Dr Heather Dyson
What is Trauma-Informed Care?
Firstly, to understand what Trauma-informed Care is, we need to firstly think about what we mean when we walk about trauma.
What is trauma?
There are many ways in which we can define trauma. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-V, 2013) defines a “traumatic event” as “actual or threatened death, serious injury, or sexual violence” (p. 271). Therefore experiences such as domestic violence, major surgery, sexual abuse, car accidents, verbal/physical assault, terrorism, bullying, life threatening illness, and many, many more, can all be classified as a trauma.
The DSM-V also recognises that we can experience these traumas in the following ways…
1. Through direct exposure – e.g., it happened to us.
2. Through witnessing the trauma first-hand – e.g., a bystander at a road traffic accident.
3. Through indirect exposure to aversive details of the trauma – e.g. Call handlers, psychologists etc.
What is perhaps more shocking is that almost 60% of us will have experienced one trauma before the age of 18, and 13% will have experienced four traumas before that age (Hughes et al, 2017). Hughes et al. (2017) demonstrated that individuals who experience four or more traumas before the age of 18 are statistically more likely to…
1. Suffer with depression and anxiety.
2. Have suicide attempts (increased risk by 1200%)
3. Have substance misuse issues.
4. Be perpetrators or victims or violence in adulthood.
5. Experience physical health issues (e.g. diabetes, cardiovascular disease).
6. Are 6 x more likely to be problematic drinkers.
What is increasingly being recognised within the healthcare community, is that these traumatic events have long lasting physical and mental health consequences. Furthermore, they are likely to have an impact on how we relate to ourselves, to others, and to the world. If we have grown up in a household in which we witnessed domestic abuse, where from our point of view, the police and health care system did nothing to prevent it, how likely are we to trust those systems when we get older?
What is Trauma-Informed Care?
Trauma-informed care (TIC) is an approach which recognises that widespread, and life-long impact of trauma, and how that trauma can shape our interactions with ourselves, others, and the World. TIC aims to change organisational culture to emphasise and respond appropriately to the effects of trauma at all levels. At its essence, TIC helps us to move away from asking people “what’s wrong with you?” to asking “what happened to you?”. It recognises the human being first and takes in to consideration how their past experiences have shaped who they are today.
The four key assumptions of TIC are...
Realise – the widespread impact of trauma and understand potential paths for recovery.
Recognise – the signs and symptoms of trauma in clients, families, staff, and others involved with the system.
Respond – by fulling integrating knowledge about trauma into polices, procedures, and practices.
Resist re-traumatisation – by recognising that current practices may unintentionally re-traumatise individuals and need to be reviewed.
The Six Principles of Trauma-Informed Care
TIC follows six principles that provide a framework for how we can reduce the likelihood of re-traumatising people. These principles are not limited to healthcare organisations, indeed, over one in ten individuals you know, will have experience 4 or more traumas before the age of 18. This means that these principles are extremely relevant to all organisational groups, as well as to society.
The six principles are
2. Trustworthiness & Transparency
3. Peer Support
4. Collaboration & Mutuality
5. Empowerment, Voice & Choice
6. Culture, Historical & Gender Issues.
Creating a safe (both in terms of physical and emotional safety) environment for individuals is the first step in creating a TIC ethos within an organisation. This can initially be achieved through ensuring that all processes and decisions are transparent and fostering a culture of trust. Trustworthiness can be evident in the establishment and consistency of boundaries and the clarity of what is expected both from the individual and the organisation.
TIC highlights the importance of incorporating peer support into systems. Peers are individuals who have previously been through “a system” (e.g. a previous service user in the NHS, an ex-convict, a carer) and have a unique perspective of that system. Peer support is a way for individuals from different backgrounds who share experiences, to come together and build relationships in which they can share their strengths and support each other. They are also in an advantageous position to recognise when practices within an organisation are potentially re-traumatising.
Through working collaboratively with both experts by experience (peer support) and experts by profession, organisations are able to provide more effective services that recognise the individual needs of all involved. Additionally, TIC recognises the importance of involving users of a service in choosing the support they receive. In recognising individual differences and empowering users in the process and decisions regarding their care/involvement, they are more likely to participate effectively within the service. Finally, TIC takes into account the cultural, historical, and gender issues and experiences that individuals may have gone through, throughout their lives, and how these may impact on how they view themselves, others, and the world.
Is TIC relevant to everyone?
In short, Yes. TIC was initially developed to focus on healthcare organisations. However, when we start to acknowledge the widespread impact on trauma, we start to notice how it impact everyone around us. Furthermore, TIC isn’t only relevant to individuals, it can also be applied to whole organisational systems. When business are “traumatised” the wellbeing of their staff deteriorates. This can lead to high rates of turnover, high levels of staff dissatisfaction, a deterioration in productivity, as well as high rates of sickness, all of which cost business’ large sums of money every year.
If you would like to learn more about how TIC is relevant to you and your organisation, feel free to contact me and we can work together to ensure that your company if promoting an ethos of trust, collaboration, and support.