(095) Bringing Trauma Informed Care Into Pelvic Health Care

Abstract Introduction Sexual and medical trauma are highly prevalent, and present challenges for patients in experiencing routine medical exams and treatments. Psychosocial and health outcomes associated with trauma are profound and diverse and can for many be associated with chronic mental and physical health conditions, and both health care access and care quality are often negatively impacted by trauma. Practice specialties, such as reproductive and pelvic health care, are more subject to risk of re-traumatizing patients with trauma histories, given invasiveness and exposure. Trauma informed care practices should be applied to obstetrician-gynecology, peri- and post-natal care, care, midwifery practice, chronic pelvic pain medicine, sexual medicine, reproductive-oncology care, and pelvic floor physical therapy. Objective To apply the Substance Abuse and Mental Health Services Administration (SAMHSA) conceptualization of trauma and guidance related to trauma informed mental health and addition care, to pelvic health care. To engage clinicians from various health care backgrounds, as well as pelvic health care patients with trauma histories to contribute to developing, and to give feedback on the development of trauma informed pelvic health care recommendations. Methods Health care providers and patients, representing the cross disciplinary nature of pelvic health care, were engaged to initially provide content and contribute to drafting a list of trauma informed care guidelines. From there, this proposed draft of guidelines was distributed amongst a larger group of pelvic health care providers and patients to gain perspectives on and feedback about implementation of these proposed guidelines. Results Proposed recommendations were organized into 9 categories of care: Environment, Clinical introduction, Exams and Procedures, Intersection between trauma and procedures, Inpatient considerations, Documentation, Querying trauma, Responding to trauma disclosures and Provider self-reflection. Specific practice suggestions are provided in each category, integrating clinical pearls throughout. Respondents largely represented pelvic floor physical therapists (29%), and family physicians (27%), with fewer representatives (≤ 10%) from each of midwifery, gynecology, urology, oncology, and nursing. While data collection is still ongoing (n = 138) and attendees will be presented with an opportunity to participate and provide feedback on the proposed guidelines, results to date suggest that the guidelines are feasible and should be prioritized by care providers. Results also indicate that while providers may currently be implementing some of these practices, there is still significant room for improvement. While some commonly cited barriers to implementation included structural barriers such as not being responsible for making decisions (particularly related to environment and inpatient settings), the most commonly cited barrier in most other categories was "never having thought about it before". Conclusions Results of this study and the clinical recommendations generated are largely endorsed by health care providers as important to be prioritized and has something they will aim to increase use of in their clinical practices. Both the large portion of responses indicating that participants had not "thought about it before", and the intention to increase use of these practices, suggests that practice recommendations are novel and pragmatic. Dissemination of trauma informed practice guidelines are likely to be useful for practitioners who hope to improve pelvic health care experiences. Disclosure No

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