Rosa* is a 57-year-old woman living in North Camden with two grown sons. She retired after 18 years as an instructional aide in the public schools.
Rosa has Type 2 diabetes as well as coronary artery disease. She has difficulty managing her condition, and as a result she has had both her legs amputated and also suffers from diabetic gastroparesis, which makes it hard for her to process food. Her lack of mobility makes it hard for her to access the nutritious food she needs, which makes it that much more difficult for her to control her blood sugar.
Rosa reports suffering from both depression and anxiety, and her children do not offer much social support. When we met Rosa she did not have a good relationship with a primary care doctor, despite her many health conditions.
Over the past year, Rosa was frequently admitted to the hospital for nausea, vomiting, abdominal pain, diabetes, and depression/anxiety. She’d like to better manage her health, but feels unable to address her own needs in any significant way.
Adverse childhood experiences & trauma-informed care
While we don’t know for sure whether Rosa has experienced adverse childhood experience, research connects multiple health conditions, poor health behavior, and poor health-related quality of life.
Providers working with Rosa approached her with a trauma-informed care mindset. The principles of trauma-informed care include:
Safety – making sure patients feel physically and psychologically safe. Providers always ask for and receive permission before interacting in Rosa’s personal space.
Trustworthiness and transparency – building and maintaining trust is paramount for patients who have experienced trauma. Providers make an extra effort to make and keep appropriate promises to Rosa.
Empowerment and choice – Rosa’s strengths are recognized, built on, and validated by her care team in order to demonstrate to her that she has the innate ability to address her health challenges.
Rosa had three inpatient stays in six months prior to our intervention, at a cost of $17,600. Within two months of the intervention she had one inpatient stay and one ED visit, costing $9,000.
* Rosa is not a specific individual; she is a composite patient.