The Central Role of Relationships to Trauma-Informed Integrated Care for Children and Youth

Objective

Primary care plays an essential role in the primary and secondary prevention of children’s mental health problems. A growing series of trials have demonstrated the capacity of primary care providers to deliver care that specifically addresses risks to healthy social and emotional development by incorporating mental health services into their routines and integrating their work with the mental health care system. This paper describes elements common to various integration schemes that seem essential to their success.

Methods

Narrative review, combining conclusions from three prior systematic reviews.

Results

Trusting, personal relationships between patients and providers, and among collaborating providers, are a critical element of successful trauma-informed integrated care. Patient-provider relationships are essential to disclosure of sensitive concerns, to engaging patients in care, and to designing care that that is responsive to individual patient needs. Studies of patient-centered care and psychotherapy suggest ways that these relationships can be built and maintained. Provider-provider relationships are, in turn, essential to coordinating the work of the range of providers and services needed to address trauma prevention and treatment. These relationships can form within a variety of organizational structures but building them may require staff training, re-design of work flows, and support from organizational structures and goals.

Conclusions

A variety interventions at the patient-provider, clinical site, system, and policy level can foster relationships and provide the foundation for care capable of addressing promotion of social and emotional well-being in general and trauma prevention and treatment in particular.