A recently-published paper by Palmer College of Chiropractic faculty, Kira Baca, M.S., D.C., BSEd and Stacie Salsbury, Ph.D., R.N., Adverse childhood experiences and trauma informed care for chiropractors: a call to awareness and action, explores the role of trauma informed care in a clinical chiropractic setting.

We sat down with the authors to learn more about their findings and the potential impact of the study on Doctors of Chiropractic and their patients.

The full paper can be found on Chiropractic & Manual Therapies

Tell us about the goals and findings of this study.

Trauma is an emotional response to distressing events where coping and recovery are absent. On a typical day in practice, most patients a Doctor of Chiropractic will care for have lived through at least one traumatic event in their lifetime.

Adverse childhood experiences, or ACEs, are very common. More than 60% of the U.S. population report a history of child abuse or neglect, caregiver instability, or household disruptions. Worldwide, child abuse and traumas are similarly prevalent – and these estimates are low, because people are reluctant to self-report trauma. 

Our responsibility as Doctors of Chiropractic is to care for and about our patients. Many health care fields have adopted trauma-informed care (TIC) as a standard of practice. However, our initial review of the literature found no references to the topics of ACEs and TIC in chiropractic. We published a commentary based on current evidence, to get the ball rolling on trauma awareness and TIC practices.

Patient-centered care is a popular model that is broadly taught and widely used, but the trauma-informed care portion is lacking in the chiropractic profession. Understanding a patient and their experience is a foundational component to caring for them in a way that makes them feel safe, secure, and engenders trust. For survivors of ACEs, among other traumatic experiences, these components of care are crucial. This paper on ACEs and TIC elaborates on the 4Rs model of TIC in the context of chiropractic:

• Realizing the impact of trauma
• Recognizing trauma in the patient population
• Responding using universal precautions, trauma-specific care and referrals when necessary, and
• Resisting Re-traumatization by accommodating care to the needs and preferences of patients, to prevent triggering past trauma. 

What prompted Palmer Center for Chiropractic Research to conduct a study on ACEs? Were there any other partners, agencies or funders involved? 

PCCR faculty and staff, including Post-Doctoral Research Scholars, produce Research Summary Series and Evidence in Action articles. I was asked to write an Evidence in Action article on a topic of my choosing. I was very interested in ACEs and TIC as a practitioner and patient. The importance of these topics lies in understanding the impact of trauma on patients before and during the patient’s experience – in the way they view their doctor, proceed through a course of care, and especially how they interpret physical touch.

PCCR faculty mentored me through the literature review and manuscript writing process, which took several months to accomplish. Ultimately, we decided to submit the commentary to a peer-reviewed journal for publication. The PCCR provided the time and resources to achieve such an article. The paper was also awarded the generous backing of Chiropractic Australia, to fund its publication costs in Chiropractic and Manual Therapies. 

How did you go about conducting this research? 

After six to eight months of literature searching on the topic of ACEs and TIC, across all health care fields, the information was synthesized into a coherent summary and useful example of how ACEs are relevant to chiropractic and how TIC can be implemented within the chiropractic profession.  

How do you envision this study can inform practicing Doctors of Chiropractic? 

As a hands-on profession, founded on the premise of health care “done by hand,” physical touch has a strong impact on the patients who receive chiropractic care. Depending on the person and their past experiences with physical touch, the positive impact may be altered by a history of trauma, like physical or sexual abuse. While these individuals may seek chiropractic care for its benefits, they may also be wary due to their negative associations with physical touch. Understanding this impact of past trauma will help Doctors of Chiropractic empathize with their patients and be more sensitive to their needs and the increased sensitivity patients may have with hands-on exams and treatment modalities. The ACEs and TIC paper also discusses universal trauma precautions and trauma-specific care including use of the ACEs screening tool and includes a series of vignettes to illustrate how TIC can be tailored for chiropractic use.  

How do you think this study can help chiropractic patients?  

Patients with a history of trauma benefit from care and environments designed with safety, transparency and trust, empathy, and patient consent in mind. When Doctors of Chiropractic adopt universal measures to ensure these conditions are met, all patients benefit. Most importantly, those with a history of trauma will feel more comfortable receiving care and will not need to be silent in situations they may find triggering, not knowing how to express their discomfort.   

Does Palmer College of Chiropractic have any plans about trauma-informed care? 

Palmer faculty are currently taking up the mantle on trauma-informed care with research projects focused on trauma-related topics in the Doctor of Chiropractic curriculum. The aim of this research is to explore how trauma-informed care is currently being taught in chiropractic education programs and used by the chiropractic profession. We’re also teaching the next generation of Palmer chiropractors about TIC in their Clinical Skills course. Efforts such as these are first steps in a much larger effort to embrace trauma-informed care and increased sensitivity to psychosocial awareness in chiropractic care, from education to clinical practice.  

Palmer Center for Chiropractic Research is the most highly-funded chiropractic research effort in the nation. Learn more about Palmer Center for Chiropractic Research.