Telehealth to Support Trauma-Informed Care

One practice utilized telehealth to support delivery of trauma-informed care to general pediatric populations as well as those placed at higher risk for child abuse and neglect. Strategies to support this practice included the following:

• Use telehealth to support provision of trauma-informed care for general pediatric populations.
  • Determine if a telehealth visit or an in-person visit is most appropriate. Key factors to consider may include an assessment of safety, suspected injury, or mental health crisis, geographic or other barriers to access care, and COVID-19 symptoms or exposure.
  • Implement virtual trauma-informed screening, including screening for potentially traumatic events and social determinants of health.
    • Note: Visit the AAP Trauma-Informed Care (TIC) webpage to read the AAP TIC polices and learn more on trauma-informed practices, and the AAP STAR Center for more information on how to screen for social determinants of health.
• Practice virtual Trauma-Informed Care Medical Practices, in alignment with SAMHSA’s Trauma-Informed Key Principles
  • Encourage the patient and family/caregiver to participate in the telehealth visit from as private of a space as possible.
  • Encourage the patient and family/caregiver to use headphones to support confidentiality.
  • Alert the patient and family/caregiver of any potential ambient noise that may occur during the visit.
  • Maintain eye contact with the camera and demonstrate affirming gestures to demonstrate active listening during the telehealth visit.
  • Sit far enough from the screen so that the patient and/or family/caregiver can see your body language.
  • Provide time for patients and families/caregivers to adapt to the telehealth environment.
  • Dress professionally for the visit and avoid busy, unprofessional backdrops in the virtual video visit.
  • Encourage/praise the patient and family/caregiver’s willingness to try telehealth as a care modality.
  • Be sensitive to the patient and family/caregiver’s feelings in revealing their personal space during the visit. Refrain from commenting on the home or living space.
  • Use gender affirming language, including the patient’s pronouns.
  • Proceed with the telehealth visit in accordance with the patient and/or family/caregiver comfort level.
    • Obtain consent for any examinations, minimize removal of clothing, proceed with follow-up discussions once the patient is fully clothed.
    • Be mindful of use of language during the telehealth appointment that may inadvertently be coercive rather than invitational.
  • Provide online and community resources and access to safety hotlines.
  • Refer to virtual and community support groups as needed.
• Use telehealth to support provision of trauma-informed care for suspected child abuse and neglect.
  • Determine if a telehealth visit or an in-person visit is most appropriate.
    • Typically, in-person care is preferred if there is suspected safety risk, suspected sexual abuse, a young patient (under 12 months of age), concern for acute injury or infection, and/or physical exam is needed.
    • If these conditions are not present, and the patient has geographic or other barriers in access in-person care (such as COVID-19 symptoms or exposure), telehealth may be an appropriate option.
    • Note that a follow up in-person visit may still be necessary in many situations of suspected child abuse and neglect.
  • Prepare for the telehealth visit:
    • Obtain consent
    • Verify state occupancy
    • Address any need for interpreter
    • Recommend as private of a space as possible for the appointment to occur
    • Explain to the family/caregiver that the visit will involve speaking with caregiver and the patient (if age-appropriate) privately, verify if this will be possible
    • Explain how the physical exam will proceed (based on age of patient and presenting complaint), and note that in-person exam may need to be schedule
    • Ask the family/caregiver to explain to the child that the clinician will be present virtually to do their check up
  • Additional considerations to implement for the telehealth visit:
    • Practice virtual trauma-informed principles as outlined for general pediatric populations.
    • Include trauma-specific screening.
    • Address lighting during the video visit to ensure optimal visibility of skin
• Other strategies for providing trauma-informed care via telehealth:
  • Telemedicine assisted examinations that include the primary examiner with the patient-in person, and a supervising specialist present via telemedicine offering live assistance. This strategy may require a telemedicine cart to be present within the primary care medical home to support telehealth appointments with specialists.
  • Store and forward telemedicine technology can support photo/video and medical record review by specialists via telehealth.
• Train all multidisciplinary team members in telehealth protocols, workflows, and technology platforms.
• Preliminary outcomes include increased access to trauma-informed care for all populations.

^{The tips and strategies outlined in this promising practice were provided by New York Presbyterian Hospital and Columbia University Irving Medical Center.}