What Is Trauma Informed Care?

Understanding Trauma-Informed Care

Trauma-informed care (TIC) is a significant concept within the healthcare and social services fields. To fully appreciate its importance, it is crucial to first define what TIC is and understand why it is so essential.

Defining Trauma-Informed Care

Trauma-informed care is a science-based approach that emphasizes strengths and is grounded in an understanding of and responsiveness to the impact of trauma. It emphasizes physical, psychological, and emotional safety for both providers and survivors and creates opportunities for survivors to rebuild a sense of control and empowerment.

In essence, trauma-informed care is a commitment to not repeat traumatic experiences and to restore a sense of safety, power, and self-worth for individuals who have been terrified, overwhelmed, and violated by traumatic experiences [2].

The approach relies on six core principles, including safety, trustworthiness and transparency, peer support and mutual self-help, collaboration and mutuality, empowerment voice and choice, as well as consideration of cultural, historical, and gender issues. These principles aim to create a supportive and empowering environment for staff and individuals who have experienced trauma.

The Importance of Trauma-Informed Care

Implementing trauma-informed care is crucial for many reasons. To start, hospitals themselves can often be a source of trauma for patients and staff. Procedures and care can be painful and frightening, hospitalization can force a loss of autonomy and agency, and hospital policies and practices often mirror oppressive, racist, and discriminatory systems.

Furthermore, the demands on the current healthcare system, as well as its long-standing emphasis on the individual responsibility of its workers, can lead to compassion fatigue, moral injury, and system-induced distress among staff.

Trauma-informed care emphasizes the importance of building and maintaining trust among staff, clients, and family members of those receiving services. It's achieved by conducting organizational operations and decisions with transparency. This approach has shown to improve patient outcomes, decrease patient and staff stress, and potentially reduce avoidable hospitalizations and emergency department visits.

In conclusion, trauma-informed care is not just about understanding the prevalence and impact of trauma; it's about creating an environment that recognizes, understands, and responds to the effects of trauma. By focusing on trauma-informed care, healthcare organizations can provide more effective care and foster a healthier and more supportive environment for both staff and patients.

Principles of Trauma-Informed Care

Understanding the core principles of trauma-informed care is crucial in providing effective care to individuals who have experienced trauma. These principles guide the approach to care, creating a supportive and empowering environment for both staff and patients.

Core Principles and Their Importance

The six principles of trauma-informed care include safety, trustworthiness and transparency, peer support and mutual self-help, collaboration and mutuality, empowerment, voice, and choice, as well as cultural, historical, and gender issues. Each principle plays a crucial role in creating a supportive and empowering environment for individuals who have experienced trauma.

1. Safety ensures that the environment is physically and psychologically secure for both patients and staff.
2. Trustworthiness and Transparency involve building and maintaining trust by conducting organizational operations and decisions transparently.
3. Peer Support and Mutual Self-Help are integral in building trust, establishing safety, and empowerment.
4. Collaboration and Mutuality mean understanding that everyone contributes to a therapeutic environment and the importance of meaningful sharing of power and decision-making.
5. Empowerment, Voice, and Choice emphasize focusing on the unique experience and needs of each person.
6. Cultural, Historical, and Gender Issues involve addressing the intersections of trauma with cultural, historical, and gender issues.

The importance of these principles is underscored by the need to shift focus from "What's wrong with you?" to "What happened to you?" This approach recognizes the need to understand a patient's complete life situation, past, and present, to provide effective health care services with a healing orientation [3].

Implementing Principles in Practice

To be effective, trauma-informed care must be adopted at both clinical and organizational levels. Recognizing how non-clinical staff, like front desk workers and security personnel, play significant roles in patient interactions and safety is essential for the success of trauma-informed care implementation [3].

Implementing these principles in practice involves making organizational changes in healthcare culture and implementing practices addressing trauma at the clinical level. By taking foundational steps towards a trauma-informed approach, organizations can create safe, caring, and inclusive environments for all patients, fostering overall well-being [3].

Studies have shown that patients appreciate the questions that clinicians ask them about trauma-related issues. When asked in a patient-centered and empathic way, it can result in better doctor-patient relationships, improved satisfaction levels, and better health-related outcomes [4].

In conclusion, implementing trauma-informed care principles in practice allows for a comprehensive approach to care that considers the whole person, not just their trauma, leading to more effective treatment and improved health outcomes.

Trauma-Informed Care: The Statistics

The importance of trauma-informed care training cannot be overstated. To understand its significance, one must first comprehend the prevalence of trauma within society, and the impact it has on an individual's health.

Prevalence of Trauma in Society

Trauma is a pervasive issue in society. According to Life Coach Magazine, 70% of adults have experienced some form of traumatic event at least once in their lives. Furthermore, childhood trauma is alarmingly widespread. Approximately 60% of US adults and 40% of children ages 6-17 report at least one type of childhood trauma. This underlines the pressing need for trauma-informed care training in various sectors, especially health care and education.

Figures courtesy PubMed Central

Trauma and Its Impact on Health

The implications of trauma extend far beyond the immediate aftermath of a traumatic event. Exposure to traumatic events can result in long-term negative health outcomes, including a greater prevalence of chronic diseases and psychiatric disorders such as obesity, post-traumatic stress disorder (PTSD), and depression [4].

The Adverse Childhood Experience (ACE) Study has provided substantial evidence linking childhood adversity and trauma to negative health outcomes in adulthood. It has been found that at least 5 of the 10 leading causes of death in the United States have childhood trauma at their root. Trauma-informed care training aims to mitigate the impact of trauma by promoting resilience and recovery [5].

Studies have shown that patients appreciate the questions that clinicians ask them about trauma-related issues and that they understand that this can be important for their healthcare. Furthermore, asking about trauma-related issues in a patient-centered and empathic way can result in better doctor-patient relationships, which improves the levels of satisfaction of both the patient and the doctor with the consultation, as well as improved health-related outcomes [4].

These statistics highlight the importance of trauma-informed care. Understanding the prevalence and impact of trauma is essential to implementing effective trauma-informed care practices.

The Need for Trauma-Informed Care Training

As our understanding of trauma's extensive impact on individuals and communities grows, so does the need for trauma-informed care training. This training enables professionals across various sectors to provide compassionate, effective support to those who have experienced trauma.

Role of Training in Healthcare

Trauma-informed care training is essential for professionals who work with children and families who have experienced trauma. This training helps professionals understand the impact of trauma, adopt trauma-sensitive practices, and engage in ongoing self-care to prevent burnout [5].

This training emphasizes the importance of building a safe environment, promoting trust, and fostering collaboration between professionals, parents, and children. This approach can enhance the effectiveness of interventions and support trauma recovery [5].

For instance, the Trauma Training Initiative by Alberta Health Services offers professional development focusing on foundational to advanced Addiction & Mental Health competency development, catering to healthcare providers assisting individuals with any traumatic experience [6].

Integrating Training Across Disciplines

Trauma-informed care training goes beyond the realm of healthcare. It needs to be integrated into the education and practice of professionals across multiple disciplines, including mental health, child welfare, education, and juvenile justice. This multi-sector approach is crucial for ensuring comprehensive and coordinated care for children affected by trauma.

Cultural competence is a key component of trauma-informed care training. Professionals need to understand diverse cultural backgrounds, beliefs, and practices to provide effective and sensitive care to children and families from various cultural contexts [5].

To illustrate, the Trauma-Informed Care (TIC) e-Learning Series comprises seven foundational self-study modules, designed for a broad audience, including providers of Addiction & Mental Health treatment services.

By integrating trauma-informed care training across disciplines, professionals can provide a more holistic approach to care and promote healing and recovery for those affected by trauma. Through this, they contribute to the broader shift from asking, "What's wrong with you?" to "What happened to you?" in providing healthcare services [3].

Implementing Trauma-Informed Care

Implementing trauma-informed care is a process that requires intentional strategies and activities at both the clinical and organizational levels. It involves creating a safe and inclusive environment where all individuals, regardless of their role, contribute to a therapeutic environment that focuses on the unique experiences and needs of each person.

Clinical and Organizational Approaches

To implement trauma-informed care effectively, it must be adopted at both the clinical and organizational levels. A narrow focus on clinical implementation without organizational culture change can lead to inconsistent and unsustainable day-to-day operations. Recognizing the importance of non-clinical staff, such as front desk workers and security personnel, in patient interactions is essential for the success of trauma-informed care implementation.

It is crucial to note that healing occurs in relationships, emphasizing the meaningful sharing of power and decision-making. Therefore, collaboration, empowerment, and humility are at the heart of successful trauma informed care training. Peer support and mutual self-help are also vital in the organizational and service delivery approach within Trauma-Informed Care, as they play a significant role in building trust, establishing safety, and empowerment for individuals who have experienced trauma [2].

Creating a Trauma-Informed Environment

Creating a trauma-informed environment involves the adoption of certain core principles. These include safety, trustworthiness, transparency, peer support, collaboration, empowerment, humility, and responsiveness. These principles aim to create a safe and inclusive environment throughout the organization where both patients and staff feel physically and psychologically secure, ultimately transforming the healthcare setting [3].

In practice, this involves conducting organizational operations and decisions with transparency, which is key to building and maintaining trust among staff, clients, and family members of those receiving services. Organizations can adopt trauma-informed strategies to help individuals overcome the effects of trauma, from making organizational changes in healthcare culture to implementing practices addressing trauma at the clinical level [3].

Trauma-informed care benefits patients by offering the opportunity to engage more fully in their health care, develop trusting relationships with providers, and improve long-term health outcomes. For providers and staff, this approach can help reduce burnout, potentially decreasing staff turnover. By taking foundational steps towards a trauma-informed approach, organizations can create safe, caring, and inclusive environments for all patients, fostering overall well-being.

Trauma-Informed Care Certification and Programs

The increasing recognition of the impact of trauma on health and wellness has led to the development and implementation of trauma-informed care training. These programs aim to equip healthcare and other professionals with the skills and knowledge necessary to effectively support individuals who have experienced trauma.

Benefits of Certification

Obtaining certification in trauma-informed care provides a multitude of benefits. It not only equips professionals with the necessary skills and knowledge to support individuals who have experienced trauma but also empowers organizations to create environments that recognize and respond to trauma effectively. Certified professionals stand out in their field as they can better assess and treat individuals impacted by trauma, ensuring that their practices are both sensitive and effective.

In addition, certification in trauma-informed care can also enhance the professional's understanding of self-care and healing. This can lead to improved resilience and prevent burnout, promoting better mental health within the professional community.

Overview of Available Programs

Several organizations offer comprehensive trauma-informed care training programs.

• The Trauma Informed Clinical Practice program offered by the NYU Silver School of Social Work provides intersectional critical trauma training to mental health professionals. The program incorporates an anti-oppressive and biopsychosocial lens, aiming to create trauma-informed organizations and promote self-care among professionals.
• Alberta Health Services offers a suite of programs as part of their Trauma Training Initiative. These programs cater to healthcare providers assisting individuals with any traumatic experience and include:
• Trauma-Informed Care (TIC) e-Learning Series: A series of seven self-study modules designed for a broad audience. Each module can be completed in approximately 30 minutes or less and is developed using evidence-informed best practices.
• Trauma-Focused Skills Workshop Series: A series of five online workshops to discuss safety creation, stabilization skill identification, and strategies for working with trauma survivors.

The content of these programs is compiled by a committee of experts, ensuring scientific integrity, objectivity, and balance. This underscores the importance of choosing a program that is comprehensive, evidence-based, and recognized within the professional community.

In conclusion, trauma-informed care training is an essential component in the evolution of healthcare and other disciplines. By equipping professionals with the knowledge and skills to recognize and respond to trauma, we can create a more supportive, effective, and compassionate environment for those impacted by trauma.

The Future of Trauma-Informed Care

As trauma-informed care continues to evolve, the future of this approach will largely depend on continuous evaluation and the incorporation of advancements and innovations.

The Importance of Evaluation

There is a critical need for rigorous evaluation of trauma-informed care in hospitals, including the development of meaningful short-, medium-, and long-term process and outcome measures. Evaluation methodologies must be flexible, inclusive, and build on the science of trauma and healing as well as the lived experience of individuals and communities.

Currently, there is a lack of consensus on an empirically supported conceptualization and operationalization of trauma-informed care. Existing resources on this topic are limited, and there is insufficient evidence to guide intentional translation, implementation, and evaluation in hospitals.

To address these limitations, ongoing evaluation efforts should focus on refining and standardizing trauma-informed care principles and practices. Rapid and accessible dissemination of evaluation findings is key to building an evidence base for widespread adoption of trauma-informed care.

Advancements and Innovations in Care

Trauma-informed care is not a static concept; it is continuously evolving in response to advancements in our understanding of trauma and its impact on health. The future of trauma-informed care will likely see the incorporation of innovative practices and technologies that enhance the delivery of care.

Key advancements may include the development of new training programs that provide healthcare professionals with the skills and knowledge they need to implement trauma-informed care effectively. Trauma-informed care training is essential for professionals who work with individuals who have experienced trauma. It helps professionals understand the impact of trauma, adopt trauma-sensitive practices, and engage in ongoing self-care to prevent burnout.

The cultivation of cultural competency is also expected to play a significant role in the future of trauma-informed care. Professionals need to understand diverse cultural backgrounds, beliefs, and practices to provide effective and sensitive care to individuals from various cultural contexts.

Finally, the future of trauma-informed care will likely see a more holistic approach that integrates this form of care into the education and practice of professionals across multiple disciplines, including mental health, child welfare, education, and juvenile justice [5].

In conclusion, the future of trauma-informed care is promising, with the potential to significantly enhance the quality of care for individuals who have experienced trauma. However, the realization of this potential will depend on ongoing evaluation and the incorporation of advancements and innovations in the field.

References

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10013720/

‍[2]: https://traumainformedoregon.org/resources/new-to-trauma-informed-care/trauma-informed-care-principles/

‍[3]: https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/

‍[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551418/

‍[5]: https://www.samhsa.gov/sites/default/files/programscampaigns/childrensmental_health/atc-whitepaper-040616.pdf

‍[6]: https://www.albertahealthservices.ca/info/page15526.aspx