National Conference 2022

Residents Seek Trauma-informed Care, Street Medicine Training

August 11, 2002, 1:11 p.m. News Staff — After two years of virtual-only interactions, participants took full advantage of the in-person meet-and-greet opportunities at this year’s National Conference of Family Medicine Residents and Medical Students in Kansas City, Mo.  During the July 28-30 event, residents and medical students from across the country had the chance to hear from nationally known speakers, explore dozens of workshops and poster presentations, and visit hundreds of exhibits featuring residency programs, physician employers, and more.

According to a resolution titled “Integration of Trauma-Informed Care into Family Medicine Training,” the Accreditation Council for Graduate Medical Education has emphasized that family physicians, in particular, need “deliberate education and training in family dynamics and trauma-informed care” as well as an understanding of how social determinants of health lead to inequities in outcomes. Yet there’s no formal guidance for providing this training to family medicine residents, said the resolution, which called for the AAFP to develop recommended curriculum guidelines and submit them to the ACGME for consideration as guidance for programs that seek to implement the existing TIC education program requirement.

Testimony given during a July 29 reference committee hearing was uniformly supportive, reflecting concerns “for not only family members but also patients and families who have suffered and survived through abuse and adverse childhood events.” Acknowledging the Academy’s position that FPs should understand and incorporate TIC in their practices and in student and resident training, the report said the resolution would go one step further, “providing resources, support and guidance for implementation of training.”

Delegates agreed, voting to adopt the resolution during their July 30 business session. But that wasn’t the only measure dealing with socially sensitive patient care issues resident delegates adopted that day.

Street Medicine

Participants in a second reference committee hearing testified on a resolution based on the premise that “housing insecurity, underhousing, and sheltered and unsheltered homelessness” represent an ongoing public health crisis that affects people of all ages and has been exacerbated by the COVID-19 pandemic.

The measure pointed to “out-of-proportion” utilization of health care resources to treat chronic and acute disease in these individuals, as well as substance use disorders and other mental health needs. Suboptimal vaccination rates also add to their risk for infectious disease.

• To address this multifactorial problem, a comprehensive response is needed, said the resolution’s authors. Among actions they asked the Academy to take were
• affirm that access to affordable housing is a fundamental human right and support state and community efforts to build permanent supportive housing;
• recognize street medicine as a unique subdiscipline that addresses the needs, mind, body, and spirit of people critically at-risk due to housing insecurity and limited community outreach;
• advocate that chapters include street medicine in their educational and training curricula; and
• develop and publish guidelines to provide comprehensive and inclusive care based on street medicine initiatives such as those from the Substance Abuse and Mental Health Services Administration and the Street Medicine Institute.

In their report, reference committee members “acknowledged the spirit and intent of the resolution and recognized the need for street medicine.” They pointed to existing AAFP policy on homelessness, which states that “access to safe and affordable housing is a social determinant of health,” and said that although additional information would be needed to determine the type of guidance family physicians would need to care for people experiencing homelessness, the resolution does offer a starting point to begin building awareness of the need for education about and training in providing street medicine.

Ultimately, the committee recommended, and delegates adopted, a substitute resolution focused on just one part of the original measure, calling for the AAFP to “recognize the importance of street medicine as a unique aspect of family medicine addressing the needs, mind, body, and spirit of those critically at-risk due to housing insecurity and limited community outreach and work to promote the role of family physicians in securing nonhospital care.”

988 Mental Health Hotline

Another resolution residents considered July 29 also featured a SAMHSA tie. Last month, the nation officially transitioned from the 10-digit National Suicide Prevention Lifeline (800-273-TALK [8255]) to the 988 Suicide & Crisis Lifeline. According to a SAMHSA press release, establishment of the lifeline, which also links to the Veterans Crisis Line, “follows a three-year joint effort by the U.S. Department of Health and Human Services, Federal Communications Commission, and the U.S. Department of Veterans Affairs to put crisis care more in reach for people in need.”

The resolution cited “national infrastructural challenges in providing both physical spaces and mental health clinicians” to handle the rising number of calls to the new three-digit hotline and called on the AAFP to advocate that family physicians be recognized as eligible to receive referrals for mental health services from these calls and that they be appropriately compensated for doing so.

The Academy has long championed family physicians’ vital role in providing mental health care services, noting that they are recognized as one of the principal sources of this type of care among U.S. residents, especially among vulnerable populations. Research has consistently demonstrated that primary care and family physicians are well equipped to care for a range of mental health issues, including a 2021 study that found that out of more than 394,000 visits to primary care physicians (i.e., family medicine, general practice, internal medicine, pediatrics, and geriatrics), psychiatrists and subspecialists, PCPs provided the majority of care for patients with depression and anxiety disorders, as well as for those with any mental illness.

Not surprisingly, then, the reference committee reported that testimony was fully supportive of the resolution, and delegates handily adopted it during the congress’ July 30 business session.

Other Business

Delegates also gave a thumbs up on the following measures:

• a substitute resolution designed to expand home and community-based senior services and boost wages for essential workers who provide these services. Although the substitute retained most of the language of the original measure, which specifically asked the Academy to advocate that Medicare coverage be expanded to cover vision, dental, and hearing impairments with reduced out-of-pocket costs, it added phrasing that aims to ensure primary care funding would not be adversely affected.
• a resolution that would allow the establishment of a “unified national chapter” for international medical graduates pursuing education or careers in the United States to represent the interests of this constituency within the AAFP. Based on uncertainty regarding the resolution’s goal and questions about feasibility and allocation of resources, the reference committee had recommended against adoption. Delegates disagreed, however, and voted to adopt the measure.
• a substitute resolution intended to remove barriers to menstrual hygiene products. Citing existing AAFP policy on this issue, reference committee members recommended adoption of one of three resolved clauses included in the original resolution. The measure adopted asked the Academy to advocate the removal of all sales tax on menstrual hygiene products.