What is Trauma-Informed Care?

Recognizing that people frequently experience a variety of traumas throughout their life is a necessary part of becoming trauma-informed. Individuals who have experienced trauma need people around them who are supportive and caring. Frequently, well-intentioned caregivers and health providers can re-traumatize survivors of trauma. Being sensitive and supportive as a community begins with an understanding of the effects of trauma and how it impacts people’s lives.

What trauma informed care means

A trauma-informed care strategy aims at a full understanding of the person seeking help. When someone experiences trauma, it changes their self-image, their view of others, and their worldview. A person’s capacity to seek and utilize help is impacted by these beliefs. A trauma-informed care strategy incorporates information about the types of traumas into all areas of treatment and educates workers to look for signs of trauma, in order to reduce the risk of re-traumatization.

These concepts have been expanded and are being used in a variety of settings, including centers for treatment of substance-abuse, child welfare agencies, schools, criminal justice systems, primary care doctors, and those working in a community that has had exposure to trauma.

The purpose of trauma-informed care

The purpose of trauma-informed care (TIC) is to reduce the likelihood of and prevent people from being re-traumatized. This includes not setting up conditions that would cause them to experience the trauma again in the moment. Assisting someone in finding purpose and meaning in their life, feeling valued and fulfilled in their community so that they can see themselves as much more than their trauma is the goal of TIC.  Learning to recognize and pursue lifestyle choices that will reduce stress and trauma-caused problems will enable them to be independent and self-reliant in their ability to make decisions. It means changing their thinking from “what’s wrong with me” to “what’s happened to me”.

Key Components of Trauma-Informed Care

Trauma awareness entails:

• Recognizing that all persons are affected by trauma histories and the effects of trauma
• Recognizing that traumatic experiences are the source of many symptoms and behaviors

• Recognizing that being treated respectfully and with kindness, as well as having choices, are critical in assisting people in recovering from the impact of trauma

Trauma-informed care for children

In the case of children, a traumatic event can be terrifying, violent, or dangerous to the point of putting their life in jeopardy. Typically, for the 68% of children in America who have been traumatized, a pediatrician will be the first healthcare provider to come into contact with them.

A definition of trauma-informed care by the National Child Traumatic Stress Network is “medical care in which all parties involved assess, recognize, and respond to the effects of traumatic stress on children, caregivers, and healthcare providers”. This includes the stress of secondary trauma that can occur from hearing about the experience of a traumatized person, and covers clinicians and therapists, guardians, parents, and siblings.

6 Guiding Principles for Trauma-Informed Services

Here are the six main principles for trauma informed care as developed by the CDC’s Center for Preparedness and Response in conjunction with SAMHSA’s National Center for Trauma-Informed Care.

1. Safety
   1. Provide emotional safety by reducing the potential of being re-traumatized or of recreating the dynamics of previous trauma
   2. Establish a safe environment that is both physically and emotionally safe
2. Trustworthiness and Transparency
   1. Help a person know that the care provider is trustworthy by establishing consistent boundaries and being clear about what is expected of them
3. Support
   1. Support and encourage independence, choice, and control over their service experience to increase the likelihood of their participation
   2. Give hope and confidence in the ability to recover
   3. Demonstrate TIC commitment at the organizational and administrative levels
   4. Clients should be familiar with trauma-informed therapies and services that treat the symptoms that are a result of a traumatic event(s)
   5. Make trauma recovery a top priority
4. Collaboration
   1. Raise awareness and understanding of trauma
   2. Create opportunities for participating in collaborative relationships
5. Personal choice and control
   1. To increase resilience, take a strengths-based approach by concentrating on a person’s strengths and helping them build on those qualities to improve coping skills
   2. Develop trauma-resilient abilities
   3. Create self-care methods to handle secondary trauma
6. Environmental, cultural and social issues
   1. Understand that behaviors and symptoms related to trauma are the result of adapting and coping with the trauma
   2. Look at an individual’s trauma in the perspective of their environment
   3. Consider the symptoms of trauma from a social perspective
   4. Implement a national screening for trauma

Trauma-Informed Approaches in Services for Behavioral Health

Many patients who get help for behavioral issues have had some trauma in their past, but they often don’t realize the effect it has had on their life. Either they don’t relate their current behavior to the trauma, or they don’t want to deal with the problem. Therapists may not have a good understanding and knowledge about trauma so they don’t inquire about a history of trauma, or they may not feel capable of dealing with issues that are responses to trauma.

Treatment plans and behavioral health services need to recognize how a history of trauma correlates to behavioral health and create health care strategies and a trauma-informed environment for their patients. The guiding principles laid out above are necessary for agencies and staff to follow in order to be successful.

Adverse childhood experiences (ACEs)

Many people have some experience with trauma at some point in their life. Some will not have any symptoms or lingering effects, while others, especially those who were exposed to multiple or ongoing acts of trauma are more likely to manifest signs and problems like drug abuse, mental health issues, and physical health problems. As a result, trauma can have a considerable impact on how a person engages in major life areas as well as therapy.

ACEs or childhood trauma are traumatic events that occur from infancy to the age of seventeen. According to the CDC, 61% of adults in 25 states reported they had experienced at least one type of ACE before age 18, and nearly 1 in 6 reported they had experienced four or more types of adverse childhood experiences. Traumatic events that can have lasting negative effects range from having a loved one attempt or die by suicide, experiencing or witnessing violence, being abused or neglected, growing up in a household where parents were separated or in jail, doing drugs or having mental health issues. Although ACEs can be prevented, sadly, they are common occurrences for many children.