Understanding Trauma 101: Trauma-Informed Care
Lauren Peffley, MSW
Trauma is an unfortunately pervasive phenomenon – presently and throughout all of human history. According to the National Center for Post-Traumatic Stress Disorder (PTSD), “70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. Up to 20% of these people go on to develop PTSD” (Mills et al, 2012). They also revealed, “An estimated 1 out of 10 women develop PTSD and women are about twice as likely as men to develop PTSD” (Mills et al., 2012). The National Council for Community Behavioral Healthcare asserted that, “51% of the general population have experienced trauma in childhood.” In addition, they cited ACE study findings to point out that, “80% of people in psychiatric hospitals have experienced physical or sexual abuse” and “90% of women with alcoholism were sexually abused or suffered severe violence from parents.” These statistics are devastating, and they suggest that each and every one of us is interacting with trauma survivors on a regular basis – perhaps without even knowing it. Whether or not you are a social service provider, you have probably encountered trauma survivors with regular frequency. As a result, this blog is dedicated to detailing what it means to provide trauma-informed care.
The term “trauma-informed care” is one that appears repeatedly throughout research regarding work with survivors of sexual exploitation and survivors of other forms of trauma and violence. The National Council for Community Behavioral Healthcare defines trauma-informed care as “an appreciation for the high prevalence of traumatic experiences in persons who receive mental health (physical health and substance abuse) services” and “a thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual” (Jennings, 2004). While conducting a community needs assessment for Healing Action, I asked local service providers how they define “trauma-informed services” and these were a few of the definitions I received:
“Treatment involving understanding, recognizing, and responding to effects of trauma...”
“Taking into consideration all the healing work that is going on beneath the surface level. It includes knowing that the healing process is different for everyone and finding the best services for each individual…”
“Realizing the widespread impact of trauma and understanding the potential paths for recovery...”
“Effective trauma-informed services are those that are client-specific and seek to meet the emotional and psychological needs of the person in the wake of trauma…”
Upon learning the basic definition of trauma-informed care, it is important to give next steps to creating an organization or a workplace that treats trauma survivors with understanding, dignity, and empathy. In her last blog entry, Jenn provided powerful examples of doing just that. She poignantly discussed looking beneath the surface, learning about trauma triggers and avoiding them, treating others with kindness, building trust, showing empathy, listening carefully, providing a non-judgmental environment, and working with survivors to find strength and light from within. Each of those things represents trauma-informed care, and they are steps that every individual should take while working with survivors of any trauma. In addition to these beautiful steps, The National Council for Community Behavioral Healthcare also created the following 7 domains necessary to creating a trauma-informed organization: 1.) Early Screening and Comprehensive Treatment of Trauma 2.) Client-Driven Care and Services 3.) Trauma-Informed, Educated, and Responsive Workforce 4.) Provision of Trauma-Informed, Evidence-Based and Emerging Best Practices 5.) Create a Safe and Secure Environment 6.) Engage in Community Outreach and Partnership Building 7.) Ongoing Performance Improvement and Evaluation.
Another crucial part of providing trauma-informed care mentioned by the National Council involves changing organizational culture. This is imperative for organizations that have been up and running for a while and do not have these provisions built in to their foundation already. Changing an organizational culture to become more trauma-informed involves conducting extensive trauma training for existing staff and seeking to hire trauma-informed staff in the future. It also requires a thorough examination of existing policies, procedures, and programs/services to gauge whether they are trauma-informed or not. If they are not, then time should be dedicated to changing/rearranging them. Another piece of becoming and staying trauma-informed is to continually evaluate the written policies, procedures, and programs/services, as well as evaluating their implementation. There is new trauma research emerging on a regular basis, so if an organization wants to be as trauma-informed as possible, they have to stay up-to-date and be willing to update as often as necessary.
I understand that this all sounds like an incredibly time-consuming process, and in reality, it truly is. That said, it is utterly imperative to dedicate substantial time to staying trauma informed if you are working with trauma survivors (and the statistics at the beginning of this blog suggest that most of us are, in fact, working with trauma survivors). Anything less than this kind of dedication to staying trauma-informed would render our practices and services ineffective and unethical. As a social worker, I have committed myself to following the National Association of Social Workers Code of Ethics and especially the part that says: “Do no harm.” If we truly want to avoid harming the clients we serve – clients who have already been harmed time and time again – then we MUST take the time and exert the empathy to be trauma-informed.
1.) The National Council For Community Behavioral Healthcare’s presentation: “Is your Organization Trauma-Informed?” http://www.thenationalcouncil.org/wp-content/uploads/2012/11/Is-Your-Organization-Trauma-Informed.pdf
2.) Neera Gupta, MD & Addictionologist, presentation: “Establishing Safety: Treating Trauma in Early Recovery” http://docplayer.net/6527060-Establishing-safety-treating-trauma-in-early-recovery-neera-gupta-m-d-psychiatrist-and-addictionologist-talbott-recovery-center.html