Does Trauma-Informed Care Have a Place in Audiology? A Review and Practical Suggestions

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This work explores the application of trauma-informed care to audiological practice.  This topic is of great importance as audiology and other medical fields turn towards more whole-health and patient-centered care models. This reviewer particularly enjoyed the final sections of the work that dealt with specific things that audiologists should be aware of when administering diagnostic evaluations and possible ways to modify test procedures for traumatized patients.  The manuscript has valuable information for audiologists, but this information is undercut by a lack of definitions and scope, and the segmenting of pediatric and adult trauma and trauma-informed care.  Clear definitions need to be provided for trauma, adverse childhood experiences, trauma-informed care, and traumatic toxic stress.  Without such definitions, I fear the authors may undercut their intent to make audiologists aware of the importance of recognizing how previous trauma may impact audiological care.  For example, “pregnancy” and “military service” are listed as sources of trauma for adults (lines 107 – 108).  Clearly, these general conditions are not the same as, for example, the unexpected loss of a fetus or the witnessing loss of life and/or limbs during wartime events.  The same is true for “adverse childhood experiences”. 

 

The discussions of pediatric and adult trauma were also confusing to this reviewer.  Throughout much of the text, the authors apply trauma and trauma-informed care more to pediatric patients (e.g., lines 37 – 39, 104 – 105 and 138 – 140).  I’m not sure this is the case since many publications exist covering TIC in adult populations.  Some of the topics addressed under Trauma in Childhood seem highly applicable to adult trauma as well (e.g., trauma associated with chronic medical conditions, high-risk populations, traumatic toxic stress, etc.).  Similarly, topics addressed under Trauma in Adulthood are highly applicable to pediatric cases (e.g., maladaptive neuroplasticity, general symptoms of trauma, and presence and effects of PTSD). 

The first citation (Larson et al., 2021) is used frequently, but it appears to be a presentation that is not accessible (and presumably not peer-reviewed).  Clicking on the link brings readers to a “Page not found” message.  Would recommend replacing these citations with peer-reviewed work wherever possible.

In summary, this manuscript could greatly benefit from the inclusion of definitions and scope of trauma and trauma informed care as well as some restructuring to bring together presently disparate ideas affecting trauma and trauma informed care.

Comments on the Quality of English Language

Generally fine.  Only minor grammatical edits needed.

Author Response

• The manuscript has valuable information for audiologists, but this information is undercut by a lack of definitions and scope, and the segmenting of pediatric and adult trauma and trauma-informed care.
  • Clear definitions need to be provided for trauma, adverse childhood experiences, trauma-informed care, and traumatic toxic stress.
    • Clarified definitions of trauma and ACEs in the first paragraph of the introduction, and TIC in the second paragraph.
    • Clarified what traumatic toxic stress is in lines 86 and 89.
  • For example, “pregnancy” and “military service” are listed as sources of trauma for adults (lines 107 – 108). Clearly, these general conditions are not the same as, for example, the unexpected loss of a fetus or the witnessing loss of life and/or limbs during wartime events.  The same is true for “adverse childhood experiences”.
    • Clarified the broad categories of events that can cause trauma with more clear examples of each and provided a reference to a comprehensive review of sources of trauma.
  • The discussions of pediatric and adult trauma were also confusing to this reviewer.
    • Throughout much of the text, the authors apply trauma and trauma-informed care more to pediatric patients (e.g., lines 37 – 39, 104 – 105 and 138 – 140). I’m not sure this is the case since many publications exist covering TIC in adult populations.
      • Clarified that TIC was originally intended for younger people and is now applied to all ages in the literature through the manuscript, for example lines 110 - 111.
    • Some of the topics addressed under Trauma in Childhood seem highly applicable to adult trauma as well (e.g., trauma associated with chronic medical conditions, high-risk populations, traumatic toxic stress, etc.). Similarly, topics addressed under Trauma in Adulthood are highly applicable to pediatric cases (e.g., maladaptive neuroplasticity, general symptoms of trauma, and presence and effects of PTSD).
      • Moved some content from the Trauma in Childhood heading and Trauma in Adulthood heading to a new Effects of Trauma section discussing the physiologic changes from trauma to it’s own section.
    • The first citation (Larson et al., 2021) is used frequently, but it appears to be a presentation that is not accessible (and presumably not peer-reviewed). Clicking on the link brings readers to a “Page not found” message.  Would recommend replacing these citations with peer-reviewed work wherever possible.
      • Thank you, more peer-reviewed citations were added to supplement non-peer-reviewed citations throughout the document and this citation was removed where possible. As for the link, it opens on all browsers and devices the author has tried to open it with, I am unsure what issue may be causing it to be unavailable. Since the link appears to be working at least some of the time it was left in the references.

Reviewer 2 Report

Comments and Suggestions for Authors

Line 139: Please rephrase the sentence. “people age birth’ does not sound right, and the sentence is too similar to the one in the previous section.

Line 167-168 “unwillingness to confront their own childhood trauma” – seems too harsh. I don't think it should be said like this. If this is a finding from a previous study, please bring the results here and not this conclusion. It sounds like an accusation.

Lines 205-220: these look like some principles of TIC. They should be put in a different section designated to all principles of TIC.

Lines 221-240: the information here can be extended and presented as a section detailing tools and questionnaires for screening trauma.

Line 244: “quieter”?

Testing modifications section – This section does not suggest any modification, and it is not clear what it adds on top of the next section.

Hearing Testing section – this section only suggests solutions to claustrophobia. Please state the other problems and add their suggested solutions.

Preparing Patients for Challenging Testing section – this should be part of the principles of TIC.

 

 

 

 

Author Response

• Line 139: Please rephrase the sentence. “people age birth’ does not sound right, and the sentence is too similar to the one in the previous section.
  • Thank you, rephrased for clarity.
• Line 167-168 “unwillingness to confront their own childhood trauma” – seems too harsh. I don't think it should be said like this. If this is a finding from a previous study, please bring the results here and not this conclusion. It sounds like an accusation.
  • Softened language to clarify this may not be an intentional process.
• Lines 205-220: these look like some principles of TIC. They should be put in a different section designated to all principles of TIC.
  • Moved this discussion to the end of the Trauma-Informed Care heading to better establish the principles of TIC earlier.
• Lines 221-240: the information here can be extended and presented as a section detailing tools and questionnaires for screening trauma.
  • Expanded this section and included more resources on choosing specific screening measures.
• Line 244: “quieter”?
  • Clarified the nature of this manual program.
• Testing modifications section – This section does not suggest any modification, and it is not clear what it adds on top of the next section.
  • Abbreviated this content and moved it to flow more smoothly from the previous section.
• Hearing Testing section – this section only suggests solutions to claustrophobia. Please state the other problems and add their suggested solutions.
  • Clarified that the focus of this section is claustrophobia, and additional suggestions for speech and UCL testing are provided later.
• Preparing Patients for Challenging Testing section – this should be part of the principles of TIC.
  • Moved this content to the Trauma-Informed Care header to better prepare the reader for specific recommendations later in the manuscript.