Trauma Informed Care and Practice – youth mental health

Creating a Culture of Prevention and Wellbeing – a Professional Development Day seminar on Youth mental Health Day September 2011

Trauma-informed Care and practice
(Youth Mental Health)

 

 

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.

 

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.

 

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.

 

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.

 

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.

 

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 dsregarded, 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.

 

  1. 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.

 

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

 

  1. 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.

 

  1. 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 skills of the second stage help clients review their traumatic experiences. Once 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. Nonintrusiveness; Visible 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.

 

A trauma informed approach 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]

 

The key principles are as follows:

  • 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

 

Trauma informed care and 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]

 

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   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.

Kezelman C (2011) Trauma informed Care and Practice – youth mental health