Trauma-Informed Care in a Primary Maternity Care Clinic: Quality Improvement Study of Patient and Physician Perspectives

BACKGROUND: Inquiring about a patient's adverse childhood experiences (ACEs) and assessment for mental health conditions such as depression and anxiety using trauma-informed care (TIC) approaches may enhance maternity care quality. This study aimed to evaluate the feasibility of a TIC program that integrated mental health and ACE assessment by examining patient and physician perspectives following clinical implementation in a primary care setting. METHODS: In this exploratory quality improvement project, a maternity care clinic in Calgary, Alberta, implemented a TIC program to assess and address patients' mental health and ACEs between July 2017 and January 2018. Patients' and physicians' perspectives of the program were also attained to understand the feasibility of implementation and use. RESULTS: Patients responded positively to their clinic's use of the TIC program and discussions about their mental health and ACEs with their physicians. They reported feelings of safety, respect, understanding, and receiving informed care. Patients also reported that discussing their ACEs encouraged them to engage in related conversations in their personal lives, seek parenting resources, and expand their knowledge about their ACEs. Physicians reported improved confidence in discussing their patients' ACEs and routine integration of the assessment tools into clinical practice. CONCLUSION: Integrating ACE and mental health assessment into routine maternity care through the TIC program was associated with positive perceptions from both patients and physicians. Enhanced communication, improved patient-physician relationships, and more optimal patient-centered care resulted. By incorporating these tools into maternity care, health care practitioners can more effectively identify psychosocial risks early, thus supporting improved maternal and fetal health outcomes.