Trauma-informed care​

Why trauma-informed care?

Definition

Trauma:

• is emotionally painful, distressful or shocking
• involves a distressing event or events
• elicits terror, shame, helplessness and powerlessness.

Types of trauma

People respond to trauma in different ways. The same event may be more traumatic for some people than for others.

There are three main categories of traumatic events:

• recent acute traumatic events (e.g., car crash, violent assault)
• past single traumatic events (e.g., rape, death of spouse, accident) and events that last longer (e.g., natural disaster, outbreak of political violence or war)
• long-term chronic abuse (e.g., ongoing childhood sexual, growing up in a violent environment).

The most common traumatic events include:

• physical assault
• sexual assault, including childhood sexual abuse
• verbal assault
• being threatened with physical or sexual assault
• witnessing violence against others
• long-term neglect in childhood.

Impact of trauma

Not all people who experience traumatic events develop mental health or addiction problems. Traumatic responses include:

• isolation
• hypervigilance
• substance use
• self-injury
• eating disorders
• depression
• anxiety.

After experiencing a traumatic event, survivors may re-experience the trauma mentally and physically. This may be a symptom of posttraumatic stress disorder.

Balancing risk

Addressing trauma is critical to helping people with complex mental health and substance use problems. Care providers must know how to work with clients in a way that does not retraumatize them.

Trauma-informed care providers:

• commit to a "do no harm" philosophy to avoid retraumatizing clients
• take a universal precaution approach, which assumes that all clients are trauma survivors
• use trauma-informed practices that focus on providing a safe, empowering experience for clients.

Principles of trauma-informed care

Implementing a trauma-informed approach within services and across systems of care is a challenge. Trauma-informed practice requires integrating several main principles:

• physical and psychological safety for care providers and clients
• trustworthiness and honesty among care providers and clients
• collaboration and leveling of power differences
• empowerment for clients to make treatment decisions
• voice and choice for clients to express differences
• resilience and the ability for clients to grow and recover from trauma
• inclusiveness, where everyone has a role in the trauma-informed approach
• cultural and gender awareness.

Related approaches

• integrative care
• recovery-based care.

Evidence summary

Centre for Addiction and Mental Health. (2011). Practice Model: Partners in Care. Toronto, ON: Author.

Harris, M. & Fallot, R.D. (2001). Using Trauma Theory to Design Service Systems. San Francisco: Jossey-Bass.

Haskell, L. (2004). Women, Abuse and Trauma Therapy. Toronto, ON: Centre for Addiction and Mental Health.

Klinic Community Health Centre. (2013). Trauma-Informed: The Trauma Toolkit (2nd ed.). Winnipeg, MB: Author.

Poole, N. & Greaves, L. (Eds.). (2012). Becoming Trauma Informed. Toronto, ON: Centre for Addiction and Mental Health.

Resources

Online resources

• Gendering the National Framework: Trauma-Informed Approaches in Addictions Treatment is a discussion guide to the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada. It addresses co-existing trauma, mental health and substance use problems experienced by girls and women.
• The Homelessness Resource Center. Search the term "trauma-informed" to find resources such as 10 Tips for Recovery-Oriented, Trauma-Informed Agencies and A Long Journey Home: A Guide for Creating Trauma-Informed Services for Mothers and Children Experiencing Homelessness.
• The U.S. National Center for Trauma-Informed Care helps publicly funded health care systems and programs to implement trauma-informed care. The site offers examples of trauma-specific interventions that can be incorporated into existing services.
• The National Child Traumatic Stress Network promotes standards for trauma-informed care for service providers who work in child-serving systems. The network provides resources for different audiences, including educators and mental health and medical professionals.
• Webinar: Women, Trauma and Substance Use (Flash plug-in required)

Toolkits

• Coalescing on Women and Substance Use is a trauma-informed online virtual toolkit developed by the B.C. Centre for Excellence in Women's Health. It focuses on the link between women's substance use and trauma and violence.
• The U.S. National Center on Family Homelessness has developed a curriculum, Trauma-Informed Care for Organizations, that includes toolkits for use in homeless service settings, agencies serving women veterans and children, and organizations serving displaced populations.
• The Toolkit on Court-Involved Youth and Exposure to Violence includes a guide for lawyers and other court-appointed advocates, as well as for other people working with children and youth.
• The Klinic Community Health Centre developed the Trauma-Informed Toolkit, which recommends practices to help service providers and organizations to increase their capacity to deliver trauma-informed services.

Resources for your clients and their families

• The American Psychological Association website features a series of articles with tips for parents and teachers on how to help children of different ages build resilience during difficult times.
• The Life Recovery Program is a trauma-informed psychoeducation course about addiction and mental health recovery. The program offers tools for clients and family members or other supports.
• The Centre for Addiction and Mental Health offers the free Mental Health and Addiction 101 Series of online tutorials that includes a course about posttraumatic stress disorder.
• The National Mental Health Association offers tips for helping children, youth, college students and adults cope with stress. It also provides tips for military families.
• The National Child Traumatic Stress Network provides resources for families, including military families.

A story

From my perspective

As a physician, what I have noticed in my practice is that some Aboriginal clients may feel disconnected from systems and personnel, not believing that they are meant to be helpful. This may stem from traumatic experiences in the past. Often, Aboriginal clients will not interact well with health systems, procedures or personnel, fearful that their traumatic experiences of neglect, disrespect and racism will re-occur. Reassurance and discussion around trust (e.g., trust-building) – and acknowledgement that occurrences in the past may be contributing to the current situation – can go a long way therapeutically. Acknowledging that what has happened to bring us to this moment – in contrast to reinforcing a perspective that focuses on individual failures or inadequacies – may open the individual to therapeutic intervention. In summary, this gives the practitioner the actions: to reassure, to build trust, to acknowledge past trauma, to not blame the person, and be prepared to hear and to help them when the opportunity occurs.