Trauma Informed Care

For Providers

Trauma Informed Care: Transforming Organizations & Client Outcomes

#1
Trauma 101

#2
Trauma Informed Care
Basics

#3
How Families Benefit

#4
How Providers Benefit

#1: Trauma 101: What, exactly, do we mean by trauma?

A traumatic event is described as something that is sudden and unexpected, something we think of as overwhelming. It impacts our immediate ability to cope with the situation. It feels intense and abrupt and it can cause us to feel fear, intense feelings, and it can even lead us to feel out of control. This is generally because our physical or emotional well-being is being threatened or harmed and our stress-response system has been activated. Download this page as a document.

But complex trauma, sometimes referred to as developmental trauma, involves a few significant differences. It represents our unique, individual experience of an event or situation or ongoing condition that results in a threat to our sanity, emotional safety, or physical safety, even our developmental processes. This means that what is perceived as traumatic for one person may not be for another person. Just like the description above, complex trauma overwhelms our in-the-moment ability to cope with the circumstance. But it's different than other types of trauma because it has the power to change the way our brain works and develops, potentially causing long-term impacts on our emotional, social, cognitive, and behavioral functioning, among other developmental capacities. This type of trauma may come in the form of experiencing violence and victimization as a result of abuse or neglect, sexual abuse, domestic violence and the witnessing of domestic violence, it may involve being a victim in a natural disaster, experiencing a significant loss, or even being a victim of terrorism. Regardless, the long-term impacts of these types of prolonged stressors can cause us to have challenges related to our daily living, our quality of life, and even on our ability to work within those service systems that are trying to help us.

As professionals, if we are working with someone who has lived through these types of experiences, we understand that their service needs may look different than someone else and we want to be sensitive to those needs so that people have every opportunity to heal and grow.

In a 2006 article, Responding to Childhood Trauma: The Promise and Practice of Trauma Informed Care, Gordon Hodas, M.D., shares the following statistics related to complex trauma:

Childhood violence is a significant causal factor in 10-25% of all developmental disabilities

Between 20-50% of abused children will have some degree of permanent disability as a result of abuse

Each year, between 3.5-10 million children witness the abuse of their mother. Up to half of these children are also abused themselves

These types of statistics suggest that we must look at the needs of those impacted by complex trauma in ways that we haven't traditionally thought about. The positive side is that there are many dedicated and energized researchers and practitioners who have made this their mission, to focus on helping people impacted by complex trauma.

There is HOPE!

If you would like more information about research or practice-driven information, make sure to contact us. We are happy to share resources!

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#2. Trauma Informed Care Basics

It is precisely because of the unique way that complex trauma impacts people that Trauma Informed Care (TIC) was created. Providing trauma informed services means that we seek to understand the role that violence and victimization have played in people’s lives and because of that knowledge, we make changes in the way we provide services so that we prevent any (unintentional) re-traumatizing practices and so that we help to create opportunities for healing.

Let's take a look at the components:

First, it's about shifting the way we think about people and their needs. Trauma Informed Care experts Maxine Harris and Roger Fallot have suggested thinking about it this way: We move from "What's wrong with you?" to "What happened to you?" When we see people doing things that we can't seem to understand or that we make judgments about, we need to remind ourselves that their story matters. That story may have played a big role in their current situation. If we assume intent or make assessments about their motivations to act or "behave" in certain ways, we may be overlooking important opportunities for appropriate, effective care.

Second, if we don't know someone is a survivor of complex trauma, how can we offer them the most appropriate, effective services and supports? The following quote rings true for service provision: Every day, “systems serve survivors of trauma without ever treating them for the consequences of that trauma; more significantly, systems serve individuals without even being aware of the trauma that occurred" (Harris and Fallot, 2009). Universal Screening is a way to ask thoughtful, simple questions of all those who walk through the doors of mental health providers, questions that seek only to know if there is the presence of trauma in the person's past or current situation, at the very least, giving them a chance to help us understand them more fully, if they choose to share. How well are we really able to help people if we treat their symptoms in isolation of a story of relational violence, victimization, and traumatic stress?

Next, all staff, from the receptionist to the CEO, and everyone in between, have training and knowledge about the way in which traumatic stress impacts the brain and human development, particularly as it relates to traumatic experiences occurring up to age 5, the time when the brain is developing the most and when it is the most sensitive to experience. This is important because we know that trauma survivors are best served when we can create relationships and environments that feel safe and non-threatening. We want to ensure that everyone who interacts with those impacted by trauma has a special understanding of their unique service needs.

There is also a dedication to changing more formal practices within an agency. First and foremost, administrators need to be on board so that any necessary funding or supports can trickle down in a way that benefits clients and staff. This type of commitment ensures that policies and procedures include trauma informed language and practices and that hiring practices are organized around recruiting staff who have knowledge about trauma and its impacts. Administrators can be the 'champions' of a trauma-informed care approach!

Also significant to a trauma informed system of care is a commitment, within the agency's culture, to specific core values; safety, trustworthiness, choice, collaboration, and empowerment. "If a program can say that its culture reflects each of these values in each contact, physical setting, relationship, and activity and that this culture is evident in the experiences of staff as well as consumers, then the program’s culture is trauma-informed."(Fallot & Harris, 2009)

It is also true that a trauma-informed approach to care is one that incorporates attention to the care of staff related to any potential secondary trauma that may exist as a result of caring for those with trauma experiences. When staff are not able to take good care of themselves, have overwhelming caseloads, and feel that they are not supported adequately by employers, there is risk of burn-out, reducing effectiveness of services, and increasing the risk of negative impacts for those we are caring for.

And, most importantly, a trauma-informed care approach is about a partnership of purpose between those who have survived trauma and those who are providing trauma-based services. Clients drive and negotiate services, goals, and processes. As providers, we are very careful not to replicate the dynamics of abuse and abusive power. But together, the provider and the client can be a powerful force for change, growth, advocacy, and healing.

#3. How Do Families Benefit?

When people with traumatic experiences have access to appropriate, effective treatment and supports, several possible benefits can occur for individuals and families:

the potential that professionals within the system would unintentionally place someone in a triggering situation decreases because they are informed, by the client or family, of the history of trauma
evidence suggests that trauma informed practices reduce behaviors that cause people to suffer and that impact their lives in negative ways
Helping one generation to heal from the adverse impacts of trauma can improve health and mental health outcomes for future generations

#4. How Do Providers Benefit?

As with most human service work, when we are able to front-load our programming with policies and practices that may take more time and/or funding in the beginning but have longer term payoffs, trauma informed care practices have far reaching impacts for staff and for programs.

For Providers