Rebecca

/Rebecca Frost

About Rebecca Frost

Rebecca is a clinical psychology registrar with an interest in all relationships. Ranging from couples, to parent / child, through to how we relate to people generally. Rebecca is currently completing a PhD looking at how mismatched libido creates problems for couples in their relationship.

Trauma Informed Care in Primary Health Settings

Dr Jasmine Pang describes the impact early adverse childhood experiences have on individual later-life health and well-being, with advice for general practitioners and health providers in how to provide trauma-informed care.

Primary health settings provide a unique environment for the provision of trauma informed care. Many trauma survivors do not seek mental health services but look for help in primary care settings. Neither patient nor providers may be aware of the link between their current physical complaints and the connection to past trauma. Yet research has clearly shown a wide-ranging impact of Adverse Childhood Experiences (ACE).

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and the links to later-life health and well-being. ACEs investigated included emotional abuse, physical abuse, sexual abuse, household intimate partner violence, household substance abuse, household mental illness, parental separation or divorce and incarcerated household members.

Results of the study found that almost two thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The study also found a graded dose response relationship between ACEs and negative health and well being outcomes across the life course.

The study showed that as the number of ACEs increases so does the risk for the following-

  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease
  • Liver disease
  • Poor work performance
  • Financial stress
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy
  • Risk for sexual violence
  • Poor academic achievement

 

 

 

ACEs continue to have a lifelong impact from conception to death as it disrupts neurodevelopment. This results in social, emotional and cognitive impairment, which causes the adoption of high health risk behaviours leading to disease, disability and social problems.

 

Role of General Practitioners

Despite the increasing evidence of the lifelong health impact of ACEs, research shows that less than one-third of primary care doctors screen for ACEs on a regular basis [1]. This was often due to a lack of knowledge of the prevalence of ACEs, discomfort with asking screening questions and perceived role. Yet, the primary care physician is uniquely positioned to play a critical role in the identification of ACEs and facilitating appropriate treatment. Interacting with adults, children and their families at regular intervals can allow patients and providers to develop a trusting relationship, which can facilitate the disclosure of ACEs. Contrary to popular belief, research has shown that screening for adversity is acceptable amongst patients. In an adult primary care setting, 79% of patients were comfortable being asked about ACEs and 86% felt comfortable being screened for ACEs[2]. However, patients would only disclose if asked directly in a safe supportive manner. In a study at the Health Appraisal Clinic at Kaiser Permanente of San Diego, there was a 35% decrease in office visits and an 11% decrease in emergency room visits among participants compared to the prior year[3] when they started screening for ACEs. Addressing childhood adversity in medical settings offers clinicians a more complete picture of important social determinants of health and has a great potential to improve health care utilization and encourage help seeking behavior.

What is trauma informed care?

A programme, organization or system that is trauma informed realizes the widespread impact of trauma and understands potential paths for healing; recognizes the signs and symptoms of trauma in staff, clients and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, practices and settings.

What can General Practitioners do?

  • Learn more about the provision of trauma informed care and about trauma. Understand that “problem behaviours” may be manifestations or symptoms of trauma, or coping skills that served to protect them when surviving their trauma.
  • Routinely ask patients about trauma history and trauma symptoms. This can be done using formal screening tools (E.g. Primary Care PTSD Screen, Brief Trauma Questionnaire) or by asking if patients had ever experienced one of the 10 ACEs identified in the ACEs study. Find out more about how to do so in a way that patients can feel supported to disclose.
  • Discuss the impact of identified traumatic events if the patient screens positive. Not everybody who has experienced ACEs have ongoing difficulties. It is important to explore if current functioning has been impacted and the patient continues to experience distress from the traumatic experience
  • Provide a referral if needed
  • Follow up with the patient

[1] Weinreb, L., et al (2010) Primary Care Companion Journal of Clinical Psychiatry, Screening of trauma in adult primary care settings, 12(6)

[2] Goldstein, E., Athale, N., Sciolla, A. F., & Catz, S. L. (2017). Patient Preferences for Discussing Childhood Trauma in Primary Care. The Permanente Journal, 21.

[3] Felitti, V. J., & Anda, R. F. (2014). The lifelong effects of adverse childhood experiences. Chadwick’s child maltreatment: sexual abuse and psychological maltreatment, 2, 203-15.

Jasmine PangThis article was written by Dr Jasmine Pang at Benchmark Psychology.  Jasmine has a particular interest in supporting children, adolescents, parents and adults who have experienced traumatic or difficult life circumstances and is passionate about ensuring high quality services be made available to them.

Trauma Informed Care in Primary Health Settings2019-04-01T12:56:39+10:00

Five keys to a satisfying sex life for parents

Between careers, children and the pressures of being a grown up, maintaining a healthy sex life can end up pretty low on the "to do" list of many couples.  Sexual desire is at an all time low for many couples in the years when their children are youngest.  But a good sex life is not only pleasurable, it also adds valuable emotional connection to relationships.  Unfortunately, many couples already know this, but view it as just more pressure and that they are somehow not up to scratch. So instead of telling you to go and buy some toys, some lingerie and scented candles in order to "spice up" your love life, this article gives some more honest if slightly less glamorous suggestions.  Here are some 'hot tips' for a lifelong and satisfying sexual relationship in the real world.

 

1. Be realistic

Know that every other couple is not having more or better sex than you. The average couple (and that includes those without kids) are having sex six times per month. With the added stress and busyness of parenting, be kind to yourselves and don’t add any extra pressure to your lives by worrying about how much sex you’re having. Regardless of what many magazines or the guys at the pub say, most people are having very irregular, vanilla sex with their partners. Why worry about everyone else anyway? All that matters is that you and your partner are happy.

 

2. Communicate

This is the big one. Nothing can ever change if you don’t talk to each other about your needs. My PhD research has found that the couples who are doing well between the sheets talk regularly and honestly about the sexual aspects of their relationships. They talk about what isn’t going well and how they can improve things. Most of all, it is less painful to experience rejection when you know that your partner cares about you and has genuine reasons for not feeling desire.

3. Find alternatives

If you are not feeling like having sex and you know that your partner misses this, try to meet some of their needs in other ways. I will let you in on a big secret – sex is often not about sex. Most of the time it is about closeness, connection and feeling desired. Often you can meet these needs for each other through hugs, kisses and just giving them your time and love. When it is actually about the sex, maybe you can meet these needs through foreplay without the actual intercourse?

4. Prioritise

Make your relationship a priority. Healthy and happy couples make better parents. You are modeling how to have strong relationships for your kids, so taking time for yourselves is not selfish. It is good for everyone. Find time for date nights, do things that you enjoy together (with or without the kids) and don’t forget to sometimes make sex a priority. Go to bed early rather than doing one more load of laundry. It doesn’t matter whether you end up having sex or not, the point is that you are making the time for each other. Generally, if you work on being a happy and connected couple, the sex will follow.

5. Be responsive

As already said, the expectation that you will have regular, spontaneous sexual desire at all times in your life is probably unrealistic. Why not see if the responsive desire is there? Tell your partner that you are not feeling like it but you’re happy to get started and see how you feel. Most likely your desire will arrive. If not, make sure that the two of you make it safe for you to say that on this occasion it didn’t work but you’re going to try again next time. Find another way to find closeness in the meantime.

 

We hope that these steps help you to find the close, connected and sexually satisfying relationship that we are all seeking.  However, if you need more assistance then you can see a couples therapist who has experience in sexual issues.  Here at Benchmark Psychology we have two psychologists who have a passion for working with couples - Dr Jennifer Wilson and Rebecca Frost.

 

Five keys to a satisfying sex life for parents2019-03-15T14:03:21+10:00