What Is Trauma Informed Care

May 12, 2024

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Understanding Trauma

Before delving into trauma-informed care, a clear understanding of trauma is necessary. Trauma can have profound effects on an individual's mental, physical, and emotional well-being, and the impact can be long-lasting, especially in the case of adverse childhood experiences (ACEs).

Definition of Trauma

Trauma, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), refers to "exposure to actual or threatened events involving death, serious injury, or sexual violation". It is an emotional response to an intense event that threatens or causes harm, either physical or emotional. Trauma can result from a wide range of events including natural disasters, violence, abuse, and significant losses. It's essential to remember that trauma is subjective and varies from person to person based on their experiences and responses.

Impact of Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) have a significant impact on individuals and can shape their physical and mental health in adulthood. ACEs, which can include experiences such as abuse, neglect, or household dysfunction, can lead to conduct issues in children and adolescents and have lifelong consequences. Adults with high ACE scores are at a greater risk for physical health issues, mental illness, and early death [1].

The prevalence of ACEs is alarmingly high. More than 46% of children have at least one Adverse Childhood Experience, highlighting the necessity for trauma-informed care. In light of these statistics, it becomes increasingly clear that addressing trauma and its impacts is a critical aspect of providing comprehensive health care, especially within mental health services. This is where trauma-informed care comes in. Understanding what trauma is and its potential impacts is the first step towards implementing effective trauma-informed care.

Benefits of Trauma-Informed Care

Trauma-informed care is a therapeutic approach that takes into account the impact of traumatic experiences on an individual's physical, psychological, and emotional health. It aims to provide a supportive environment and effective treatment strategies for individuals who have experienced trauma. In this section, we will explore the effectiveness of trauma-informed care in addressing trauma and its role in tailoring interventions to individual needs.

Effectiveness in Addressing Trauma

Trauma-informed therapy can increase effectiveness in both youth and adults who have experienced trauma. This approach addresses issues of guilt and shame often carried by trauma survivors, providing a more comprehensive and empathetic form of care.

Moreover, trauma-informed care enables a shift in perspective from "What's wrong with you?" to "What happened to you?" This approach acknowledges that health care organizations and care teams need a complete picture of a patient's life situation to provide effective health care services with a healing orientation, which can potentially improve patient engagement, treatment adherence, and health outcomes.

Tailoring Interventions to Individual Needs

Trauma-informed care is not about a specific intervention but about tailoring interventions to the individual's trauma history, triggers, and specific needs. This individualized approach acknowledges that each person's experience is unique and requires a personalized strategy for healing, building on their strengths rather than focusing on perceived deficits.

Implementing a trauma-informed approach can result in patients engaging more fully in their healthcare, developing a trusting relationship with their provider, and improving long-term health outcomes. This approach also has the potential to reduce burnout among health care providers by fostering a more understanding and empathetic work environment.

In summary, trauma-informed care offers a multitude of benefits in addressing trauma and tailoring interventions to individual needs. By considering the individual's history, needs, and strengths, this approach seeks to provide the most effective and compassionate care possible for those affected by trauma.

Core Principles of Trauma-Informed Care

The approach to trauma-informed care is built on a set of core principles that guide the care delivery process. These principles, focusing on safety and trustworthiness and peer support and collaboration, not only shape the patient's experience but also the overall therapeutic environment.

Safety and Trustworthiness

One of the key principles of trauma-informed care is ensuring safety and trustworthiness. This principle recognizes the importance of creating safe environments for both patients and staff. It involves building trusting relationships and ensuring physical and psychological safety [2].

Safety and trustworthiness are critical in establishing an environment where patients feel secure and can develop a sense of trust in their healthcare providers. These aspects can significantly improve patient engagement, treatment adherence, and long-term health outcomes [2].

In addition, these principles provide a foundation for improved patient outcomes and reduced burnout among healthcare providers.

Peer Support and Collaboration

The second core principle of trauma-informed care involves peer support and collaboration. This highlights the importance of shared experiences and mutual support in the healing process.

By promoting collaboration, patients are encouraged to engage in their treatment actively, leading to more personalized and effective care. Peer support, on the other hand, provides a platform for individuals to share experiences and learn from each other.

These principles, when implemented correctly, create an environment where individuals feel safe and supported, enabling them to engage more fully in their healthcare and improve long-term health outcomes.

In summary, the principles of safety and trustworthiness, along with peer support and collaboration, play a crucial role in implementing trauma-informed care. By adhering to these principles, healthcare providers can ensure a safe and supportive environment that promotes healing and improves overall health outcomes.

Implementing Trauma-Informed Care

The implementation of trauma-informed care requires a comprehensive and dedicated approach at both the clinical and organizational levels. This commitment to transformation ensures broad organizational culture change and sustainable shifts in day-to-day operations, which are essential in addressing trauma effectively.

Organizational Adoption

The adoption of trauma-informed care within an organization encompasses more than clinical practices—it also requires a fundamental shift in the organization's culture and operations. This approach recognizes and addresses the widespread impact of trauma and understands potential paths for recovery. It actively resists re-traumatization and works to create safe, caring, and inclusive environments [2].

The core principles of a trauma-informed approach to care are critical to this transformation. These principles include safety (both physical and psychological) for patients and staff, trustworthiness, transparency, peer support, collaboration, empowerment, humility, and responsiveness.

Furthermore, organizations engaging in trauma-informed care actively work to move past cultural stereotypes and biases, provide culturally responsive services, utilize traditional cultural connections, and address historical trauma.

Importance of Non-Clinical Staff

Implementing trauma-informed care is not solely the responsibility of clinical staff. Non-clinical staff, such as front desk workers and security personnel, who interact significantly with patients also play a crucial role in ensuring patient safety and well-being [2].

These staff members are often the first point of contact for patients and their families, making their understanding and adoption of trauma-informed care principles essential. They can contribute to creating a safe, respectful, and welcoming environment that acknowledges and addresses the impact of trauma on individuals' lives.

By equipping all staff with the knowledge and skills to adopt a trauma-informed approach, organizations can ensure that they consistently provide care that recognizes and responds to the effects of trauma, ultimately enhancing patient safety, engagement, and outcomes.

Healing Through Trauma-Informed Care

The healing power of trauma-informed care lies in its ability to acknowledge the impact of trauma on an individual's life and to provide care that prioritizes safety, trust, and empowerment. This approach is crucial in restoring safety and self-worth and in strengthening therapeutic relationships, thereby promoting healing and recovery.

Restoring Safety and Self-Worth

Trauma-informed care aims to restore a sense of safety and self-worth in individuals who have experienced trauma. This approach is different from traditional models of care as it shifts the focus from "What's wrong with you?" to "What happened to you?" This shift in perspective allows healthcare providers to gain a more complete understanding of a patient's life situation, leading to more effective health care services with a healing orientation.

Furthermore, trauma-informed therapy can increase effectiveness in both youth and adults who have experienced trauma. It addresses issues of guilt and shame that are often carried by trauma survivors, providing necessary support and facilitating dialogue about difficult experiences. This makes it easier to address traumatic events and promotes healing.

Strengthening Therapeutic Relationships

Trauma-informed care recognizes that healing occurs in relationships. It emphasizes the importance of establishing a trusting relationship between the patient and the provider. This approach allows patients to engage more fully in their healthcare, improving long-term health outcomes and potentially reducing burnout among healthcare providers.

Moreover, this approach acknowledges that everyone can play a role in a trauma-informed approach, even if they are not therapists. It emphasizes meaningful power-sharing, recognizing the importance of the patient's voice and perspective in the healing process.

Through these core principles, trauma-informed care fosters a supportive and empowering environment, enabling individuals to heal from their traumas and rebuild their lives. It represents a significant shift in the understanding and treatment of trauma, promising better outcomes for individuals who have experienced adversity.

Strategies for Trauma-Informed Care

Effective implementation of trauma-informed care (TIC) requires a comprehensive approach, encompassing a series of strategies that focus on creating safe environments and addressing trauma during treatment.

Creating Safe Environments

An important aspect of TIC involves establishing and supporting a client's sense of physical and emotional safety. This includes anticipating and addressing potential triggers that may evoke trauma-related reactions, ensuring consistency, dependability, and honest communication to promote safety. It's crucial for safety to extend to behavioral health staff members as well.

The Substance Abuse and Mental Health Services Administration recommends ten implementation domains for creating a trauma-informed environment, which includes Governance and Leadership, Policy, Physical Environment, Engagement and Involvement, Cross-Sector Collaboration, among others.

Implementation Domains
Governance and Leadership
Policy
Physical Environment
Engagement and Involvement
Cross-Sector Collaboration
Screening, Assessment, and Treatment Services
Training and Workforce Development
Progress Monitoring and Quality Assurance
Financing
Evaluation

Creating a safe environment also involves avoiding re-traumatization, which can occur in any situation or environment that symbolically resembles an individual’s original trauma, triggering difficult feelings and reactions associated with it.

Addressing Trauma in Treatment

Trauma-informed care involves a bottom-up approach, where the therapist follows the client, supporting their unique movements towards release and health in the present moment. This approach holds that all trauma can be released and healed with appropriate support [6].

TIC helps in healing by providing necessary support, overcoming feelings of shame and guilt, and facilitating dialogue about difficult experiences, making it easier to address traumatic events.

TIC strives to understand the whole of an individual seeking services. It recognizes that trauma affects an individual's sense of self, their sense of others, and their beliefs about the world. These beliefs directly impact an individual's ability or motivation to connect with and utilize support services.

TIC recognizes that many individuals seeking treatment in behavioral health settings have histories of trauma, but they often don't recognize the significant effects of trauma in their lives. Treatment providers may also not ask about trauma or feel unprepared to address trauma-related issues. TIC aims to build a trauma-informed environment across the continuum of care by meeting client needs in a safe and compassionate manner, preventing retraumatization, and building on client strengths and resilience.

TIC is an intervention and organizational approach that focuses on how trauma may affect an individual's life and their response to behavioral health services from prevention through treatment. It incorporates three key elements: realizing the prevalence of trauma, recognizing how trauma affects all individuals involved with the program, organization, or system, and responding by putting this knowledge into practice.