Psychiatrists often serve in a collaborative role with primary care providers and other healthcare professionals. A trauma-informed approach to medical treatment and understanding how various responses to trauma exposure may be related to other health concerns is imperative.

Pediatricians encounter children that have experienced trauma in over 60% of their patient interactions and serve a critical role in screening and identification of trauma-related symptoms, along with associated physical and mental health conditions. Primary care and other pediatric health providers often collaborate with other members of the treatment team, including case managers, nurses, and social workers to coordinate services to address trauma-related concerns.

Models for supporting the collaboration of child and adolescent mental health professionals and pediatric providers include educational support, clinical access to consultation by a mental health professional via phone or e-communication, onsite consultation by an embedded mental health provider, and traditional referral for mental health assessment.

When considering the provision of trauma-informed healthcare, SAMHSA identifies six guiding principles of trauma-informed care:

• Safety – Insuring psychological, emotional and physical safety
• Trustworthiness and Transparency – Providing truthful information clearly and consistently 
• Peer Support – Identifying social support or resources that align with individual’s community or peer group
• Collaboration – Working in partnership with family and individual toward identified goals
• Empowerment – Supporting autonomy of individuals and families by facilitating development of skills and connecting to resources related to identified goals
• Cultural and Historical Awareness – Recognizing current and historical marginalization and traumatic experiences of individuals based on race, ethnicity, gender, sexual orientation, and class.

Psychiatrists find themselves in clinical leadership roles of various organizations within healthcare and other child-serving agencies. Adoption of a trauma-informed organizational culture builds capacity for trauma-informed practices throughout the clinical team.

Child Welfare

• Children involved with child welfare are at greater risk of experiencing emotional or behavioral health symptoms due to exposure to adversity and trauma. Understanding the trauma related to involvement with child welfare and intergenerational trauma informs assessment and recommendations to child welfare professionals and other child-serving systems. Children involved in foster care are prescribed psychotropic medications at higher rates than other children. Every effort is made to minimize the unnecessary use of psychotropic medication by advising the youth's caregiver and other members of their care team on effective psychotherapeutic treatments and practices for traumatic stress. Medication is recommended for specific symptoms and diagnoses identified through a trauma-informed assessment. 

Justice

• Youth involved in the juvenile justice system have higher rates of exposure to trauma and mental health concerns that go unidentified, which places them at risk for additional traumatic experiences. Juvenile justice professionals (including judges, attorneys, law enforcement, probation officers, frontline residential staff, and mental health personnel) often have limited training and familiarity with trauma-informed practices. Psychiatrists and other pediatric mental health professionals can be important resources for early identification of trauma-related symptoms, assessment, and consultation.

Schools

• Trauma exposure and traumatic stress can interfere with development, learning, and social functioning which is often first recognized in a school setting. Psychiatrists often collaborate with school staff to gather information about a child’s functioning in the school setting and can provide insights into the effects of trauma on learning and behavior. Additionally, in collaboration with educational professional, parents,  and other mental health professionals, psychiatrists help identify mental health and educational supports to optimize child’s functioning in the school setting.