What is Trauma-Informed Care?

Trauma-Informed Care understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize.

road to TIC

Graphic by the Institute on Trauma and Trauma-Informed Care (2015)

Trauma-Informed Care

Trauma-Informed Care (TIC) is an approach in the human service field that assumes that an individual is more likely than not to have a history of trauma. Trauma-Informed Care recognizes the presence of trauma symptoms and acknowledges the role trauma may play in an individual’s life- including service staff.

On an organizational or systemic level, Trauma-Informed Care changes organizational culture to emphasize respecting and appropriately responding to the effects of trauma at all levels.[1][2] Similar to the change in general protocol regarding universal precautions, Trauma-Informed Care practice and awareness becomes almost second nature and pervasive in all service responses. Trauma-Informed Care requires a system to make a paradigm shift from asking, “What is wrong with this person?” to “What has happened to this person?”[3]

The intention of Trauma-Informed Care is not to treat symptoms or issues related to sexual, physical or emotional abuse or any other form of trauma but rather to provide support services in a way that is accessible and appropriate to those who may have experienced trauma.[3] When service systems operating procedures do not use a trauma-informed approach the possibility for triggering or exacerbating trauma symptoms and re-traumatizing individuals increases.[3]

Re-traumatization

Re-traumatization is any situation or environment that resembles an individual’s trauma literally or symbolically, which then triggers difficult feelings and reactions associated with the original trauma.[4][5] The potential for re-traumatization exists in all systems and in all levels of care: individuals, staff and system/organization.

Re-traumatization is often unintentional. There are some “obvious” practices that could be re-traumatizing such as the use of restraints or isolation, however, less obvious practices or situations that involve specific smells, sounds or types of interactions may cause individuals to feel re-traumatized.[3]

Re-traumatization is a significant concern, as individuals who are traumatized multiple times frequently have exacerbated trauma-related symptoms compared to those who have experienced a single trauma. Individuals with multiple trauma experiences often exhibit a decreased willingness to engage in treatment.

Re-traumatization may also occur when interfacing with individuals who have history of historical, inter-generational and/or a cultural trauma experience.

Re-traumatization

Chart by the Institute on Trauma and Trauma-Informed Care (2015)

A Trauma-Informed Care Approach

A Trauma-Informed Care approach strives to understand the whole of an individual who is seeking services. When trauma occurs, it affects an individual's sense of self, their sense of others and their beliefs about the world. These beliefs can directly impact an individual's ability or motivation to connect with and utilize support services. [3] A system utilizing a Trauma-Informed Care approach realizes the direct impact that trauma can have on access to services and responds by changing policies, procedures, and practices to minimize potential barriers. A system utilizing a Trauma-Informed approach also fully integrates knowledge about trauma into all aspects of services and trains staff to recognize the signs and symptoms of trauma and thus avoid any possibility of re-traumatization.[1]

The Five Principles of Trauma-Informed Care

Trauma-Informed Care follows five Guiding Principles that serve as a framework for how service providers and systems of care can work to reduce the likelihood of re-traumatization.[3] These principles are generalizable across a variety of service settings. Rather than providing a set of practices and procedures, the principles can be interpreted and applied in ways that are appropriate for a specific type of service setting.

The Five Guiding Principles are; safety, choice, collaboration, trustworthiness and empowerment. Ensuring that the physical and emotional safety of an individual is addressed is the first important step to providing Trauma-Informed Care. Next, the individual needs to know that the provider is trustworthy. Trustworthiness can be evident in the establishment and consistency of boundaries and the clarity of what is expected in regards to tasks. Additionally, the more choice an individual has and the more control they have over their service experience through a collaborative effort with service providers, the more likely the individual will participate in services and the more effective the services may be. Finally, focusing on an individual's strengths and empowering them to build on those strengths while developing stronger coping skills provides a healthy foundation for individuals to fall back on if and when they stop receiving services.

The Five Principles of Trauma-Informed Care

Chart by the Institute on Trauma and Trauma-Informed Care (2015)

Key Components to Trauma-Informed Care

Creating a physically and emotionally safe environment, establishing trust and boundaries, supporting autonomy and choice, creating collaborative relationships and participation opportunities and using a strengths and empowerment-focused perspective to promote resilience are ways in which the principles of Trauma-Informed Care work to reduce re-traumatization and promote healing.[5]

A Trauma-Informed approach also considers and modifies policies, procedures and treatment strategies from the top-down in order to ensure they are not likely to mirror the common characteristics of traumatic experiences.[3]

The Substance Abuse and Mental Health Services Administration recommends that when organizations and systems create a trauma-informed environment the following ten implementation domains be considered; Governance and Leadership; Policy; Physical Environment; Engagement and Involvement; Cross-Sector Collaboration; Screening; Assessment; Treatment Services; Training and Workforce Development; Progress Monitoring and Quality Assurance; Financing; Evaluation.[1]

The manner in which a system or organization views and responds to individual trauma (that of both clientele and staff) sets the stage for the degree of severity of the impact of trauma as well as the facilitation of the healing and recovery process.[1]

Key Components of Trauma-Informed Care

Chart by the Institute on Trauma and Trauma-Informed Care (2015)

References

1. Substance Abuse and Mental Health Services Administration. (2014). Concept of Trauma and Guidance for a Trauma-Informed Care Approach. U.S. Department of Health and Human Services.

2. Bloom, S. L. (1997). Creating sanctuary: Toward the evolution of sane societies. New York: Routledge.

3. Harris, M. & Fallot, R. D. (Eds.) (2001). Using Trauma Theory to Design Service Systems. New Directions for Mental Health Services. San Francisco: Jossey-Bass.

4. Jennings, A. (2015). Retraumatization [PowerPoint slides]. Retrieved from http://theannainstitute.org

5. Substance Abuse and Mental Health Services Administration (2014). A Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services, Tip 57. U.S. Department of Health and Human Services, 14-4816.

6. Bloom, S. L. (2010). Organizational stress as a barrier to trauma-informed service delivery. In M. Becker & B. A. Levin (Eds.), Public Health Perspective of Women’ s mental health (pp. 295–311). New York, NY: Springer. 

ITTIC Trauma-Informed Care Resources