According to the Institute on Trauma and Trauma-Informed Care (ITTIC), trauma-informed care refers to the practice of understanding and making active consideration of the pervasive nature of trauma by “promoting environments that foster healing instead of engaging in practices that can re-traumatize” [1].

To examine what this “actually means,” we can consider trauma- its definition, complexities, and effects as something experienced by the average person. Additionally, we must consider the organizational culture of trauma and how the human service and healthcare industries must place an intentional emphasis on “understanding, respecting, and appropriately responding to the effects of trauma at all levels” [1].

Oftentimes in these unique industries providers and staff will be exposed to the signs and symptoms of trauma that can affect the daily functioning of individuals in their care. It is important to understand what trauma is under a person-centered lens instead of focusing on diagnosis; “what is wrong with this person?” turns into “what has happened to this person?” [2]. This will foster respect for an individual, their history, their goals, and their treatment options. Remaining mindful that we are interacting with human beings with unique thoughts, feelings, ambitions, values, culture, and a sense of self by demonstrating empathy and compassion in some of their most challenging times.

The way in which we respond appropriately means that we as professionals seek to form therapeutic partnerships with individuals while avoiding the environments and actions that could lead to re-traumatization; a literal or symbolic resemblance of an individual’s trauma or traumatic event [2].

When an individual experiences trauma- no matter the length or severity- it often changes that individual’s sense of self and their perception of the world, its safety, and the trustworthiness of the people in it [3]. This can make it especially challenging for the individual to engage in care services effectively [4].

The intention of trauma-informed care is not simply to treat the direct symptoms of any physical, sexual, and emotional abuse that happened but also to provide a thorough system of accessible support in an individual’s community [4].

Many industries are directly transformed by implementing trauma-informed care. We can easily see how health care and allied health professionals would need to provide services that are trauma-informed. Part of that condition is making an active effort to be inclusive of an individual’s entire life situation while making care decisions with them [5].

Adopting and implementing a trauma-informed care approach to service is beneficial to both patients/clients as well as for professional staff. Ensuring that trauma-informed protocols and environmental factors are in place can lead to improved long-term health outcomes for individuals, more secure partnerships between an individual and their care team, as well as a decrease in burnout of staff which can avoid high turnover [5].

There are multiple ways for an organization to become trauma-informed, and it does not stop at simply executing a list of steps. Organizations and their leadership must commit to remaining accountable and being open to consistent evaluation of their policies and practices.

Providing a trauma-informed practice, clinic, agency, office, etc. can begin to be achieved by following some foundational steps:

• Build awareness of and generate buy-in for a trauma-informed approach
• Support staff wellness
• Aim to hire a workforce that embodies the values of trauma-informed care
• Create a safe and healthy physical, social, and emotional environment [5]

New York State offers a self-assessment tool for organizations to discover their status of being “trauma-informed” and how they can generate more progress to that end. The TRUST tool uses the Substance Abuse and Mental Health Services Administration’s 10 Implementation Domains as a guidepost. For those who are currently unfamiliar with these domains, they include:

1. Governance & Leadership
2. Policy
3. Physical Environment
4. Engagement & Involvement
5. Cross Sector Collaboration
6. Screening, Assessment & Treatment Services
7. Training & Workforce Development
8. Progress Monitoring & Quality Assurance
9. Financing
10. Evaluation

These domains are meant to encompass the organizational domains as often described in management literature [6].

The TRUST tool is accessible for use by any organizational program regardless of its size or structure. However, there is an additional tool for assessing trauma-informed factors specific to schools- the TRUST-S [7].

While it may be obvious to most of us how practicing trauma-informed care is an incredibly essential element of a career in medicine, nursing, psychology, social work, and allied health it may be less apparent and therefore less prevalent to find other industries operating in trauma-informed ways.

Trauma as a human experience does not delegate; it does not exist solely in the bubble of health care and treatment. As we have experienced since the start of the COVID-19 pandemic, workplace stress has been at an all-time high with 7 in 10 employed people reporting that this has been the most stressful time of their careers [8].

We have been living in an unprecedented sustained traumatic experience made complicated by systems that have failed us. Employees are struggling to remain productive under the catastrophic impact that COVID has had on society and the economy while communities also experience the unrest associated with long-standing social inequities [8].

Feelings of fear, anxiety, grief, and loss permeated our everyday lives and contributed to environments that often felt incredibly xenophobic, oppressive, and isolating. Like with many traumatic events, the effects are not always seen in the immediate aftermath but can influence our physical and emotional health for the remainder of our lives [8].

It is more important now than ever for all workplaces to check in with their staff to evaluate wellness regardless of the formality of the tool or method. Creating avenues for employees to request accommodation while maintaining a culture that will not guilt or shame their individual needs is a suitable place to start. In addition, creating partnerships with community resources to assist your staff externally can also be a valuable tool to foster workplace resilience [8].

Lastly, we need to pay attention to the link between trauma-informed care and ACEs (Adverse Childhood Experiences). This is a screening tool that assesses trauma or high stress experiences in a person’s childhood and adolescence (ages 0-17). Although this list is not exhaustive, it is meant to capture frequently targeted trauma histories:

1. Directly experiencing physical/sexual/emotional abuse or neglect
2. Witnessing violence or abuse in the home or in the community
3. Having a family member attempt or die by suicide
4. Growing up with a caregiver who struggles with substance abuse and/or mental illness
5. Instability due to parental separation or incarceration
6. Experiencing systemic poverty and discrimination*

*As understood by SAMHSA (2016)

The accumulation of these experiences can increase a person’s risk factors as they grow older, leading to chronic mental and physical health complications [9]. While it is important for providers to understand a patient’s historical narrative, it is equally important to provide an emotionally safe space to disclose. Providing a supportive and compassionate partnership in assisting with someone’s trauma history while empowering individuals to recognize their own trauma responses is hugely beneficial in a treatment relationship [10].

Of course, every one of us processes experiences differently. What may be incredibly traumatic to one person may not illicit such a response in the next. There is no universal definition of “trauma;” experts have created flexible definitions based on their clinical experiences and best practices. This can be complicated; many experts disagree with the development of a universally accepted definition, stating that because trauma is so broad and complex, there is a fear that defining it could exclude people from receiving trauma-centric treatment. However, it is recognized that having some working definition would help with cross-sector collaboration and advancements in trauma treatment overall [11].

Trauma is a public health issue and therefore demands public education campaigns to generate broader awareness of and reduce the associated stigma. To create a more empowered trauma-informed workforce, cross-disciplinary education on trauma and trauma-informed practices should be foundational in a future health care professional’s formal education and training [11].

Systems that follow a trauma-informed approach follow the Five Guiding Principles of trauma-informed care: safety, choice, collaboration, trustworthiness, and empowerment. These principles will be discussed in more detail in future posts.

Footnotes

[1] Institute on Trauma and Trauma-Informed Care. (2015). What is trauma-informed care? Buffalo: ITTIC (Institute on Trauma and Trauma Informed Care).

[2] Institute on Trauma and Trauma-Informed Care. (2015). Retraumatization. Buffalo: ITTIC.

[3] Institute on Trauma and Trauma-Informed Care. (2015). A trauma-informed care approach. Buffalo: ITTIC.

[4] Harris, M. & Fallot, R. D. (2001). Using trauma theory to design service systems. New directions for mental health services. San Francisco: Jossey-Bass.

[5] Trauma-Informed Care Research & Implementation Center. What is trauma-informed care? New Jersey: The Center for Health Care Strategies.

[6] SAMHSA (Substance Abuse and Mental Health Services Administration). (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. US Department of Health and Human Services.

[7] Coordinated Care Services Inc. (n. d.). Learn about TRUST and TRUST-S.

[8] Taillac, C. (2020). The new workplace is trauma-informed. Kaiser Permanente: California.

[9] CDC (Centers for Disease Control). (n. d.). Adverse childhood experiences. Washington, DC: Division of Violence Prevention.

[10] ACES Aware. (n. d.). Trauma-informed care: ACES. California: Department of Health Care Services.

[11]. Menschner, C. & Maul, A. (2016). Key ingredients for successful trauma-informed care implementation. New Jersey: The Center for Health Care Strategies.