This article originally appeared in the Summer 2015 issue of Brigham and Women's magazine.
Sarah*, a 24-year-old woman severely beaten by her boyfriend, arrives at the Brigham and Women’s Hospital (BWH) Emergency Department with bruises, bleeding, and broken bones. The emergency medical team stabilizes her wounds and arranges consultations with neurology, social work, and other experts.
Once Sarah is stitched up and ready for discharge, her fight for survival begins all over again. With no income and no home, she is still in crisis. Soon, she finds a new ally at her side—Annie Lewis O’Connor, PhD, NP-BC, MPH—a BWH nurse with three decades of experience advocating for victims of trauma and abuse.
BWH’s C.A.R.E. (Coordinated Approach to Recovery and Empowerment) Clinic, founded by Lewis O’Connor in 2010, provides follow up care for women and men who have experienced intimate partner violence, sexual assault, and human trafficking. The clinic connects survivors with vital additional medical services and programs for food, shelter, mental health, and substance abuse.
“The health consequences for our patients are profound,” says Lewis O’Connor, the clinic’s director. With one-third of women in the U.S., approximately 42 million, experiencing rape, violence, or stalking by an intimate partner in their lifetimes, “this is a major public health epidemic,” she explains.
“Sarah received excellent care in the emergency room,” Lewis O’Connor says. “When she was ready to leave, she got a packet of instructions with many phone numbers to call. This is where the C.A.R.E. Clinic steps in. We guide patients with significant trauma histories by developing a plan of medical care to meet their unique needs.”
Lewis O’Connor is leading an effort with colleagues at Partners HealthCare to advocate for Trauma-Informed Care at BWH, other Partners-affiliated institutions, and across the country. This new approach aims to understand patients’ exposure to violence and trauma in a broader context, not just the most recent event that brings them to the hospital.
Based on research and pilot testing, the group is developing a trauma-informed care toolkit any healthcare institution can use. “There are trauma-informed practices in place for mental health, substance abuse, and shelters, but no one has done this in health care. We’ve already done groundwork on this; it’s a huge opportunity to shift the paradigm in the health care system.”
Lewis O’Connor believes Trauma-Informed Care guidelines will help many patients coming in for health services. “When you’re getting medications and being examined by health professionals, this can set off triggers of past trauma,” she says. “There’s a phenomenon called the dose response, which means the more you’re exposed to trauma, the more it impacts your health.”
In addition to clinical care and research, the C.A.R.E. Clinic educates the next generation of caregivers through affiliations with area nursing programs, and helps to shape public policy at the national level with direct recommendations to the U.S. Department of Health and Human Services, the Office of Violence Against Women, and major health care organizations.
Lewis O’Connor holds conference calls with police officers, the district attorney’s office, shelters, and the faith community to coordinate services for patients. The clinic receives referrals from throughout BWH, and connects with outside community programs in addition to essential hospital colleagues in social work, infectious disease, and other areas to coordinate patient visits for the same day.
Another group that informs practice is the clinic’s Patient and Family Advisory Council—a group of 12 individuals who understand trauma firsthand. The advisors suggested that the clinic send text messages to patients in addition to reaching out by phone after their acute care visit, a step that improved the engagement rate dramatically. Patients said they appreciate the ability to get in touch easily, and to be discreet, Lewis O’Connor says. “Our advisors play a critical role, and even came up with the clinic’s name,” she says.
Before patients leave the hospital, Lewis O’Connor provides pre-paid wireless phones and phone cards, funded through a donor. “The phones are a lifeline,” she says. “We can’t connect with patients if they have no means of communicating with us.”
The C.A.R.E. Clinic’s philosophy is to listen to patients and deliver care based on their needs. “For Sarah, it means saying to her, ‘Tell me about you and what is most important to you right now,’” Lewis O’Connor says. “I’ve learned her life was not always in turmoil. Each person has strengths and we need to lift that up. These are resilient, incredible people; otherwise they wouldn’t have survived.”
Someday, Lewis O’Connor would like to see seamless, connected care between community and hospital-based services. “It is exciting to see the model of care evolving into a trauma-informed response,” she says. “We have made progress, and are on the path to doing even more.”
“I am honored and fortunate to be able to move this work forward,” she says. “To have this as my full-time job, and for the institution to see it and value it, is a dream.”
*The patient’s name was changed to protect her identity.
Pictured above: Emily Dollar, BS, research assistant, Connors Center for Women’s Health and Gender Biology; Hanni Stoklosa, MD, MPH, physician, emergency medicine, Global Women’s Health Fellow, Connors Center for Women’s Health and Gender Biology; Mardi Chadwick, JD, director, Violence Intervention Prevention Programs; Annie Lewis-O'Connor, PhD, NP-BC, MPH, director, C.A.R.E. Clinic; Myia Campbell, Patient Family Advisory Council member; Elaine Devine, MSW, LICSW, clinical social worker, emergency medicine; Kevin Hulme, finance manager, nursing administration; Amanda Berger, RN, MSN, SANE-A, staff nurse, emergency medicine.