Trauma-Informed Care

Original Editor - User Name Top Contributors - Naomi O'Reilly, Jess Bell, Anna Fuhrmann, Wanda van Niekerk, Ewa Jaraczewska and Robin Tacchetti

Introduction

Due to a high prevalence of unidentified trauma and Adverse Childhood Experiences (ACE) within the population, Trauma-Informed Care (TIC) has become a valuable part of patient care. Especially in settings of conflict or natural disasters, a mindset within the professional health and social services, which is attentive towards past trauma in care-seekers, can prevent retraumatization and improve treatment outcome. Individuals who have experienced trauma or ACE are more vulnerable to a variety of health implications and diseases, e.g. mental health disorders, substance abuse, cardiovascular diseases, chronic pain disorders, etc. Often, trauma is not detected or dealt with and subconsciously affects the patients' response to treatment. Mindfulness towards trauma and ACE can help to lessen the long-term effects on physical and mental health in affected individuals by addressing the underlying conditions in a sensitive and respectful matter.

“Trauma-informed services do no harm i.e. they do not re-traumatise or blame victims for their efforts to manage their traumatic reactions, and they embrace a message of hope and optimism that recovery is possible. In trauma-informed services, trauma survivors are seen as unique individuals who have experienced extremely abnormal situations and have managed as best they could”. (Dr Cathy Kezelman)

Principles

To promote TIC, service providers and systems of clinical practice and social services should follow the basic principles. Depending on the source, five to seven principles can be found.

• SAFETY The first and most important principle of TIC is to ensure a feeling of physical, psychological and emotional safety - for both staff and patients.
• COLLABORATION It is essential to involve the patient into treatment plans. In general, decisions should be shared between staff of different levels/ professions and the individual.
• TRUSTWORTHINESS (& TRANSPARENCY) An important aspect includes clarity in communication and decision-making in order to build trust.
• EMPOWERMENT Both, patients and professionals need to be able to make use of their strengths. This principle supports the resilience and self-efficacy within therapy/ the process of healing by giving back control to the individual.
• CHOICE One vital aspect is to provide and encourage opportunities to make individual choices for all involved patients and professionals, along all stages of treatment.
• PEER SUPPORT Bringing together patients and professionals with similar experiences can help to achieve integration of individuals into the service or therapy.
• HUMILITY AND RESPONSIVENESS/ RESPECT FOR DIVERSITY Trauma based on discrimination (e.g. of gender, skin colour, ethnicity, ...) are recognized, bias and stereotypes are addressed, and diversity is respected in every way during treatment by both patients and staff.

Definition of Trauma

As defined by the Substance Abuse and Mental Health Service Administration (SAMSA) in their Concept of Trauma and Guidance for a Trauma-Informed Approach, "trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being".Trauma can affect any person from any cultural, socio-economic, ethnic, religious or educational background and is non-specific to gender or age. Trauma can also include second-hand experiences, meaning that someone might have a trauma which they have not experienced themselves but were indirectly affected.

Key Components to Implement Trauma-Informed Care

To implement a TIC, training of clinical and non-clinical staff is necessary. The framework should strongly be founded on the above-mentioned principles to TIC. Standard clinical and administrative procedures neet to be reviewed under those aspects, and should also be considered from a patient-centred point of view.

An approach to TIC must be made on both an organisational and a clinical level. By training staff (clinical and non-clinical) about TIC, opening up opportunities of communication about trauma and coping (for both patients and staff) and providing means to include patients and workers into organisational tasks, a workplace can start corporating the principles. It is also advised to hire a trauma expert for both consultation and training. Knowing that there is a specialised contact person who can be consulted for trauma-realted issues, already helps creating a safe environment for many individuals. To encorporate this, first the structural requirements have to be created. Leadership personnel needs to acknoledge and support the approach to TIC as it requires changes within the clinical organisation. The allocation of resources and funding is a first step to establish a trauma-informed clinical setting. The group overseaing the integration of TIC into the clinical setting should also include individuals who have experienced trauma, to ensure a feeling of transparency, trustworthiness and collaboration between the care personnel and the patients.

Further Resources

Physiotherapy Assessment of Pain within a Trauma-Informed Care Model

For more information and practice implementation strategies, visit the websites of the Trauma-Informed Care Resource Centre or the Californian Department of Health Care Service ACEAWARE. The official Concept of Trauma and Guidance for a Trauma-Informed Approach by SAMHSA can be found under this link.