What is trauma-informed care?
Learn what it means to be trauma-informed in this introduction by Dr Sheena Webb.
The term ‘trauma-informed’ is suddenly everywhere. In the past few years, interest in trauma has exploded, partly driven by the Adverse Childhood Experiences research, which has highlighted the impact of early adversity on health and wellbeing. But what exactly do we mean when we talk about trauma and trauma-informed care?
In the context of mental health, we use the word ‘trauma’ to refer to both the exposure to, and psychological impact of, distressing or harmful events. These events can vary, encompassing shocking experiences such as accidents, natural disasters or violence, but also more chronic adversities such as neglect, emotional abuse and coercive control.
Trauma can have profound and lasting effects on individual mental and emotional well-being, often leading to symptoms such as anxiety, depression, and post-traumatic stress disorder. This understanding of trauma is nothing new; it has been visible in the field of mental health for over a century, and part of lay culture for many centuries. So why all the hype now?
I think there is a growing recognition that some of our existing ways of working are not working. That our service systems – including residential units, drug and alcohol services, mental health teams, social services, homelessness services, specialist educational provisions and criminal justice – have simply not been built with trauma in mind, and because of this, at best we are not responsive to survivors and at worst, we cause more harm. Trauma-informed care has evolved from this understanding; it is a call to action, a shift in perspective, a culture change. The core message is to develop our awareness and understanding of trauma and use this knowledge to reshape the way we do things.
However, because trauma-informed care is more about principles for practice than a prescriptive model, it is easily misunderstood. Some of us feel pretty well-informed about trauma already – so what’s new about this? The oft-cited principles of trauma-informed care such as ‘safety’, ‘choice’ and ‘trustworthiness’ feel like values we already work with and aspire to. And yet, we continue to see those who have experienced the most trauma being the most neglected by our system, the most reluctant to engage, the least likely to benefit from intervention.
In reality, trauma-informed care involves rethinking many aspects of what we do, from the moment-to-moment interactions between practitioners and survivors, to the policies and procedures that define our service delivery. It involves reconceptualising what we mean by ‘non-engagement’ as well as what we label as ‘symptoms’. It involves recognising that services are delivered by thinking, feeling people who are themselves impacted by the work they do. It involves recognising that what we think is helpful can sometimes be harmful.
Trauma-informed care is something that is developed through an ongoing process of learning, reflection, practice changes and evaluation. This takes time, and to be effective, should be a whole service approach. By engaging in such a process, however, the benefits are wide ranging. By making services feel safer, survivors are more likely to engage. By recognising the role that trauma plays in presenting issues, practitioners are more likely to offer the right kind of help. By supporting practitioners with the emotional demands of the work, services are more likely to run efficiently. Ultimately, the hope is for emotionally safe and effective services that overcome the barriers encountered in traditional service models.
Trauma-informed approaches are increasingly being adopted across a range of organisations with promising impacts. Implementation of trauma-informed approaches in inpatient adolescent units has led to reductions in the use of restraint and seclusion (Azeem et al, 2011). Meanwhile, other studies have found that a trauma informed culture can increase workplace satisfaction (Hales et al, 2019).
Our new course, Trauma-informed care: from theory to practice, looks at how our understanding of trauma has evolved, and how this has impacted the way in which we deliver services and, as a result, survivors of trauma. We will consider how trauma-informed care emerged and how it has evolved over time, looking at the various ways in which these ideas have been implemented on the frontline, at the organisational level and across service systems. We will think about the various models that inform our understanding of trauma and how we can integrate and use these ideas to design services and interventions and shape our communication. We will also think about trauma, not as an isolated event or condition, but in the context of people’s lives, communities and cultures.
Trauma-informed care is a new and evolving field – and we invite you to join us and consider where we are now and the opportunities to take things forward.
Azeem, M. W., Aujla, A., Rammerth, M., Binsfeld, G., & Jones, R. B. (2011). Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. Journal of Child and Adolescent Psychiatric Nursing, 24(1), 11-15.
Hales, T. W., Green, S. A., Bissonette, S., Warden, A., Diebold, J., Koury, S. P., & Nochajski, T. H. (2019). Trauma-informed care outcome study. Research on Social Work Practice, 29(5), 529-539.