Creating a Culture of Prevention and Wellbeing – Trauma informed Care and Practice

This paper was presented at Youth Mental Health Day Sept 2011 in ACT at a professional development seminar.

Trauma-informed Care and practice (Youth  Mental Health Day)

 I plan to speak with you today about trauma and especially trauma in childhood and its impact on youth mental health. I would like to highlight how
awareness of trauma and its impact, and responsiveness to it can make a significant difference to the lives of young Australians. We are living in a
changing political environment and one which has a greater focus on mental health than ever before. This focus is long overdue. However responses to mental
health issues still are not on par with those to physical illnesses. However inroads are being made all the time.

Mark Butler the first ever federal minister for mental health recently announced a number of new initiatives and funding opportunities and they were most
welcome. However trauma and its impacts did not receive a Guernsey within those announcements. Planning and funding for individuals impacted by trauma
histories continues to fall perilously short of what’s needed. Whilst trauma is core to the difficulties of many Australians and awareness of it pivotal to
their sustained recovery, in services, trauma per se is seldom identified or addressed. This leaves many individuals struggling and without the right help
they will continue to struggle with their daily functioning from childhood through adolescence to adulthood and right into old age.

It is rare to travel through life without experiencing trauma and the spectrum of trauma that can impact the human condition is vast. Any traumatic experience has the potential to invoke fear, helplessness, and horror, and overwhelm a person’s resources for coping. However today I would like to talk about trauma of childhood abuse, which can be characterised as complex trauma.

Complex trauma refers to trauma which is compounded and cumulative. It is most often interpersonal i.e. perpetrated by one human being on another, intentional and of early life onset.   So the individual experiences multiple, chronic, and/or extreme developmentally adverse traumatic events (e.g., sexual, emotional or physical abuse, witnessing and experiencing domestic violence, neglect, community violence), often within the child’s care-giving system.

Other stressors occur in childhood, for example traumatic medical and surgical procedures, accidents, war trauma and civil unrest. However most trauma begins at home with up to 80% of child maltreatment perpetrated by a child’s parents. Child abuse is of course not only perpetrated within the immediate family but within the extended family and by other adults in positions of trust and in regular contact through school, church, sporting groups or other community activities.

While health practitioners and workers happily ask about developmental milestones and the family’s medical history obtaining information about childhood trauma, abuse, neglect and other exposures to violence has not been routine. Perhaps this reluctance parallels the social taboos and stigma which have further prevented those who have lived with childhood trauma from receiving the help and support they need to live healthy engaged lives.

Adverse childhood experiences

Traumatic childhood experiences are not only extremely common but they also have a profound impact on diverse areas of functioning. Children with alcoholic parents, parents with a mental illness, who are abused or neglected in some way or who live in a family violence situation struggle to feel safe and secure.

The impacts of their trauma are often pervasive and multifaceted, and can include depression and a range of mental health impacts, various medical illnesses, as well as a variety of impulsive and self-destructive behaviours. All of the presentations need to be considered in the context of the lived experience of their trauma, regardless of their age. This is the basis of a trauma-informed approach to care which I’ll talk about later.

To date our health system generally has failed in this regard. Rather than approaching individuals holistically services and practitioners have approached people in a piecemeal way. All workers and professionals need to remain cognisant of the possible impacts of traumatic stress and the systemic internal disorganization it often causes.

By way of illustration I would like to share a bit of my personal story. I am a survivor of child sexual and emotional abuse, the impact of which I have
grappled with for 13 years. My story of recovery and beyond has been chronicled in a memoir entitled Innocence Revisited – a tale in parts.

As a medical practitioner, one would assume that I was informed about trauma, its effects on mental health and how to address the impact. Nothing was
further from the truth! I was a GP in Sydney for twenty years. I worked hard juggling the demands of practice with being married with 4 children and a foster child. Back then I could, do most things relatively easily.

In April 1998 when I was in my mid 40’s my niece was killed in a car accident. I grieved for her, as one would expect and grieving takes as long as it takes. As other members of my family started to come to terms with their loss I was becoming more distressed. I started to feel anxious and then had my first panic attack. I thought I was going to die! The panic attacks became more frequent, the anxiety generalized and I grew depressed. Then came the nightmares and flashbacks as the trauma stored in my subconscious unlocked.

Soon I could barely function. I was forced to leave work setting myself a 4 month sabbatical – that was 13 years ago. After that my world collapsed.

I spent most of the next 2 years in bed, completely immobilized, battling a relentless blackness of mood. I struggled with suicidal thoughts and then gestures. The antidepressants the psychiatrist prescribed helped take the edge off my mood at times, but it was a lengthy psychotherapeutic process which
helped me come to terms with my history and its impact which finally got me functioning again.

Therapy guided my process of integration and I am now well and no longer subsumed in my trauma. For the first time, I can not only live in the present
but embrace my future.  Acknowledging and appropriately addressing my complex trauma caused by childhood abuse was core to my recovery. Anything less would have, at worst, seen me lost to suicide, or at best barely functioning in my daily life.

Prevalence

I am one of more than 2 million Australian adults who suffered some form of childhood trauma and I am lucky.  I had the resources and the support to recover.
Research tells us that 1 in 5 women and 1 in 7 men are affected.

A seminal study the Adverse Childhood Experiences (ACE) study by Kaiser Permanente in 1998, which is still ongoing, looked at the impacts of all forms of abuse and neglect as well as that of family dysfunction i.e. living with parent with mental illness, substance abuse, who is incarcerated. It  showed that
adverse childhood experiences are vastly more common than recognized and that they have a powerful relation to adult health and social outcomes. It found a
highly significant relationship between adverse childhood experiences and depression, suicide attempts, alcoholism, drug abuse, sexual promiscuity,
domestic violence, cigarette smoking, obesity, physical inactivity, and sexually transmitted diseases. The more adverse childhood experiences reported,
the more likely a person was to develop heart disease, cancer, stroke, diabetes, skeletal fractures, and liver disease, as an adult.

Childhood trauma

Experiences of interpersonal trauma are appallingly prevalent in our society. One off events such as a physical or sexual assault, perpetrated by a stranger produce discrete behavioural and biological responses to reminders of the trauma as are characterised by PTSD – hyperarousal, numbing and intrusive re-enactments of the trauma such as flashbacks or nightmares. These are devastating enough but the repercussions of childhood trauma tend to be more global. Let me tell you why.

Childhood trauma is usually intentional, generally perpetrated by someone the child knows and trusts, often the person charged with the child’s care, and it disrupts the earliest of attachments. Without a safe, stable attachment, abused children focus on simply surviving, shifting resources normally earmarked for learning and development. Thirdly the traumatic acts are generally repeated, prolonged and extreme.  This combination of ongoing trauma exposure and the developmental impact of such exposure typifies complex trauma.

 Impacts on brain and mind 

During childhood the brain grows and develops rapidly, especially in the first 3 to 5 years, with further rapid development during puberty and it continues to grow and develop until a person is in their twenties. During this entire period trauma can and does impact fundamental neuro-chemical processes,
and these in turn can affect the growth, structure, and functioning of the brain and the mind. Chronic trauma interferes with the capacity to integrate sensory, emotional and cognitive input into a cohesive whole. Neural development and social interaction are inextricably intertwined.

Attachment

A child’s capacity to regulate their emotions and behaviour is a reflection of their caregivers’ responses to them. Children internalise the affective and cognitive
characteristics of their relationships with their primary care-givers and form internal working models for their feelings, thoughts and reactions. Early
patterns of attachment determine how effectively individuals will process information from then on. Infants who feel safe, secure and understood learn to
trust what they feel. They also come to make sense of and the world around them. They come to rely on their emotions and thoughts and this informs their
reactions to any situation. They become confident about their feelings and can express them. They learn to feel good about themselves, to value themselves and
feel confident that they can make good things happen. They also are reassured that if they don’t know how to deal with a difficult situation that someone
else around them will. They are able to develop strategies for responding purposefully to a range of situations rather than reacting to them.

When a child experiences trauma, the parent or caregiver of a child, whose environment is secure, can help restore a sense of safety and control. In
this way a child’s distress can be ameliorated and their fear dissipates. A parent or caregiver’s capacity to mitigate a child’s terror reflects the capacity of the parent or caregiver to respond to the threat.

If the parent is unable to manage their own reactions, and is themselves distressed and overwhelmed, the child will be similarly overwhelmed. When this happens repeatedly or worse still if the parent or caregiver is the source of the distress, the child does not learn how to modulate their emotional arousal. As a result the child is unable to process and attribute meaning to what is happening.

The child does not learn to self-regulate and might dissociate or stay agitated as a result. Spaced out and hyperaroused children learn to ignore their emotions and/or what their thoughts. They can’t connect the dots and make meaning of what they are experiencing and so do not learn to respond appropriately to a range of situations.

Children who have experienced insecure attachments also have trouble relying on others. They utilise a range of childhood defences to try and manage their extreme emotions.  Their excessive anxiety, rage and an intense desire to be taken care of are often matched by behaviours which push those seeking to help them away.

With childhood trauma, the acts are often repeated and the child often becomes hyper-vigilant, anxiously anticipating the next episode. When children are unable to feel safe, secure and in control they feel helpless. If the child is unable to grasp what is happening, or do anything about it, and no one else is there to intervene, the child will go immediately from (fearful) stimulus to (fight/flight/freeze) response without being able to learn from the experience.

These children are easily triggered by any reminder of the trauma  – sensations, physiological states, images, sounds, situations. These reminders throw the child back into the original trauma and they behave as if they are experiencing the trauma all over again. When workers and health professionals are not trauma informed they are likely to label such children as “oppositional”, ‘rebellious”, “unmotivated”, and “antisocial” and respond in a punitive rather than a supportive way.

The fundamental betrayal the child experiences establishes lifetime patterns of fear and mistrust. Traumatized children struggle to modulate their aggression and impulse control. They also have difficulty negotiating relationships with caregivers, peers, and, subsequently, intimate partners. They also experience a host of other challenges: substance abuse, borderline and antisocial personality, as well as eating, dissociative, affective, somatoform, cardiovascular, metabolic, immunological, and sexual disorders. They are also prone to re-victimisation – repeated interpersonal trauma – community and domestic violence, physical and sexual assaults.

The medical model works on the principle that something is wrong with a person rather than highlighting that something wrong was done to or happened to
a person. Trauma survivors are frequently pathologised with a range of diagnoses over a long period of time. Anyone interacting with trauma survivors must understand the impact traumatic life events have on the development of individuals.

I am a medical practitioner by training. The Hippocratic Oath states: “First do no harm”. However harm is done to trauma survivors when their experience goes unacknowledged and when their particular vulnerabilities and sensitivities are disregarded, disrespected and misunderstood. Harm is done when survivors are labelled; when they are negated as human beings; and when the traumatic experience at the very core of their being is disaffirmed.

The impacts are far more pervasive than those characterised by PTSD alone. In fact the majority of traumatized children do not meet the diagnostic criteria
for PTSD.  The current psychiatric diagnostic classification system does not capture the lived experiences of these children. The narrow PTSD diagnosis is often used and other labels are also applied with so called co-morbid pathology – Depression, Attention Deficit Hyperactivity Disorder (ADHD),Oppositional Defiant Disorder (ODD), Conduct Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder, and Reactive Attachment Disorder.

Each of these diagnoses cherry-picks an aspect of the child’s experience rather than looking holistically in the context of their trauma and their attempts to manage their traumatic stress. Such diagnoses and treatment responses often focus on particular behaviours or symptom complexes rather than on the core impacts of the trauma on the child.

Diagnosis does not capture the complex disruptions of affect regulation, disturbed attachment patterns, rapid behavioural regressions and shifts in emotional states,  loss of autonomous strivings, the aggressive behaviour against self and others, failure to achieve developmental competencies; loss of bodily regulation in the areas of sleep, food and self-care;  altered schemas of the world; anticipatory behaviour and traumatic expectations; multiple somatic problems,
from gastrointestinal distress to headaches; apparent lack of awareness of danger and resulting self endangering behaviours; the self-hatred and self-blame
and the chronic feelings of ineffectiveness.

Many areas of functioning can be affected and let’s examine them in a little more detail.
1. Affects are often intense and include rage, terror, shame and self-blame, betrayal. Traumatised children exhibit intense reactions to stimuli which secure children would find  trivial. They struggle to regulate their emotions and reactive behaviours and settle them back down.
They work to feel in control in the face of perceived threats and to ward off unwanted emotions. They tend to either re-enact prior traumas as perpetrators,
acting aggressively or sexually acting out with other children or alternatively employ frozen avoidance reactions. They show little insight into the origins of
their reactions.

They are prone to somatic symptoms such as headaches or stomachaches, an expression of their physiological dysregulation, a response to fearful and helpless emotions.

Their view of the world incorporates their betrayal and hurt. Children who have been traumatised are continually anticipating that they will be hurt again. Their response to stress varies from hyper-vigilance and being constantly on guard, frightened and over-reactive to feelings of helplessness, defeat and freeze
responses.  They readily become confused or dissociate in the presence of stressful stimuli.
Anticipating further trauma permeates these children’s relationships with themselves and others. They do not believe that anyone will look after them and keep them safe and continually anticipate that they will be victimised or abandoned.

These reactions and behaviours will show up across the board in educational, familial, peer relationships, problems with the legal system, and problems in holding down jobs.

Obviously therapeutic/counselling support is crucial but often other support is needed first or concurrently.  Support in dealing with the powers that be i.e. the “red tape” in health or social welfare bureaucracies so they receive the services of funds they need, providing advocacy support in a judicial hearing, , or working with school personnel to keep them in the education system. It may include filling out forms, writing letters, making phone calls, or completing reports.

In addition the adolescent trauma survivor may need support in the most basic and important ways –  food, shelter, financial support, social integration, and physical/social protection. All of these basic needs may need to be addressed before attention to psychological issues can be made.

Does the client have a place to stay tonight? When did he or she last eat? When did he or she last get a medical examination? Is he or she engaged in unsafe sex, IV drug abuse, or other risky behaviours? Does he or she report self-injurious behaviour? Is there evidence of a severe eating disorder?

Therapeutic approaches for traumatized youth has four main aims:
(1) establishing safety in their environment, including home, school, and community, (2) developing skills in emotional regulation and interpersonal functioning, (3) making meaning about past traumatic events and finding more positive, constructive views of themselves with hope for the
future (4) enhancing resiliency and integration into social network.

 Almost all traumatized youth live in a continually traumatizing environment. They either need to learn how to live in that environment or find a new environment. Creating a system of care and safety in which a child and the family can begin to heal often means working with child protection, the police
and courts to develop a safer living environment, engaging the family and the school, and other primary support figures, in order to create a network to develop safety within the living environment. It is impossible for any child to take in new information when he or she is fighting for survival. Building a network of support for the child and their family is vital.

Development of basic skills which have been lost or never acquired such as managing feelings and forming healthy relationships can occur within a therapeutic context.  Caretakers and family and community agencies need to be engaged so new skills can be reinforced at home and then incorporated into the day-to-day world.

A phased approach is recommended to avoid “information overload” which affects the capacity to learn. Lessons learned in the first phase serve as a building block for other phases. The process is not linear and it is often necessary to revisit earlier phases of treatment time and again.  Before any therapeutic work can begin, the safety of the child and family must be addressed.

Therapists/counsellors need to work closely with child protection, schools, and family support networks to develop safety and a treatment plan that addresses the needs of the child, as well as the family. The focus is on building trust and a positive working relationship. The emotion regulation skils of the second stage help clients review their traumatic experiences. nce children possess improved methods for coping and an increased capacity for
emotion regulation, they are better able to communicate and process traumatic memories.

They will then experience less distress about their history and react less to triggers. As they learn to regulate their emotions and develop better social skills

they will start to see themselves differently. This will make  them feel better about themselves and more confident that change is possible.

 Instilling the principles of resiliency in youth means they can  continue to develop in positive, healthy, and functional ways and avoid future
victimization and/or aggressive behaviours. Involving the youth in creative  projects or youth programs, identifying expectations and responsibilities,
working with families and communities to maximize safety will encourage youth  to achieve and develop their unique talents. The traumatic experience can then  move from being the central aspect of their lives to being a part of their  history. All of these phases can take place within community mental health
settings, hospitals, schools, and families with support services.

Often complex trauma is compounded  by socioeconomic deprivation or social marginalization. The adolescent abused  at home, assaulted as a result of community violence or gang activity, and who  lives with poverty, poor nutrition, inadequate schools, social discrimination, is often struggling not only with a trauma history and social deprivation, but  also the likelihood of additional trauma in the future.

Although the youth may appear to  be “acting out,” “self-destructive,” “borderline,” or “conduct-disordered,” these  behavioural patterns reflect strategies to cope with or the effects of, prior  victimization – suicidal behavior, self harm, substance abuse, eating  disorders, dysfunctional sexual behavior, excessive risk-taking, and  involvement in physical altercations. These  activities help the adolescent to distract, soothe, avoid, or otherwise reduce  ongoing or triggered trauma-related dysphoria.

We need to speak a little about  risk because although many of the effects of trauma are chronic, others are  more severe, and may endanger a youth’s  immediate wellbeing, or in fact  threaten his or her life. His or her environment may still be exposing him or  her to risk and ongoing victimization. He or she may be suicidal, abusing major  substances, or involved in various forms of risky behaviour.

 It is very important  to evaluate current safety. Is the client in imminent danger or at risk of  hurting others? In cases of ongoing interpersonal violence, is the client in  danger of victimization from others in immediate future? Is the client acutely  suicidal? Is the client’s immediate psychosocial environment unsafe?

 Although a number of specific trauma  therapies help it is the development of a positive therapeutic relationship that is crucial to progress. This is probably especially true for adolescents  who have been repeatedly traumatised, whose life experiences have taught them  to mistrust authority and to anticipate being maltreated.

The adolescent will often test  the therapist and in fact anyone trying to support him/her. He/she will  continue to practice behaviours which they have utilised in the past, coping  mechanisms such as feigning disinterest despite being desperate for connection  and validation. It is important for the therapist not to react and become angry,  punitive or rejecting as that will reinforce the youth’s beliefs from the past.  Showing empathy, understanding, respect and a non-shaming non-blaming approach  will ultimately lead to trust and a collaborative relationship of care.

 The therapeutic  relationship and process will undoubtedly trigger memories, feelings, and  thoughts associated with prior relational traumas. In the midst of a positive  therapeutic relationship the youth will experience reactivated rejection,  abandonment fears, misperception of danger, or authority issues but also respect, caring, and empathy.  The positive relational feelings will gradually win over and such intrusions will  lose their generalizability.

 In dealing with youth with trauma  histories it is important to be developmentally sensitive and to work with traumatized  youth as is appropriate to their psychological ages. Similarly  some traumas are more common in one sex than the other, and that sex-role  socialization often affects how such injuries are experienced and expressed.

 Research indicates  that girls and women are more at risk for victimization in close relationships  than are boys and men, and are especially more likely to be sexually  victimized, whereas boys and men are at greater risk than girls of physical  abuse and assault. In addition to  trauma exposure differences, young men and women tend to experience,  communicate, and process the distress associated with traumatic events in  somewhat different ways. Cultural differences also need to be taken into  account as do different views of the world and experiences.

 The process also needs to keep  the client’s level of affect regulation, i.e., his or her relative capacity to  tolerate and internally reduce painful emotional states in mind. Adolescents  with limited affect regulation abilities are more likely to be overwhelmed and  destabilized by current negative events and those triggered by painful  memories. Those with less ability to internally regulate painful states are  more likely to become highly distressed, if not emotionally overwhelmed, during  treatment, and may respond with increased avoidance, including “resistance”  and/or dissociation

In supporting youth with impaired  affect regulation capacities any therapeutic work should proceed carefully, so  that traumatic memories are activated and processed in small increments –  “working within the therapeutic window”. That way the trauma processing will  not exceed the capacities of the survivor to tolerate that level of distress.

The therapist’s  ability to communicate and demonstrate safety is a central component to  relationship building. The adolescent is more likely to “let down his/her  guard” and open himself or herself to a relationship if, repeatedly over time, the  therapeutic process is safe with little evidence of any danger. NonintrusivenessVisible positive regard; Reliability and stability; Transparency; Demarking the limits of confidentialit are important.

Trauma also makes one  feel very alone, isolated from others, and, at the core, unknowable. Being able  to interact regularly with a person who is attuned, who listens and hears, and  who seems to understand, can be a powerfully positive experience and helps  build the therapeutic alliance, and so a new form of attachment between client  and therapist.

Despite the  prevalence of short-term interventions for traumatised youth most therapy for  complex trauma proceeds slowly. As the therapist counsels patience and remains  constant and invested in the therapeutic process, he or she has the opportunity  to communicate acceptance of the client and trust in the therapeutic  relationship. This process requires the therapist to model patience as well.

Suicidal thoughts and behaviors  are relatively common among abused or traumatized individuals perhaps  especially in the context of ongoing adversity. In some cases, suicidal behaviors are passive, wherein the client engages in high risk activities  and/or fails to protect him/herself in dangerous situations. In other cases,  there may be repeated suicide attempts. Anyone interacting with traumatised adolescents must be vigilant to the possibility of suicidal behavior. And when  there is imminent risk institute a crisis plan and seek a psychiatric consultation, medication, or hospitalization.

I’m now going to speak more generally about trauma informed care and practice, which effectively has been the basis of everything I’ve said to date
but perhaps not named so specifically. Many in the mental health sector have long advocated the necessity of a new approach to service delivery for people
with mental illness and co-existing problems who frequently have a history of  trauma. This approach must move away from prioritising the search for diagnoses to recognising the person’s traumatic life experience within a holistic  framework.

“Trauma-Informed Care and Practice is a strengths-based framework grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and  empowerment.”

A large percentage of those seeking help at a diversity of health and welfare settings have trauma histories which are severely affecting their health and wellbeing. Australia’s mental health system has, generally speaking, a poor record in recognising the relationship between trauma and the development of mental health problems. There is a lack of policy focus as to how this knowledge can be incorporated into service delivery.

The substantive core issue of what happened to that person to impact them so profoundly is often relegated to ‘interest value’ only. This characterisation makes little sense given that recognition and integration of experienced trauma is fundamental to the recovery process. People can be impacted by trauma through a diversity of experiences which know no boundaries with  regards to age, race, ethnicity, social or economic status, gender, disability;
geography or sexual orientation. Trauma affects us all, directly or indirectly and can be devastating and debilitating.

Contexting a particular diagnosis as a means to access services is stigmatising and discriminatory. Only a wide range of flexible services holistically delivered with an understanding of the behaviours which characterise presentations in terms of traumatic stress, disrupted attachment, personal invalidation and adaptive coping  strategies can meet the needs of these consumers.

A trauma informed approach to care and practice moves away from prioritising the search for a diagnosis to recognition of the person’s traumatic life experience and that it is the consumer’s lived experience which may have resulted in an individual’s contact with mental health services through adoption of extreme coping strategies. We propose that a shift to a trauma informed care and practice approach are not limited to mental health but apply to multiple systems requiring an integrated approach which has survivors at the centre of a model of recovery.

A trauma informed approach to care must also be supported by trauma specific services, providing specific interventions designed to address the consequences
of trauma in the individual and facilitate recovery.

However, whilst conversations and program delivery around TIC are occurring in small service pockets this does not amount to a broad based systemic change across the mental health service system. Such TIC programs and services that do exist clearly acknowledge ‘that no one  understands the challenges of the recovery journey from trauma better than the person living it’.  The underpinning philosophy is informed by an understanding of the particular vulnerabilities and ‘triggers’ that trauma survivors experience, with services delivering better outcomes; minimising re-victimisation and ensuring self and community wellness and connectedness can be promoted. It is a paradigm shift in service delivery culture.

Trauma informed care is grounded in and directed by a thorough understanding of the neurological, biological, psychological and social effects
of trauma and violence and the prevalence of these experiences in persons who receive mental health services.

 What is a Trauma-Based Approach?

 

It primarily views the individual as having been harmed by something or someone:  thus connecting the personal and the socio-political environments, (Bloom, 1997, p. 71).

 

This framework expects individuals to learn about the nature of their injuries and to take responsibility in their  own recovery (Bloom, 2000). [i]

 

  1. What are the Key Principles?

 Integrate philosophies of quality care that guide assessment and all clinical interventions

 

  • Is based on current literature

 

  • Is informed by research and evidence of effective practices and philosophies

 

  1. Trauma Informed Care & Practice

 

  • Involves not only changing assumptions about how we organise and provide services, but  creates organisational cultures that are personal, holistic, creative, open, and therapeutic

 

It is a practice  that can be utilised to support service providers in moving from a caretaker to a collaborator role using a model of recovery-orientated approach  

Trauma-informed programs and services internationally represent the ‘new generation’ of transformed mental health and allied human services  organisations and programs which serve people with histories of violence and  trauma.[ii]

 

Systemic Transformation occurs when a human service program seeks to become trauma-informed, every part  of its organisation, management, and service delivery system is assessed and  modified to ensure a basic understanding of how trauma impacts the life of an
individual who is seeking services.

 

Organisations, programs, and services are based on an understanding of the particular vulnerabilities and/or triggers that trauma survivors experience  (that traditional service delivery approaches may exacerbate), so that these  services and programs can be more supportive, effective and avoid  re-traumatisation.[iii]

 

So how different  might service systems look if the Trauma Informed?

 

  1. Key Features of Trauma Informed Care & Practice Systems

 

Examples

 

Systems
without Trauma Sensitivity
Trauma
Informed Care Systems
Consumers are labelled &
pathologised as manipulative, needy, attention-seeking
Are inclusive of the survivor’s
perspective
Misuse
or overuse of displays of power – keys, security, demeanour
Recognise
that coercive interventions cause traumatization / re-traumatization – and
are to be avoided
Culture
of secrecy – no advocates, poor monitoring of staff
Recognise
high rates of PTSD and other psychiatric disorders related to trauma exposure
in children and adults
Staff
believe key role are as rule enforcers
Provide
early and thoughtful diagnostic evaluation with focused consideration of
trauma in people with complicated, treatment-resistant illness
Little use of least restrictive alternatives
other than medication
Recognise that mental health
treatment environments are often traumatizing, both overtly and covertly
Institutions that emphasize
“compliance” rather than collaboration
Recognise that the majority of mental
health staff are uninformed about trauma, do not recognize it and do not
treat it

 

 

Trauma
informed care involves the provision of services that do no harm – e.g., that
do not re-traumatise or blame victims for their efforts to manage their
traumatic reactions. Trauma-informed
care facilitates recovery, minimises re-victimisation and promotes self and
community wellness and connectedness.

 


[i]
Bloom, S. 1997: 2000. Creating Sanctuary: Toward the evolution of sane
societies. New York: Routledge

[ii] Corinne Henderson
& Jenna Bateman. 2010. A National
Strategy for Trauma Informed Care.
Mental Health Coordinating Council.

[iii] Corinne Henderson
& Jenna Bateman. 2010. A National
Strategy for Trauma Informed Care.
Mental Health Coordinating Council.