactions.

  • Practice a reflective, continuous commitment to ongoing education, which is an important aspect of trauma-informed practice (TIP).

  • Practice trauma-informed care, including considerations for staff and clinicians who have experienced trauma in their own lives. This trauma may come from personal experiences, or it could be secondary trauma experienced during exposure to another individual's traumatic experiences.

  • It is important that healthcare providers build an informal system of peer support that they can draw on or contribute to. Skills, such as “The Four Cs,” can support care providers’ well-being while delivering TIP. The Physician Health Program (PHP) offers a confidential 24-hour intake and crisis support line (1-800-663-6729).

  • It is not enough to have cultural awareness and cultural sensitivity to improve access and quality of health care services.  It is imperative that all these concepts are applied in practice as practitioners continue their cultural safety and humility journey and learning.