Date of Award

Winter 12-2017

Degree Type


Degree Name

Doctor of Social Work (DSW)

First Advisor

Ram Cnaan, PhD

Second Advisor

Jo Anne Schneider PhD



A Two-Article Examination oF the Integration of Trauma-informed Care with Adult Medical Care

Author: Sharon Czabafy

Dissertation Chair: Ram Cnaan, PhD

The intersection of attachment theory and trauma theory provides information on how a person understands and communicates health symptoms and explains interactions in a relationship such as with a medical care provider. Extensive research exists regarding health effects and health behaviors related to the experience of trauma and attachment styles for adults, people 21-years-old and older and demonstrates the intersection of trauma, attachment styles, and health outcomes for adults. Additionally, numerous studies portray the spiraling costs of healthcare and identify the super-utilizers of health care.

Super-utilizers are adults who have preventable and frequent visits to emergency rooms and or hospitalizations. Super utilizing patients have complex medical issues often exacerbated by mental illness and or substance use. The Adverse Childhood Experience (ACE) study demonstrates that people who had adverse childhood experiences have multiple medical problems as adults as well as mental health disorders and addictions, factors for super-utilizers.

Weaving the cords of attachment and trauma theories with health outcomes suggest a trauma-informed approach to adult health care improve health care outcomes. Trauma-informed care acknowledges the impact of trauma and provides care with an awareness of those effects. Understanding the impact that trauma has on patients may assist care providers in offering a more efficient effective approach to service delivery. Recent research suggests integrating effective trauma-informed care programs, into mental health and addiction treatment is best practice. However, little research is available regarding trauma-informed adult physical health care.

This two-article theoretical-conceptual dissertation seeks to address the gap in the literature by further investigating the benefits of providing adult, trauma-informed medical care. The first paper, in this dissertation, explores the intersection of attachment and trauma theories with health outcomes. The second article builds on the need for trauma-informed care and defines the tenets of a trauma-informed care framework with examples of a trauma-informed approach through composite case vignette.

Included in

Social Work Commons