Psychiatrist is Innovator in Trauma Treatment, Education

As soon as she began her psychiatry residency at the New York State Psychiatric Institute/Columbia Presbyterian Medical Center in the late 1980s, Paula Panzer, M.D., knew she was interested in better understanding trauma and its effects on the patients she was seeing.

Paula Panzer, M.D.

“I began to hear stories of patients’ lived experiences and their treatment at the hands of people who should have been protecting them,” such as parents and guardians, she told Psychiatric News. The urge to discover the facts surrounding the disproportionate exposure of women to trauma drove most of her work from that time forward.

With much to be discovered about trauma, Panzer was uniquely positioned to forge collaborations with private and government funding agencies, communities, coalitions, and even the survivors to learn and teach others about trauma-informed care and trauma-specific services.

Today, these partnerships remain an essential part of her role as chief clinical and medical officer of the Jewish Board of Family and Children’s Services), a social-services agency serving 35,000 New Yorkers in New York City and suburban Westchester County. “My career in trauma has informed the way I think and operate in my current role,” said Panzer.

After residency training, Panzer, then working with Columbia University psychiatrist Mindy Fullilove, M.D., received funding for research and training projects with a focus on women and families to better understand their exposure to trauma at the height of the crack-cocaine epidemic in New York. “We were trying to create a language to describe how childhood trauma exposure led to a cycle in which these women became more likely to engage in unsafe behaviors, thereby leading them to experience more trauma.” The women also became more vulnerable to HIV and mental health challenges, she noted.

She worked in a variety of settings, including at a substance abuse clinic, with a mobile outreach team, and at a multidisciplinary AIDS housing and treatment program. Her experience working at a domestic-violence shelter run by the Jewish Board enabled Panzer to become aware of trauma occurring on a daily basis and to see eventual recovery in the clients with whom she worked.

Panzer began to teach others what she knew about trauma, much of which came directly from her clients. “I learned how important it was to partner with my clients,” she said. In the mid-1990s, Panzer co-wrote a trauma treatment curriculum called “Connecting and Coping” for use in group settings for both women and men recovering from substance use issues and dealing with trauma. “They taught me that the training must be relevant, practical, and culturally competent,” she remarked.

Trauma Curriculum Developed

She created a course at Columbia University for PGY-3 residents called Traumatic Stress Studies in 1993 and has been teaching it since. She also developed a similar course that she teaches to public-psychiatry fellows.

In her later role as deputy chief psychiatrist and associate director at the Jewish Board’s Center for Trauma Program Innovation, Panzer began to focus on creating trauma-informed care, to ensure that systems of treatment do not retraumatize patients who have already experienced a trauma but instead promote hope and resilience. Through training materials and services administration, Panzer advocates for systems that are welcoming, safe, and collaborative and promote healing.

Following the terrorist attacks of September 11, 2001, Panzer provided crisis intervention to survivors and trained many of her colleagues and staff at the Jewish Board to do the same.

These trainings emphasized the importance of self-care for clinicians both in and out of the workplace, she said. “Every time we do a trauma training, we talk about how to prevent secondary trauma” while helping others deal with its aftermath. Working in teams is helpful, Panzer said, as is having an opportunity to discuss cases with others in a structured and supportive environment. It is vital to take breaks while helping clients cope with trauma, Panzer noted, and to balance trauma work with self-care, including activities outside of work. She also advises mental health professionals to seek treatment for their own experiences with trauma, if any, so that patients’ stories of trauma do not retraumatize them.

Understanding ‘Structural Racism’ Key

In her current role at the Jewish Board, Panzer strives to ensure that all service delivery is trauma-informed, recovery-oriented, person-centered, and culturally competent. She also acknowledged that an initiative at the Jewish Board has taught her to understand the process of confronting structural racism in a human-services agency. This involves addressing disparities in program staffing, promoting understanding about racism, and raising awareness about how internalized and institutionalized racism are barriers to meaningful relationships with communities, she said.

APA Deputy Medical Director Annelle Primm, M.D., M.P.H., told Psychiatric News that APA has long valued Panzer’s efforts to improve patient care. “For many years, Dr. Panzer has been a leader at the vanguard of ensuring that principles of recovery-oriented, trauma-informed, culturally competent, and person-centered care are applied at the individual level and the systems level of mental health and substance use services.” Primm also noted that Panzer convened “groundbreaking” sessions and symposia on racism and trauma at APA’s Institute on Psychiatric Services to help “make real the impact of racism on mental health as well as pathways for healing and wellness in its aftermath.”

Panzer said that her involvement with APA and the American Association of Community Psychiatrists is vital to ensuring that community psychiatrists are properly integrated into systems of care and adequately reimbursed. She added, “I think psychiatrists are uniquely positioned to address health, wellness, the impact of trauma, and collaborations with communities—we are superb system thinkers.” ■